Don't do EM unless you're doing it specifically to open your own facility or as a bridge to another field (ICU, pain).
I appreciate your detailed response! I’m sure you’re correct and I’m beating a dead horse here. Admittedly, I don’t spent much time on SDN so I could’ve looked at past threads before asking my questions here. That being said, I appreciate you taking the time to respond and providing some substance for me to consider.
No worries. There are much better ways to get the rush of taking care of sick patients. Do critical care medicine, anesthesia, acute care surgery, interventional cardiology, or I'm sure one of half a dozen others I'm not thinking of. All specialties have their issues, but EM really seems to be in a uniquely ****ty spot.
Doesn’t really matter, but I’m a woman.
These are good recommendations. I’ll make sure to prioritize shadowing in these environments and try to soak it all in on rotations.
Lol I’m not the largest fan of children either so I see where you’re coming from there.
Oh no you diiinnnnttttt two genders gonna piss someone off.
I remember being an M4, applying EM and being so excited for peds cases in the ED. Changed that opinion around July 3rd of intern year.
Clearly I hopped into the wrong thread hoping to receive some insight and guidance about the future of EM/other options to pursue instead only to be mocked and belittled.
I didn’t literally mean peds and geriatrics specifically. I meant it more as a range from peds patients all the way to geriatrics. But point well taken 🤣
I appreciate your insight. All good things to consider. My best friend is an EM nocturnist here in the metro Nashville area where I live. So perhaps my good experiences working in the ED + her experiences being happy with her job have created some roses colored glasses for me. I’ll certainly keep my mind open and explore other specialties.
Youre gonna need a tougher skin if youre gonna survive med school and residency. You came into a thread talking about the implosion of the specialty all excited about walking into said implosion. You brought this on yourself.
Agree, no more peds or geriatrics.
Peds in the ED is:
1) Cough. Fever. Viral URI. Go home.
2) Cough. Stridor at 2 AM. Dex. Go home.
3) Fell down. Hit head. No CT. Go home.
4) Chronically ill FLK with multiple genetic abnormalities. Try to transfer to quaternary center with no beds and then board in the ED continuing to get stern looks for parents asking if you really know about their super rare disease as they carry around their binder.
5) Cough.
6) Cough and runny nose.
7) Congestion and cough.
8) Second visit. Why still coughing, it’s been 3 days already?
9) Cough, rhinorrhea and congestion for 5 days. The antibiotic from the urgent care doesn’t seem to be working. Now they have a rash!! Is it an allergic reaction? I need a new antibiotic!
10) Cough. Cough. Cough…….soul sucking.
Geriatrics in the ED is:
1) Fell down 2 AM.
2) Weak. But why is my mom weak?
3) Dizzy. Which means anything.
4) Altered from SNF. Nope just the dementia that the new nurse didn’t know about.
5) Want to send them all home, but their family knows something is wrong and last time they were sent home they had to come back and were admitted. Can’t they just be admitted for a day so you can watch them?
6) I don’t know why I’m here?
7) What are my medications? It’s in the compuder.
8) No we didn’t talk about a DNR/DNI. She was so healthy with her end stage cancer and a very active 90 year old. Can’t you do something more?
9) I’m still weak!
10) Whoops, I fell again.
Are you excited yet?
My skin is sufficiently thick, I just don’t understand why some people have to be mean for no apparent reason.
Your skin will become much thicker as you move through your training, especially if you pick EM where you’ll develop bags under your eyes dealing with the stress (not sick patients that cause stress) and Circadian rhythm disruption. Your outlook will change. This isn’t necessarily a good thing. Ignorance is bliss and sometimes the best way to see the world is through the eyes of a child.
I appreciate your sentiment about childlike positivity and agree— I’m thankful that losing my mother in undergrad, taking care of my sick father, switching careers, and watching my grandmother succumb to Alzheimer’s last year have not jaded me. I’m sure over time it will happen. But today I’m just happy to be here.
Fair enough 🤣 we all need a resident madman, I reckon. Keeps things interesting.
The dread.
And yet, after flying her to tertiary care 2 weeks ago with multisystem organ failure on two pressors along with an insulin and D5 gtt, she returns to the local nursing home only to be sent back to the ED a few days later for "weakness", but still "wants everything done!"
Reading some of your posts, you should really consider FM more seriously. You can do clinic of course. But you can also do rural EM and have a definite escape plan that a lot of people in this thread wish they had. If you go to a good program (and none of them are really competitive) then you can be trained as a hospitalist, you can deliver babies, you can manage “womb to tomb” age ranges. The difference is that it’s actually more complex management than what you do in the ED which is discharge the urgent care type complaints and stabilize the sick patients while waiting for someone else to direct patient care. (I don’t mean this as a slight to ED docs as this is still important to do.). Admittedly, it’s very hard to be great at such a wide spectrum of care.
“We’re going to spend several million dollars investigating why this room is so hot.”
The only thing it was missing, at least for me, is some variant of, "she's demented/altered at baseline, but this is different " *insert vague subjective difference*
No there haven't been.
You're correct. The only big changes we've seen is in popularity of certain specialties and that's almost always due to changing reimbursement.
IM PGY-1 here. I thought I made a mistake going into IM and was seriously considering switching to EM so much so that I reentered the match late this year and had a few interviews. When I learned that EM is becoming a waste land job market wise, I decided to withdraw from the match and stay the current course. Nobody can tell you what to do with your life. My only advice is to not stay fixated on one path. Keep all of your options open and do as well as possible in school and on clinical to keep as many doors open for yourself as you can.
So many things wrong with this, not the least of which is this sentence: "We will work to ensure medical students fully understand our specialty when making their residency selections by proactively showcasing the advantages and addressing negative perceptions." So... we're going to put rose-colored glasses on the students and hope it works instead of actually fixing the problems. That's a recipe for burnout, and it's already happened to lots of us here.
They'll need tougher skin if they're gonna survive a career in EM where people will regularly curse, scream, assault and threaten to murder you on a regular basis.
This is all really good advice. I am from a rural area and, although I live in a Nashville suburb right now, my spouse and I will likely choose to remain in a rural area long-term so that would likely naturally lead to a wider scope as you have mentioned. Thanks for your insight!
This has been happening to me in the ED for the past 4 years already. I promise I'm not crying in the corner over here. I appreciate the insight you all have as someone who is young and not yet too jaded with medicine. I'm sure it will come.
Thanks for all the solid advice here! IM is definitely a great specialty and will likely be at the top of my list of considerations because of the wide variety of fellowship opportunities as well as opportunities straight out of residency. I think because I'm a non-trad student and older than most of my peers it's probably harder for me to not stress about these things too early... It's way too easy to feel like I am already behind the curve a bit. But I'll definitely heed your advice and just focus on academic success for now.
Do any of these organizations actually have any power to close or stop residencies? Isn't this all acgme? If anything all they can do is lobby the government I guess.
