ER-no respect?

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I have a 'friend' who is hard core surgury and gave me a smart ass comment when I told her that I am interested in ER, she said "ER docs are at bottom of the barrel, incompetent and are only capable of being able to refer when needed. It really pissed me off- any input???????

Funny, coming from a general surgeon. You can get into that specialty with a 190 on your Step I. Talk about your bottom of the barrel.....they get a lot of the dregs of applicants.

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The lack of respect for EM docs at academic centers flows primarily from the residents/fellows in the various subspecialties. I've found the attendings to be very cognizant of our skills and utility. The residents however are still in the "I'm hot-s***" mode and tend to denigrate everyone around them. And EM people are an easy target.

Very true. The cure for disrespectful surgical residents is to not talk to them. I'm all for teaching and letting residents have first crack at patients, but if you're consulted on a patient and being a dick I will call your attending and only talk to your attending for the rest of the night.
 
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Very true. The cure for disrespectful surgical residents is to not talk to them. I'm all for teaching and letting residents have first crack at patients, but if you're consulted on a patient and being a dick I will call your attending and only talk to your attending for the rest of the night.

And the resident appreciates that. Perhaps it would be better to keep consulting that resident.
 
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When I wake up the orthopedic chief at 3 AM it does not bode well for the consult resident.

When you wake up the chief and explain why you're doing it, you're going to be the one yelled at.
 
When you wake up the chief and explain why you're doing it, you're going to be the one yelled at.

"Your resident is obstructing patient care. Make them do their job, or I need you to do it."

To misquote Greg Henry, "Never let a resident get in the way of appropriate patient care."
 
When you wake up the chief and explain why you're doing it, you're going to be the one yelled at.

more lmao.

I've been in this situation, usually due to transfers from outside facilities for higher level of care. It always goes like this: resident is lazy and doesn't want to come see a consult. So you page the on-call plastics/nsgy/etc attending and say:

"I have a patient transferred who you accepted for emergent evaluation due to X. I discussed with your resident who refused to evaluate the patient. Patient was transferred here for higher level of care and requires your evaluation."

at this time invariably the response is: "I'll tell my resident to come see the patient."

Amazingly the resident shows up.

The people who have yelled at ED attendings/residents in this situation end up spending their 4 days off a month in anger management.
 
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Bullsh.t.

I dunno, man. Every time I've ever had an attending go to another attending (which has been few and far between), they have taken that stuff pretty seriously.

I had one consultant hang up on me. My attending called theirs and I literally got an apology with the consulting resident barely making eye contact. Attendings don't like getting bothered, especially woken up, because their resident is acting like a d-bag. It makes more work for them and makes their department look bad.
 
Bullsh.t.
I am not sure what you find so unbelievable. That's a pretty standard reaction that happens when attending gets called in place of a resident. Resident always gets into trouble. Especially surgical specialties.
 
"Your resident is obstructing patient care. Make them do their job, or I need you to do it."

To misquote Greg Henry, "Never let a resident get in the way of appropriate patient care."
Or the Birdstrike version, "Never let patient care get in the way of an inappropriate resident."
 
The lack of respect is interesting...when I manage to diagnose stabilize and initiate therapy on the hundreds of patients walking through the ED. When following up on patients...credit seems to go to other services? I've never seen anyone thank the ER. I see...thank you Critical Care for rescucitation (what do they add? Everything was completed...I wanted a unit bed but they rejected the patient), thank you ID (when all the abx have been given? ID likes to get involved in certain cases), thank you Ortho (I already said it wasn't cord compression...but I got you the MRI anyways...and Ortho spine to follow your patient after all the tests were done)...
First to blame...last to thank.
In the end having a good self confidence is important in Emergency Medicine...because others don't understand us.
 
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The lack of respect is interesting...when I manage to diagnose stabilize and initiate therapy on the hundreds of patients walking through the ED. When following up on patients...credit seems to go to other services? I've never seen anyone thank the ER. I see...thank you Critical Care for rescucitation (what do they add? Everything was completed...I wanted a unit bed but they rejected the patient), thank you ID (when all the abx have been given? ID likes to get involved in certain cases), thank you Ortho (I already said it wasn't cord compression...but I got you the MRI anyways...and Ortho spine to follow your patient after all the tests were done)...
First to blame...last to thank.
In the end having a good self confidence is important in Emergency Medicine...because others don't understand us.

I have felt this frustration too, but I think that understanding the motivation helps. "We appreciate the recommendations of Orthopedics/ID/Cardiology" isn't really saying "Wow, those specialists are sooooo smart and good looking." Rather, it's chartspeak for "Don't sue me if this patient has cauda equina/an undiagnosed fungal infection/NSTEMI. I consulted the specialist!"
 
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IM/CCM here.

A few points: First, as with any area of medicine, there are different levels of competence in ER medicine. Some folks are better than others. For a medicine or ccm admission, IDEALLY, the patient should be seen and examined, diagnostic studies should be ordered and done, a differential diagnosis should be formulated, and treatment should be started. then the admitting doc should be called. This does not always happen, or alternatively, the ER doc may be dead nuts wrong for a few reasons:
-some ER docs are actually just not very good (show me a specialty that does not have incompetence)
-the time allotted to an ER doc (good or bad) is just not enough to work through everything-- hence the need to admit for workup
-the patient has something more complex or subtle going on and really needs subspecialty workup and care

I confess: when I was a medicine resident, I would occasionally indulge in: " DO you know what that idiot ER doc did to this poor patient..."

