I’ve worked in the ED for the past several years (I’m a nontrad with some life experience) and really enjoy the diverse patient population, breadth of cases (from trauma to psych and everything in between), and scheduling. I prefer shift work to a 9-5, but that’s just me. I also appreciate that it’s non-surgical but involves plenty of procedures. Also enjoy that (in community EM) you get to treat peds - geriatric patients.
I am open to any suggestions for other specialities you would suggest. And I’m sorry if it seems like I’m beating a dead horse here in the thread.
I’m not trying to be an instigator or an ass kisser— I genuinely appreciate the insight and advice you all can give.
I do find it interesting that some of the reasons you list you are interested in EM are not considered very desirable by seasoned EM physicians.
Specifically peds EM cases and geriatric cases are very dull. Mount Asclepius' post really captures the nature of these interactions well. In all seriousness, these cases tend to be very unsatisfying.
Peds: 95% self limited illnesses (URI, pharyngitis, gasteroenteritis) 5% very scary/complex kids who should go straight to a children's hospital but parents can't be inconvenienced to drive 10 minutes farther. These cases have gotten much more stressful with the transfer/capacity squeeze.
Geriatrics: 95% "weak and dizzy", patients with poor quality of life and your heroic interventions in the 5% who are very sick do not dramatically improve quality or span of life.
Psych: just keeping the patient in the ER for days on end waiting for psych placement. Really no medicine at all, just implementing whatever the social workers recommend. We don't actually formulate or provide any longterm treatment or relief of depression, anxiety, schizophrenia, etc.
The types of cases me (and I think most attending physicians) enjoy the most are fundamentally healthy at baseline adult patients with discrete illnesses that have well defined treatment/intervention and the implementation thereof can help restore the patient to their good normal baseline quality of life which is worth preserving. There are surprisingly few of these cases in EM.
Other specialties:
What draws students to different specialties varies and is a personalized decision, but having worked with med students interested in EM for about a decade now I do see some common themes of things they are interested in:
-procedures
-resuscitation
-trauma
-being able to "fix stuff", particularly quickly
-no long term continuity with patients
They tend to be less interested in preventative care, long term health maintenance and disease screening, "not doing stuff." I know I felt the stuff we did in primary care clinics was pretty dull as a student. That being said, I now think it can be more satisfying as an attending and really knowing patients and seeing them do well medically in their life over years. But as a student dropping into a clinic for a few weeks, you don't get to experience that.
So, what is the truth of EM about the "draws."
-We really don't do a lot of procedures. It's emergency MEDICINE not emergency SURGERY. I'd say 95% of my time is spent doing medicine and 5% procedures. That 5% is strictly non-invasive. IF you really want to do lengthy complex invasive procedures, you should consider surgery.
-Resuscitation. Yeah we do this, it's cool. But we do less than you think. Again 90% of patients are very stable and eventually you start to view resuscitation as somewhat of an annoyance as those patients are time/labour intensive and distract you from the stable patients who can and will fill out negative surveys about you or complain if you don't get back to them quick enough. Meanwhile people on ventilators don't fill out surveys.
-trauma. The roll of EM physicians in trauma is primarily diagnostic. We simply find patients who have had a trauma mechanism and determine if they really have serious injuries or not. If they DO have serious injuries, those problems are by definition mechanical and require mechanical solutions: i.e. surgery. The surgeons are the ones who actually fix these problems.
-being able to "fix stuff." A lot of patients we see have either chronic problems or no discrete acute problem for us to fix.
So what do I recommend to students?
I recommend anesthesia or if you've got the CV for it IR.
anesthesia has a lot of procedures (doing airways, lines, and US guided procedures EVERY day). They have an important roll in the resuscitation of acute surgical patients. They have a more important and respected roll in the care of trauma patients as they work with surgeons in the OR, which is what these patients really need. The patients you are seeing have a definite diagnosis or problem to be fixed (why they are having surgery) and so you have less of the pointless undifferentiated care we do in the ER (i.e. "just don't feel good "in a 25 year old).
