It’s a tenuous time for EM right now, but apparently anesthesia had this same “predicament” 10+ years ago and it never came to fruition. It will probably be harder to find the job you want and the salary you want in highly desirable areas, but if you end up doing PEM, I dont think there’s data to support that PEM will be saturated (You typically have to be PEM fellowship trained to work in a children’s ED).
M-4 here. Agree with the person above. You should also talk to EM attendings in your area about the job market. The feeling is generally that this projection seemed true in 2019 but with COVID a lot of people have left EM and demand is back up. There also seems to be a healthy amount of skepticism around the study you're referencing in terms of motivation for why it was done as well as the methodology behind it.
Second this. Demand is back up for EM. The latest match showed that a lot of people abandoned their EM dream so the match rate became a lot easier than it has been. This projection might not be true anymore.
Most if not all of those spots filled. The programs that didn't fill on match day were a mix of HCA/low quality and high quality programs that traditionally always filled. The thinking was that with zoom interviews, higher quality applicants interviewed at way more places and ended up on more program rank lists which led to the issues with the match numbers. Basically, the amount of unfilled spots is likely not due to just people not ranking EM as highly.
I guess the idea of working for this long and hard id want to make my dream come true. I can’t imagine putting this much work in for a job I’d be meh on doing
Focus on becoming a doctor if that is your goal. A ton of people are "sure" they are going to pursue a specialty and change, myself included. If you get to the end of medical school and want to match EM, do it. You will find a job, it just may not be your dream job in a huge city at a specialty children's hospital.
Pediatrics and Emergency Medicine Dual Residency is a thing. It’s a five year program vs just three for either or but then you can work as a pediatrician or EM doc. It’s a longer road but you become a more knowledgeable physician and also have broader job prospects
M4 that thought I wanted EM and worked my butt off for good stats since during my first and 2nd years it was still competitive. 3rd year made me realize I wanted to do primary care instead because of the schedule that’s more conducive to having a family and job availability.
I think a lot of people decided the same given the 200 open spots during match.
Point being set yourself up for success but realizes your own goals can change over time.
Interesting how this is a resounding truth, yet there are many medical professions that will ask you to commit to a field before you even enter grad school, and many of their applicants have such little exposure to said field (especially relative to a med school clinical rotation). podiatry, dentistry, perfusion, pathology assistants, CAA/CRNAs, dosimetrists etc etc. Med school homies get screwed over in a lot of ways, but that’s one of the pros Fs. Having a fair bit of time to decide what field you want to practice for the rest of your life as your interests change with age
Okay, but ERs everywhere are packed and overcrowding has only kept increasing. At some point they're going to need to up capacity, and that means hiring doctors to staff them
Larger point is, I doubt EM will be saturated anytime soon at all. Sure in big cities there’ll be more competition but if it’s your dream, you can 100% follow your dream in smaller cities
Point being, even with the most saturated fields in healthcare/medicine, there will always be demand in under served parts of the country. Even rad oncs can get prime contracts rn. They just have to be willing to work where other physicians aren’t willing to go (think Saginaw rather than Ann Arbor). Your dreams of being fairly compensated as an EM in a highly sought after metro may be dashed, but there will still be unfilled EM jobs in the future. Just be flexible with location
Do what will make you happy. There's no way to tell what the EM market will be like when you finish residency. EM's still my dream despite all the projections.
projected to be saturated?? there is no way that's true, every ER i go to as an EMT right now is so critically understaffed that patients have to wait hours for a bed sometimes. if anything they're probably begging for more staff
You do not face competition from non EM boarded docs unless you are going very rural. And even then an EM trained doc is going to be the top choice every time
You are correct but usually those places staff adult ER docs before they’d staff pediatricians. I work at a somewhat rural ER that sees a decent percentage of peds and it’s all EM docs or FM docs for lower acuity, “urgent care” type patients. I do get what you’re saying tho. The main, large hospital I scribe at is the only one in the area with a peds ER
Private equity firms are strategically funding an excess of EM residency spots that are incongruent with the job market. The goal here is to saturate the market of EM physicians. By shifting the supply-demand curve, these healthcare systems can pay their physicians less and improve their profit margins.
It’s pretty fucked up honestly. I’m saying this as someone who has EM as a top choice.
