Longtime SDN member and current EM resident - AMA or don’t. Whatever.

[alpinism]

what did you mean by the radiologist part. Why do you think they're super happy? Serious question!

'Hmm I'd say about average. Probably above surgeons but below radiologists."

Just my experience. Most attending radiologists I've met tend to really enjoy their jobs. There are obviously exceptions and radiology is definitely not for everyone but overall its a great field if you like medicine but don't want to deal with all the BS that comes with taking care of patients.

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[JustintheDoctor]

Just my experience. Most attending radiologists I've met tend to really enjoy their jobs. There are obviously exceptions and radiology is definitely not for everyone but overall its a great field if you like medicine but don't want to deal with all the BS that comes with taking care of patients.

Do you think Anesthesiology residents/fellows enjoy their jobs too? I only ask because my two fields of interest is radiology and Anesthesiology

 

[Vladimir7]

I missed my chance to do ROTC as an undergrad. (junior now). And like you I would love to work internationally. MSF (or Doctors Without Borders) but also being a medic (which i believe means doctor on the warfront?) sounds like a solid giving back to the world experience. What are good paths to take next? OCS or rotc during med school??

 

[ewax]

Crispy Salmon.

Number 35 looks interesting though.

https://www.buzzfeed.com/mjs538/35-...ound-the-world?utm_term=.avyyyaYOp#.addDDX2jV

#19... how is that a flavor?

 

[alpinism]

Have you had to deal with toxic personalities in the workplace as a resident? How do you keep those people (attendings, residents, nurses, etc) from bringing you down when you spend 80 hours with them each week?

Not really. I've been extremely lucky and most people are very friendly and down to earth at my program. Occasionally there will be a consultant who's just an a$$hole but I usually just shrug it off and move on with my life. Its one of the main reasons why I chose to rank them 1st when I was a 4th year medical student. Honestly the program is very self selecting since most people have no desire to work at my hospital. Its a very intense place to work so most people who come here know what they're getting into and enjoy the challenge of taking care of our patient population.

 

[alpinism]

@alpinism
Do you ever feel like a plastic bag?
Drifting through the wind, wanting to start again?
Like a house of cards, one blow from caving in?

Edit: Serious question here. Would you say trauma surgery could be for someone who likes the trauma/codes side of EM, but wants to actually go in there and fix something? Surgeons don't run codes, huh?

Considering that over 95% of traumas in the US are non operative, IMO you'd probably be very disappointed as an attending trauma surgeon.

http://www.annemergmed.com/article/S0196-0644(11)00461-6/abstract

 

[alpinism]

Do you think Anesthesiology residents/fellows enjoy their jobs too? I only ask because my two fields of interest is radiology and Anesthesiology

Definitely. I'm probably just biased from spending too much time over in the anesthesiology forum as a med student.

 

[alpinism]

I missed my chance to do ROTC as an undergrad. (junior now). And like you I would love to work internationally. MSF (or Doctors Without Borders) but also being a medic (which i believe means doctor on the warfront?) sounds like a solid giving back to the world experience. What are good paths to take next? OCS or rotc during med school??

If you want to work internationally I'd recommend steering clear of the military. No matter what your recruiter tells you in reality you'll have no control over your career once you sign on the dotted line. You may or may not end up getting deployed, and even if you do get deployed it might not be to an actual war zone.

The best way to work internationally is just to go to a civilian med school that offers a global health track. Most med schools have some version of this and offer multiple opportunities to go overseas during 1st year and 4th year. Many residencies also offer international rotations or research projects that can be done as a senior resident. After you become an attending then you're free to go anywhere you want overseas and work in refugee camp or war zone.

 

[alpinism]

In honor of my last heroin overdose patient and our lord and savior Jesus Christ:

 

[The Buff OP]

In honor of my last heroin overdose patient and our lord and savior Jesus Christ:

 

[Vladimir7]

In honor of my last heroin overdose patient and our lord and savior Jesus Christ:

LOL, savage, can you detail the experience/medical procedure of what happened??

Also, would being an attending in a warzone qualify as a medic?? Idk what it is, maybe i just idealize being a medic from hollywood portayals/novels.

 

[The Buff OP]

What are some cool stuff that you guys get to do?

 

[alpinism]

LOL, savage, can you detail the experience/medical procedure of what happened??