But a few more points:

ER docs see a lot of patients in each shift. They see them quickly. The ER is not an optimal setting for complicated diagnosis or intervention. ER docs have a lot of paperwork. ER docs see and treat a greater variety of pathology than any other specialty.
We all make mistakes-- more often than we care to admit. Medicine is a tough job. None of us like to feel like WE make mistakes, so we feel better by blaming others.
Of course ER docs "get it wrong" more than other specialties... they are the first guess, with very limited time and data.
We should be thankful that we have them on the front lines, dealing with difficult patients. We should also be thankful, that we have them there making very understandable front line errors, so we can do better, after admission. I guess we should also be thankful that they are there to be scrutinized and called "idiots" so we can feel better about ourselves..
Thanks...
 
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IM/CCM here.

A few points: First, as with any area of medicine, there are different levels of competence in ER medicine. Some folks are better than others. For a medicine or ccm admission, IDEALLY, the patient should be seen and examined, diagnostic studies should be ordered and done, a differential diagnosis should be formulated, and treatment should be started. then the admitting doc should be called. This does not always happen, or alternatively, the ER doc may be dead nuts wrong for a few reasons:
-some ER docs are actually just not very good (show me a specialty that does not have incompetence)
-the time allotted to an ER doc (good or bad) is just not enough to work through everything-- hence the need to admit for workup
-the patient has something more complex or subtle going on and really needs subspecialty workup and care

I confess: when I was a medicine resident, I would occasionally indulge in: " DO you know what that idiot ER doc did to this poor patient..."

But a few more points:

ER docs see a lot of patients in each shift. They see them quickly. The ER is not an optimal setting for complicated diagnosis or intervention. ER docs have a lot of paperwork. ER docs see and treat a greater variety of pathology than any other specialty.
We all make mistakes-- more often than we care to admit. Medicine is a tough job. None of us like to feel like WE make mistakes, so we feel better by blaming others.
Of course ER docs "get it wrong" more than other specialties... they are the first guess, with very limited time and data.
We should be thankful that we have them on the front lines, dealing with difficult patients. We should also be thankful, that we have them there making very understandable front line errors, so we can do better, after admission. I guess we should also be thankful that they are there to be scrutinized and called "idiots" so we can feel better about ourselves..
Thanks...
What a nice post. And all the better coming from one outside our specialty. Please do not lose this sense of perspective.
 
I'm so glad I don't have to deal with b-tchy, unhappy, over-worked doctors who think it's okay to take out their unhappiness on others, anymore. It's hard enough to deal with stressed patients, and do one's own work, without all the childish in-fighting and misery sharing that can be so common place working where people are so unhappy. I count my blessings daily.
 
IM/CCM here.

A few points: First, as with any area of medicine, there are different levels of competence in ER medicine. Some folks are better than others. For a medicine or ccm admission, IDEALLY, the patient should be seen and examined, diagnostic studies should be ordered and done, a differential diagnosis should be formulated, and treatment should be started. then the admitting doc should be called. This does not always happen, or alternatively, the ER doc may be dead nuts wrong for a few reasons:
-some ER docs are actually just not very good (show me a specialty that does not have incompetence)
-the time allotted to an ER doc (good or bad) is just not enough to work through everything-- hence the need to admit for workup
-the patient has something more complex or subtle going on and really needs subspecialty workup and care

I confess: when I was a medicine resident, I would occasionally indulge in: " DO you know what that idiot ER doc did to this poor patient..."

But a few more points:

ER docs see a lot of patients in each shift. They see them quickly. The ER is not an optimal setting for complicated diagnosis or intervention. ER docs have a lot of paperwork. ER docs see and treat a greater variety of pathology than any other specialty.
We all make mistakes-- more often than we care to admit. Medicine is a tough job. None of us like to feel like WE make mistakes, so we feel better by blaming others.
Of course ER docs "get it wrong" more than other specialties... they are the first guess, with very limited time and data.
We should be thankful that we have them on the front lines, dealing with difficult patients. We should also be thankful, that we have them there making very understandable front line errors, so we can do better, after admission. I guess we should also be thankful that they are there to be scrutinized and called "idiots" so we can feel better about ourselves..
Thanks...

I agree with a lot of your points. One thing I always tell rotating Medicine/FP/other specialty residents in the ED is that our role is not to make diagnoses. Sometimes we make a diagnosis because it's something life-threatening or we happen to make a diagnosis while ruling out dangerous things, but it's ok to not make a diagnosis in the ED. Our main role is resuscitation of really sick patients and being able to differentiate between sick and not sick patients.

We all (hopefully) know what do to when a really sick patient hits the doors, and we can all deal with the bull**** (if you aren't lucky enough to have PAs for that), but the hard part is deciding what to do when it's not really clear if the patient is sick or not.

I saw this sign hung up in the ED once and it's pretty accurate:
 

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I saw this sign hung up in the ED once and it's pretty accurate:
That's a cute list of priorities, but it is not current. The advent of Press-Ganey and profit-obsessed "customer is always right" consumerism, has attempted to cause the subversion of the time honored Hypocratic Oath which took a medical and ethical approach to patient care.

Currently, the correct order of those priorities as enforced and pressured by hospital administrators through customer-survey based coercion, and the Federal Government through "customer-satisfaction based" compensation plans (actually codified into law now with ACA, CMS/HCAHPS, etc) is as such:

1. "All other sh¡t" first (as demanded by patients, any day, any time, whether appropriate or ethical or not, done as absolutely quickly as possible "in less than 15 minutes!" promised by the billboard on the highway).

