Considering getting out of EM

[DocEspana]

I love the utter disdain for another specialty you're exhibiting. Sure, FM resident is 3 years but you can make up the difference between that and the ED in an hour.


The bold just shows your intense ignorance. If you screw up and a primary care patient ends up in the ED than you have probably been screwing up for months/years. If I do a **** job with a patients diabetes then by the time they have a foot ulcer that I'm sending to the ED their neuropathy is going to be severe and will almost certainly lead to amputations in the future since nothing I can do will reverse that. If I ignore high cholesterol and someone has a stroke, even if they get great stroke care, their risk of future strokes is now very high. And again, that's assuming they pull through with no deficits. If I ignore someone's high calcium and don't find their hyperparathyroidism, its very difficult to completely replace the bone loss. Same with HTN leading to CKD.

Most poorly done primary care complications don't end up in the ED because its not an emergency or isn't one until the disease process hits end-stage and there's nothing we can do to reverse it. But the guy who's half-blind from his retinopathy isn't any less bad off for that.

I take a lot of pride in telling my patients that I am simply trying to do their PCP a favor by guessing at what they should be at long term and that if they don't want this band-aid fix to fail they need to see the experts at long term control.

I admittedly do it to plant just enough fear and lack of confidence in them that they don't come back to clog up my ER with medication adjustments 30 days later, but my ulterior motives don't change I'm saying (and mean) the good stuff about my FM peeps.

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[Lexdiamondz]

Lol.

A lot of things they do in medicine are just... arbitrary

3-yr vs. 4-yr EM

3-yr med school vs. 4-yr med school

Baccalaureate degree not really needed to become a doc

Don't swallow what people in these ivory towers are jamming down our throat.

Let's be real here: 80%+ of what EM do, FM can just do it as well.

You're forgetting that unlike most specialties, EM still has a large cohort of physicians practicing in ERs who aren't EM trained. I've encountered a fair number of FM and IM trained doctors who work in ERs and most of them are mediocre at best at handling actual emergencies.

Even if you were correct that there was an 80% overlap between our specialties, that leaves 1 in 5 patient encounters that the average non EM doc simply isn't equipped to handle without additional training.

 

[Lexdiamondz]

I have lived in 4 countries so far, and there is nothing different form kids here than the rest of the world.

Med school is a pre-seclection thing probably almost everywhere.

2 of these countries are in latin America and these kids finish HS at the age of 16.

One of my co-residency (also friend) finished residency at the age of 25 and she is doing more than ok as a hospitalist.

I have many friends who are FMG and the one thing all of them will tell you our med school here go more more in depth in basic science than most other countries. Debatable how useful that is.

You have absolutely zero idea what you're talking about. None.

 

[Splenda88]

You have absolutely zero idea what you're talking about. None.

Thoughtful reply.

 

[Splenda88]

You're forgetting that unlike most specialties, EM still has a large cohort of physicians practicing in ERs who aren't EM trained. I've encountered a fair number of FM and IM trained doctors who work in ERs and most of them are mediocre at best at handling actual emergencies.

Even if you were correct that there was an 80% overlap between our specialties, that leaves 1 in 5 patient encounters that the average non EM doc simply isn't equipped to handle without additional training.

80%+ of what you guys do is not emergency. It's IM/FM. Don't lie to yourself.

EM should have been a 1-yr fellowship from FM.

Tell me a few things an EM can do that a CCM physician can't. Are we creating specialties for the sake of it?

 

[gutonc]

80%+ of what you guys do is not emergency. It's IM/FM. Don't lie to yourself.

I'm not EM, but I'm going to guess that most of the EM trained docs here wouldn't argue with this statement. But it's the 20% (by your math) that people die because of.

EM should have been a 1-yr fellowship from FM.

2 years and we're talking. IM/EM or FM/EM (or OB/EM or GS/EM) as 2+2 is actually a pretty reasonable option.

Tell me a few things an EM can do that a CCM physician can't.