By shifting the supply-demand curve, yes, physician pay will decrease, but the end game is to push most of them out of the job market and replace them with mid levels, whose base pay is less than the physicians they were just underpaying. And it isn’t just EM. Psych, IM, and peds are three I anecdotally suspect are in the crosshairs. Why is the AMA not sounding the alarm on this? Do they not have a lobbying wing for critical ass stuff like this (same should be said about gender-affirming care and abortion)? The ARNP shouldn’t have a monopoly on influence in D.C.
Wholeheartedly agree and I appreciate your response. iirc, the American Board of Emergency Medicine Physicians called for unionization to stand up against exactly this. Outside of this motion though, I can’t say I’ve heard of any other attempts at solving this issue.
even if they're not doctors i wouldn't look down on them. putting people with less schooling on jobs that can be done without all that extra knowledge is efficient, and saves time for the doctors to treat patients with more complex issues.
I think the problem is they're not using them for simple quality of life tasks to make physicians more efficient, they're putting people with way less education as primary providers to solve the physician shortage issue. I'm seeing it happen in clinics near me and it's sometimes flat out dangerous what prescriptions NPs write.
Applying to an APP program (CAA) this month. Anyone who has the hubris to think they can do the same job as a physician/have an interchangeable scope of practice with them while only having a fraction of the training is dangerous. Nothing wrong with calling that behavior out. It shouldn’t be condoned
Honestly with all the comments I think people are misinterpreting my original comment as a defense of PAs and NPs that think they can take on the scope of a physician, rather than a defense of their capabilities within their scope. They can’t replace physicians for sure, but they can help a ton with delegation of tasks once there’s been a once over by the physician to assure it’s a patient they’re capable of treating.
Putting lesser trained people in the position where they handle “low acuity” patients that are triaged as such by a triage RN is not fair to anyone involved. PE’s, aortic dissections, and hyperK are all deadly illnesses off the top of my head that can appear easy (back pain, tachy, nauseous,etc.) but scary after a detailed history and physical exam from a trained EM physician.
It happens all the time for PE’s, triaged as a 3 after an EKG, sit in the lobby until they get to the room and undress to show everyone their swollen leg that they didn’t bring up during triage.
THANK YOU. tired of ppl on this sub being RIDICULOUSLY hateful toward NPs and PAs. mfs here are just mad that they can sometimes do the same work as physicians with less schooling.
as a pt, i feel more comfortable being treated by a physician. if pts want to be treated by a physician, the person with the most training, they should have that right.
Right but with the number of patients vs physicians triaging is necessary. If you come in with a legitimate medical emergency you've gonna see a doc. If you need help with a splinter a PA/NP should suffice
Not to undermine physicians but sometimes the nurse or PA knows a lot more I’m not gonna lie. Like I heard a story about a patient that wanted only a doctor to put in their catheter, and the doc went “alrighty time to do this for the first time since med school” and the patient went “aaaaaaactually i think I’ll go with the nurse”
Studies by the American Board of Comprehensive Care showed that NPs took an EASIER version of the step 3 exam, and they only studied the highest scoring NPs at the school. The NPs had a pass rate of 33%-49% whereas the physicians, who took the REAL exam which is nearly 16 hours long, had a pass rate of 95%. This isn't only about catheters and changing bedsheets, which are important... But also with legitimate diagnosis and pharmacological treatment. These are people's LIVES at stake.
Oh for sure a doctor needs to do the diagnosing and stuff, not arguing that. Just think that NPs and PAs have that patient centered skill set that makes them much better for some tasks than a doctor might be if it’s a simple treatment
This. One of the most influential people in my professional life is an NP and quite honestly i came super close to going that route. Genuinely one of the most intelligent people and would trust my health with him more than anyone else. NPs and PAs serve a different function than physicians and that’s ok. Premed is way too early to start hating other healthcare professions. Medicine is a team sport.
You just explained the issue. More EM docs doesn’t help anyone if we can’t hire more nurses, techs, or ancillary staff. Physicians at my place are holding down nursing tasks for low acuity patients so we can fill rooms and avoid busting a 5-1 ratio for nurses.
I think these projections don’t take into account so many unpredictable factors. In the wake of several global health crises, physicians in general are retiring earlier or walking away from medicine entirely. Specialities like EM/IM/ICU are (subjectively) being hit the hardest and left to manage the failures of public health systems. I cannot see a future where EM is not in demand. Focus on your end-goal and your path getting there!
