zero unfilled positions this year

[veaselhaufen]

Good god, enough whining. Does anyone have anything to say about the thread topic? Is this the first year that there have been 0 spots unmatched? I recall that applications jumped a ton last year, has anyone heard if this number has continued to increase this year

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[RustedFox]

Good god, enough whining. Does anyone have anything to say about the thread topic? Is this the first year that there have been 0 spots unmatched? I recall that applications jumped a ton last year, has anyone heard if this number has continued to increase this year

You missed the boat, brother. - I'll fill you in.

This is the first year in "recent" history that yes, 0 spots have gone unmatched.

At my place, applications jumped again.... a lot more than last year. This sentiment was echoed by my buddies at different programs from New England to SoCal.


Now, back to the regularly scheduled whining and the airing of grievances. Soon... the feats of strength !

 

[otacon88]

when do we get the statistics of how many applied to EM and how many didn't match into EM?

 

[Dane07MD]

when do we get the statistics of how many applied to EM and how many didn't match into EM?

What you are looking for is the "Results and Data: 2012 Main Residency Match".

The 2011 edition currently available is dated April 2011, so I suspect you can expect the data to be published a few weeks from now. Next Monday a document is made available to all NRMP registered students that details match statistics by specialty and state. I don't know if that will give applicant numbers, etc.

I'm just starting to wonder if the number has jumped dramatically, or that the number of applications and subsequent interviews are increasing... Time will tell.

 

[fergustsi]

Someone forgot to put up the festivus pole.

You missed the boat, brother. - I'll fill you in.

This is the first year in "recent" history that yes, 0 spots have gone unmatched.

At my place, applications jumped again.... a lot more than last year. This sentiment was echoed by my buddies at different programs from New England to SoCal.


Now, back to the regularly scheduled whining and the airing of grievances. Soon... the feats of strength !

 

[DreamingTheLive]

Someone forgot to put up the festivus pole.

Yes! Such a good episode!

 

[Socrates25]

I don't buy it. I think being super afraid of changes in healthcare, whether it's the inclusion of mid-level practitioners, or new technology, or women becoming physicians in larger numbers, or whatever, is a mistake. Will board certified EM docs have to innovate to set themselves apart? Probably. Maybe doing more administrative work, or research (in academic jobs), or involving themselves in various oversight activities. But I really don't think that being "very, very afraid" of PAs or NPs is going to accomplish anything at all. Nobody argues that a Trauma PA is the same thing as a trauma surgeon. We have a responsibility to perhaps set stronger parameters as a field for what are appropriate tasks for PAs or NPs to handle--something that I think is well worth a lot of EP advocacy. But I refuse to feel threatened by mid-level pracitioners as a matter of principle.

It is NOT simply a matter of principle. You want a real world example? Here you go: a hospital in New York was foolish enough to elect an ER NP to the medical staff, and gave him the power to fire all of the MDs in the ER and replace them with midlevels.

here's the link: http://www.healthleadersmedia.com/c...ioner-Elected-Medical-Staff-PresidentQuestion

You cant put your head in teh sand and pretend this is not a problem.

 

[deuist]

It is NOT simply a matter of principle. You want a real world example? Here you go: a hospital in New York was foolish enough to elect an ER NP to the medical staff, and gave him the power to fire all of the MDs in the ER and replace them with midlevels.

here's the link: http://www.healthleadersmedia.com/c...ioner-Elected-Medical-Staff-PresidentQuestion

You cant put your head in teh sand and pretend this is not a problem.

My favorite line is, "Turf wars don't have to be a distraction. Clearly, this hospital has collaborative practice figured out," coming from someone who fired all of the physicians. And giving him attending status?

 

[DreamingTheLive]

I'm sorry. I don't mean to offend anyone. But NP's just should NOT be considered equal to Physicians. In many practices/environments they serve a very vital role, but the quality/duration/intensity of their education pales in comparison to physicians. Not even close.

I find it really hard to believe that this many physicians thought this was a good idea. I'm assuming this arrangement somehow benefits the physicians in ways not described in this article. Still a travesty though.

