How long before there are no jobs left?

[deleted813736]

Anyone else having no luck finding jobs currently? Are all future classes trapped into doing fellowship to get an academic job?? WHY DID I CHOSE ER?? I am attempting to find a metropolitan job in the midwest and am having zero luck for 2 months now. Will it get better?

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[RustedFox]

 

[nexus73]

I’m telling you, shift to psychiatry you can start as a pgy2. Best job ever. Except the pay isn’t necessarily the best, and you have to see psych patients all day. But otherwise...

 

[deleted813736]

i think i would rather pick up crummy urgent care shifts for 95 an hour than move to psych lol

 

[nexus73]

i think i would rather pick up crummy urgent care shifts for 95 an hour than move to psych lol

With the problem of psych patients boarding in EDs for more than two decades, I’d think ED doctors would be a little more comfortable and interested in treating them. I mean, it’s practically a pillar of the ED experience.

 

[deleted813736]

With the problem of psych patients boarding in EDs for more than two decades, I’d think ED doctors would be a little more comfortable and interested in treating them. I mean, it’s practically a pillar of the ED experience.

comfortable? yes. interested? no.

 

[alpinism]

I did my residency in the midwest and talking to former classmates it seems like every major city is basically full right now unless you're okay with freestanding emergency departments right after residency. A couple friends were able to find a job in Milwaukee but they won't be starting until the winter and they won't have a job for at least six months after graduation. What's most likely going to happen is that large numbers of people will start their careers working at rural hospitals until they can find an opening at metropolitan hospitals.

 

[Old_Mil]

Anyone else having no luck finding jobs currently? Are all future classes trapped into doing fellowship to get an academic job?? WHY DID I CHOSE ER?? I am attempting to find a metropolitan job in the midwest and am having zero luck for 2 months now. Will it get better?

Do a critical care medicine fellowship and practice in a closed unit. That may be the only place in medicine left where the interests of administration and insurance align with yours: do everything you can to keep people from reaching your door, do everything you can to get them back out of it.

 

[bravotwozero]

Can we stop beating this dead horse? enough already.

 

[Old_Mil]

We need to keep beating it so people don't fall victim to the propaganda of the medical education-industrial complex.

 

[Rekt]

Can we stop beating this dead horse? enough already.

Yeah sweep it under the rug. What a boomer ass post.

"I have a job! See it's easy! I get an (automated) weekly email from a hospital that sees five patients a day! Plenty of jobs!"

So completely absent minded. Tell people to stop worrying about the market to the three+ people that verbalized they lost their contract over the past couple days on em docs.

 

[RustedFox]

Yeah, I like both of the above posters - but I'm in Rekt's camp here. Thread stays open if my vote counts for anything.

 

[emergentmd]

Can someone start a thread about NP encroachment?

How about HCA residency?

Another doom/gloom/job post would

 

[Rekt]

Can someone start a thread about NP encroachment?

How about HCA residency?

Another doom/gloom/job post would

Then you can reply about how amazing EM is, how business is booming, and how the market is fine.


But conveniently leave out you run a bunch of freestandings by employing pretend level providers to run your business for you and some wage slaves probably hired from HCA sweatshops to fill your coffers.

Full circle baby

 

[emergentmd]

I never said EM was great. To the contrary.
Pull up any thread and I will be the first to admit it is worse than 3 yrs ago.

But if this makes you happier, go ahead and wallow in your sadness.

Another outright lie about hiring pretend level providers.

We have only board certified docs which is the way it should be.

But if it makes u feel better being a widget go ahead. Maybe you should do something about being a widget.

 

[EctopicFetus]

I did my residency in the midwest and talking to former classmates it seems like every major city is basically full right now unless you're okay with freestanding emergency departments right after residency. A couple friends were able to find a job in Milwaukee but they won't be starting until the winter and they won't have a job for at least six months after graduation. What's most likely going to happen is that large numbers of people will start their careers working at rural hospitals until they can find an opening at metropolitan hospitals.

The problem with this idea of start rural and then move inward is 2 fold Given the rural sites are usually lower volume and lower acuity. To see a normal number of patients you Need a 18-20k volume ED.

1) New grads need to firm up their skills working independently at “real” EDs. working at a rural ED seeing 1pph and that being your only job post graduation will surely make your skills flounder, your speed be slower.
2) New grads have a tremendous amount of debt. City hospitals are paying $200+/hr. The rural hospitals are 180 or less. When you have 3-400k in debt that $20-40+/hr adds up.