2. Pain control (regardless of appropriateness or lack thereof; you must not "judge," after all you're not a doctor anymore, you're a "healthcare service 'provider.'")

3. Discharge home (to open new bed quickly, for paying "customer.")

4. Admission (for "paying customer" just don't break random "two-midnight rule.")

>Haldol (a haldolized customer is a happy customer).

5. Resuscitation/stabilization of critical patients ("This is your first priority, dontcha know!?" Just don't let this rule get in the way of priorities 1-4 so that it extends wait times beyond 15 minutes for customers relying on priorities 1-4, which are those customers most important [because there's more of them] to those signing your paycheck.)
 
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Gosh,

Just to squash some big headed residents, I would pay to work in an academic center. I face very little pushback from the community docs so rarely do I have to go to plan B. There have been times when I get lip from specialists, and when I do, they are put in their place quickly. The all understand the power I wield. I can create more pain for them than they can for me.

A few admission 10 minutes before they end their shift will fix any lip. And that is just the first bullet I can use.

If a resident ever gave me lip, I would not only call his attending but would make his/her life miserable for the rest of their call month. Trust me, ED docs hold much more power over on call doc's lives than the other way around. I am working no matter what and have to be up for my 8 hrs.

If an ENT doc gives me a hard time, this would be the last time I am draining a peritonsillar abscess.
If an CT doc gives me a hard time, the 2am Chest tube is theirs
If a hospitalist gives me a hard time, that 645 admission is theirs.
The list goes on and on.
 
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If a resident ever gave me lip, I would not only call his attending but would make his/her life miserable for the rest of their call month. Trust me, ED docs hold much more power over on call doc's lives than the other way around. I am working no matter what and have to be up for my 8 hrs.

If an ENT doc gives me a hard time, this would be the last time I am draining a peritonsillar abscess.
If an CT doc gives me a hard time, the 2am Chest tube is theirs
If a hospitalist gives me a hard time, that 645 admission is theirs.
The list goes on and on.

Wow with attitudes like this, no wonder some people may have problems with your specialty. You love to dish out to everyone else but don't take any yourself. It's almost a power trip to you because you can consult everyone else, but no one consults you and wakes you up at night.

Most consult residents' lives are already miserable enough as it is while you work 40 hours a week on a shift schedule making literally 20 fold the resident's hourly wage. Try to empathize and see from the perspective of an overworked resident in his 26th hour of call when you page him just before signout.

Make his life miserable? Shameful.
 
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Wow with attitudes like this, no wonder some people may have problems with your specialty. You love to dish out to everyone else but don't take any yourself. It's almost a power trip to you because you can consult everyone else, but no one consults you and wakes you up at night.

Most consult residents' lives are already miserable enough as it is while you work 40 hours a week on a shift schedule making literally 20 fold the resident's hourly wage. Try to empathize and see from the perspective of an overworked resident in his 26th hour of call when you page him just before signout.

Make his life miserable? Shameful.

Not to speak for womp, but his post seems to be more of a reaction to disrespect from resident to EM attendings. As a resident, you owe a certain amount of respect to any attending from any specialty. Obviously, this is not absolute, but nonetheless these interactions should be approached with respect and collegiality. As a resident you should be cognizant of the need to be respectful to attendings and also to the fact that in EM in particular, there is often thought given to where you are physically and where you are in time. As an EM resident, I am reminded by attendings to give a "heads-up" to specialty or admission services when it is coming toward the end of their in-house shift, so that they aren't surprised or requested for consult once they are in their car. When we can, we will delay a consult or admission so that the oncoming resident from the service can take it instead of the off-going resident. Or, we are a little more lenient with long delays for response to admission/consults. There are policies that could make non-EM residents lives 10x worse if we strictly enforced them, but we don't because it's not usually necessary. Of course, we can't always do what is convenient for someone else. Labs and imaging results are not reported based on what is convenient to you and patients do not present at a time that is convenient to us or you.

Medicine is 24/7. Your and our responsibilities do not diminish at night or on weekends, no matter how much you or I want that to be. It is stupid and archaic to expect a hospital to be run differently at 3am as opposed to 3pm ,or on a Saturday as opposed to a Wednesday (yet, based on schedules and services in-house, most in medicine want medicine to be M-F, 9a-5p, despite that it never has been and never will be). Never forget that the specialty of Emergency Medicine grew to not only improve care for patients, but also to make lives EASIER for general practitioners and specialists alike. There was a time when the ER was a place YOU would get called to just to see a patient of yours primarily (as in an RN would assess the patient and then call you to come see them). Or, maybe an intern or 4th year med student would see the patient on your behalf without any attending oversight. Or, you would get a call at home from one of your patients and you would tell them to meet you at the ER, where you would see them. If you weren't available, then hopefully some other doc would come see them. I had the privilege of speaking to one of the pioneers of the EM specialty (a pediatric surgeon who began practicing in the late 50s), who at one time was the ONLY physician regularly assigned to the ER when he began practicing at a major academic hospital. He only worked one night a week. There's a reason why he ended up founding one of the first EM residencies and became one of the major influences upon the specialty's foundation. And he wasn't the only one who saw the horrendous organization and care of patients in the ED by physicians who were not dedicated to such care. It was internists and surgeons who saw the need for EM to be a specialty. Unfortunately, the physicians who practiced during that time are a rarity now. We could all use some historical insight, because it would certainly help us all to better appreciate what we have and why we have it, for better or worse.
 