 

[RustedFox]

See my above post:

I will be happy to put the midlevels on equal footing when they:

1). Can pass STEP 1, 2 CK, 2 CS, and 3... (or their DO equivalent, for formality's sake)... just like 'WE' did.

2). Can carry their own liability insurance, and stop using us as a liability offset.


I can imagine a situation in twenty years where I need a colon resection... Do I want the "surgical PA" to do it ? No effing way. Period. Do (does) anyone want the "ER-PA" to interpret their EKG after syncope ? ... Nope.

If you want to play in the big leagues... study hard... study long...

 

[Makati2008]

See my above post:

I will be happy to put the midlevels on equal footing when they:

1). Can pass STEP 1, 2 CK, 2 CS, and 3... (or their DO equivalent, for formality's sake)... just like 'WE' did.

2). Can carry their own liability insurance, and stop using us as a liability offset.


I can imagine a situation in twenty years where I need a colon resection... Do I want the "surgical PA" to do it ? No effing way. Period. Do (does) anyone want the "ER-PA" to interpret their EKG after syncope ? ... Nope.

If you want to play in the big leagues... study hard... study long...

I disagree with you about PA/NPs taking the Steps and then gaining more respect. You can teach anyone how to pass the exams if you give them enough information and/or chances. Without the further training to back it up it is dangerous.

Personally I notice you have a very severe disdain for Midlevel's I hope that you are not one of those Docs that are jerks to PA/NP's that ask you questions to get better understand because you are not only hurting your patient, you are hurting yourself(opening yourself up to more liability because the provider feels like they have to walk on egg shells around you) and the PA/NP as well.

If you truly have this hatred then 1.)Refuse to take a job that uses PA/NPs 2.)If you decide to take the job then be sure to not take any of the bonus money that those PA/NPs earn you and instead give it to your colleagues....

 

[Hamhock]

I will be happy to put the midlevels on equal footing when they:

1). Can pass STEP 1, 2 CK, 2 CS, and 3... (or their DO equivalent, for formality's sake)... just like 'WE' did.

2). Can carry their own liability insurance, and stop using us as a liability offset....

I won't be happy with this.

A few USMLEs and some insurance do not make a physician. Do not minimize me.

HH

 

[Old Grunt]

It is NOT simply a matter of principle. You want a real world example? Here you go: a hospital in New York was foolish enough to elect an ER NP to the medical staff, and gave him the power to fire all of the MDs in the ER and replace them with midlevels.

here's the link: http://www.healthleadersmedia.com/c...ioner-Elected-Medical-Staff-PresidentQuestion

You cant put your head in teh sand and pretend this is not a problem.

If I am looking at the correct hospital, it seems like a pretty small operation. I couldn't find a trauma surgery service listed, so I wonder if they are dealing with much trauma.

I don't think they could get away with this at a larger shop.

Just a thought.

 

[Taurus]

It's cases like these that should scare the public about NP's.

Widower Sues Clinic Over Wife's Suicide

IOWA CITY, Iowa -- A North Liberty widower is suing an Iowa City health clinic and its nurse practitioner, saying they failed to properly diagnose and treat his wife before she committed suicide in 2010.

The Gazette of Cedar Rapids reports that Kevin Ropp's lawsuit blames the Coralville Healthcare Clinic and the nurse practitioner for the death of 32-year-old Kathleen Ropp.

The lawsuit says Kathleen Ropp went to the clinic in 2008 suffering from depression. Test results showed she had high levels of thyroid antibodies, but that the clinic did not tell Ropp of that or treat her for a thyroid condition.

After her death, an autopsy showed Ropp had Hashimoto's disease, a treatable thyroid condition linked to severe depression and suicide.​

 

[RustedFox]

I disagree with you about PA/NPs taking the Steps and then gaining more respect. You can teach anyone how to pass the exams if you give them enough information and/or chances. Without the further training to back it up it is dangerous.

Personally I notice you have a very severe disdain for Midlevel's I hope that you are not one of those Docs that are jerks to PA/NP's that ask you questions to get better understand because you are not only hurting your patient, you are hurting yourself(opening yourself up to more liability because the provider feels like they have to walk on egg shells around you) and the PA/NP as well.