It’s all screwed. The head ACEP clown 🤡 says the future is bright.. it isnt. Maybe we move out of bricks and mortar EM. HOw much of a need is there? The clown show that is ACEP fails to understand the basic premise that even if we do that there is only a finite amount of care we can provide to our society. The LLP/PLP types are scrounging for jobs. They never experienced the opportunity cost of med school or residency. They will work for way less than a doc and until value based reimbursement is a real thing their ilk will proliferate and provide substandard idiotic care.

 

[DocEspana]

August 15th 2023.

 

[Dr Mantis Toboggan]

The problem with this idea of start rural and then move inward is 2 fold Given the rural sites are usually lower volume and lower acuity. To see a normal number of patients you Need a 18-20k volume ED.

1) New grads need to firm up their skills working independently at “real” EDs. working at a rural ED seeing 1pph and that being your only job post graduation will surely make your skills flounder, your speed be slower.
2) New grads have a tremendous amount of debt. City hospitals are paying $200+/hr. The rural hospitals are 180 or less. When you have 3-400k in debt that $20-40+/hr adds up.

It’s all screwed. The head ACEP clown 🤡 says the future is bright.. it isnt. Maybe we move out of bricks and mortar EM. HOw much of a need is there? The clown show that is ACEP fails to understand the basic premise that even if we do that there is only a finite amount of care we can provide to our society. The LLP/PLP types are scrounging for jobs. They never experienced the opportunity cost of med school or residency. They will work for way less than a doc and until value based reimbursement is a real thing their ilk will proliferate and provide substandard idiotic care.

Heck these low covid volumes have taken a few MPH off my fastball compared to before.

 

[deleted813736]

I will not be doing that. There are a million threads that are discussing the subject, no need to start a new one.

Mods, this has been discussed in lots of other places. Can we consider a merge/close?

Just my two cents. But threads like this will explode over the next year. You think its a problem now? Wait till theres 2000 more of us that aren't finding anything. And if you don't want to read the post..you don't have to. Instead of spilling negativity from your 1995 windows desktop just don't comment on threads if you don't have anything to add except 'lets delete this'.

I think there is a fundamental issue here that needs to be addressed. Whether thats creating a petition to EMRA, whether we need objective data to present at ACEP to open the eyes of these boomers, or even if more sdn threads are needed to create more situational awareness of the issue. This is the BIGGEST issue affecting the future of EM at this point. Stop brushing it under the table just because you worked in the ER golden era.

 

[MechEDoc]

Just my two cents. But threads like this will explode over the next year. You think its a problem now? Wait till theres 2000 more of us that aren't finding anything. And if you don't want to read the post..you don't have to. Instead of spilling negativity from your 1995 windows desktop just don't comment on threads if you don't have anything to add except 'lets delete this'.

I think there is a fundamental issue here that needs to be addressed. Whether thats creating a petition to EMRA, whether we need objective data to present at ACEP to open the eyes of these boomers, or even if more sdn threads are needed to create more situational awareness of the issue. This is the BIGGEST issue affecting the future of EM at this point. Stop brushing it under the table just because you worked in the ER golden era.

I for one am not too worried about medical students figuring this out. There will be a long lag between the market crashing and medical students changing their residency aspirations, but it will happen. High paying fields will get qualified students, low paying fields won't.

Decent students will go elsewhere. The low quality residencies will gradually cut slots or fail to exist once their is cost equilibrium between running a residency and just hiring the next poorly trained "provider". Sadly I think a new normal will exist with physicians in the ER seeing higher acuity for lower pay. I doubt that significant changes will occur due to the increased liability. Libby Zion? Sure, there are work hour restrictions, but they're not meaningful. Only New York State codified work hour restrictions into law. Those restrictions are largely toothless as residents will falsify their hours. Furthermore, any industry that is actually serious about cognitive impairment due to work hours has much more restrictive work hour requirements (trucking, aviation, nuclear Navy).

Even massive product failures compounded by inadequate training (737 Max!) have only led to product changes and no improvement in training. The 737 max had a poorly designed control system, this lead to numerous near misses that were handled by well-trained crews, but poorly qualified crews (Lion Air and Ethiopian Air) were unable to handle the malfunctioning control system. While it would be possible to mandate both improved training and a resolved control system, it appears that only the control system is being addressed. Future unanticipated difficult aviation scenarios will lead to repeated fatalities in the hands of poorly qualified crews. Heck, Pakistan international airline was blatantly falsifying crew training and they were still allowed to fly international routes until their gross incompetence was demonstrated by a gear up touch and go that wrecked both their engines leading a crash with 97 deaths (2 survivors!).