1. Take care of babies/kids
2. Take care of pregnant patients
3. Crash procedures...how many CCM docs are trained in crash airways, or crash thoracotomies?

That's just a few, and I'm already bored with this discussion.

Oh, wait, I know...consult cards/ortho/OB/plastics/anesthesia....

Are we creating specialties for the sake of it?

I mean, EM, was "created" 4+ decades ago, so while your argument isn't completely without merit, that ship sailed before you were born.

 

[Splenda88]

I'm not EM, but I'm going to guess that most of the EM trained docs here wouldn't argue with this statement. But it's the 20% (by your math) that people die because of.

2 years and we're talking. IM/EM or FM/EM (or OB/EM or GS/EM) as 2+2 is actually a pretty reasonable option.

1. Take care of babies/kids
2. Take care of pregnant patients
3. Crash procedures...how many CCM docs are trained in crash airways, or crash thoracotomies?

That's just a few, and I'm already bored with this discussion.

Oh, wait, I know...consult cards/ortho/OB/plastics/anesthesia....

I mean, EM, was "created" 4+ decades ago, so while your argument isn't completely without merit, that ship sailed before you were born.

12-16 months. I am not talking about fellowship at 100-200 beds HCA hospital. I am talking about fellowship at academic centers.

EM do NOT take care of pregnant patients. 1-2 month L&D not enough to 'take care' of pregnant patients

CCM are trained at crash airways at least where I did residency (major trauma center)

I know the ship has sailed but we should be honest that a bunch of stuff we do in medicine can be A LOT more efficient

 

[Rekt]

12-16 months. I am not talking about fellowship at 100-200 beds HCA hospital. I am talking about fellowship at academic centers.

EM do NOT take care of pregnant patients. 1-2 month L&D not enough to 'take care' of pregnant patients

CCM are trained at crash airways at least where I did residency (major trauma center)

I know the ship has sailed but we should be honest that a bunch of stuff we do in medicine can be A LOT more efficient

You literally have no idea what you're talking about, constantly. Making yourself even more of a fool. Just close your flappy gums. I could do your job better than you could do mine, easily.

 

[Splenda88]

You literally have no idea what you're talking about, constantly. Making yourself even more of a fool. Just close your flappy gums. I could do your job better than you could do mine, easily.

This is your EM colleague here: @emergentmd

"FM docs can do an avg job with 90% of EM pts.
EM docs can do an avg job with 90% of FM pts."

EM should have never existed as a specialty. There are many EM posters here that share this sentiment. Too much overlap with IM/FM. Again, 80%+ of what you see in the ED is not emergency.

The highlighted part is probably true. Hence, you kind of make my point.

If you read my prior posts here, you will see that I am the first one to admit EM docs should be allowed to do hospitalist medicine just like FM

 

[Lexdiamondz]

12-16 months. I am not talking about fellowship at 100-200 beds HCA hospital. I am talking about fellowship at academic centers.

EM do NOT take care of pregnant patients. 1-2 month L&D not enough to 'take care' of pregnant patients

CCM are trained at crash airways at least where I did residency (major trauma center)

I know the ship has sailed but we should be honest that a bunch of stuff we do in medicine can be A LOT more efficient

Dude I delivered a baby in the waiting room a week ago.

 

[Splenda88]

Dude I delivered a baby in the waiting room a week ago.

Are you serious?. People deliver baby on the street.

You must be a gem man.

 

[Lexdiamondz]

Are you serious?. People deliver baby on the street.

You must be a gem man.

You know who don't? IM/CCM doctors.

happy new year homie

 

[Splenda88]

You know who don't? IM/CCM doctors.

happy new year homie

You really think highly of yourself.

Happy new year!

 

[Rekt]

You really think highly of yourself.

Happy new year!

You’re the one in the EM thread saying how superior you are and EM shouldn’t exist.