Also, would being an attending in a warzone qualify as a medic?? Idk what it is, maybe i just idealize being a medic from hollywood portayals/novels.

https://en.wikipedia.org/wiki/Opioid_overdose

So traditionally speaking the term "medic" refers to army soldiers trained as emergency medical technicians. They usually go through a 3 to 6 month training program before being attached to a combat unit and working out in the field. There really isn't any specific term for army physicians and most work in hospitals rather than out in the field. In other words, attending physicians wouldn't really qualify as a medic unless they previously worked as a medic prior to medical school.

 

[ZorkDork1]

Do most your serious traumas come from car accidents?
I think within 10-20 years they'll have fully driverless cars on the road. I wonder if that'll limit the serious traumas the ER sees


Sent from my iPhone using SDN mobile

 

[MusicDOc124]

You sound very similar to me also! I am a Marine Corps vet, a medic, and starting medical school next month and I'm pretty much set on EM (I will keep my mind open of course to everything else). What would you say are some good things to do while in school to be able to match into a good EM residency? I'm trying to start figuring out what extra I want to do over these next 4 years. Thanks for your time!!!

rah!

 

[Doudline]

Where do you stand on the Kinsey scale?

 

[Symmetry11]

As an EM resident how much of other organ systems must you know? I like radiology because you have to learn the pathology that comes with studying multiple organ systems. Does the same apply for EM? Are you expected to constantly further your knowledge anatomy and physiology?

 

[Symmetry11]

Also do you plan on joining MSF right after residency because if you were to do it once you are established it would breach the terms of your contract once you become partner or something like that?

 

[Brahnold Bloodaxe]

How much "thinking" do you do on an average shift? Are most patient encounters reflexive, meaning you shotgun a bunch of lab or imaging tests or follow a protocol, or do you often find yourself pondering the finer aspects of pathophysiology before deciding what to do?

 

[alpinism]

What are some cool stuff that you guys get to do?

We get to do a ton of cool stuff for cardiac emergencies. I really like taking care of SVT patients (vagal maneuvers/pushing adenosine/performing synchronized cardioversion). Besides that performing double sequential defibrillation for refractory VF/VT, floating transvenous pacemakers for unstable bradycardia, administering high dose nitroglycerin for acute decompensated heart failure, giving push dose pressors for sudden onset severe hypotension, and looking at real time heart function using ultrasound.

 

[alpinism]

Do most your serious traumas come from car accidents?
I think within 10-20 years they'll have fully driverless cars on the road. I wonder if that'll limit the serious traumas the ER sees


Sent from my iPhone using SDN mobile

We get a good mix of car accidents, assaults, gunshots, stabbings, and burns. That being said at most trauma centers car accidents will make up the vast majority of your serious traumas on a daily basis. What you're describing has already started to happen over the past 50 years. Cars in the 1960s were essentially death traps and most people did not wear seatbelts. Most cars on the road today are ten times safer and everyone wears seatbelts. As a result the amount of serious trauma from car accidents has gone down significantly since then and we only see a fraction of what we used to see 50 years ago.

 

[The Buff OP]

We get to do a ton of cool stuff for cardiac emergencies. I really like taking care of SVT patients (vagal maneuvers/pushing adenosine/performing synchronized cardioversion). Besides that performing double sequential defibrillation for refractory VF/VT, floating transvenous pacemakers for unstable bradycardia, administering high dose nitroglycerin for acute decompensated heart failure, giving push dose pressors for sudden onset severe hypotension, and looking at real time heart function using ultrasound.

How good do you have to be at reading EKG's?
If I were to do mil med, do you think I can receive good thorough training with them for my specialty?

 

[235009]

How good do you have to be at reading EKG's?
If I were to do mil med, do you think I can receive good thorough training with them for my specialty?

You only have to be able to identify the basics: STEMI, NSTEMI, basic arrhythmias
You also have to be able to identify when something is funky and just doesn't look right and you need to have more trained eyes look at it

 

[The Buff OP]

You only have to be able to identify the basics: STEMI, NSTEMI, basic arrhythmias
You also have to be able to identify when something is funky and just doesn't look right and you need to have more trained eyes look at it

Thank god. lol

 

[Cyberdyne 101]

You only have to be able to identify the basics: STEMI, NSTEMI, basic arrhythmias
You also have to be able to identify when something is funky and just doesn't look right and you need to have more trained eyes look at it

How's life as a fellow?

