A Bad Prognosis for Emergency Medicine

I read a fascinating piece by Dr. Thomas Cook in the December edition of Emergency Medicine News. In it, he cites work done by Cameron Gettel, MD who devised an interesting way to assess the attrition rate of emergency physicians (EPs): Gettel and his colleagues used data from the Centers for Medicare and Medicaid Services (CMS), noting which healthcare providers stopped billing CMS for emergency medical services. Gettel used this information to calculate the attrition rate for EPs. What he and his colleagues found is that the EP attrition rate was approximately 5% prior to the pandemic while it shot up to approximately 8% in urban spots and more than 11% in rural areas during the first year of the pandemic.

Using information from the American Board of Emergency Medicine, Gettel found - shockingly - that the median age of attrition for male EPs was 53.5 years and for female EPs was 43.7 years in 2019. This means that the median EP career was around 23 years long for men and fewer than 14 years long for women. Wow!

It's absolutely critical that medical students who are considering a career in emergency medicine think about what their professional trajectory might be, considering the short median lifespan of the typical EP.

For more information on this interesting topic and how attrition might affect the job market, the need for physician personal finance training, and who applies to emergency medicine, see Dr. Cook's piece here.

For Pre-Meds Applying in the Next Cycle, What IS Solid Clinical Experience Anyway?

Getting into medical school has gotten so competitive that it's increasingly important to have a strong candidacy with excellent grades and robust extracurricular activities. As I've mentioned in previous blog entries, one mistake I see pre-meds make is that they are so focused on leadership and research, they forget a critical component - clinical experience. To prove you want to be a doctor, it's essential you obtain clinical experience for a significant period of time - not just a health fair or two. Good grades will not make up for a lack of clinical experience. Here are some ideas for obtaining strong clinical experience:

EMT (some universities have EMT classes and/or jobs on campus)
Participate in a good hospital clinical care extender program
Work at a low-income clinic
Certified Medical Assistant
Certified Phlebotomist
Certified Nursing Assistant
Work at a hospice
Scribe (usually a full-time job)
Veterinarian's Assistant (a great way to get hands-on procedural experience)
Volunteer for a crisis text/phone line (might need to be paired with an in-person clinical experience)

Shadowing is a mixed bag: Medical schools don't know whether you're second-assisting in the operating room or just standing in a corner being ignored :(. If you choose to shadow, make sure you strategically delineate your clinical experience in your written materials.

If you're not excited about getting clinical experience, it's time to question your interest in a career in medicine... which is exactly what admissions committees will do if they don't see that experience.

Do your research before accepting a "clinical" job so you ensure you'll really get a satisfying experience and show admissions committees you can handle the heat.

Medical School and Residency Admissions: It's Not Personal

When I was in my second year of medical school, a third-year student (who later also went into emergency medicine, as I did) came to speak to our class about being on the wards. He gave an animated talk about how important it was to recognize that when residents, attendings, or nurses hollered at us on our clinical rotations, 99% of the time, it wasn't personal. He likened the situation to Boston traffic - how drivers lean on their horns for little cause because they are simply frustrated about their days. 

It's not personal, he said.

I say the same to those I mentor. Candidates get an interview at one highly ranked institution but rejected at what is considered a lesser one with no clear cause. Faculty interviewers mix applicants up with one another; some turn up wholly unprepared - reading students' applications for the first time during the interview itself. Remember: It's not personal. This process is arduous and cruel, and most candidates, faculty, and program coordinators are tired and doing their best in a dysfunctional system. 

The AAMC Will Expand the FAP to Include Some Residency Applicants

The American Association of Medical Colleges has announced that they will expand their Fee Assistance Program to certain residency applicants starting with the 2024-5 ERAS application season. At that time, the FAP will include residency candidates who were previously approved for the program during their medical school application process. The qualifying candidates will receive a 60% fee discount on up to 50 ERAS applications. This is great news for medical students who have severe financial needs. The AAMC reports that it will be providing more information in the following months.