 

[Groove]

Weird. I'm just not used to seeing this amount of vitriol or d**k measuring from an ICU doc. There's gotta be something else going on here. @Splenda88 , aren't you a new CCM (non pulm) grad? Are you still in an academic hospital? (It would explain why you don't have overnight NPs as the majority of private practice hospitals in the nation have moved and are moving towards APC overnight coverage. In my case, zero in house coverage overnight as I cover any MRT/codes for the ICU in my community hospital while the intensivist is asleep at home.) It would also explain some of your ignorance in previous posts. Maybe you need some time away from the ivory tower to get broken by the system like the rest of us. After awhile, you'll learn to get along with other specialties, especially the ED docs. When you start working in a shop with overnight NPs, we're the ones responding to the ICU when they can't get an airway. We're the ones writing a note not mentioning that the supervising attending was not in house and not within an appropriate distance to respond. Of all the specialties, we are most likely to cover for you when you can't respond or are not in house to respond. A tremendous amount of your ICU admissions come from the ED. If you don't like us, that's fine but you at least need to learn to get along well enough to have a smooth working relationship. You're setting yourself up for many years of pain as a new attending.

 

[Lexdiamondz]

Weird. I'm just not used to seeing this amount of vitriol or d**k measuring from an ICU doc. There's gotta be something else going on here. @Splenda88 , aren't you a new CCM (non pulm) grad? Are you still in an academic hospital? (It would explain why you don't have overnight NPs as the majority of private practice hospitals in the nation have moved and are moving towards APC overnight coverage. In my case, zero in house coverage overnight as I cover any MRT/codes for the ICU in my community hospital while the intensivist is asleep at home.) It would also explain some of your ignorance in previous posts. Maybe you need some time away from the ivory tower to get broken by the system like the rest of us. After awhile, you'll learn to get along with other specialties, especially the ED docs. When you start working in a shop with overnight NPs, we're the ones responding to the ICU when they can't get an airway. We're the ones writing a note not mentioning that the supervising attending was not in house and not within an appropriate distance to respond. Of all the specialties, we are most likely to cover for you when you can't respond or are not in house to respond. A tremendous amount of your ICU admissions come from the ED. If you don't like us, that's fine but you at least need to learn to get along well enough to have a smooth working relationship. You're setting yourself up for many years of pain as a new attending.

Pretty sure homie is a first year fellow.

 

[always.chillin]

Idk why docs have such egos/dick measuring contests. I don't think I'm anything special and nor do I think any of the surgical subspecialists at my hospital are. Tons of musicians/actors/entrepreneurs making millions in their early 20s. Unless you're replacing the former president's knee or fixing his daughter's nose you got nothing really to brag about. We have to slog it out for years to make what some of these people make in a month. Really puts things into perspective.

 

[goodoldalky]

At the end of the day, all these back and forth pissing matches are misguided.

All anybody in any speciality really wants to do is their job. To have the resources to do it well and be paid fairly.

Most people in most specialties (especially emergency medicine) no longer feel this way, which leads to people wanting to switch specialties, pissing matches like this one, etc. Just remember that the other docs, in whatever other specialty… are not the problem.

 

[CoolDoc1729]

I'm not EM, but I'm going to guess that most of the EM trained docs here wouldn't argue with this statement. But it's the 20% (by your math) that people die because of.

2 years and we're talking. IM/EM or FM/EM (or OB/EM or GS/EM) as 2+2 is actually a pretty reasonable option.

1. Take care of babies/kids
2. Take care of pregnant patients
3. Crash procedures...how many CCM docs are trained in crash airways, or crash thoracotomies?

4) Manage an emergency department


I actually think a lot of the difference between the training is workflow.

We see it all the time with our rotating IM/FM residents. Most of them will do a fine job with any one given patient. Their risk tolerance is often different than ours, and they might not know how to do a procedure, but any of these little things would be easy to teach to someone with a physician’s education.

What I feel I truly bring to the table as a 12 year attending is the ability to manage the department, prioritize the critical patients and stabilize dangerous psych/drunk patients, but also keep on top of seeing new patients and dispositioning when possible. I don’t think I was good at it until >5 years out from a solid residency. Sure you could throw a new grad or an IM/FM moonlighter in and it will be ok most of the time, but only time and experience can make you good at it.

