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Click to enlarge the Southeast data.

I sit here in early August contemplating my retirement at the end of the year and writing up my final jobs report, I am plagued by one very important and all-encompassing question:

Will Paris ever be allowed to host the Olympics again?

From the controversial opening ceremonies to an Olympic village with lousy food, no real air conditioning and cardboard beds, to swimming in a toxic river, the future looks a bit dicey! I mean, who puts Simone Biles in a cardboard bed? There were definite expectations—the athletes expected a village and venues that gave comfort and safety, but the organizers expected a thumbs-up for a “green” environment. Expectations—a slippery slope! It takes me back to my early days in the emergency medicine arena 34 years ago, and I can’t help but be nostalgic.

Click to enlarge the Midwest data.

In 1990, residency programs in emergency medicine were only in existence for about 15 years. Those programs graduated less than 400 residents a year. Emergency departments (EDs) were primarily staffed with area primary care docs, many of whom had been working exclusively in the ER for years. Emergency docs were the real cowboys of medicine—they did a lot of locums work, and many of them had their own airplanes, flying themselves to gigs around the country. Hospitals didn’t have Emergency Departments per se, they had ERs under the department of Surgery. Even most residency programs operated under the surgical umbrella. There were no mid-level providers. There were no scribes. The gold standard job was with a democratic private group with partnership opportunities.

Click to enlarge the Southwest data.

There was no sign-on bonus, loan forgiveness, stipends or other front money. Docs were lucky to get basic relocation funds from a new employer. But with all of that, emergency physicians lived to work. They wanted to work as many shifts as they could—2,080 clinical hours a year was the norm. Earning $150 an hour was high income, and their primary expectations were to work hard and make a difference.

Thirty-four years later, we are graduating more than 2,200 emergency physicians a year whose job search expectations have become more like entitlements, even though there are just 1,700 jobs available and 33 percent of those jobs are open to primary care boarded physicians. There is no balance in residency program location or physician compensation on a national basis. Large, national contract groups run 68 percent of the EDs in the country and sign-on bonuses reach as high as $150K for a 3-year contract. There is even an opportunity being advertised for a “casual emergency physician with occasional sitting and standing.”