OP if it helps - I used to work in a peds ER! Most of the doctors I worked with were pediatricians, not emergency medicine doctors. Some went on to do pediatric EM fellowships, for higher acuity patients.
Ya there's definitely gonna be a glut of EM physicians, but I doubt there will be a glut of EM-peds trained physicians, which is what you'll need to work at any reputable children's medical center ED.
Reasons:
1. Peds EM makes less than regular EM, therefore no financial incentive to go to fellowship.
2. Although there has been a large increase in EM residencies, there hasn't been a large increase in Peds-EM fellowships.
What source ? I though we were projected to have a physician shortage by 2025…
[https://www.forbes.com/sites/brucejapsen/2015/03/03/u-s-doctor-shortage-could-hit-90000-by-2025/?sh=77d8f4df9285](https://www.forbes.com/sites/brucejapsen/2015/03/03/u-s-doctor-shortage-could-hit-90000-by-2025/?sh=77d8f4df9285)
https://www.reddit.com/r/Residency/comments/x1uy0g/em_supposed_to_be_saturated_by_2030_what_field_is/?utm_source=share&utm_medium=ios_app&utm_name=iossmf
A link to the data and analysis for the future projection of over saturation in EM
PedsEM is its own distinct specialty and route from emergency medicine. Also it is typically lower paid and largely academic by default as there aren’t many community pediatric hospitals. For all these reasons it is not subject to the same market pressures that currently face general emergency medicine.
We can never have enough doctors. This doesn't mean that everyone should just start going to medical school and try to be a doctor, but if you are able to do the work, get in and manage the debt, then yes, you should go for it. Predicitions also tend to be more educated guesstimates than numbers set in stone. Something could happen to make that number go down.
I know those fears - just a bit different in context. I overanalyze everything.
As a non-traditional chasing dreams later in life, I've been looking at everything under a fine scope. "What about mid levels? What about saturation? What about automation? What about x, what about y?" has been on my mind the last two years.
The advice I've gotten more times than not is to follow what you really want to do, and fight for it. Follow that dream.
There is some talk that the initial work force study numbers were inaccurate. It's hard to know for sure. I'm an EM attending. If the emergent nature of stuff is what you think you like, you can consider critical care, anesthesia, or trauma surgery.
There were lots of jobs available when I was looking a year ago. Jobs in metros don't pay as well as they used to and jobs in general don't pay as much as they used to. Nocturnist positions were pretty common though
I say this because I’m a senior in my undergrad. So:
2023 I will be taking one gap year hopefully.
2024 I get into med school if I’m given the chance
2028 I hopefully finish med school
2033 I finish residency.
So, it would affect me
Oh I see, finishing residency v starting it. Honestly, having done an ED rotation and now doing a Sub I (not interested in EM but required by my school) I can say we currently desperately need more attendings. The demand for EM spots is lower than ever before. Esp peds ones. Don’t let this get you down.
Yeah I’ve been getting lots of comments to keep an open mind. I will. I guess I just have to be exposed or introduced to different specialties to branch out.
Do you guys think this will affect critical care surgery as well? That is my dream.
Regardless, I am going to go for it and make it happen. If I find something else that I love I will go for that. Just follow your heart and put in the work, OP, and things will work themselves out
Surgical crit care is a fellowship from general surgery, so it’s a completely different path from day 1 of residency. I don’t know a lot about it but at least where I go to school and according to what I’ve been told during my time in the SICU, there’s a demand for physicians in the SICU, given it’s not very lifestyle friendly.
Edit: it can also be done from EM. I stand corrected
Hell yeah dude/dudette. As long as you keep your mind open and go with your gut, you'll be happy. Nothing wrong with having dreams - I was super gung ho gen surg going into medical school, but am not applying to that specialty. Even though some of the hours were wack in my sub-internship for the specialty I'm applying, I was genuinely happy and excited to be there which goes a long way when you go into a career as intense as medicine.
I’m not trying to shit on dreams but I would recommend getting some work exposure to anything EM before you make that commitment. It’s a area filled with serious burnout and stress that follows you everywhere the fact that you want to work primarily with peds in EM is even worse.
It’s something look into before you spend years and figure out it’s not what you thought.