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Who cares what other people think?? The public thinks you are one of the coolest doctors. You make a ton of money compared to other fields, even better than residency is only 3-4 years. You get 15 days off!! If i had all these i would not care at all about what surgeons think...

Though I can't deny that that a lot of doctors think lowly of EM doctors. When I was on surgery, I was having a random conversation with the director of surgery department, and he randomly started talking about not understanding why medical students would go thru medical school to become a EM doctors when they are glorified triage nurses. On my medicine rotation, people crap on EM docs for getting everyone a CT, and diagnosing half of the patients wrong. But in the end i think most fields get crapped on by some other field. Just love what you do and thats good enough.
 
Not to speak for womp, but his post seems to be more of a reaction to disrespect from resident to EM attendings. As a resident, you owe a certain amount of respect to any attending from any specialty. Obviously, this is not absolute, but nonetheless these interactions should be approached with respect and collegiality. As a resident you should be cognizant of the need to be respectful to attendings and also to the fact that in EM in particular, there is often thought given to where you are physically and where you are in time. As an EM resident, I am reminded by attendings to give a "heads-up" to specialty or admission services when it is coming toward the end of their in-house shift, so that they aren't surprised or requested for consult once they are in their car. When we can, we will delay a consult or admission so that the oncoming resident from the service can take it instead of the off-going resident. Or, we are a little more lenient with long delays for response to admission/consults. There are policies that could make non-EM residents lives 10x worse if we strictly enforced them, but we don't because it's not usually necessary. Of course, we can't always do what is convenient for someone else. Labs and imaging results are not reported based on what is convenient to you and patients do not present at a time that is convenient to us or you.

Medicine is 24/7. Your and our responsibilities do not diminish at night or on weekends, no matter how much you or I want that to be. It is stupid and archaic to expect a hospital to be run differently at 3am as opposed to 3pm ,or on a Saturday as opposed to a Wednesday (yet, based on schedules and services in-house, most in medicine want medicine to be M-F, 9a-5p, despite that it never has been and never will be). Never forget that the specialty of Emergency Medicine grew to not only improve care for patients, but also to make lives EASIER for general practitioners and specialists alike. There was a time when the ER was a place YOU would get called to just to see a patient of yours primarily (as in an RN would assess the patient and then call you to come see them). Or, maybe an intern or 4th year med student would see the patient on your behalf without any attending oversight. Or, you would get a call at home from one of your patients and you would tell them to meet you at the ER, where you would see them. If you weren't available, then hopefully some other doc would come see them. I had the privilege of speaking to one of the pioneers of the EM specialty (a pediatric surgeon who began practicing in the late 50s), who at one time was the ONLY physician regularly assigned to the ER when he began practicing at a major academic hospital. He only worked one night a week. There's a reason why he ended up founding one of the first EM residencies and became one of the major influences upon the specialty's foundation. And he wasn't the only one who saw the horrendous organization and care of patients in the ED by physicians who were not dedicated to such care. It was internists and surgeons who saw the need for EM to be a specialty. Unfortunately, the physicians who practiced during that time are a rarity now. We could all use some historical insight, because it would certainly help us all to better appreciate what we have and why we have it, for better or worse.
Good post
 
Med Studs, don't listen to the ass clown who bumped a 10 year old thread just because he was insecure with the size of his penis.

EM really is a great field. Unfortunately, those gunners in medical school who you hate...you know, the guy who was likely abused in high school, never worked a job, and seemed to only go to medical school because he thought it would make him cool, and eventually went into surgery because he thought this would make him cool...well these people end up eventually becoming attendings. They tend to remain dbags.

Most consultants will realize we have a tough job and have to essentially know every field of medicine, as anything, at anytime, at any age can walk into the ED: these people are generally courteous and thankful for the job we do. They understand that we might not know their field as well as them, but that we know almost every other field better than they do. Ortho is better at splinting that fracture and reading that xray than I am, but I surely wouldn't want them reading my ECGs, doing my pregnancy ultrasounds, or managing my hypertensive emergency patient. OB is better at delivering that baby that I just delivered in room 8 in our ED, but I definitely wouldn't want them placing that chest tube for my stab victim, resuscitating my asthma arrest patient, or treating my posterior nose bleed. ENT is better at doing that Cric than I just did, but I wouldn't want them treating my WPW pt who is in Afib with RVR, my DKA pt, or my calcium channel blocker overdose pt.

Like the majority of my colleagues, I had great board scores and could have went into almost anything. I chose EM because I enjoyed seeing a multitude of pathologies across all ages and demographics, and although I considered a surgical subspecialty, what I found is that they ended up super-specializing so much, that they forgot all other fields of medicine. Every shift that I work there is something that I see that I have never seen before or have never done before. It keeps the job exciting and I actually enjoy going home and reading up on things. To only do a few types of operations or to only focus on one body part or only 1 age group for the rest of my life sounds awful.

There are downsides to EM, but they are largely overstated. Drug seekers are easy. I tell them you are not getting any narcotics from me. If they have any issue with this, I call security and have them escorted out. Now that prescription drug monitoring programs and EMRs are becoming standard, drug seeking is much more difficult to do. Alcoholics are easy. I sternal rub them really hard. If they are not as responsive as I like, I scan their head and get a finger stick. If they have trauma to their face/head, I scan their head. If their presentation is not consistent with alcohol intoxication, I scan their head. If they say they got drunk, and passed out, and did not hit their head, I watch them for a few hours and send them home. These patients only take a few minutes of my time. Working nights, weekends, and holidays sucks, but the tradeoff to this is only working 13 days a month and being able to take 3 weeks off to travel, all while making 350k a year.

