Name: 多一年時間成為醫生 😨 （這對您意味著什麼？） (1 Additional Year to Become a Doctor 😨 (What This Means for YOU))
Uploaded: 2025-09-29T18:53:01.000Z
Duration: 11 min 1 s

Think it takes a long time to become a doctor?

您認為成為一名醫生需要很長時間嗎？

程度副詞

Earlier this year, the Accreditation Council for Graduate Medical Education, or ACGME, dropped a bombshell, new emergency medicine residency requirements of a four-year or 48-month program across the board starting as soon as July 1st, 2027.

今年早些時候，美國畢業後醫學教育認證委員會（ACGME）拋出了一枚重磅炸彈，即從 2027 年 7 月 1 日起，新的急診醫學住院醫師培訓要求一律為四年或 48 個月。

For decades, 80% of EM residencies have been three-year programs.

幾十年來，80%的急診科住院醫生都是三年制。

So if you're a pre-med just starting out, a medical student applying this cycle, or even an existing EM resident, this is massive.

是以，如果你是一名剛起步的醫學預科生、本週期申請的醫學生，甚至是一名現有的急診科住院醫師，這都是非常重要的。

What does this mean for your doctor journey, your finances, and the very landscape of emergency medicine?

這對您的就醫歷程、財務狀況以及急診醫學的前景意味著什麼？

Let's first start with why these changes are being proposed.

首先讓我們來談談為什麼要提出這些修改。

The ACGME stated goal is to improve physician preparedness.

ACGME 的既定目標是提高醫生的準備水準。

The review committee looked at what a successful EM curriculum should be based on required experiences, stakeholder feedback, and areas for growth in the specialty.

審查委員會根據所需的經驗、利益相關者的反饋以及該專業的發展領域，研究了成功的電磁學課程應該是什麼。

And keep in mind that this rationale is coming from the American Board of Emergency Medicine, which means it's only one side of the story.

請記住，這個理由來自美國急診醫學委員會，這意味著它只是故事的一面。

We cover the controversies later in this video, and as you may have guessed, it involves money.

我們將在本視頻的稍後部分介紹這些爭議，正如你可能已經猜到的那樣，這與錢有關。

They found that the ideal curriculum, once built out, simply couldn't be accommodated within the traditional 36-month period.

他們發現，理想的課程一旦建立起來，根本無法在傳統的 36 個月期限內完成。

They pointed to factors like shorter shifts in EDs nationwide, leading to fewer patient encounters and a need for more time to gain experience.

他們指出了一些因素，如全國急診室的輪班時間縮短，導致接診病人減少，需要更多時間積累經驗。

There's also a noted downward trend in the American Board of Emergency Medicine's board pass rates.

美國急診醫學委員會的考試通過率也呈明顯下降趨勢。

A survey of EM program directors, representing about 60% of all accredited programs, indicated an average desired training length of over 43 months, excluding vacation.

一項針對電磁學項目主任（約佔所有認證項目的 60%）的調查顯示，他們希望獲得的平均培訓時間超過 43 個月（不包括假期）。

This new 48-month proposed format is supposed to provide the foundational framework needed for independent practice.

這一新的 48 個月擬議模式應該為獨立實踐提供所需的基礎框架。

That said, this is a complete curriculum redesign for all EM programs.

也就是說，這是對所有電磁課程的全面課程重新設計。

Every institution will need to revise its teaching to fit this new four-year model.

每所院校都需要修訂其教學，以適應這種新的四年制模式。

It's a complete evolution of EM training.

But before we go there, let's break down the core shifts that will define a new four-year EM residency.

但在此之前，我們先來分析一下新的四年制電磁住院醫師培訓的核心轉變。

This redesign hits at the very core of how programs are structured.

這種重新設計觸及了計劃結構的核心。

Some may need to reduce their resident numbers to meet new requirements.

有些國家可能需要減少居民人數，以滿足新的要求。

Others, with high patient volume, might actually expand their total numbers.

另一些病人數量較多的醫院，可能實際上會擴大總人數。

The minimum program size will adjust from 18, which is six plus six plus six, across three years, to 16, which would be four plus four plus four plus four, across four years, to better align with the four-year length.