 

[235009]

How's life as a fellow?

No complaints so far

 

[alpinism]

Where do you stand on the Kinsey scale?

I want to say 0 but since I was a firefighter I have to say 1 if I'm being totally honest.

 

[alpinism]

As an EM resident how much of other organ systems must you know? I like radiology because you have to learn the pathology that comes with studying multiple organ systems. Does the same apply for EM? Are you expected to constantly further your knowledge anatomy and physiology?

We have to know about all the organ systems. Unlike specialties like cardiology, pulmonology, nephrology, and gastroenterology we do not focus on a specific organ system but rather a specific acuity level. In a perfect world emergency medicine would be the complete opposite of family medicine.

No matter what field you do into you'll be constantly studying and reading for the rest of your life.

 

[alpinism]

Also do you plan on joining MSF right after residency because if you were to do it once you are established it would breach the terms of your contract once you become partner or something like that?

Its a lot easier to work for them when you're younger and don't have an established job with a wife and kids at home.

 

[235009]

We have to know about all the organ systems. Unlike specialties like cardiology, pulmonology, nephrology, and gastroenterology we do not focus on a specific organ system but rather a specific acuity level. In a perfect world emergency medicine would be the complete opposite of family medicine.

No matter what field you do into you'll be constantly studying and reading for the rest of your life.

All the specialists you named are internal medicine trained so they actually know about all the organ systems as well (or at least they did at some point).

 

[bcemslayer]

I want to say 0 but since I was a firefighter I have to say 1 if I'm being totally honest.

How does being a firefighter shift your standing on the scale?

 

[Psai]

How does being a firefighter shift your standing on the scale?

Because firefighters are hot

 

[ZorkDork1]

Do you wear a watch in the ER? Any recommendations?

 

[alpinism]

How much "thinking" do you do on an average shift? Are most patient encounters reflexive, meaning you shotgun a bunch of lab or imaging tests or follow a protocol, or do you often find yourself pondering the finer aspects of pathophysiology before deciding what to do?

Depends on the patient and the chief complaint. There are definitely times when there's minimal thinking involved, like in the case of elderly chest pain. Almost everyone is getting a CBC, BMP, Troponin, 12 lead ECG, Chest x-ray, etc... no matter what they tell me during the interview. At the same time myself and most other EM residents don't "shotgun" labs for patients and always have a reason for each test we order. As far as patients becoming reflexive it does start to happen after you see enough disease presentations. This isn't really EM specific though and happens in every field. After you see enough adult headaches you know what to look for and what questions to ask without really thinking about it all that much. If it turns out to be a migraine you also know how to treat if without having to look up specific drugs and dosages. On an average shift I'd say its about a 50/50 split between thinking and non thinking patients. The "non emergency" patients tend to require less thinking while the "emergency" patients tend to require more thinking.

 

[deleted407021]

I know that peds and EM can sub-specialize in peds/adolescent EM, but do EM residents and attendings regularly treat all age groups, or do y'all see the IM population while the peds EM people see the peds population?


So many initialisms and abbreviations.

 

[avgn]

I know that peds and EM can sub-specialize in peds/adolescent EM, but do EM residents and attendings regularly treat all age groups, or do y'all see the IM population while the peds EM people see the peds population?


So many initialisms and abbreviations.

Depends if there's a peds ED at the hospital. If there is, peds gets sent there where it's mostly pediatricians who've specialized in EM. I would imagine his safety net shop does not differentiate and they see most everything.

 

[alpinism]

How good do you have to be at reading EKG's?
If I were to do mil med, do you think I can receive good thorough training with them for my specialty?

Regardless of what our Cardiologist friend thinks you need to be good at reading ECGs to be a great ER doctor. Basic ECG interpretation is essentially nothing more than ACLS and that doesn't even begin to scratch the surface of what we are required to learn during residency. Now, obviously we are not on the same level as most Internists and Cardiologists, however, we do need to know way more than most other doctors. Not to mention there are multiple ER doctors out there who are considered experts in ECG interpretation and who have even written books on the subject.

I'm probably biased but unless you get really lucky chances are you'll receive subpar training through the military. There's entire threads dedicated to this subject over in the Military Medicine forum if you haven't seen them yet but personally speaking I'd stay away from the HPSP and USUHS.

 

[alpinism]

How does being a firefighter shift your standing on the scale?