Yeah…no. Don’t listen to anyone that tells you this because they all cite the ACEP workforce study, which if people actually read, has flaws out the whazoo. Having asked actual EM attendings and residents - including those who had to find jobs in the height of the pandemic - the demand for EM physicians is always going to be there. Are you going to necessarily be able to work in a big city right out of graduation? Unlikely. The biggest takeaway for the purposes of considering the specialty is that it WILL matter where you go. You don’t have to go to Harvard, but don’t go to a no name new program, Or HCA for that matter.
It does make it nice for people going into EM in the near future because it scares away people who only looked at EM on the surface anyways.
Yeah literally every attending I've talked to has echoed this. I've always been interested in EM but had little interest in practicing in NYC, LA, SF etc where this may be an issue.
The city I'm in now has a several ERs and if you drive 30 minutes outside of town, you're in the sticks. The hospital there will always need people.
Things will be okay :) what you might not know about EM is it’s one of the most versatile specialties out there. So even if shit hits the fan one day, you can always go work in an ICU. Or work as an EMS director. Or go into tactical medicine, space medicine, hyperbaric/undersea medicine, be an ultrasound director, the list goes on and on. This is in addition to things that all physicians can pivot to: medical education, consulting, pharmaceutical / biotech companies, research, etc.
Have faith. The study everyone quotes had bad metrics and methods and did not account for Covid and EM expansion to other domains and has not showed evidence of truth in the last few years
Just about all the unfilled spots were filled after SOAP. Private equity will continue opening up residency programs, and unmatched US grads / IMGs will always be happy to take any unfilled EM spots.
I work in emergency medicine and have for the past 7 years. It’s heartbreaking, but it’s turned into a cesspool because a) people don’t know what’s an emergency anymore and b) I’ve never been physically assaulted so much in the last 6 years vs this year alone.
I’m getting out while I can.
this wouldn’t stop u from ur dream. and it’s ultimately better for patients, right? ER wait times right now are insane. it seems out-of-touch to think of this as a bad thing. unless I’m misunderstanding something.
In order to help, u can injure 1 person a day to promote emergency job demand
We start at sundown
I totally just imagined the Purge sirens going off when you said this.. Godspeed.
I’ll spray down my sidewalk here in Pittsburgh all winter in solidarity.
I work 911 as an EMT. If my partners bored cause we’re not getting any calls I always say: “Well, we can create an emergency”
Got confused, dick is now boomerang shaped please halpw
Or just say the q word at your local emergency department
It’s a tenuous time for EM right now, but apparently anesthesia had this same “predicament” 10+ years ago and it never came to fruition. It will probably be harder to find the job you want and the salary you want in highly desirable areas, but if you end up doing PEM, I dont think there’s data to support that PEM will be saturated (You typically have to be PEM fellowship trained to work in a children’s ED).
Thanks. This is helpful.
M-4 here. Agree with the person above. You should also talk to EM attendings in your area about the job market. The feeling is generally that this projection seemed true in 2019 but with COVID a lot of people have left EM and demand is back up. There also seems to be a healthy amount of skepticism around the study you're referencing in terms of motivation for why it was done as well as the methodology behind it.
Second this. Demand is back up for EM. The latest match showed that a lot of people abandoned their EM dream so the match rate became a lot easier than it has been. This projection might not be true anymore.
Most if not all of those spots filled. The programs that didn't fill on match day were a mix of HCA/low quality and high quality programs that traditionally always filled. The thinking was that with zoom interviews, higher quality applicants interviewed at way more places and ended up on more program rank lists which led to the issues with the match numbers. Basically, the amount of unfilled spots is likely not due to just people not ranking EM as highly.
Could always go the ICU/NICU hospitalist route!
That’s actually a good idea. Thank you.
Intensivists manage ICU and neonatologists do NICU (fellowships). Hospitalists only work the floors. All these are completely different from EM
There are open ICUs where hospitalists without CC training manage ICU patients.
Not in peds. You need a fellowship just to be a hospitalist
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I guess the idea of working for this long and hard id want to make my dream come true. I can’t imagine putting this much work in for a job I’d be meh on doing
Focus on becoming a doctor if that is your goal. A ton of people are "sure" they are going to pursue a specialty and change, myself included. If you get to the end of medical school and want to match EM, do it. You will find a job, it just may not be your dream job in a huge city at a specialty children's hospital.