Good luck to all the students matching; EM really is a great field.
 
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I am a med student and read the necrobump. Glad it was just a troll. ER medicine seems very cool. Do you guys have to work 15 on/off or is it possible to work more? Do you HAVE to work at night or can you work day shifts? Why did that guy who necrobumped say that EM has the highest burnout rate? I love the idea of shifts. Don't really care about the disrespect thing... It seems that those who are happy and content with their job don't care about it either. Kudos to you. You may find this funny, but there are literally M1's at my school who already crack jokes about EM docs... I don't think they know anything about it... Maybe they are just trying to sound "in the know about the goings around the hospital".
 
I am a med student and read the necrobump. Glad it was just a troll. ER medicine seems very cool. Do you guys have to work 15 on/off or is it possible to work more? Do you HAVE to work at night or can you work day shifts? Why did that guy who necrobumped say that EM has the highest burnout rate? I love the idea of shifts. Don't really care about the disrespect thing... It seems that those who are happy and content with their job don't care about it either. Kudos to you. You may find this funny, but there are literally M1's at my school who already crack jokes about EM docs... I don't think they know anything about it... Maybe they are just trying to sound "in the know about the goings around the hospital".

You can work as much or as little as you want. The rates of burnout are lower than had been reported in the past as most of those studies were done with non EM trained docs who switched from IM or surgery. They switched because they were already burnt out. Burnout in EM is a real thing though and is likely higher than in other fields. This is because of the nature of our job. Working a 12 hour ER shift is much more work intensive than working 12 hours as an internist or working 12 hours doing lap choles. Oftentimes you will be so busy your entire shift that you will forget to eat or even go to the bathroom. Throw on top of this a few really sick patients during a shift where their living or dying depends on your medical decision making or procedural skills and it can becomes a stressful job that can lead to burnout. Most of us in EM like the chaos of it and are generally bored in other specialties. Rounding on patients hour after hour bores us. Doing the same procedure or operation day after day bores us. There really is a personality in the field. If you don't have that personality, you will burn out pretty quick. There are EDs where you see hardly any patients at all and get payed to check your email and sleep. This is an option for those who go into EM and don't like it, but for people who enjoy EM, this also bores us.

The real solution to avoid burnout is working less shifts. An ortho doc doing hip replacements at a surgery center will have to reach a certain income level to surpass expenses. It makes sense to work as many hours as possible after this as these are the most profitable hours. In EM we don't have to worry about this. I will make $200 an hour from the start of the year. Many people will work more hours after finishing residency to pay off loans. 40 hours per week at 50 weeks per year making $200 an hour puts you at 400k a year. If you wanted to bust your ass for a few years after residency and work 50 hours per week and found an undesirable place that payed $250 an hour, you would make 625k a year. You could probably do this for a few years, but this would likely be unsustainable for most people long term. I would rather work 30 hours per week, make a little less, but spend my free time with my kids or my other interests. If you really want to make bank, work 20 hours per week in EM and spend the rest of your time opening up Subway chains with the money you made in EM and your time off that EM affords. You'll make much more this way than you ever would being a spine surgeon. Clinical medicine is not how you get filthy rich.

You don't have to work nights. Many places have a dedicated night person because it appeals to certain people. Many people are just night owls. Lots of people like the predictability of the schedule. You'll find lots of mothers working nights. They can work 11p-7a Sunday through Wednesday. They work while their kids sleep. They sleep while their kids are at school. Some people have their contract worked out so they work no nights at all. Some people have it worked out so they do 2 nights a month. Some people will string their nights into 2 blocks for the entire year. It all depends on where you want to practice and how bad they need docs as to how nights will pan out.

As for the M1s already badmouthing EM, the truth of the matter is that people like to talk trash about awesome fields. "Rads just sits in front of a dark screen all day." "Derm docs are just pimple poppers." "Anesthesiology plays sudoko all day." "Ortho is dumb and knows no other field of medicine." "EM docs are just triage nurses." All of these fields make awesome money and have pretty good hours; of course everyone hates us. If I had to be on call every third night for 7 years only to realize that my life would likely get worse as an attending, while making less money and working more hours, I would hate these other specialties as well. The key is to find what you like. If you love bones and you think the OR rocks, don't go into EM: that would just be silly. If you really enjoy the eye, go into ophtho. The problem is when med students choose a speciality like the troll poster. They chose it because they think it will garner respect from others, not because they love the speciality. In medicine, no one cares that you are a neurosurgeon or worked more hours in residency. I could have chose to do that, but I realized I would hate my life. You worked more hours per week and only slept 5 hours per night: boo hoo, I don't care...that was your choice. I have much more respect and admiration for the military grunt who made 20k a year, while working 120 hours a week, while sacrificing life and limb. You slept in a warm bed every night, always had 4 warm meals a day and never had to worry about walking into an IED; your problems pale in comparison.

With that said, I know some great neurosurgeons. They are great because they are proficient in the OR, collegial, and genuinely good people who like their jobs. They went into it because they were amazed by the field. I enjoy calling them my colleagues and I look forward to discussing consults with them. I also know people like the troll poster who thought because they chose a surgical subspeciality that people would "owe" them respect. Unfortunately, this is not how medicine works. We all started on the same path and could have made the same choice: caveat emptor.
 
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Ask a physician this, if I were out in the middle of nowhere, and I fell down a mountainside, and I could have one physician with me to take care of me, what type of physician would that be? 100% of physicians would say Trauma surgeon, Orthopod, ENT etc (even the ED docs would have to agree, unless theirs a phone that they can use to place a consult)


Uh that's a dumb scenario. It's not like the Ortho, trauma or ENT are going to perform surgery out in the middle of the woods...
 