I think medicine will be worse - our bad outcomes are largely hidden. We will continue to use poorly qualified labor, have to rely more and more on consultants to perform procedures (LP, airway, chest tube or difficult IV? Call the CRNA) and outsource more and more of our diagnoses to radiology.

As for me? I'm going to try to make hay while the sun in shining.

 

[deleted813736]

I for one am not too worried about medical students figuring this out. There will be a long lag between the market crashing and medical students changing their residency aspirations, but it will happen. High paying fields will get qualified students, low paying fields won't.

Decent students will go elsewhere. The low quality residencies will gradually cut slots or fail to exist once their is cost equilibrium between running a residency and just hiring the next poorly trained "provider". Sadly I think a new normal will exist with physicians in the ER seeing higher acuity for lower pay. I doubt that significant changes will occur due to the increased liability. Libby Zion? Sure, there are work hour restrictions, but they're not meaningful. Only New York State codified work hour restrictions into law. Those restrictions are largely toothless as residents will falsify their hours. Furthermore, any industry that is actually serious about cognitive impairment due to work hours has much more restrictive work hour requirements (trucking, aviation, nuclear Navy).

Even massive product failures compounded by inadequate training (737 Max!) have only led to product changes and no improvement in training. The 737 max had a poorly designed control system, this lead to numerous near misses that were handled by well-trained crews, but poorly qualified crews (Lion Air and Ethiopian Air) were unable to handle the malfunctioning control system. While it would be possible to mandate both improved training and a resolved control system, it appears that only the control system is being addressed. Future unanticipated difficult aviation scenarios will lead to repeated fatalities in the hands of poorly qualified crews. Heck, Pakistan international airline was blatantly falsifying crew training and they were still allowed to fly international routes until their gross incompetence was demonstrated by a gear up touch and go that wrecked both their engines leading a crash with 97 deaths (2 survivors!).

I think medicine will be worse - our bad outcomes are largely hidden. We will continue to use poorly qualified labor, have to rely more and more on consultants to perform procedures (LP, airway, chest tube or difficult IV? Call the CRNA) and outsource more and more of our diagnoses to radiology.

As for me? I'm going to try to make hay while the sun in shining.

very eloquently put. good support for why we are all screwed. But really appreciated the post!

 

[blue.jay]

I for one am not too worried about medical students figuring this out. There will be a long lag between the market crashing and medical students changing their residency aspirations, but it will happen. High paying fields will get qualified students, low paying fields won't.

Decent students will go elsewhere. The low quality residencies will gradually cut slots or fail to exist once their is cost equilibrium between running a residency and just hiring the next poorly trained "provider". Sadly I think a new normal will exist with physicians in the ER seeing higher acuity for lower pay. I doubt that significant changes will occur due to the increased liability. Libby Zion? Sure, there are work hour restrictions, but they're not meaningful. Only New York State codified work hour restrictions into law. Those restrictions are largely toothless as residents will falsify their hours. Furthermore, any industry that is actually serious about cognitive impairment due to work hours has much more restrictive work hour requirements (trucking, aviation, nuclear Navy).

Even massive product failures compounded by inadequate training (737 Max!) have only led to product changes and no improvement in training. The 737 max had a poorly designed control system, this lead to numerous near misses that were handled by well-trained crews, but poorly qualified crews (Lion Air and Ethiopian Air) were unable to handle the malfunctioning control system. While it would be possible to mandate both improved training and a resolved control system, it appears that only the control system is being addressed. Future unanticipated difficult aviation scenarios will lead to repeated fatalities in the hands of poorly qualified crews. Heck, Pakistan international airline was blatantly falsifying crew training and they were still allowed to fly international routes until their gross incompetence was demonstrated by a gear up touch and go that wrecked both their engines leading a crash with 97 deaths (2 survivors!).

I think medicine will be worse - our bad outcomes are largely hidden. We will continue to use poorly qualified labor, have to rely more and more on consultants to perform procedures (LP, airway, chest tube or difficult IV? Call the CRNA) and outsource more and more of our diagnoses to radiology.

As for me? I'm going to try to make hay while the sun in shining.

So we basically only needs surgeons, radiologists, stentologist, scopoligst and aplenty of midlevels for the rest.