If you truly have this hatred then 1.)Refuse to take a job that uses PA/NPs 2.)If you decide to take the job then be sure to not take any of the bonus money that those PA/NPs earn you and instead give it to your colleagues....

*Facepalm* Spoken like a true medical student. Where to begin...

I don't 'hate' anyone. I, like many other posters on this forum, do have some rather large concerns regarding midlevels and their scope of practice. I work superbly well with the PAs that I am presently around. Hell, I'm even running a charity race with a PA team from our shop in the days to come.

What it boils down to is this... midlevels need to know their scope of practice, and stay within it. As healthcare costs go up and reimbursement goes down (thanks, federal government), many hospitals are turning to MLPs as a 'cheaper' option, and using the "overseeing" MD/DO as a liability offset. That's bogus, because 1) its not realistic... no human can oversee that much MLP work and continue to manage higher-acuity cases on their own, and 2) I've seen too many cases royally screwed up by MLPs who are "working beyond their scope", so to speak.... yet they're pushing for a bigger scope of practice and more autonomy.

If your concern is truly for your (future) patients as you say... then you should recognize that you want the best and most appropriate care for them... and that means making sure that you don't have an MLP doing things they don't know how to do well.

Your assertion that we "make bonus money" off of the MLPs is just incorrect. At my new gig - I'm a straight-up employee with a good hourly and benefits. I'll be paid the same no matter how many patients are seen by either me, or the MLP. However, I will be responsible for anything bad that happens should they make a mistake. See... I get all the responsibility, and no additional benefit.

You're still a student. You will see... Yes, you will see.

 

[RustedFox]

I won't be happy with this.

A few USMLEs and some insurance do not make a physician. Do not minimize me.

HH

You have a good point. I agree, and I should include "completing a residency" on the list.

...but for the sake of the argument at hand (MLP vs. MD/DO)... we have to ask ourselves: what can we do that they can't, and why are we (demonstrably) better? This dovetails into a discussion about education and curriculum. I frequently give pathophys lectures to the PA students here at my institution (so much for the poster who accused me of 'hatred'), and I know their curriculum well. It is very simliar. It is condensed, but it is FAR more clinically focused than what I did in medical school. One of the things that I am a big proponent of is completely overhauling MD/DO education. I find that there's too much waste, and repetition of subjects that were covered in undergrad. I remember having to suffer thru the krebs cycle (again) lipid metabolism and embryology... and find that I never, ever used this knowledge clinically... yet, what I could have really used prior to starting residency were USEFUL topics, such as "how to manage hyponatremia"... "how to interpret an ABG"... etc. Medical school should prepare you to have those clinically useful skills mastered, not waste your time with blastua/gastrula/neural tube/phosophofructokinase nonsense. I find that the PA students are getting curriculum that is much more 'useful' than what I got.

I posit the following.... if the PAs can take and pass the STEP exams like we can... then we're doing something very wrong with medical school. I doubt that they can, but if they do...

 

[Makati2008]

*Facepalm* Spoken like a true medical student. Where to begin...

I don't 'hate' anyone. I, like many other posters on this forum, do have some rather large concerns regarding midlevels and their scope of practice. I work superbly well with the PAs that I am presently around. Hell, I'm even running a charity race with a PA team from our shop in the days to come.

What it boils down to is this... midlevels need to know their scope of practice, and stay within it. As healthcare costs go up and reimbursement goes down (thanks, federal government), many hospitals are turning to MLPs as a 'cheaper' option, and using the "overseeing" MD/DO as a liability offset. That's bogus, because 1) its not realistic... no human can oversee that much MLP work and continue to manage higher-acuity cases on their own, and 2) I've seen too many cases royally screwed up by MLPs who are "working beyond their scope", so to speak.... yet they're pushing for a bigger scope of practice and more autonomy.

If your concern is truly for your (future) patients as you say... then you should recognize that you want the best and most appropriate care for them... and that means making sure that you don't have an MLP doing things they don't know how to do well.