Uh that's a dumb scenario. It's not like the Ortho, trauma or ENT are going to perform surgery out in the middle of the woods...

Yea... that's what always bugged me about those scenarios. Honestly if you're out in the woods and something bad happens... you probably just want a paramedic. Or an EM person with a wilderness medicine fellowship. Because without all of our fancy equipment and hospital-based resources, we're just glorified medics who know a lot but can't do anything about it.
 
Wow with attitudes like this, no wonder some people may have problems with your specialty. You love to dish out to everyone else but don't take any yourself. It's almost a power trip to you because you can consult everyone else, but no one consults you and wakes you up at night.

Most consult residents' lives are already miserable enough as it is while you work 40 hours a week on a shift schedule making literally 20 fold the resident's hourly wage. Try to empathize and see from the perspective of an overworked resident in his 26th hour of call when you page him just before signout.

Make his life miserable? Shameful.

Calm down there buddy. I have a great relationship with my specialists b/c I treat them with respect and I get the same respect back. I realized they have it tough and it sucks to get the 10th admission in the first hour. I realize it sucks being in clinic all day and then have to come back to the ED for an emergent appy in the middle of the night knowing they have a full clinic the next day. I am well aware of this. That is why I bend over backwards for my specialists/hospitalist.

I will put in chest tubes, Drain peritonsillar abscess. I have gone to the floor to do an eye exam, suture a fistula bleed, suture an inpatient's scalp lac, put in central lines, etc. I am happy to do this when I am not crushed in the ED b/c it takes me 30 min to do rather than having the specialists waste 2 hrs coming from home. But if I am willing to bend over backwards for them, they need to bend over backwards for me. If I call on them for help, or do a soft admit, they need to just suck it up.

Its the docs that don't bend over backwards for me, that I will not bend over backwards for them. If a CT surgeon is a PITA when I consult them, why would I put in a chest tube for them? If a hospitalist complains about every soft admission, why would I hold an admission for the next guy? I am nice but not stupid.

Give respect and you will get respect. That is why I rarely have issues with specialists.

Residents who are PITA will soon learn that this is the wrong way to act as an attending. Its so much easier to say, "thank you for the admission" rather than be a PITA. In the long run, their lives are so much better being nice.
 
Yea... that's what always bugged me about those scenarios. Honestly if you're out in the woods and something bad happens... you probably just want a paramedic. Or an EM person with a wilderness medicine fellowship. Because without all of our fancy equipment and hospital-based resources, we're just glorified medics who know a lot but can't do anything about it.

My thoughts exactly.
 
To be honest, I haven't actually experienced any disrespect at my institutions. Maybe other services are just that courteous to our faces, but I feel that for the most part we do our jobs as best as we can given limited data and time and other folks realize and respect this. Occasionally we'll get a disgruntled medicine resident that doesn't like an admission, but that has more to do with the poor quality of their own life than the quality of the admission. When I'm off service, us ED folks are genuinely valued as we are very well rounded, can do tons of procedures fast, think about medicine, identify sick patients, and take care of mundane floor work at break neck speeds.

Nurses, residents, and attendings on other services understand what our strengths are and realize that really no one else in the hospital has that combo of skills. People can complain or talk down to us, but ultimately most people can only think about the 1 organ system they are trained to think about. We can identify and treat all the emergencies in their fields in addition to every other specialty out there.

Another thing to realize is that the make-up of emergency medicine is drastically changing, particularly in the last 5 or so years. We are drawing a much more competitive applicant pool consisting of many AOA, 250+ types. On the whole, people realize we're tough to match in and I think this leads to the greater respect my generation of ED residents has gotten.
 
To add to my post, people may not think we have any specific skill, but we're actually experts in the undifferentiated patient. No one else is trained to differentiate a complex patient with a complex presentation and to make treatment decisions with little time or data. Our ability to do this based on history and physical is unparalleled amongst all specialties. We still practice a brand of medicine that has largely been muddied by radiology and labs but we often times don't have the luxury of waiting for either. Medicine can't make a decision without labs and surgery can't make a decision without a CT scan, but for an experienced ED physician a good physical exam and astute history is enough to make a treatment call. This is a real skill that very very few physicians have outside of EM.
 
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Who cares most about "respect": Medical students and premeds.
Who cares the least about "respect": Attendings

That alone should tell you something.
 
Ask a physician this, if I were out in the middle of nowhere, and I fell down a mountainside, and I could have one physician with me to take care of me, what type of physician would that be?
And that's the super cool thing about it, because that's exactly how it happens in the real world. You do get to pick which type of physician will be there at the cliff-bottom waiting for you before your slip off the mountain side while performing your poorly executed selfie.
 
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...EM for the win :beat:
 
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Honestly, respect.. what does that mean? I can tell you this from a guy who has worked in the community for 6 years.

Some ED docs suck.. thats the truth. I just had one of our ortho guys come in for a bad wrist. Took him about 20 mins of attempts to try to fix it. He is a great ortho doc but he came in with fire.. Spewing about the bad ed docs.

To me I appreciate when they tell me that I do a good job. The hospitalists are always nice and appreciate that 1) I dont admit a bunch or crap and 2) when I do I dont try to sell them a "good admit" when it is crap.