Maybe the icu thinks we should have put in an art line. 🤷🏻‍♀️ medicine thinks we admit everyone with chest pain (LOL!!!) surgery thinks we consult for everyone with abdominal pain (double LOL!!) and the patients think we are sitting around watching TikTok while we’re sewing up someone’s face or telling someone’s girlfriend that he didn’t make it. But none of them could do what we do and keep coming back and doing it again.

I’m sure there’s components like this to the other fields too. So while we can be perfectly capable of learning vaccination schedules and hypertension guidelines I think it would take a long time before I would be a good FP, even if I could upload VAHopefuls whole brain into mine.

Happy new year!

 

[southerndoc]

OK, this is going off about EM vs FM. An above poster made an unnecessary comment that has fired up the troops.

Please get back to the topic at hand and not EM vs FM. I do not want to lock this thread.

 

[sylvanthus]

80%+ of what you guys do is not emergency. It's IM/FM. Don't lie to yourself.

EM should have been a 1-yr fellowship from FM.

Tell me a few things an EM can do that a CCM physician can't. Are we creating specialties for the sake of it?

Sorry dude the above was an ignorant statement. Im EM/IM/CC, have been out of the ED for a bit, and quite frankly going back and seeing an eye complaint requiring the slit lamp, ob/gyn patients, sick kids, managing the department, etc has me a tad worried. No I dont think an ICU doc can handle it. I work with 4 EM/CC docs and theyve all voiced the concern that they feel theyve been out too long to just jump right back in without refreshing their memory on stuff and were all EM boarded.

Youve been an attending for what? Two years? Show some humility.

 

[Birdstrike]

Ask yourself this: Do you feel like you are at peace?

 

[Siggy]

Tell me a few things an EM can do that a CCM physician can't. Are we creating specialties for the sake of it?

Peds, non-CCM obstetrics (even then, most intensivists try to have as little to do with OB as possible), and ortho to name 3.

Procedure wise, it's been forever since I've done an abscess drainage. I've never drained a peritonsillar abscess, but I see that get referred to ENT more often than not anyways. It's been forever (medical school) since I've done lac repair.

Most CCM physicians aren't going to feel comfortable with a trauma resuscitation. Since trauma arrests go to the closest ED, saying, "don't work at a trauma center" isn't really an option. Also you can have walk-ins.

The admit/discharge score knowledge base is also going to be a learning deficit to overcome.

 

[Siggy]

3. Crash procedures...how many CCM docs are trained in crash airways, or crash thoracotomies?

I put my own chest tubes and do my own tubes. I also do central lines, arterial lines, dialysis catheters, and transvenous pacers... including as a crash procedure, when appropriate. I emergently consult EM and/or anesthesiology to help with failed airways and return the favor, but a failed airway is different than a crash airway.


...but sure, I don't know and I'm not going to clamshell a patient. I also don't work at a trauma center, so no one should be clamshelled at any of the hospitals the company I work for covers anyways.

 

[DocEspana]

Before this thread gets locked, I think it's worth mentioning that the biggest unique element of the emergency medicine formal training is 1a. Just work flow stuff that is not necessarily intuitive but is so inherent to actually "moving the masses" 1b. The immediate sick vs not sick gestalt that requires and 2. Any procedure that other specialties do, but being told that you can't have your first or second preference of equipment, you need to do it with no advanced warning, and you have to get it on your first or second shot otherwise this becomes a full CPR situation.

I think the biggest skill we don't talk about is the fact that we have a very good idea of who is not sick. I'm sure lots of specialties could come on here and begin arguing that they have a great gestalt as to who's sick. Cool. Except that's not the part that impresses me. Tell me who's not sick. Tell me who's so not sick that you're okay not working them up. That your MDM says "reassurance" was your intervention. Whatever number you think you can do, you probably have to do it with 3-5x more people than that. Because otherwise you won't see the sick people in the sea of healthy ones. And they ALL think they're sick, and will get pissed at you that you don't.