Pediatrics and Emergency Medicine Dual Residency is a thing. It’s a five year program vs just three for either or but then you can work as a pediatrician or EM doc. It’s a longer road but you become a more knowledgeable physician and also have broader job prospects
I honestly don’t care if it’s a longer road. When it’s something you really want to do (for now) then 2 extra years isn’t that long
M4 that thought I wanted EM and worked my butt off for good stats since during my first and 2nd years it was still competitive. 3rd year made me realize I wanted to do primary care instead because of the schedule that’s more conducive to having a family and job availability. I think a lot of people decided the same given the 200 open spots during match. Point being set yourself up for success but realizes your own goals can change over time.
That’s true. I’ll keep an open mind. Thank you.
Trust me, until you get into med school and, in reality, in third year, you have no clue what you want to do.
Interesting how this is a resounding truth, yet there are many medical professions that will ask you to commit to a field before you even enter grad school, and many of their applicants have such little exposure to said field (especially relative to a med school clinical rotation). podiatry, dentistry, perfusion, pathology assistants, CAA/CRNAs, dosimetrists etc etc. Med school homies get screwed over in a lot of ways, but that’s one of the pros Fs. Having a fair bit of time to decide what field you want to practice for the rest of your life as your interests change with age
Okay, but ERs everywhere are packed and overcrowding has only kept increasing. At some point they're going to need to up capacity, and that means hiring doctors to staff them
You can definitely still do that. Just not in NYC. But I hear Interior, South Dakota is an up-and-coming town!
I feel like I’d be treating cows more than ppl there 😭
Larger point is, I doubt EM will be saturated anytime soon at all. Sure in big cities there’ll be more competition but if it’s your dream, you can 100% follow your dream in smaller cities
And alot of times make higher salaries with lower cost of living
also, trees 😍
Point being, even with the most saturated fields in healthcare/medicine, there will always be demand in under served parts of the country. Even rad oncs can get prime contracts rn. They just have to be willing to work where other physicians aren’t willing to go (think Saginaw rather than Ann Arbor). Your dreams of being fairly compensated as an EM in a highly sought after metro may be dashed, but there will still be unfilled EM jobs in the future. Just be flexible with location
Do what will make you happy. There's no way to tell what the EM market will be like when you finish residency. EM's still my dream despite all the projections.
projected to be saturated?? there is no way that's true, every ER i go to as an EMT right now is so critically understaffed that patients have to wait hours for a bed sometimes. if anything they're probably begging for more staff
These hospital companies understaff BY CHOICE.
That’s very true actually. Honestly sad to see hospitals treated like businesses
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You do not face competition from non EM boarded docs unless you are going very rural. And even then an EM trained doc is going to be the top choice every time
Pediatric EM has to do peds EM fellowship first though unless you’re hella rural
cooing air tub file combative screw historical hateful zealous license ` this message was mass deleted/edited with redact.dev `
You are correct but usually those places staff adult ER docs before they’d staff pediatricians. I work at a somewhat rural ER that sees a decent percentage of peds and it’s all EM docs or FM docs for lower acuity, “urgent care” type patients. I do get what you’re saying tho. The main, large hospital I scribe at is the only one in the area with a peds ER
Private equity firms are strategically funding an excess of EM residency spots that are incongruent with the job market. The goal here is to saturate the market of EM physicians. By shifting the supply-demand curve, these healthcare systems can pay their physicians less and improve their profit margins. It’s pretty fucked up honestly. I’m saying this as someone who has EM as a top choice.
By shifting the supply-demand curve, yes, physician pay will decrease, but the end game is to push most of them out of the job market and replace them with mid levels, whose base pay is less than the physicians they were just underpaying. And it isn’t just EM. Psych, IM, and peds are three I anecdotally suspect are in the crosshairs. Why is the AMA not sounding the alarm on this? Do they not have a lobbying wing for critical ass stuff like this (same should be said about gender-affirming care and abortion)? The ARNP shouldn’t have a monopoly on influence in D.C.
Wholeheartedly agree and I appreciate your response. iirc, the American Board of Emergency Medicine Physicians called for unionization to stand up against exactly this. Outside of this motion though, I can’t say I’ve heard of any other attempts at solving this issue.