Just be honest, work hard etc.. In the community only a handful of hospitalists were ever a pain. A few complaints by the lowly ED docs to their boss and their attitudes got fixed. As many of us have said before, outside of residency there is usually a direct correlation between work and money.
 
Honestly, respect.. what does that mean? I can tell you this from a guy who has worked in the community for 6 years.

Some ED docs suck.. thats the truth. I just had one of our ortho guys come in for a bad wrist. Took him about 20 mins of attempts to try to fix it. He is a great ortho doc but he came in with fire.. Spewing about the bad ed docs.

To me I appreciate when they tell me that I do a good job. The hospitalists are always nice and appreciate that 1) I dont admit a bunch or crap and 2) when I do I dont try to sell them a "good admit" when it is crap.

Just be honest, work hard etc.. In the community only a handful of hospitalists were ever a pain. A few complaints by the lowly ED docs to their boss and their attitudes got fixed. As many of us have said before, outside of residency there is usually a direct correlation between work and money.
I know orthopedists who are horrendous, and near criminal in that they fuse every spine they see, unnecessarily. I know a neurologist who failed his boards 3 times and has been arrested once. I know another 2 specialists who've lost their licenses and gotten them back. And lost them again! I know a surgeon who lost his license and had to leave the state because he was scrubbing out of the OR to smoke crack, then scrubbing back in. I know a cardiologist so negligent and incompetent he recently had to flee the country to start over. But it's not necessarily in your face every day in the ED. They're better able to hide in their better protected outpatient world, and behind the built-up specialist facade, until they're outed. If you're around long enough, you'll find there's plenty deserving of respect and also those undeserving of respect, to be spread around, everywhere. Incompetence does not discriminate by specialty. Neither does quality.

EM is a convenient punching bag for the bullies of the medical world. Ignore these small-penis overcompensating trolls. Karma is a helluva b¡tch.
 
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I'll echo the above several posts:

I sometimes run into the d!ckhead consultants, and I'm happy to just let them be miserable and think that they're 'all that'.

On the other hand, I know a good OBGYN that I once told a "cool cardiology story", who looked at me and said - "Dude, you mean there's something ABOVE the pelvis ?!"

The level of bravado and vitriol displayed by those mouth-breathers is directly proportional to how little they know about anything else other than their own chosen sub (and often, sub-sub specialty).

A cool consultant is a self-aware consultant.
 
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I'll echo the above several posts:

I sometimes run into the d!ckhead consultants, and I'm happy to just let them be miserable and think that they're 'all that'.

On the other hand, I know a good OBGYN that I once told a "cool cardiology story", who looked at me and said - "Dude, you mean there's something ABOVE the pelvis ?!"

The level of bravado and vitriol displayed by those mouth-breathers is directly proportional to how little they know about anything else other than their own chosen sub (and often, sub-sub specialty).

A cool consultant is a self-aware consultant.
Do you think a lot of it is jealousy? I mean , I've been seeing a lot of "glorified triage nurse" talk in this thread, but let's be honest... A triage nurse cannot possibly do or know as much as an EM doc. Am I right? So, why , if EM docs have so much more education AND training, would they ever be compared to a nurse (of any kind)? Also, I'm sure the jealousy is rooted in the fact that EM docs make a lot more money and work in shifts.
 
Yesterday had a little old lady who couldn't swallow. Probably had achalasia or an esophageal stricture. The Hospitalist refused to admit her without labs and a neck CT, because "We need imaging to make sure her airway is okay". After explaining to him why her airway was okay (she could talk in full sentences) I convinced him to admit the patient for an EGD, and assured him I would call him back if the labs were abnormal.

Sometimes the lack of basic medical knowledge is astonishing.
 
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And that's the super cool thing about it, because that's exactly how it happens in the real world. You do get to pick which type of physician will be there at the cliff-bottom waiting for you before your slip off the mountain side while performing your poorly executed selfie.

As someone who spends a lot of time around cliffs, I generally do make sure there is an emergency doc at the other end of the rope. They're the only ones with the time off to be there anyway.
 
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Working nights, weekends, and holidays sucks, but the tradeoff to this is only working 13 days a month and being able to take 3 weeks off to travel, all while making 350k a year.

that's definitely on the high side of the pay scale. Average is roughly 100K less.
 
Where are you getting those numbers?

Here's where I got mine:
http://www.medscape.com/features/slideshow/compensation/2013/emergencymedicine

Avg overall = $270K
male = $277K
female = $242K

These are all full time positions.
if you want to practice in CA, you're looking at $258K. If you want to practice in the New England, you're looking at $242K.
Even the highest area (Texas) is less than 300K.

Emergency Medicine Physician Compensation in 2012

Physicians have done well in 2012, and that's true for EM physicians as well. EM physicians were the 12th highest-ranked specialty, with a mean income of $270,000. Topping the list were orthopedists, cardiologists, radiologists, gastroenterologists, and urologists.

Historically, EM physicians have ranked in the middle among the specialties in Medscape's surveys, although there has been a slight decline. In our 2012 report, EM physicians ranked 14th highest, while in the previous year they were 11th from the top.

About 10% of EM physicians earn $400,000 or more, the highest income category in the specialty; 5% earn $100,00 or less.

For employed physicians, compensation includes salary, bonus, and profit-sharing contributions. For partners, compensation includes earnings after tax-deductible business expenses but before income tax. Compensation excludes non-patient-related activities (eg, expert witness fees, speaking engagements, and product sales). Compensation in this chart includes only that for physicians working full-time.

Note: Totals in slideshow may not add up to 100% due to rounding. "Not applicable" (N/A) responses were not included in the charts and graphs.