Your assertion that we "make bonus money" off of the MLPs is just incorrect. At my new gig - I'm a straight-up employee with a good hourly and benefits. I'll be paid the same no matter how many patients are seen by either me, or the MLP. However, I will be responsible for anything bad that happens should they make a mistake. See... I get all the responsibility, and no additional benefit.

You're still a student. You will see... Yes, you will see.

Well the reason I make these comments is because I have already seen some of this working as a PA. One of the places I worked there was(and probably still is) a nice bonus system partly based on production of the MLPs that the doc's got(which is fine they take the larger liability).

I agree with you PAs/NPs both need their scopes watched closely. I am anti-MLP owned practices, anti-DNP etc... but your tone reminds me of a certain Attending I worked with years ago(fresh out of residency and had never worked with a PA) that was a nice guy to everyone's face(pts) but a total dick behind the scenes(nurses/pas/etc..) and eventually let it slip out to the wrong person. So I know that this will make someone that is timid less likely to ask questions and put patients at risk.

So I have already "seen" it. But I honestly agree with you about limiting the scope of practice and stopping the profileration of sooo many MLP schools(both PA/NP).

 

[RustedFox]

Well the reason I make these comments is because I have already seen some of this working as a PA. One of the places I worked there was(and probably still is) a nice bonus system partly based on production of the MLPs that the doc's got(which is fine they take the larger liability).

I agree with you PAs/NPs both need their scopes watched closely. I am anti-MLP owned practices, anti-DNP etc... but your tone reminds me of a certain Attending I worked with years ago(fresh out of residency and had never worked with a PA) that was a nice guy to everyone's face(pts) but a total dick behind the scenes(nurses/pas/etc..) and eventually let it slip out to the wrong person. So I know that this will make someone that is timid less likely to ask questions and put patients at risk.

So I have already "seen" it. But I honestly agree with you about limiting the scope of practice and stopping the profileration of sooo many MLP schools(both PA/NP).

Agreed. Everyone wants to wear a white coat and be called a boss... but science is like, hard... so, is there an easier way for them to do it without... y'know.... having to study so much ?

I'll also put it out there: the MD/DO curriculum is "broken". Its archaic, redundant, and frequently just plain irrelevant. It can be fixed. We can make students into better clinicians, faster. We can make MDs/DOs better, without having to waste extraordinary amounts of time and money like we do with the current curriculum. We should train more MDs/DOs, not more MLPs.

 

[Makati2008]

Agreed. Everyone wants to wear a white coat and be called a boss... but science is like, hard... so, is there an easier way for them to do it without... y'know.... having to study so much ?

I'll also put it out there: the MD/DO curriculum is "broken". Its archaic, redundant, and frequently just plain irrelevant. It can be fixed. We can make students into better clinicians, faster. We can make MDs/DOs better, without having to waste extraordinary amounts of time and money like we do with the current curriculum. We should train more MDs/DOs, not more MLPs.

I study my butt off in med. school. I slept in PA school and made A's(because it's almost 100% clinically based without embroy,histo, patho, etc...)

Yep its frustrating that so many people want to take the easy way out. My all time favorite from a DNP(prior to her knowing I was going back to school)- I have more training than a Physician I had to do a Thesis and they didn't. This was after a doc said I want your ATTENDING not YOU lol. Dangerous the mind set of some of these individuals, I also feel like some of the Physician groups have missed the chance to stop the profileration(DNP) but I might be an oddity in feeling this way. I have also noticed the same thing from some PA's as well but at least you have the BOM that can put the stop on that getting out of hand(you probably think I am a little hateful against my own profession but like you I have seen TOOO many errors made by MLPs not necessarily because they were hard Dx but because of the hubris these individuals have/had.)

GL

 

[Venko]

See my above post:

I will be happy to put the midlevels on equal footing when they:

1). Can pass STEP 1, 2 CK, 2 CS, and 3... (or their DO equivalent, for formality's sake)... just like 'WE' did.

2). Can carry their own liability insurance, and stop using us as a liability offset.


I can imagine a situation in twenty years where I need a colon resection... Do I want the "surgical PA" to do it ? No effing way. Period. Do (does) anyone want the "ER-PA" to interpret their EKG after syncope ? ... Nope.