 

[nexus73]

So we basically only needs surgeons, radiologists, stentologist, scopoligst and aplenty of midlevels for the rest.

midlevels can do surgery

 

[.Asterion]

midlevels can do surgery

In the UK don’t they have “surgical technicians” for appendectomies and other straight forward stuff where that’s their procedure and they only do that?
Actually sort of makes sense in a way.

 

[Spikebd]

midlevels can do surgery

At least most of the floor work and clinic work. It’s easy to see surgeons being forced into working in centralized “centers of excellence” for joint replacements, spine surgery, etc where it’s assembly line work with less surgeons and more midlevels carrying out orders.

 

[Old_Mil]

midlevels can do surgery

I don't know about you, but there is no way I he'll that I'm letting a midlevel operate on me. I'll go to a foreign country first to see an actual surgeon first.

 

[TheComebacKid]

Surgeons feel like they are immune to encroachment by midlevels but they will likely be the next ones to fall. Midlevels already are part of outpatient cosmetic practices doing injections and other "procedures". It's a matter of time before Dr. Surgeon Jenny McJennerson will be doing laparoscopic appendectomies, simple toe amputations, etc. Surgeons are already so overworked, many of them would be happy to give up those procedures to midlevels and to "supervise" them.

I'm sure there are still many surgery egomaniacs who would never let anyone else touch their patient, which is why I think they have held out so long. But surgeons are expensive, and I can see hospital systems definitely using midlevels wherever possible.

 

[emergentmd]

Surgeons are already being taken over and having overlords. Many Surgeons are hospital employees without much say. MLPs do not even need to do surgery. They just need to do the other 80% of the work and that will start to kill the market and drop rates.

Watch the dominoes fall. Talk to many surgeons and they already feel the pressures.

 

[DoctwoB]

Surgeons are already being taken over and having overlords. Many Surgeons are hospital employees without much say. MLPs do not even need to do surgery. They just need to do the other 80% of the work and that will start to kill the market and drop rates.

Watch the dominoes fall. Talk to many surgeons and they already feel the pressures.

I don't feel any pressure from midlevels currently and likely won't but that doesn't mean it doesn't affect the job market at all. I don't see forsee midlevels doing any real surgeries any time soon. The reality is more that the group of 4 surgeons that is somewhat overly busy clinically may choose to hire an NP or two rather then a 5th surgeon to see routine follow ups, routine consults, etc which saves money and boosts the surgical volume of the existing partners (by shunting cases their way) rather then splitting them with a 5th partner.

 

[emergentmd]

I don't feel any pressure from midlevels currently and likely won't but that doesn't mean it doesn't affect the job market at all. I don't see forsee midlevels doing any real surgeries any time soon. The reality is more that the group of 4 surgeons that is somewhat overly busy clinically may choose to hire an NP or two rather then a 5th surgeon to see routine follow ups, routine consults, etc which saves money and boosts the surgical volume of the existing partners (by shunting cases their way) rather then splitting them with a 5th partner.

And this is my point. Its all supply and demand. If volume increases there should be an increase in need for more surgeons thus increase in pay/leverage. If volume increases without increase in demand, then surgeons are going down the wrong path.

EM had the same dilemma 10 yrs ago when there were very little MLP penetration. Most SDG/CMGs became greedy and wanted to maximize profit, so with increase in volume they just hired MLPs and lined their pockets.

All specialties are going down that path.

 

[Backpack234]

Per today’s ACEP study, the answer to OPs question is “before 2030”

 

[Rekt]

Per today’s ACEP study, the answer to OPs question is “before 2030”

And that surplus is almost ~10,000. So in reality, there won't be any jobs in about 3 years.

 

[Dr.Bruh]

So with that projection by 2030 of 1/5 EM docs not able to get a job what things should incoming residents do to make themselves more marketable for employment? Does training in the city you want to practice give any weight? Fellowship? if willing to go really rural (ie middle of kansas type rural) are you more likely to find jobs? Any specific ways to best network as a resident to increase employment prospects??

 

[skougess]

Imagine letting FM/IM practice our specialty while our BCEM grads are unemployed.

 

[RustedFox]

So with that projection by 2030 of 1/5 EM docs not able to get a job what things should incoming residents do to make themselves more marketable for employment? Does training in the city you want to practice give any weight? Fellowship? if willing to go really rural (ie middle of kansas type rural) are you more likely to find jobs? Any specific ways to best network as a resident to increase employment prospects??

Might wanna check that math.