最低計劃人數將從 18 人（即 6 加 6 加 6，跨 3 年）調整為 16 人（即 4 加 4 加 4 加 4，跨 4 年），以便更好地與 4 年學制保持一致。

Next, get ready for more direct patient encounters, as the patient volume and acuity will be intensified.

接下來，要準備好更多地直接接觸病人，因為病人的數量和嚴重程度都將增加。

The ACGME wants every EM grad to be more battle-tested.

ACGME 希望每個 EM 畢業生都能經受更多的實戰考驗。

They're mandating at least 3,000 annual patient visits per resident tallied across all training sites.

他們規定，在所有培訓地點，每名住院醫師每年至少要看 3000 名病人。

Programs must now secure at least 120 critical care patient visits per resident annually.

現在，計劃必須確保每位住院醫師每年至少 120 次危重病人就診。

If your program can't hit that mass, you'll need to add on an additional month of critical care rotation to make up the difference.

如果您的計劃達不到這個數量，您就需要增加一個月的重症監護輪轉來彌補差額。

Now, let's talk about the sharp end of the stick, procedures.

現在，讓我們來談談 "利器"--程序。

There will be more of them, and they'll be tracked individually.

他們的數量會更多，而且會被單獨跟蹤。

The ACGME is not only beefing up the requirements, but completely overhauling how they're counted.

ACGME 不僅提高了要求，還徹底改變了計算要求的方式。

Prepare for new requirements like arthrocentesis, neonatal resuscitation, and regional anesthesia.

為關節穿刺術、新生兒復甦和區域麻醉等新要求做好準備。

However, the numbers for some EM procedures have skyrocketed.

然而，某些電磁手術的數量卻在激增。

For example, adult intubations went from 35 to 75, and central venous catheter access went from 20 to 30.

例如，成人插管從 35 例增加到 75 例，中心靜脈導管接入從 20 例增加到 30 例。

The focus is now on leading resuscitations.

You'll need to show competence as a team leader for adult medical trauma, pediatric, and even neonatal resuscitation.

您需要展示作為成人創傷醫療、兒科甚至新生兒復甦團隊領導者的能力。

And this is a big one for POCUS enthusiasts.

對於 POCUS 愛好者來說，這是一個大問題。

Point-of-care ultrasound is no longer a numeric procedural requirement.

護理點超音波檢查不再是一項數字程序要求。

最低掃描次數為 150 次，現在沒有了。

Instead, you'll need competency in performing and interpreting POCUS fully integrated into your curriculum.

相反，您需要將執行和解釋 POCUS 的能力完全納入課程。

Every single one of these procedures will now be tracked individually through the ACGME case log system, rather than just program averages.

現在，所有這些程序都將通過 ACGME 病例記錄系統進行單獨跟蹤，而不僅僅是項目平均值。

Next, there will also be more diverse clinical exposure during training, as the ACGME wants you ready for any environment.

其次，在培訓期間還將有更多不同的臨床接觸機會，因為 ACGME 希望你能為任何環境做好準備。

That means mandatory experience in both high-resource and low-resource emergency departments.

這意味著必須在資源豐富和資源匱乏的急診科都有工作經驗。

However, only shifts supervised by board-certified EM positions will count toward your core training weeks.

不過，只有由委員會認證的急診科醫生指導的班次才能計入您的核心培訓週數。

Plus, the youngest patients are getting more focus too.

此外，最年輕的病人也得到了更多的關注。

You'll now have a minimum of 24 weeks dedicated to pediatrics, including time in a pediatric ED and PICU.

現在，您將有至少 24 周的時間專門從事兒科工作，包括在兒科急診室和重症監護室工作。

You'll also get structured experience in evolving fields like telemedicine and observation medicine, as well as a mandatory rotation in toxicology and addiction medicine, and two weeks in obstetrics.

您還將在遠程醫療和觀察醫學等不斷髮展的領域獲得結構化的經驗，以及毒理學和成癮醫學方面的強制性輪換和為期兩週的產科輪換。

Programs must now plan 240 hours of synchronous didactic content annually, and you, as a resident, must attend at least 170 hours.