Okay *now* I'm okay moving on from the topic.

 

[Splenda88]

Peds, non-CCM obstetrics (even then, most intensivists try to have as little to do with OB as possible), and ortho to name 3.

Procedure wise, it's been forever since I've done an abscess drainage. I've never drained a peritonsillar abscess, but I see that get referred to ENT more often than not anyways. It's been forever (medical school) since I've done lac repair.

Most CCM physicians aren't going to feel comfortable with a trauma resuscitation. Since trauma arrests go to the closest ED, saying, "don't work at a trauma center" isn't really an option. Also you can have walk-ins.

The admit/discharge score knowledge base is also going to be a learning deficit to overcome.

I don't think people here get where I am coming from.

I have nothing against EM docs. The ones I work with are very good and I got along with ALL of them.

I actually think they should be allowed to work as hospitalists if they want to. In all honesty, I actually think it will take EM docs less time to learn how to do my job as a hospitalist than me doing theirs.

Also, they are better suited than FM to work as hospitalist IMO. My shop no longer wants to hire FM w/ no prior hospitalist experience (that is a different conversation).

My point in this whole thread, the medical complex do a lot of things that are unnecessary.

Again, EM as a specialty would have been better served if it was a fellowship.



Do we have to have a separate specialty because of these when it's arguable 5-10% of what you do.

Residents are required to perform the minimum numbers indicated for each key index procedure below by the time of graduation from the program.

Adult Medical Resuscitation 45
Adult Trauma Resuscitation 35
Cardiac Pacing 6
Central Venous Access 20
Chest Tubes 10
Cricothyrotomy 3
Dislocation Reduction 10
ED Bedside Ultrasound 50
Intubations 35
Lumbar Puncture 15
Pediatric Medical Resuscitation 15
Pediatric Trauma Resuscitation 10
Pericardiocentesis 3
Procedural Sedation 15
Vaginal Delivery 10

No more than 30 percent of required logged procedures performed in simulated settings can count toward the required minimum, with the exception of rare procedures, namely pericardiocentesis, cardiac pacing, and cricothyrotomy. One hundred percent of these rare procedures may be performed in the lab.

 

[Groove]

 

[HemorrhagicShock]

Before any of the mods consider closing this, I would like to add that I'm gaining a lot from reading the back-and-forth among the participants.

More and more I am starting to agree with people like Splenda88 and others (to be fair though, he's still missing a big part of the EM picture). As an ER doc, it's getting clearer to me that the only reason our specialty took off is because of the massive holes in our healthcare system, rather than bringing any unique clinical value.

EM would have been better off as a fellowship after FM, and this would have also given all ER docs an outpatient pop-off valve when it comes to getting out of the ED.

Please continue the back and forth because I'm gaining a lot of perspective from it (mods permitting of course!)

 

[Siggy]

Before any of the mods consider closing this, I would like to add that I'm gaining a lot from reading the back-and-forth among the participants.

More and more I am starting to agree with people like Splenda88 and others (to be fair though, he's still missing a big part of the EM picture). As an ER doc, it's getting clearer to me that the only reason our specialty took off is because of the massive holes in our healthcare system, rather than bringing any unique clinical value.

EM would have been better off as a fellowship after FM, and this would have also given all ER docs an outpatient pop-off valve when it comes to getting out of the ED.

Please continue the back and forth because I'm gaining a lot of perspective from it (mods permitting of course!)

I think there's two separate issues here.

1. Should EM be a formal fellowship with quality programs (I've heard some grumbling in the past on here on the quality of the FM fellowships currently in place)?

2. Can EM do FM and can FM or IM do EM with no additional formal training (the 10 years experience and some CME videos from earlier)?

I personally have no opinion on number 1.

For number 2, I think it's a bit insulting to all parties involved that the difference between EM and FM or IM are CME videos.