 

[cyanide12345678]

Anyone else having no luck finding jobs currently? Are all future classes trapped into doing fellowship to get an academic job?? WHY DID I CHOSE ER?? I am attempting to find a metropolitan job in the midwest and am having zero luck for 2 months now. Will it get better?

There are still some scattered jobs available. Keep trying, the landscape is only going to get worse unfortunately.

 

[Dr.Bruh]

Might wanna check that math.

Maybe I’m misunderstanding but the projection is by 2030 there will be 60k EM docs with only 50k available jobs.

 

[Rekt]

Maybe I’m misunderstanding but the projection is by 2030 there will be 60k EM docs with only 50k available jobs.

No. In 2030. There will be 10k EM docs without employment.

 

[RustedFox]

Maybe I’m misunderstanding but the projection is by 2030 there will be 60k EM docs with only 50k available jobs.

No. In 2030. There will be 10k EM docs without employment.

He beat me to it.

 

[Dr.Bruh]

Might wanna check that math.

Maybe I’m misunderstanding but the projection is by 2030 there will be 60k EM docs with only 50

No. In 2030. There will be 10k EM docs without employment.

isn’t that the same thing? If the projected EM doc supply is 60k and projected demand is 50k then thats 10k em docs without a job (1/6)

 

[Rekt]

Maybe I’m misunderstanding but the projection is by 2030 there will be 60k EM docs with only 50

isn’t that the same thing? If the projected EM doc supply is 60k and projected demand is 50k then thats 10k em docs without a job (1/6)

I misunderstood your first post and your second made sense. Obviously you know me. I think that's an extremely overly optimistic number. But regardless, Is 80% chance of having ANY job acceptable to you?

 

[RustedFox]

Maybe I’m misunderstanding but the projection is by 2030 there will be 60k EM docs with only 50

isn’t that the same thing? If the projected EM doc supply is 60k and projected demand is 50k then thats 10k em docs without a job (1/6)

Wont' matter. Those 50k employed won't budge. No job will be open.
If you're still a student; stay the hell out of EM.
I wish that I did.

 

[sylvanthus]

Wow this is so f’ed, I honestly dont see a solution. Not a single thing is working in our favor. The absolute only chance I see is if the public realizes they pay the same whether they see a doctor or midlevel and demand to see doctors. But, we all know people are stupid, they dont care who gives them their narcotics or unnecessary antibiotics.

 

[Dr.Bruh]

I misunderstood your first post and your second made sense. Obviously you know me. I think that's an extremely overly optimistic number. But regardless, Is 80% chance of having ANY job acceptable to you?

No did you read my post? I said with 1/5 with no job what are ways to increase your marketability (if there are any)?

 

[RustedFox]

No did you read my post? I said with 1/5 with no job what are ways to increase your marketability (if there are any)?

Not going into EM is the best way to increase your marketability.

 

[sylvanthus]

No did you read my post? I said with 1/5 with no job what are ways to increase your marketability (if there are any)?

Give everyone narcotics and antibiotics. Xrays for all. Work notes for all. Basically practice bad medicine.

 

[Rekt]

No did you read my post? I said with 1/5 with no job what are ways to increase your marketability (if there are any)?

I think you're still mildly confused. Every year 80% aren't going to find jobs. Once we hit a surplus, only a scattered few will find jobs. A majority of each graduating class will be unemployed is what this means. The figures state that there will be 49000 jobs and 5900 docs. The next year there will be 49xxx employed and 62000 docs then probably 49xxx then 65000 docs. Etc.

Another part of the presentation said they need to CUT 1100 spots to be at a steady state to keep everyone employed, including crappy little places and FSEDs etc

 

[RuralEDDoc]

Most residents would be wise to plan to do additional value-added training of some sort. For most that will be clinical training (critical care fellowship, pain, maybe addiction medicine), others might be admin (MBA vs admin fellowship). A lot of admin sucks, but not all of it does, some physician administrators do add value to the practice of medicine. Just don’t plan on 3 years of residency and out there, it’s too risky financially with the oversupply, unless you already have a solid skill set that is recognized and marketable.

 

[GeneralVeers]

Value added, like get an MBA. Honestly all of medicine is screwed. Anesthesia, Rad-onc, and us are just the first victims.

 

[emergentmd]

I will tell you how the EM practice environment has changed. 10 yrs ago, it was close to impossible to get rid of an ER doc. Now, I hear from old partners of docs getting cut just for minor stuff.

Sucks but there are still jobs in the boonies.