Anyone interested in trauma but chose EM for better hours?

[607955]

So I'm doing an elective trauma surgery rotation at an inner city level 1 and trauma runs the show when anything major comes through. All the EM doc does is manage the air way. The trauma surgeon was the one giving all the orders in the EM and managed the patient in the SICU. I'm really liking trauma surgery but I'll still probably do EM for the better hours and shorter residency. Anyone else in the same predicament as me when they were trying to decide residency?

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[Bostonredsox]

Your comparing fundamentally different physicians. Do Ed docs manage tons of trauma? Sure. But to make the extension to a surgeon because of the trauma exposure is a huge leap. You need to decide do you want to be a surgeon or not. You can b a shift work based trauma surgeon, I know many, and work a very similar schedule to an Ed doc, with the exception you will have 24hour call shifts or home call or whatever. But at the core, you are a surgeon making a living operating or an Ed doc running an Ed. Apples to oranges. I wouldn't make the decision based on shorter hours or shorter residency or less call. Make the decision based on whether you want to operate for a living or not.

I loved trauma surgery and surgical critical care in med school. But ultimately loved managing pts in the unit, and could not see myself being a surgeon, so I chose to go IM/CC. But the decision had nothing to do with the residency length. Residency is short in the grand scheme of your career. Figure out what you WANT to do, and do it.

 

[LifetimeDoc]

I was a general surgery resident, and honestly the only part of surgery that I liked was the trauma critical care part of it, not so much the actual operating room. I switched to emergency medicine because I like working with the variety in the ED, being the "jack of all trades" kind of person. Hopefully I can get back into doing some part of the trauma critical care through a fellowship in EM, but if not I'd be happier in the ED than I was as a general surgeon.

 

[bougiecric]

So I'm doing an elective trauma surgery rotation at an inner city level 1 and trauma runs the show when anything major comes through. All the EM doc does is manage the air way. The trauma surgeon was the one giving all the orders in the EM and managed the patient in the SICU. I'm really liking trauma surgery but I'll still probably do EM for the better hours and shorter residency. Anyone else in the same predicament as me when they were trying to decide residency?

Because the majority of medical training occurs in academics, that's what you're exposed to: academic emergency medicine.

In the community (where most ER docs end up), trauma is vastly different. Where I work, the "trauma" surgeon (general surgeon) may or may not be in house. When a trauma comes in, I run the entire thing and do all the procedures. For the most part, the surgeons ask us to call them off unless the patient truly has a surgical emergency. As you're probably aware, the vast majority of traumas nowadays do not have the need for emergent laparotomy. So the ER doc ends up intubating, doing the lines, doing the chest tubes, doing the reductions, and admits to the ICU with specialty consultations as needed. Don't get me wrong, there's still a cluster of people during a resuscitation, but it only includes the ER doc, ER nurses, and ER techs. No surgeons or residents to be found.

On that note, if I may editorialize for a moment, why is trauma training so backward? I had the same experience that you describe in both med school and residency. General surgery residents run trauma in academic hospitals, but as soon as they complete training, they don't want to be within 100 feet of a trauma bay. So much training that goes to waste... it makes much more sense to provide it to the EM residents who do the majority of it in the community.

EDIT: I should mention I'm only referring to the immediate resuscitation in the ED. Our surgeons still admit all multi-system traumas, and obviously need training on the inpatient side whereas we do not.

 

[hoot504]

Being exposed to ED docs in the trauma bay was the push that led me to choose EM. Assessing and stabilizing a trauma patient was the first part of 3rd year that really stuck with me as something I would want to have as part of my career.

Once the case got to the OR I wanted to shoot myself in the face. But prior to that, the trauma bay was a ton of fun, and I can relate to the OP.

 

[Angry Birds]

I am completing my residency at a Level 1 trauma center. Here, I would say we run 80% of trauma resuscitations. However, keep in mind that less than 10 percent of the patients I see are trauma patients and probably only a quarter of those are serious traumas that would be considered "cool." So, a very small percentage of patients I see are the type you want. After residency I will work in a community ED that sees far less trauma. You might be limiting your options as an ED doctor if you only want to work in trauma centers. Also, most trauma centers (I assume) would be run heavily by trauma surgeons.

You would need to like a good chunk of the other 90 percent of EM--other than trauma--to really justify going into EM. Just my opinion.

 

[The White Coat Investor]

While trauma and emergency medicine might look similar to the unexperienced, they are dramatically different specialties in what you actually spend the majority of your time doing. One operates, the other doesn't. One has clinic, the other doesn't. One takes call, the other doesn't. One works a billion hours, the other doesn't. One has to deal with flaky medical complaints and lots of drug seekers and the other doesn't...as much. One does mostly inpatient work and the other does mostly outpatient work. Sure, they hang out together for 5 or 10 minutes a day, but that's about it.