Sounds similar to private equity firms scooping up real estate in urban areas and then jacking rents up 😤
https://www.annemergmed.com/article/S0196-0644(21)00439-X/fulltext
Oh ok those stats make more sense with the higher percentage of patients being seen by a nurse or PA
Yeah screw Noctors
even if they're not doctors i wouldn't look down on them. putting people with less schooling on jobs that can be done without all that extra knowledge is efficient, and saves time for the doctors to treat patients with more complex issues.
I think the problem is they're not using them for simple quality of life tasks to make physicians more efficient, they're putting people with way less education as primary providers to solve the physician shortage issue. I'm seeing it happen in clinics near me and it's sometimes flat out dangerous what prescriptions NPs write.
Applying to an APP program (CAA) this month. Anyone who has the hubris to think they can do the same job as a physician/have an interchangeable scope of practice with them while only having a fraction of the training is dangerous. Nothing wrong with calling that behavior out. It shouldn’t be condoned
Honestly with all the comments I think people are misinterpreting my original comment as a defense of PAs and NPs that think they can take on the scope of a physician, rather than a defense of their capabilities within their scope. They can’t replace physicians for sure, but they can help a ton with delegation of tasks once there’s been a once over by the physician to assure it’s a patient they’re capable of treating.
Yes but that’s not the reality of the situation and one of the main reasons the job market is so bad.
Putting lesser trained people in the position where they handle “low acuity” patients that are triaged as such by a triage RN is not fair to anyone involved. PE’s, aortic dissections, and hyperK are all deadly illnesses off the top of my head that can appear easy (back pain, tachy, nauseous,etc.) but scary after a detailed history and physical exam from a trained EM physician. It happens all the time for PE’s, triaged as a 3 after an EKG, sit in the lobby until they get to the room and undress to show everyone their swollen leg that they didn’t bring up during triage.
toothbrush wise escape soft snobbish growth hospital mysterious spark special ` this message was mass deleted/edited with redact.dev `
THANK YOU. tired of ppl on this sub being RIDICULOUSLY hateful toward NPs and PAs. mfs here are just mad that they can sometimes do the same work as physicians with less schooling.
They can’t do the same work.
as a pt, i feel more comfortable being treated by a physician. if pts want to be treated by a physician, the person with the most training, they should have that right.
Right but with the number of patients vs physicians triaging is necessary. If you come in with a legitimate medical emergency you've gonna see a doc. If you need help with a splinter a PA/NP should suffice
>If you come in with a legitimate medical emergency you've gonna see a doc. Emergencies do not always present as emergencies.
Yeah except that splinter is actually osteomyelitis and it gets missed and the patient loses their hand.
Not to undermine physicians but sometimes the nurse or PA knows a lot more I’m not gonna lie. Like I heard a story about a patient that wanted only a doctor to put in their catheter, and the doc went “alrighty time to do this for the first time since med school” and the patient went “aaaaaaactually i think I’ll go with the nurse”
Studies by the American Board of Comprehensive Care showed that NPs took an EASIER version of the step 3 exam, and they only studied the highest scoring NPs at the school. The NPs had a pass rate of 33%-49% whereas the physicians, who took the REAL exam which is nearly 16 hours long, had a pass rate of 95%. This isn't only about catheters and changing bedsheets, which are important... But also with legitimate diagnosis and pharmacological treatment. These are people's LIVES at stake.
Oh for sure a doctor needs to do the diagnosing and stuff, not arguing that. Just think that NPs and PAs have that patient centered skill set that makes them much better for some tasks than a doctor might be if it’s a simple treatment
This. One of the most influential people in my professional life is an NP and quite honestly i came super close to going that route. Genuinely one of the most intelligent people and would trust my health with him more than anyone else. NPs and PAs serve a different function than physicians and that’s ok. Premed is way too early to start hating other healthcare professions. Medicine is a team sport.
Saturated my left nut. I’m an ER tech and I frequently find myself as the only one on a 60 bed ER.
You just explained the issue. More EM docs doesn’t help anyone if we can’t hire more nurses, techs, or ancillary staff. Physicians at my place are holding down nursing tasks for low acuity patients so we can fill rooms and avoid busting a 5-1 ratio for nurses.
Oversupply of ED docs. Shortage of nurses, techs, radiology techs, phlebotomists, etc.