If you want to play in the big leagues... study hard... study long...

Dont forget they need to complete a residency to gain experience and then also pass the specialty board examination. Then they have proven they are equally knowledgeable and capable of hand.

BTW, did someone truly compare the discomfort with midlevels functioning independently to women in the workplace? This is a complete misrepresentation in my opinion.

 

[RustedFox]

Dont forget they need to complete a residency to gain experience and then also pass the specialty board examination. Then they have proven they are equally knowledgeable and capable of hand.

BTW, did someone truly compare the discomfort with midlevels functioning independently to women in the workplace? This is a complete misrepresentation in my opinion.

A technicality, but even before/during residency... we have the title of "Dr." - even when we were interns that didn't know our olecranons from our rectums... therefore, if they pass the STEPS, and graduate... I'll use the title of "Dr."


... and maybe I missed it, but who compared MLPs to 'women in the workplace' ?

 

[Haemr Head]

I don't buy it. I think being super afraid of changes in healthcare, whether it's the inclusion of mid-level practitioners, or new technology, or women becoming physicians in larger numbers, or whatever, is a mistake. Will board certified EM docs have to innovate to set themselves apart? Probably. Maybe doing more administrative work, or research (in academic jobs), or involving themselves in various oversight activities. But I really don't think that being "very, very afraid" of PAs or NPs is going to accomplish anything at all. Nobody argues that a Trauma PA is the same thing as a trauma surgeon. We have a responsibility to perhaps set stronger parameters as a field for what are appropriate tasks for PAs or NPs to handle--something that I think is well worth a lot of EP advocacy. But I refuse to feel threatened by mid-level pracitioners as a matter of principle.

Innovation is one thing. Greed is another. I agree that we need to set strong standards for the scope of practice of physician extenders (that is exactly what we have done in our practices). But you assume that the progress and innovation in the emergency department will be driven and controlled only by emergency physicians. The hospital, the megagroups, and the contract holders who administer but do not work clinically, will drive this change. They have a strong voice within ACEP as do the PAs. I'll stop being concerned once your assumption is verifiable. But more than 20 years of experience and active participation in change does not make me optimistic, particularly if we take a relaxed approach to the problem.

With a priority to cut health care costs, moving expensive providers from clinical work into administrative work hardly makes sense. The NIH budget is going to be cut and there will be less dollars available to support research. Certainly some will be able to make it, although the NIH cap is far below the income level of most emergency physicians presently make and expect to generate in the future.

If the standard of care ends up being that a PA is capable of providing unsupervised emergency care, then economic forces, not rhetoric or position statements will drive the change that will displace board certified emergency physicians out of the emergency department. Once you loose control over this expertise, there is no Specialty of Emergency Medicine.

Innovation in emergency medicine is finding out how to deliver lower cost care while maintaining the same quality, not downgrading care. There is quite a lot to be done that can be defined as innovation. More effective gate keeping and decreased reliance on expensive testing through clinical pathways, observation, urgent care, better communication with PCP, and expanded use of bedside ultrasound are innovations. But replacing the safest provider and best gate keeper, the board certified emergency physician, to reduce costs is a classic penny wise pound foolish maneuver driven by greed. You can sadly trust many hospital administrators and contract holders will go there if enough obstacles are removed.

 

[Venko]

For Rusted,

You're right about the fact that the title Physician is bestowed upon completion of Steps 1 and 2 and graduation of medical school. I was broadening my thoughts to beyond the title to the ability to practice independently; in my opinion this should be limited to board eligible / board certified inidividuals which means those who have passed all steps, completed residency, and who have not failed the board examination repeatedly. I know this would challenge the notion that residents should be able to practice independently, and I do not wish to open that debate here... you're right I brought too many requirements to the issue of title.

As for the women remark...

I don't buy it. I think being super afraid of changes in healthcare, whether it's the inclusion of mid-level practitioners, or new technology, or women becoming physicians in larger numbers, or whatever, is a mistake.