現在，教學計劃必須每年安排 240 個小時的同步教學內容，而作為住院醫師，您必須參加至少 170 個小時的同步教學。

Every resident must also complete and disseminate a scholarly project.

每位住院醫師還必須完成併發布一項學術項目。

Now, amidst all these changes, there is some positive news for your work-life balance.

現在，在所有這些變化中，有一些積極的消息可以幫助您平衡工作與生活。

The ACGME has heard the calls for better fatigue mitigation.

ACGME 聽到了關於更好地緩解疲勞的呼聲。

You can now work no more than six consecutive days in the emergency department.

您現在可以在急診科連續工作不超過六天。

Second, you're guaranteed at least one equivalent period of continuous time off between scheduled EM shifts.

其次，保證在預定的電磁輪班之間至少有一段同等的連續休息時間。

Third, the 80-hour weekly limit remains your hard cap, covering all clinical activities, including any moonlighting or work from home.

第三，每週 80 小時的限制仍然是您的硬性上限，涵蓋所有臨床活動，包括任何兼職或在家工作。

And finally, you get a minimum of one 24-hour period free per seven days, which cannot be averaged and must be free from all administrative, clinical, and educational activities, including at-home call.

最後，每七天至少有一次 24 小時的免費時間，這段時間不能平均計算，而且必須與所有行政、臨床和教育活動（包括在家通話）無關。

While these are certainly steps forward for the profession, it's wild to think that only working six consecutive days in a high-stress job with a maximum of 80 hours a week is a big win.

雖然這些無疑是該行業向前邁出的一步，但如果認為在每週最多工作 80 小時的高壓力工作中只連續工作六天就是大獲全勝，那就太荒唐了。

In some specialties, and based on my personal experience in plastic surgery, it's not uncommon for residents to work two weeks straight with no days off.

在某些專科，根據我在整形外科的親身經歷，住院醫生連續工作兩週而沒有休息日的情況並不少見。

These new bare minimum standards point out just how inhumane residency training is in the US.

這些新的最低標準表明，美國的住院醫師培訓是多麼不人道。

Working 80-hour weeks doesn't train you to be a better doctor.

每週工作 80 小時並不能把你訓練成更好的醫生。

In fact, your information retention goes down when you're sleep-deprived, overworked, and burnt out.

事實上，當你睡眠不足、工作過度和疲憊不堪時，你的資訊保持能力就會下降。

The unfortunate truth is there's clear financial incentive for hospitals to extract as much value out of cheap labor residents as they can.

不幸的事實是，醫院有明顯的經濟動機從廉價勞動力居民身上榨取儘可能多的價值。

But before we go any further, it's important to note that there are a number of caveats to these changes.

但在進一步討論之前，我們必須注意到，這些變化有一些注意事項。

On paper, more training, more procedures, and more diverse experience sound great, but this extended training comes with significant costs.

從紙面上看，更多的培訓、更多的程序和更豐富的經驗聽起來很不錯，但這種擴展培訓的成本也很高。

Let's talk about the elephant in the room, the financial burden.

讓我們來談談房間裡的大象--經濟負擔。

As a medical student or current resident, you're already facing monumental student loan debt, averaging about $260,000 for med school graduates.

作為一名醫學生或在讀住院醫師，您已經面臨著巨大的學生貸款債務，醫學院畢業生的平均貸款額約為 26 萬美元。

An extra year of residency means another year of living on a resident salary, which averages around $67,400, whereas an EM attending salary averages at nearly $400,000.

多一年的住院實習意味著多一年靠住院醫生的工資生活，住院醫生的平均工資約為 6.74 萬美元，而急診科主治醫生的平均工資接近 40 萬美元。

At an approximate loss of $330,000, that's a staggering financial hit.

大約損失 33 萬美元，這是一個驚人的經濟損失。

Additionally, it's one more year of interest accrued on any medical student debt you might have.

此外，您可能欠下的醫科學生債務也會增加一年的利息。

When accounting for hours worked, many residents earn less than some retail staff despite years of training and mountains of debt, and this additional year of residency exacerbates that pinch.