 

[larpleston]

I’m surprised any EM doc looks at what we do and says, yeah, FM or IM is up to the task. It’s not that what we do for any individual patient is incredibly intellectual (it isn’t, but then again I’d argue the same is true for most specialties) or that our procedures are super technical (they aren’t), but it’s a totally different approach to working people up, and you need to be fast, and you need the procedural experience, and you need to see enough emergent peds and Ob, and you need enough airway experience, and trauma experience, etc, etc. Maybe FM could do it after 2 year fellowship, so a 5 year training pathway. There’s no way enough ER doctors would be produced in that alternate realty. Meanwhile there are hundreds of ERs that need the skills an EM doc offers, today, in our current world in which patients are sicker and more complicated than they’ve ever been, hence why the specialty exists.

 

[Splenda88]

Before any of the mods consider closing this, I would like to add that I'm gaining a lot from reading the back-and-forth among the participants.

More and more I am starting to agree with people like Splenda88 and others (to be fair though, he's still missing a big part of the EM picture). As an ER doc, it's getting clearer to me that the only reason our specialty took off is because of the massive holes in our healthcare system, rather than bringing any unique clinical value.

EM would have been better off as a fellowship after FM, and this would have also given all ER docs an outpatient pop-off valve when it comes to getting out of the ED.

Please continue the back and forth because I'm gaining a lot of perspective from it (mods permitting of course!)

Can you elaborate on that?

There might be things I am missing of course because I only spend 3 months in the ED (2 as resident and 1 as a med student). However, I like to ask questions. Just like I did when some programs are spouting IM as a primary care specialty and the same program has IM PCP track (which on is it then?)

Again I am not an expert but I like to ask questions when things don't make sense to me.

For instance, I remember when myself and other co- resident were rotating in endo together. We both came to the conclusion that 80%+ of what the attending was seeing were DM, thyroid dx and osteoporosis. I had to ask does the other < 20% needs 2-3 yr of fellowship. Will 1-yr fellowship not sufficient?

I would like to know why IM has a monopoly on fellowships? Why can't EM grad become a cardiologist? Is an IM graduating resident so far ahead of an EM graduating resident that the EM person won't be able to catch up if both start fellowship at the same time?

 

[Splenda88]

I’m surprised any EM doc looks at what we do and says, yeah, FM or IM is up to the task. It’s not that what we do for any individual patient is incredibly intellectual (it isn’t, but then again I’d argue the same is true for most specialties) or that our procedures are super technical (they aren’t), but it’s a totally different approach to working people up, and you need to be fast, and you need the procedural experience, and you need to see enough emergent peds and Ob, and you need enough airway experience, and trauma experience, etc, etc. Maybe FM could do it after 2 year fellowship, so a 5 year training pathway. There’s no way enough ER doctors would be produced in that alternate realty. Meanwhile there are hundreds of ERs that need the skills an EM doc offers, today, in our current world in which patients are sicker and more complicated than they’ve ever been, hence why the specialty exists.

Sans procedure, you think a graduating FM/IM residency is equivalent to a beginning PGY2 EM resident...

It's the mindset and the procedures that make EM "the difficult to master specialty"

 

[larpleston]

Sans procedure, you think a graduating FM/IM residency is equivalent to a beginning PGY2 EM resident...

It's the mindset and the procedures that make EM "the difficult to master specialty"

No, I don’t think that? You are way overestimating the role of procedures in EM which shows that you don’t fully understand what we do. Our procedures are relatively simple. They’re important and you need competency but it’s a pretty small part of our job. That said, because of the hit or miss nature of the ER you easily could have an unusually slow few months and not get enough procedural experience if EM training were a 1 year fellowship.

Otherwise, mindset is a big part of it. Not that the mindset is any more complicated (it might even be less complicated than IM) but it’s a lot to take an IM doc who is used to establishing diagnoses and tell them to completely switch gears to ruling disease out and stabilization (the inverse would also be difficult). It’s also speed, heterogeneity of presentations from newborn to geriatrics to OB to peds, triaging patient acuity, etc. Even graduating EM residents regularly struggle with “running the department” for the first bit of attending life. EM isn’t about accumulating massive book knowledge. It is the development of soft skills which take time.