 

[RustedFox]

For Rusted,

You're right about the fact that the title Physician is bestowed upon completion of Steps 1 and 2 and graduation of medical school. I was broadening my thoughts to beyond the title to the ability to practice independently; in my opinion this should be limited to board eligible / board certified inidividuals which means those who have passed all steps, completed residency, and who have not failed the board examination repeatedly. I know this would challenge the notion that residents should be able to practice independently, and I do not wish to open that debate here... you're right I brought too many requirements to the issue of title.

As for the women remark...

Meh. Dun matter none. We're arguing over syntax.

 

[sylvanthus]

4 EM/IM spots

Huh, wonder why this is. Wasn't there 0 the year before?

 

[DreamingTheLive]

I disagree with you about PA/NPs taking the Steps and then gaining more respect. You can teach anyone how to pass the exams if you give them enough information and/or chances. Without the further training to back it up it is dangerous.

Personally I notice you have a very severe disdain for Midlevel's I hope that you are not one of those Docs that are jerks to PA/NP's that ask you questions to get better understand because you are not only hurting your patient, you are hurting yourself(opening yourself up to more liability because the provider feels like they have to walk on egg shells around you) and the PA/NP as well.

If you truly have this hatred then 1.)Refuse to take a job that uses PA/NPs 2.)If you decide to take the job then be sure to not take any of the bonus money that those PA/NPs earn you and instead give it to your colleagues....

You have some confusing and rather contradictory posts. I doubt anyone on these forums truly dislikes mid-levels, in fact, I'm sure it is quite the opposite.

They have a fraction of the education, training and experience as physicians and want Equal rights and compensation.....in the name of patient care?!?!? And physicians, after all of their hard work and sacrifices, should just be OK with it because they're nice/selfless?!?!

Sorry, I love Nurses, PA's, MA's, you name it.....when they're doing the job they were trained for. Pretending this is a non-issue or choosing not to engage in this discussion and sticking our collective "head in the sand" is why physicians are currently losing this battle.

And ya, I'm going to advocate the **** out of this argument for physicians because I still truly believe that the talents/services that hard-working and intelligent board-certified physicians possess are irreplaceable and an immense boon to our immediate communities at-large.

DTL

 

[DreamingTheLive]

Sorry for the above rant. A little "passionate" about some of these "scope of practice" political battles beginning to surface. Obviously I'll be pursuing an EM residency which affords ample opportunity to learn about the administrative/policy side of medicine.

 

[EM_Rebuilder]

Here to me is one of the big issues.. not only in my mind, but something our specialty and ACEP has struggled with on a national level for sometime...

We all are aware that it will be probably outside most of our careers that we can even THINK of every "ER" in the country being staffed by BE/BC in EM. Even then, did you do a residency to work in a 10K/year (or even less) volume ED? I know I didn't.. they are fun to moonlight in, but I'd rather be a barber than work in a place like that full time.

So... when push comes to shove.. who do we advocate for... NON EM Trained Physicians (Family Med, IM, intern year only, tired of surgery, retired OB/Gyn, Extra money as a psych... these are ALL people I have run into during my moonlighting career) OR... do we advocate for NP/PAs that we assumbly have some control over?

I think we all can agree 100% BE/BC EM Physicians seeing every patient in all EDs big or small across the country is ideal...but thats just not going to happen.

 

[GoBuckeyes913]

All EM spots filled, kinda awesome. My program upped their spots +4 this year, and we only interviewed for 7 spots.

Ironically..... 40 radiology programs didn't fill. No one wants to sit at a computer and count money anymore?

 

[Apollyon]

All EM spots filled, kinda awesome. My program upped their spots +4 this year, and we only interviewed for 7 spots.

Ironically..... 40 radiology programs didn't fill. No one wants to sit at a computer and count money anymore?

A friend of mine is rads, and she and her husband are visiting HI now. I asked her about that. She said there aren't any jobs, and that's starting to filter to the residents and then med students. Her group is looking to cut 1 to 2 FTEs.

 

[RustedFox]

A friend of mine is rads, and she and her husband are visiting HI now. I asked her about that. She said there aren't any jobs, and that's starting to filter to the residents and then med students. Her group is looking to cut 1 to 2 FTEs.

Hmm... verrrr-ryy interest-t'ing.