如果按工作時間計算，許多住院醫師儘管接受了多年的培訓並欠下了高額債務，但他們的收入卻比一些零售店員工還低，而多一年的住院醫師培訓更加劇了這種壓力。

In fact, one study showed that hospitals can actually generate a slush fund after a resident's third year due to their increased productivity.

事實上，一項研究表明，由於住院醫師的工作效率提高，醫院實際上可以在住院醫師第三年後產生一筆專項基金。

It begs the question, is this about better training or is it another year of cheap labor?

這就引出了一個問題：這是為了更好地培訓，還是又一年的廉價勞動力？

Many argue that three-year EM programs have been successfully producing competent board-certified physicians for decades.

許多人認為，數十年來，三年制的電磁學課程已經成功地培養出了合格的委員會認證醫生。

Anecdotal evidence and even some publications suggest there's no substantial difference in residents completing a three- or four-year program when it comes to skills or board scores.

軼事證據甚至一些出版品都表明，完成三年或四年課程的住院醫師在技能或考試成績方面並無本質區別。

Dr. Amy Ho, an EM physician, pointed out that the caliber of the program might be a larger factor in resident preparedness than simply its length.

急診科醫生 Amy Ho 博士指出，課程的品質可能是影響住院醫師準備程度的更大因素，而不僅僅是課程的長短。

If the goal is stronger doctors, shouldn't the focus be on improving the quality of existing programs rather than simply extending everyone's training?

如果我們的目標是培養更強的醫生，難道不應該把重點放在提高現有項目的品質上，而不是簡單地延長每個人的培訓時間嗎？

And this leads directly into a potential workforce crisis.

這直接導致了潛在的勞動力危機。

If you add a year to the training, you essentially create a gap year in 2030.

如果再增加一年的培訓時間，那麼 2030 年基本上就是一個空檔期。

That's the year when the three-year programs would have graduated.

This means thousands fewer EM doctors entering the workforce in 2030, which could have some serious ripple effects.

這意味著到 2030 年，將有成千上萬的急診醫生加入工作隊伍，這可能會產生嚴重的連鎖反應。

Adding to this shortage is the strong potential that fewer students will apply to EM if the training length is increased, as it lowers the appeal of emergency medicine.

如果增加培訓時間，申請急診醫學的學生很可能會減少，因為這會降低急診醫學的吸引力。

If someone is looking for a three-year program, the prospect of another year of training and the financial burden that comes with it may be enough to sway them to a different three-year residency option, like family medicine or internal medicine.

如果有人正在尋找一個為期三年的項目，那麼多一年的培訓前景和隨之而來的經濟負擔可能足以動搖他們選擇其他三年制住院醫師培訓項目的決心，比如家庭醫學或內科醫學。

While only one factor, residency length contributes to a specialty's appeal.

實習期的長短雖然只是一個因素，但也會對一個專業產生吸引力。

Ultimately, a longer program makes emergency medicine less desirable, resulting in fewer candidates.

最終，較長的課程會降低急診醫學的受歡迎程度，導致候選人減少。

There's a real concern that changes could lead to a shrinkage in the EM applicant pool.

人們確實擔心這些變化會導致少 數族裔申請者人數減少。

For rural areas, this could be devastating.

對於農村地區來說，這可能是毀滅性的。

Also, this mandatory four-year extension, perceived by many as an additional year of undervalued labor, could intensify the drive for resident unionization.

此外，這種強制延長四年的做法被許多人視為增加了一年被低估的勞動價值，可能會加劇居民加入工會的動力。

When the individual has no bargaining power, collective action becomes a compelling alternative.

當個人沒有討價還價的能力時，集體行動就成了一種令人信服的選擇。

This change may add fuel to an already growing fire.

這一變化可能會給本已愈演愈烈的火災火上澆油。

We've covered the nuances of physician unionization before on this channel, link in the description.

我們曾在本頻道介紹過醫生工會的細微差別，鏈接在說明中。

So what does this mean for you, whether you're a pre-med or already on your EM journey?

那麼，無論你是醫學預科生還是已經踏上電磁之旅，這對你意味著什麼？

If you're a pre-med or med student, understand that EM will be a longer commitment.

如果您是醫學預科生或醫科學生，請理解電磁學將是一項較長的承諾。