 

[Splenda88]

No, I don’t think that? You are way overestimating the role of procedures in EM which shows that you don’t fully understand what we do. Our procedures are relatively simple. They’re important and you need competency but it’s a pretty small part of our job. That said, because of the hit or miss nature of the ER you easily could have an unusually slow few months and not get enough procedural experience if EM training were a 1 year fellowship.

Otherwise, mindset is a big part of it. Not that the mindset is any more complicated (it might even be less complicated than IM) but it’s a lot to take an IM doc who is used to establishing diagnoses and tell them to completely switch gears to ruling disease out and stabilization (the inverse would also be difficult). It’s also speed, heterogeneity of presentations from newborn to geriatrics to OB to peds, triaging patient acuity, etc. Even graduating EM residents regularly struggle with “running the department” for the first bit of attending life. EM isn’t about accumulating massive book knowledge. It is the development of soft skills which take time.

Again, you did not get my point. I am not saying IM should/can practice EM. What I am saying is: Would the system be worst if EM were simply a 12-16 months fellowship from FM (not IM cause IM knows nothing about OB and peds).

Again, all you are talking about is organization..."only is innate to people who pursue EM residency"

Let me make it blunt: If Emory designs a 12-16 months EM fellowship for FM grad, do you think the people graduating from this fellowship will be below average than EM grad?

 

[larpleston]

Again, you did not get my point. I am not saying IM should/can practice EM. What I am saying is: Would the system be worst if EM were simply a 12-16 months fellowship from FM (not IM cause IM knows nothing about OB and peds).

Again, all you are talking about is organization..."only is innate to people who pursue EM residency"

Yes it would be worse because it would take more than 12 months for FM to get enough experience with running a department, gaining procedural experience, managing critically ill patients simultaneously, etc. Bear in mind you can have an “unlucky” month as a trainee where all of the sick people are coming in when you’re off. As I said I think 2 years would be possible, but at that point it is a 5 year pathway to produce ER doctors which would not work in our healthcare system.

 

[HemorrhagicShock]

Splenda, in reference to what I was talking about regarding "the bigger picture" goes directly to what larpleston is talking about. There's an art of managing the department, keeping it flowing, balancing personalities/consultants/teams during simultaneous high-stress resuscitations, and dispoing/seeing new patients all at the same time

I think this takes probably 2 years to develop.

Much like I think I could be equal to a strong new-grad FM resident with a two-year FM fellowship on my end.

 

[DocEspana]

I think there's two separate issues here.

1. Should EM be a formal fellowship with quality programs (I've heard some grumbling in the past on here on the quality of the FM fellowships currently in place)?

2. Can EM do FM and can FM or IM do EM with no additional formal training (the 10 years experience and some CME videos from earlier)?

I personally have no opinion on number 1.

For number 2, I think it's a bit insulting to all parties involved that the difference between EM and FM or IM are CME videos.

I mean I'm relatively certain that I could do 90% of any non-surgical fields job at a level considered "not negligent" as long as I was given a little time to consult a few convenient websites. But that's not a brag on me (or emergency medicine). Any competent graduate of a medical school and residency should be able to handle 90% of any cognitive part of medicine (path and radiology excepted). Any non surgical specialty isn't defined by being competent at 90% of any of cases. It's being *great* at that 90% and that last 10% that is just too complex/unique to leave to anyone else.

 

[sylvanthus]

I don't think people here get where I am coming from.

I have nothing against EM docs. The ones I work with are very good and I got along with ALL of them.

I actually think they should be allowed to work as hospitalists if they want to. In all honesty, I actually think it will take EM docs less time to learn how to do my job as a hospitalist than me doing theirs.

Also, they are better suited than FM to work as hospitalist IMO. My shop no longer wants to hire FM w/ no prior hospitalist experience (that is a different conversation).

My point in this whole thread, the medical complex do a lot of things that are unnecessary.