PS -- Listen, I'm not trolling. Never have. Not everyone can secure a partnership in a small democratic group with a high payer mix, with a few FSEDs and plenty of PAs working under you to rake in the cash. In fact, this is the minority. Sure, anyone can do a quick calculation based off of a $220/hr payscale, but this is not average by any means.
 
Medscape polls for pretty much everything are entertaining at best, and have mostly anecdotal evidence character due to the methodology.
 
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Where are you getting those numbers?

Here's where I got mine:
http://www.medscape.com/features/slideshow/compensation/2013/emergencymedicine

Avg overall = $270K
male = $277K
female = $242K

These are all full time positions.
if you want to practice in CA, you're looking at $258K. If you want to practice in the New England, you're looking at $242K.
Even the highest area (Texas) is less than 300K.

Emergency Medicine Physician Compensation in 2012

Physicians have done well in 2012, and that's true for EM physicians as well. EM physicians were the 12th highest-ranked specialty, with a mean income of $270,000. Topping the list were orthopedists, cardiologists, radiologists, gastroenterologists, and urologists.

Historically, EM physicians have ranked in the middle among the specialties in Medscape's surveys, although there has been a slight decline. In our 2012 report, EM physicians ranked 14th highest, while in the previous year they were 11th from the top.

About 10% of EM physicians earn $400,000 or more, the highest income category in the specialty; 5% earn $100,00 or less.

For employed physicians, compensation includes salary, bonus, and profit-sharing contributions. For partners, compensation includes earnings after tax-deductible business expenses but before income tax. Compensation excludes non-patient-related activities (eg, expert witness fees, speaking engagements, and product sales). Compensation in this chart includes only that for physicians working full-time.

Note: Totals in slideshow may not add up to 100% due to rounding. "Not applicable" (N/A) responses were not included in the charts and graphs.



PS -- Listen, I'm not trolling. Never have. Not everyone can secure a partnership in a small democratic group with a high payer mix, with a few FSEDs and plenty of PAs working under you to rake in the cash. In fact, this is the minority. Sure, anyone can do a quick calculation based off of a $220/hr payscale, but this is not average by any means.

Medscape is not very useful here. Go with the most recent Daniel stern survey instead.
 
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Where are you getting those numbers?

Here's where I got mine:
http://www.medscape.com/features/slideshow/compensation/2013/emergencymedicine

Avg overall = $270K
male = $277K
female = $242K
.

These sites are notoriously inaccurate. A recent lecture at AAEM by Manny Hernandez showed average EM compensation at 330 per year, but you have to remember this average includes moms working part time, academic EM (you will make much less), etc. The other thing with EM is that more people work part time than in other fields because you do not have practice expenses that you need to cover; making 400k vs 200k does not improve your quality of life much and likely makes it worse so many prefer to only work part time or work less hours. Comparing average salaries of a cardiologist who works 60 hours per week to an EM doc who works 33 hours per week is comparing apples to oranges. You would be better off comparing per hour averages.

If you want to work in NYC, Boston, LA, you will likely not make good money. However, if you are okay working in a suburban community ED, and you don't demand one specific location, there is no reason you shouldn't demand to make 350 a year starting out. Look in the back of any EM magazine or journal and you will find multiple offers for 350k plus. I will occasionally get offers for 500k plus, for 120 hours per month, in areas that really need docs.

Because EM is generally payed hourly, simple math is your friend. Making $180 an hour (which is average and even attainable in large cities), while working 40 hours per week, 48 weeks a year, puts you at 346k. This number is based on the average American work week with the average of 4 weeks vacation per year. This does not include all of your other benefits that are standard (family health/dental, CME money, productivity bonus, Retirement plan, etc). If you don't need money, you can work less hours (most of us do). If you want more money, find a better hourly rate or work more hours.
 
Sorry, I don't have access to the latest Daniel Stern as it needs to be purchased. But from the 2009 Daniel Stern survey, it appears their methods are somewhat flawed. More than 1/3 of the survey respondants were medical directors. This is misleading and greatly skews the average salary upward. How many ED's do you know that only have 3 physicians, one of which is the medical director? Correct me if I'm wrong, but aren't most Emergency Physicians either independent contractors or employees? Seems like the contract management groups make up a large portion of these. They only make up $250-270K (in 2009 dollars). Partnerships / democratic partnerships, though plentiful, are less common. Also, keep in mind if you're part of a partnership, you're likely not getting any employer match on your retirement account, CME money, and often you have to pay for your own family health and dental insurance.

Don't get me wrong, I love working 15 or fewer shifts a month. I love getting paid. But a lot of these numbers that are thrown around seem artificially inflated. I don't think it's >$300K/yr. Probably more in the $250-275K range for your average, non-medical-director non-administrative ED physician.

Yeah, I know, earlier I said ~$100K less than $350K, but I like round numbers.

--------------------------

http://www.acep.org/Clinical---Prac...vey-Says-Average-EP-Makes-More-Than-$300,000/
Although it varies by geographic location and other factors, the average salary for a partner in an emergency physician group is $301,274, according to a salary survey released in June.

The “2009 Daniel Stern & Associates Emergency Medicine Compensation and Benefit Survey” represented input from 1,009 physicians from all 50 states and the District of Columbia. Of this total, 624 were staff physicians and 385 were emergency department directors.
On the national level, total compensation for staff physicians at the 50th percentile was highest for “partners” who earned $301,274, compared to “independent contractors” who earned $270,000 and “employees” whose total compensation was $252,690.
 
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