 

[DocEspana]

While trauma and emergency medicine might look similar to the unexperienced, they are dramatically different specialties in what you actually spend the majority of your time doing. One operates, the other doesn't. One has clinic, the other doesn't. One takes call, the other doesn't. One works a billion hours, the other doesn't. One has to deal with flaky medical complaints and lots of drug seekers and the other doesn't...as much. One does mostly inpatient work and the other does mostly outpatient work. Sure, they hang out together for 5 or 10 minutes a day, but that's about it.

Are you telling me that he just hangs out with me for the patients; that he is using me? You mean he doesn't really love me for me? Our relationship is more than just 5-10 minutes per day. We have something

 

[gman33]

Please don't choose EM because there is some trauma and better hours.
If you want to be a surgeon, do that. After residency, you can find a job that is shift based.
Still probably more all over hours than EM, but doable.

The intersection between EM and trauma surg is very small.
Depending on where you work an EM doc spends little time dealing with trauma.

 

[two guys]

You should probably do a trauma icu and trauma floor month. It's not unusual at all to like trauma surgery, I definitely did. The personalities are probably more similar than most of us would like to admit. That being said, I really only like the first day of someones trauma care. I also found the more serious it was, the more I liked it. That being said, doing the rest of the patients care (sometimes weeks and months as an inpatient) was no fun at all. Extubation trials, neuro checks, back to the or for the umptenth try to close the belly...none of that was stuff I wanted to do on a regular basis. Sure, if you're an academic trauma suregon at a busy institution you can probably spend your whole day in the OR or responding to traumas but I'll bet that represents a minority of people who started a gen surg residency. Most of thise guys did gen surg and then a trauma fellowship.

It might not hurt to ask this on the surgery forum as well. You'll probably get a better perspective on how a typical trauma surgeons day is divided. I suspect it is filled with a large percentage of stuff I don't like but they'd know better than most of us who only did at most 6 months of trauma between med school and residency (and never as an attending).

 

[bleeker10]

You should probably do a trauma icu and trauma floor month. It's not unusual at all to like trauma surgery, I definitely did. The personalities are probably more similar than most of us would like to admit. That being said, I really only like the first day of someones trauma care. I also found the more serious it was, the more I liked it. That being said, doing the rest of the patients care (sometimes weeks and months as an inpatient) was no fun at all. Extubation trials, neuro checks, back to the or for the umptenth try to close the belly...none of that was stuff I wanted to do on a regular basis.

Agree completely. I am in my first year of my ortho residency and had to do a month of trauma ICU and a month of trauma floors. Running the floor was very similar to medicine wards. All I did was round, write notes, get labs/imaging, work with SW/CM for dispo or discharge patients. At least in the ICU I got to go down to the ED for the traumas. I never was in the OR. The only person from the trauma team who got to operate was the PGY4. The rest of us (5 interns and a PGY2) all were either in the ICU (2 interns + PGY2) or on the floor (2-3 interns).

A lot of the operations after the initial trauma ex-lap were washouts/abdominal closures, wound vac changes, PEG/trachs, revision amps, etc. The attendings didn't operate all the time either. They either covered trauma or acute care surgery. They would either round in the trauma ICU, SICU or on the floor with trauma or acute care. They also had clinic a half day a week as well as administrative duties.

In my limited experience on trauma (8 weeks), it seemed like the big ex-laps for GSW or stabbings occurred at night. In fact, most of the traumas that come in were non-operative or operative for another service (ortho, NSG, ENT, ophtho). It's always fun managing the care of a trauma patient who has had surgeries by other services but you get to be primary because they had a questionable CHIBLOC with neg CT. It's even more fun when the operating consult service signs off within 24 hours post-op and says the patient can followup in their clinic after d/c. The problem is d/c may be at least 2 weeks because the patient doesn't have insurance/doesn't qualify for rehab/SNF somewhere. So this means you get to round on the patient everyday even though you aren't doing anything for them. Granted the attendings don't deal with the patients beyond the 2 minutes they are in the room. Just make sure you are at an academic place or have a PA/NP running the floor for you.

 

[The White Coat Investor]

Are you telling me that he just hangs out with me for the patients; that he is using me? You mean he doesn't really love me for me? Our relationship is more than just 5-10 minutes per day. We have something

Yes, you do have something. You can tell because he is always at your beck and call, chained to you with an electronic leash.