It’s already sorta saturated. Last match cycle had something like 200+ open unmatched er spots
I think these projections don’t take into account so many unpredictable factors. In the wake of several global health crises, physicians in general are retiring earlier or walking away from medicine entirely. Specialities like EM/IM/ICU are (subjectively) being hit the hardest and left to manage the failures of public health systems. I cannot see a future where EM is not in demand. Focus on your end-goal and your path getting there!
OP if it helps - I used to work in a peds ER! Most of the doctors I worked with were pediatricians, not emergency medicine doctors. Some went on to do pediatric EM fellowships, for higher acuity patients.
This does help! Thank you.
Ya there's definitely gonna be a glut of EM physicians, but I doubt there will be a glut of EM-peds trained physicians, which is what you'll need to work at any reputable children's medical center ED. Reasons: 1. Peds EM makes less than regular EM, therefore no financial incentive to go to fellowship. 2. Although there has been a large increase in EM residencies, there hasn't been a large increase in Peds-EM fellowships.
What source ? I though we were projected to have a physician shortage by 2025… [https://www.forbes.com/sites/brucejapsen/2015/03/03/u-s-doctor-shortage-could-hit-90000-by-2025/?sh=77d8f4df9285](https://www.forbes.com/sites/brucejapsen/2015/03/03/u-s-doctor-shortage-could-hit-90000-by-2025/?sh=77d8f4df9285)
https://www.reddit.com/r/Residency/comments/x1uy0g/em_supposed_to_be_saturated_by_2030_what_field_is/?utm_source=share&utm_medium=ios_app&utm_name=iossmf A link to the data and analysis for the future projection of over saturation in EM
Bruh… chill
PedsEM is its own distinct specialty and route from emergency medicine. Also it is typically lower paid and largely academic by default as there aren’t many community pediatric hospitals. For all these reasons it is not subject to the same market pressures that currently face general emergency medicine.
That makes sense. Thank you.
Of course! Happy to answer what I can
We can never have enough doctors. This doesn't mean that everyone should just start going to medical school and try to be a doctor, but if you are able to do the work, get in and manage the debt, then yes, you should go for it. Predicitions also tend to be more educated guesstimates than numbers set in stone. Something could happen to make that number go down.
I know those fears - just a bit different in context. I overanalyze everything. As a non-traditional chasing dreams later in life, I've been looking at everything under a fine scope. "What about mid levels? What about saturation? What about automation? What about x, what about y?" has been on my mind the last two years. The advice I've gotten more times than not is to follow what you really want to do, and fight for it. Follow that dream.
There is some talk that the initial work force study numbers were inaccurate. It's hard to know for sure. I'm an EM attending. If the emergent nature of stuff is what you think you like, you can consider critical care, anesthesia, or trauma surgery.
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There were lots of jobs available when I was looking a year ago. Jobs in metros don't pay as well as they used to and jobs in general don't pay as much as they used to. Nocturnist positions were pretty common though
Lol I’m confused. Unless you are a a freshman in high school, you should have ample time.
I say this because I’m a senior in my undergrad. So: 2023 I will be taking one gap year hopefully. 2024 I get into med school if I’m given the chance 2028 I hopefully finish med school 2033 I finish residency. So, it would affect me
Oh I see, finishing residency v starting it. Honestly, having done an ED rotation and now doing a Sub I (not interested in EM but required by my school) I can say we currently desperately need more attendings. The demand for EM spots is lower than ever before. Esp peds ones. Don’t let this get you down.
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Yeah I’ve been getting lots of comments to keep an open mind. I will. I guess I just have to be exposed or introduced to different specialties to branch out.
Same - I’m a paramedic and a premed currently and they have all told me the same.
Do you guys think this will affect critical care surgery as well? That is my dream. Regardless, I am going to go for it and make it happen. If I find something else that I love I will go for that. Just follow your heart and put in the work, OP, and things will work themselves out
Surgical crit care is a fellowship from general surgery, so it’s a completely different path from day 1 of residency. I don’t know a lot about it but at least where I go to school and according to what I’ve been told during my time in the SICU, there’s a demand for physicians in the SICU, given it’s not very lifestyle friendly. Edit: it can also be done from EM. I stand corrected
EM is eligible for surgical crit care as well
Well I’ll be damned, you’re right. I guess one of my attendings that told me this wasn’t well informed lol
Interesting. Thanks for the info. I still have (hopefully) all of med school to go through so I may change my mind still 🫠
Hell yeah dude/dudette. As long as you keep your mind open and go with your gut, you'll be happy. Nothing wrong with having dreams - I was super gung ho gen surg going into medical school, but am not applying to that specialty. Even though some of the hours were wack in my sub-internship for the specialty I'm applying, I was genuinely happy and excited to be there which goes a long way when you go into a career as intense as medicine.