Let's just say that being a firefighter is a lot like being in a fraternity.

Lots of hazing and practical jokes taking place in the showers and bedrooms.

 

[The Buff OP]

Let's just say that being a firefighter is a lot like being in a fraternity.

Lots of hazing and practical jokes taking place in the showers and bedrooms.

They shaved off your pubes too? Jokes on them, they did me a solid.

 

[The Buff OP]

Regardless of what our Cardiologist friend thinks you need to be good at reading ECGs to be a great ER doctor. Basic ECG interpretation is essentially nothing more than ACLS and that doesn't even begin to scratch the surface of what we are required to learn during residency. Now, obviously we are not on the same level as most Internists and Cardiologists, however, we do need to know way more than most other doctors. Not to mention there are multiple ER doctors out there who are considered experts in ECG interpretation and who have even written books on the subject.

I'm probably biased but unless you get really lucky chances are you'll receive subpar training through the military. There's entire threads dedicated to this subject over in the Military Medicine forum if you haven't seen them yet but personally speaking I'd stay away from the HPSP and USUHS.

I guess I feel a bit scared because I still haven't got the training for reading ECGs. I'm just an EMT, but hopefully one day if I go to med school.

That's what I thought too. In a military residency, I feel like I won't have a great diversity. I'm actually thinking of doing AFROTC, but I don't know. I'm in my mid 20s and one of my dreams is to get to fly (fighters, bombers, or cargo). However, the cut off age is at 29 and I'm just thinking what to pick. It doesn't help that I live next to a base and I see jets on the daily.

 

[alpinism]

Do you wear a watch in the ER? Any recommendations?

I stopped wearing one since it kept getting covered in bodily fluids plus I always have my cell phone with me during shifts.

That being said, I still wear a timex ironman whenever I'm outdoors running or biking.

 

[alpinism]

I know that peds and EM can sub-specialize in peds/adolescent EM, but do EM residents and attendings regularly treat all age groups, or do y'all see the IM population while the peds EM people see the peds population?
So many initialisms and abbreviations.

Outside of academic medical centers most ERs treat patients of all age groups ranging from 1 day old to 100 years old. The whole separate ER thing doesn't really occur at community hospitals since they don't see enough peds to justify building a whole separate ER or hiring a peds EM specialist. Every EM residency is required to provide peds training and most EM doctors are fully capable of handling any peds patient. At the present time the only real reason to do a peds EM fellowship would be to work at a large academic medical center with a children's hospital since most places now require fellowship training in order to work in their ER.

 

[Psai]

I stopped wearing one since it kept getting covered in bodily fluids plus I always have my cell phone with me during shifts.

That being said, I still wear a timex ironman whenever I'm outdoors running or biking.

Mt sinai?

 

[ZorkDork1]

How are patients assigned to you in an ER? Randomized?

If a seriously injured patient comes crashing through the door, is it whoever is closest?

 

[deleted407021]

How often would you say that a good understanding of psychology and behavioral science come into play in your work?


Thanks!

 

[alpinism]

They shaved off your pubes too? Jokes on them, they did me a solid.

One of our Captains used to love to take off his clothes and sneak into probies beds after they fell asleep.

You're not a real firefighter until you've woken up lying next to a completely naked man whispering in your ear and kissing you on the cheek.

 

[The Knife & Gun Club]

One of our Captains used to love to take off his clothes and sneak into probies beds after they fell asleep.

You're not a real firefighter until you've woken up lying next to a completely naked man whispering in your ear and kissing you on the cheek.

[it was a Nope GIF that wouldn't link..never mind, forget I said anything]

 

[alpinism]

Mt sinai?

Yeah no thanks.

Mostly vomit and blood.

 

[alpinism]

How are patients assigned to you in an ER? Randomized?

If a seriously injured patient comes crashing through the door, is it whoever is closest?

The ER is divided into 6 modules and each one has 2 residents plus an attending. After patients are triaged they are assigned to one of the modules based on their order of arrival (mod 1 gets the 1st, mod 2 gets the 2nd, mod 3 gets the third). That way no one gets slammed if 10 seriously injured patients walk through the door at the same time.

 

[alpinism]

How often would you say that a good understanding of psychology and behavioral science come into play in your work?


Thanks!

Honestly not that often. Unless you count talking to patients with drug seeking behavior which I may or may not have time to do depending on how busy I am that shift.