Seems like "correlate clinically" isn't going to cut it anymore... about effing time.

 

[geauxtigers82]

As per regional stats on nrmp website.

13 hours til announcement time
Good luck

 

[Makati2008]

You have some confusing and rather contradictory posts. I doubt anyone on these forums truly dislikes mid-levels, in fact, I'm sure it is quite the opposite.

They have a fraction of the education, training and experience as physicians and want Equal rights and compensation.....in the name of patient care?!?!? And physicians, after all of their hard work and sacrifices, should just be OK with it because they're nice/selfless?!?!

Sorry, I love Nurses, PA's, MA's, you name it.....when they're doing the job they were trained for. Pretending this is a non-issue or choosing not to engage in this discussion and sticking our collective "head in the sand" is why physicians are currently losing this battle.

And ya, I'm going to advocate the **** out of this argument for physicians because I still truly believe that the talents/services that hard-working and intelligent board-certified physicians possess are irreplaceable and an immense boon to our immediate communities at-large.

DTL

Review my post history and it will explain itself. I don't see how I am contradicting myself. Although I may be a PA I still believe in a scope of practice that must be abided by as well as no independence for the DNP/NP/PA. Nothing contradictory about it. I also believe that in the PA-Physician team both members must know their roles without the Physician member constantly trying to belittle the PA member while keeping them in their place(I am an advocate of watching from a distance;personally there are colleagues I don't want to supervise when I get back but I will be sure to review their charts to make sure I won't be at risk of malpractice and explaining where and why they were deficent in their treatment plan with tact.).

Explain how your confused and maybe I can explain it better?(Not trying to be a jerk and hopefully this message isn't conveyed in that manner).

Have you even started rotations at this point?

 

[turkeyjerky]

Here to me is one of the big issues.. not only in my mind, but something our specialty and ACEP has struggled with on a national level for sometime...

We all are aware that it will be probably outside most of our careers that we can even THINK of every "ER" in the country being staffed by BE/BC in EM. Even then, did you do a residency to work in a 10K/year (or even less) volume ED? I know I didn't.. they are fun to moonlight in, but I'd rather be a barber than work in a place like that full time.

So... when push comes to shove.. who do we advocate for... NON EM Trained Physicians (Family Med, IM, intern year only, tired of surgery, retired OB/Gyn, Extra money as a psych... these are ALL people I have run into during my moonlighting career) OR... do we advocate for NP/PAs that we assumbly have some control over?

I think we all can agree 100% BE/BC EM Physicians seeing every patient in all EDs big or small across the country is ideal...but thats just not going to happen.

Therein lies the rub. How long will physicians continue to exert "control" over mid-levels for? I'm not sure of the rationale that you'd prefer a PA or NP staffing an ED over a FM-trained physician--even if the PA has completed a "EM residency".

 

[Bojack Horseman]

Therein lies the rub. How long will physicians continue to exert "control" over mid-levels for?

as long as they have to accept liability for their decisions?

 

[jbar]

Back to the original post, I think that the fact that there are no unfilled spots just means that the match is working better. I think this is because programs are leaving themselves a better safety margin, which is good. If you interview more people than you need, and don't rank only those people who you don't want at your program, then there are enough candidates for the computer to fill all your spots. My understanding is that most places that had unfilled spots was because they didn't interview enough people, or got cocky and only ranked the top of their list.

I'd also point out that in past years some of the "unfilled" spots were really new programs that were accredited too late to do the match, so they used the scramble to fill their intern class. I think Staten Island did this a few years ago.

So there may be less new programs, or those that are new are filling without using the scramble.

 

[RustedFox]

Review my post history and it will explain itself. I don't see how I am contradicting myself. Although I may be a PA I still believe in a scope of practice that must be abided by as well as no independence for the DNP/NP/PA. Nothing contradictory about it. I also believe that in the PA-Physician team both members must know their roles without the Physician member constantly trying to belittle the PA member while keeping them in their place(I am an advocate of watching from a distance;personally there are colleagues I don't want to supervise when I get back but I will be sure to review their charts to make sure I won't be at risk of malpractice and explaining where and why they were deficent in their treatment plan with tact.).

