ER Scribes: Do you see yourself in EM?

[Hospitalized]

I am an EMT, but I could definitely see myself in EM.

It seems that about 1/4 of the physicians I work with had some sort of ER experience prior to medical school. Does anyone know when scribes really started to be more common practice? I know it was relatively recent, and I'm just curious if there's a correlation between use of scribes and increase in EM residency applicants.

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[LostinLift]

Initially when I started scribing I wanted nothing to do with the ED after medical school. Following a change in attitude, I realized that first of all, an EM physician is the kind of doc I wanted to be growing up. You get to do a little bit of everything and help people in their most frantic, panicked moments. Whether it's a 8 year old kid with a 2 cm laceration or a new parent with their first child's illness or gramps fell going to the bathroom, these can all be very frightening situations for the patients and their families.


Also I get bored easily, I plan to travel a ton (weekend trips with SO on my weekends off 1-2x a month), I actually prefer night shifts (especially grouped together with no flip-flopping, which is not hard to get as a scribe nor as a Doc from what I hear) and I like the opportunity for flexible Locums work if I so desire. The drug seekers and non-emergent complaints used to bother me, but hey, everyone needs help. They might not have anywhere else to go, they might not be able to get in to a regular doctor, they might be having a terrible year and are genuinely worried about a new cough at 3 am, they might just be trying to get in to see a doctor without having to pay, who knows why.... but I want to be there and be a positive influence on as many people as possible.

Lack of continuity: You can still follow-up with anyone simply by giving them a call and I would prefer to help a patient identify a serious problem right away or at least get them going in the right direction, than fiddle around with medications or be in the OR for more than an hour. I do enjoy short surgeries, but my attention span gets the best of me. 5-8 years of residency for surgery would not be doable.


Every field has its fair share of problems, but all in all I think EM is wonderful. The question you have to ask yourself (through direct, longitudinal experiences) is can you brush aside the problems and focus on the good stuff.

 

[mikil100]

I'm not a scribe, but I am a charge nurse for a 27 bed ER. I personally can't see myself in emergency medicine as a physician for a few reasons.
Obviously I don't have a direct experience as a physician but I see what our docs go through working closely with them. I'm not at a computer to make a nice list so I'll post tomorrow and maybe give a different opinion based off of my experiences

Edit:
Here are my personal reasons of being disinterested in EM. Perhaps when(if) I go through rotations I will see it differently. I'm certainly going to go in with an open mind, but I would like to share my experiences here regardless

So, I absolutely love emergency medicine. It is unpredictable, fast paced, and rewards quick thinkers. However, there is also a lot of frustration involved with working in an emergency room.
This depends widely on location, but the clientele makes a HUGE difference. Working in the ED has made me a much more... wordly person. You see things that the average person simple cannot fathom, and in a sense, this is cool. You will see the best and worst of society, I guess is what I mean.

In a world where people expect instant gratification (or feel self entitled), emergency medicine can fall horribly short (in the patients views).
Some examples of this are:
Patients becoming very disgruntled over wait times, or patients dissatisfied with care. The second one in particular deserves a paragraph on its own. The amount of times I have cared for a patient that has seen multiple specialists, been under treatment unsuccessfully for some time, and then expects to have their condition miraculously cured by the ED attending who has never met the patient before is very frustrating. The best the attending can do is treat the symptoms and refer the patient out to whomever has assumed care of the patient. Maybe, if the patient is sick enough, they get to be admitted to the hospitalist service to be under the care of more physicians who aren't familiar with the patient (of course the specialist is consulted, but still...)


Drug seekers, now it may seem like a non-problem but it is. It is a time intensive problem that wastes resources and energy. It is also demoralizing. Obviously this depends on the person.

Time management: This may seem like a minor thing, but this is main reason I'm less interested in EM. An attending in my ED typically has ~20 patients at any given time. These patients can run from a stubbed toe to a patient crashing hard... (guess which one complains about waiting 30 minutes to be seen?). In the craziness of the ED the doc has to manage the care of these patients, perform procedures (best part of EM after the diagnostic part imo), see more patients, perform discharge teaching to leaving patients, answer questions from nurses/other staff, and in general is constantly getting pulled from one thing to the next. This certainly isn't all bad, but on a very busy day it can be frustrating trying to see all the patients that really need to be seen right away. A very unique frustration to EM is when there are multiple patients that need care. Of course, the EM doc will triage and pick the most sick, but there will be days when there are a few "most sick." To me this type of crazy does not seem appealing. I want to be able to really focus on my patients, one at a time, and not rush my care because another life saving urgent thing needs to be done. Some will love flying from room to room, a fireball of life saving beauty.

One small factor I've been starting to notice is that EM docs seem to get questioned a LOT by other physicians. I'm not sure of why this is, but it does seem there is at times a general disdain for EM docs from other specialties.. I've seen other elaborate on this already so I won't delve into detail when I only have a superficial experience of it in the first place.

These are the big things that I really cared to elaborate on, I could go on and on for each topic, giving the pros and cons of EM back and forth. The reality is it's a GREAT specialty. But one must consider very carefully before going into it. It is certainly not a relaxed specialty (if there is such a thing). For those who have very high energy and love a mix of medicine and procedures, it is a great field.

As a disclaimer I would like to note my hospital is a smallish community hospital that does not have the resources of a large medical center, thus a lot of what I said is probably quite different for those who want to work in a big academic, level 1 trauma center.