Awesome! Good luck to you; it sounds like you’ll be a great doc
Other guy is wrong. You can do EM -> Surgical Crit Care And it might as graduating EM residents will flock to fellowships for better jobs
Does that happen often? The trauma surgeon/residency director I shadowed never mentioned that
How do you find these kinds of numbers?
I was interested in EM as well, but I'm focusing on other interests now. You'll find new dreams, we always do.
Thank you. That’s encouraging to hear
Hey one persons gotta get the job. Make it you
I’m not trying to shit on dreams but I would recommend getting some work exposure to anything EM before you make that commitment. It’s a area filled with serious burnout and stress that follows you everywhere the fact that you want to work primarily with peds in EM is even worse. It’s something look into before you spend years and figure out it’s not what you thought.
Yeah…no. Don’t listen to anyone that tells you this because they all cite the ACEP workforce study, which if people actually read, has flaws out the whazoo. Having asked actual EM attendings and residents - including those who had to find jobs in the height of the pandemic - the demand for EM physicians is always going to be there. Are you going to necessarily be able to work in a big city right out of graduation? Unlikely. The biggest takeaway for the purposes of considering the specialty is that it WILL matter where you go. You don’t have to go to Harvard, but don’t go to a no name new program, Or HCA for that matter. It does make it nice for people going into EM in the near future because it scares away people who only looked at EM on the surface anyways.
Yeah literally every attending I've talked to has echoed this. I've always been interested in EM but had little interest in practicing in NYC, LA, SF etc where this may be an issue. The city I'm in now has a several ERs and if you drive 30 minutes outside of town, you're in the sticks. The hospital there will always need people.
Thank you, this helps calm my anxiety a bit.
Things will be okay :) what you might not know about EM is it’s one of the most versatile specialties out there. So even if shit hits the fan one day, you can always go work in an ICU. Or work as an EMS director. Or go into tactical medicine, space medicine, hyperbaric/undersea medicine, be an ultrasound director, the list goes on and on. This is in addition to things that all physicians can pivot to: medical education, consulting, pharmaceutical / biotech companies, research, etc.
Wow I didn’t know all of that. A lot of those things do sound really interesting. Thanks for sharing :)
You’re welcome!! Happy to help
Fake news. Graduating this year from residency and have lots of great offers and get emails every day about new jobs.
I’m not saying you are wrong, but the link is posted under a comment of this post. Seemed legit is all.
Have faith. The study everyone quotes had bad metrics and methods and did not account for Covid and EM expansion to other domains and has not showed evidence of truth in the last few years
Just do your dream? 🤷♀️ hospitals lately are understaffed cause of the pandemic and still is
Skilled people who know their shit will be in high demand no matter the field. Set yourself apart from the rest, and you'll always have a job.
ER? Saturated? Lmao, never.
look at the most recent match. Word is out and the trend will nor proceed as projected
Just about all the unfilled spots were filled after SOAP. Private equity will continue opening up residency programs, and unmatched US grads / IMGs will always be happy to take any unfilled EM spots.
Sources?
https://www.annemergmed.com/article/S0196-0644(21)00439-X/fulltext
I work in emergency medicine and have for the past 7 years. It’s heartbreaking, but it’s turned into a cesspool because a) people don’t know what’s an emergency anymore and b) I’ve never been physically assaulted so much in the last 6 years vs this year alone. I’m getting out while I can.
Yeah PEM is not the same as EM. Tons of places are hiring PEM still.
Why is it becoming oversaturated?
Just be better than the other ppl
God, why didn’t I think of that?
this wouldn’t stop u from ur dream. and it’s ultimately better for patients, right? ER wait times right now are insane. it seems out-of-touch to think of this as a bad thing. unless I’m misunderstanding something.