Again, EM as a specialty would have been better served if it was a fellowship.



Do we have to have a separate specialty because of these when it's arguable 5-10% of what you do.

Residents are required to perform the minimum numbers indicated for each key index procedure below by the time of graduation from the program.

Adult Medical Resuscitation 45
Adult Trauma Resuscitation 35
Cardiac Pacing 6
Central Venous Access 20
Chest Tubes 10
Cricothyrotomy 3
Dislocation Reduction 10
ED Bedside Ultrasound 50
Intubations 35
Lumbar Puncture 15
Pediatric Medical Resuscitation 15
Pediatric Trauma Resuscitation 10
Pericardiocentesis 3
Procedural Sedation 15
Vaginal Delivery 10

No more than 30 percent of required logged procedures performed in simulated settings can count toward the required minimum, with the exception of rare procedures, namely pericardiocentesis, cardiac pacing, and cricothyrotomy. One hundred percent of these rare procedures may be performed in the lab.

Physicians jobs are to be the pinnacle of their specific specialty, if all we gave a **** about was the 80% of nonsense in medicine, wed all be NPs.

Ahh fuk it, im not engaging further, youll make a great admin someday and I dont mean that as a compliment.

 

[Splenda88]

Splenda, in reference to what I was talking about regarding "the bigger picture" goes directly to what larpleston is talking about. There's an art of managing the department, keeping it flowing, balancing personalities/consultants/teams during simultaneous high-stress resuscitations, and dispoing/seeing new patients all at the same time

I think this takes probably 2 years to develop.

Much like I think I could be equal to a strong new-grad FM resident with a two-year FM fellowship on my end.

Not agreeing with you but I understand your point.

I am not arguing for the sake of arguing. I am someone who like to ask questions and that put me in hot water when I was in residency.

I remember vividly 1st month of PGY2 I was admitting 8-10 patients from 7pm-7am at the VA (~200 beds) and while supervising a PGY1 that was cross covering... No access to any attending except the ED docs whom were not affiliated to our residency program. I though that was not safe.

We were having a meeting with the PD and I told him it's not safe. He ridiculed me saying in front of everyone 'If you believe you don't have enough knowledge to take of patient after PGY1, maybe we might consider having you repeating PGY1.' My reply was why PGY3 is needed then? He gave me some BS answer that did not make sense.

Later on our GME director said IM residency can be a 2-yr program and 'she has not come across a resident that was not competent after PGY2 and suddenly become competent as a PGY3.'

I am that type of individual that asks questions. I don't do now because I have too much to lose. Still entertaining to do it on the internet

 

[Rekt]

Again, you did not get my point. I am not saying IM should/can practice EM. What I am saying is: Would the system be worst if EM were simply a 12-16 months fellowship from FM (not IM cause IM knows nothing about OB and peds).

Again, all you are talking about is organization..."only is innate to people who pursue EM residency"

Let me make it blunt: If Emory designs a 12-16 months EM fellowship for FM grad, do you think the people graduating from this fellowship will be below average than EM grad?

Yes. They would be much worse. Your off service rotation where the attending had you see one patient at a time or stuck your ass in the corner seeing sore throats and coughs is not real world EM. Not even close. It's really just a waste of time to even engage with you because you're completely clueless.

 

[Splenda88]

Yes. They would be much worse. Your off service rotation where the attending had you see one patient at a time or stuck your ass in the corner seeing sore throats and coughs is not real world EM. Not even close. It's really just a waste of time to even engage with you because you're completely clueless.

Not even sure you read what you responded to.

Thanks for your thoughtful answer.

 

[Splenda88]

Pretty lovely curriculum.

The whole first year is akin to FM 1st year where I did IM residency.

Curriculum | Program | Emergency Medicine Residency

www.orlandohealth.com

Again. Nothing is unique here. Sorry.

 

[southerndoc]

Because of the back and forth going on, we're going to lock this thread for a week. When it reopens, please do not argue about which specialty is better, etc.