Have you even started rotations at this point?

Tact ? This is the interweb, amigo. : ) In real-life, we're all very PC, especially with our patient populations... after all, they fill out those pesky PG surveys... but nobody polices the interwebs. Let your freak flag fly.

 

[Apollyon]

My understanding is that most places that had unfilled spots was because they didn't interview enough people, or got cocky and only ranked the top of their list.

"Most"? What other option is there? If a place doesn't fill, they didn't have a long enough list. Period. Why, then, is either didn't interview enough, or did, but cut too many. Unless there's some other way I am missing, that's it.

 

[Bojack Horseman]

Everyone hated the program and no one ranked it? Maybe not likely but possible

 

[DreamingTheLive]

Review my post history and it will explain itself. I don't see how I am contradicting myself. Although I may be a PA I still believe in a scope of practice that must be abided by as well as no independence for the DNP/NP/PA. Nothing contradictory about it. I also believe that in the PA-Physician team both members must know their roles without the Physician member constantly trying to belittle the PA member while keeping them in their place(I am an advocate of watching from a distance;personally there are colleagues I don't want to supervise when I get back but I will be sure to review their charts to make sure I won't be at risk of malpractice and explaining where and why they were deficent in their treatment plan with tact.).

Explain how your confused and maybe I can explain it better?(Not trying to be a jerk and hopefully this message isn't conveyed in that manner).

Have you even started rotations at this point?

Ya kid. I'm a rotation away from being a 4th year. Hence my earlier anecdote about the DO and PA (which seemed to strike a nerve with you...). Anyways....

 

[Apollyon]

Everyone hated the program and no one ranked it? Maybe not likely but possible

Well, there you go! That is one of which I did not think.

 

[WildMed16]

So this thread got stupid. Another PA pissing match.

In other news and back on topic, my school matched 28 out of 33 in EM. Biggest year in history! Pretty amazing. I also matched today at my #4 and I'm feeling pretty fortunate to be training amongst some of the best in the biz. Cheers and Congrats to all the new interns!

 

[Makati2008]

Ya kid. I'm a rotation away from being a 4th year. Hence my earlier anecdote about the DO and PA (which seemed to strike a nerve with you...). Anyways....

Smh. Mostly because they are worthless generalizations but again you know that as well as I do. I am just as guilty as you are in that dept(giving useless anecdote) in some previous post.

 

[Makati2008]

Tact ? This is the interweb, amigo. : ) In real-life, we're all very PC, especially with our patient populations... after all, they fill out those pesky PG surveys... but nobody polices the interwebs. Let your freak flag fly.

Lol. Good point sir.

 

[DreamingTheLive]

So this thread got stupid. Another PA pissing match.

In other news and back on topic, my school matched 28 out of 33 in EM. Biggest year in history! Pretty amazing. I also matched today at my #4 and I'm feeling pretty fortunate to be training amongst some of the best in the biz. Cheers and Congrats to all the new interns!

Wow. 28 seems pretty high. Congrats all around.

 

[la gringa]

Wow. 28 seems pretty high. Congrats all around.

agree... 33 applied? how big is your class???

 

[WildMed16]

agree... 33 applied? how big is your class???

255. Big class.

 

[Arcan57]

255. Big class.

1:8 applicants is a stupid high percentage for EM. The national percentage of EM docs in '07 was 4%http://www.bls.gov/oco/ocos074.htm.

 

[DrHoffy]

I think also that last year was very competitive so many qualified people did not match. Instead they choose to do a trad year or research, and are applying again. Each year this is compounded as the number of residency spots minimally increases but the number of new schools or schools increasing their class size increases faster; therefore causing more to scramble.

If you look at the statistics there are way more applicants than spots and this is just going to continue.

 

[Dr Lyss]

is there a feeling that as EM becomes more popular as a "lifestyle" kind of specialty, the market will become saturated?

I'm still deciding between EM vs Peds and as excited as I am that med students all over the country are hopping on the EM bandwagon, I wonder if the EM job market can handle a huge surge of new blood a few years from now when it comes time for all these people to get jobs... or maybe I'm thinking too hard.

Thoughts?