Our Workforce: A Senior Resident’s Perspective

Dustin Bratton, MD

I think most senior residents this year would agree that one of the most stressful parts of this year has been securing employment. I spent 4 years in undergraduate, 1 year in a masters program, 4 years in medical school, and 3 years in residency. It is demoralizing to come out at the end and have minimal job opportunities and to see how little your skillset is valued. Also during residency you become very close to your classmates and to watch them struggle through the same issues is disheartening.

This was also the first time for many of us to see the inner workings of the business side of emergency medicine and begin learning acronyms such as CMG (contract management group), PE (private equity), SDG (small democratic group), IC (independent contractor), NPP (non-physician provider), etc. Even more demoralizing is seeing multiple large hospital systems and universities advertise NPPs to be a reasonable replacement for our training in the emergency setting and working at an institution where you watch NPP training taking precedence over resident training because “they’re only here for a few shifts”.

I was one of the lucky few that secured a job early in my 3rd year with plans to transition to a medical director role within 6 months of starting. The problem was the more I looked into the staffing company I signed with, the more unsettled I felt. I learned this system was designed for profits with little regard to healthcare workers’ wellness, quality of care given, or patient outcomes. This bothered me immensely. With less than 3 months from graduation, I resigned my “sweet gig” and have been looking to join a SDG in a different city. This comes with a lot of challenges such as selling our home of 12 years, my wife looking for a different job, and scurrying to get credentialing at a new hospital.

I share this story not to be “woe is me” but to encourage you to educate yourselves on these issues and start helping protect the future of our profession. The time for action is now and I hope the leaders of ACEP will take notice and be part of the solution. Without drastic action the future of EM looks bleak and our patients will be the ones who suffer the most. It is time we fight to return to the backbone of medicine and remember the Hippocratic oath we took so many years ago when we started our medical training.

>> Up Next: Our Workforce: View from a Retiring E.R. Doctor, by Philip L Levin, MD, FACEP