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

[alpinism]

http://sbdww.org/speaker-jason-prystowsky-md-mph/

Jason is on the EM faculty at Loma Linda University and currently works at Cottage Hospital in Santa Barbara.

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[deleted647690]

http://sbdww.org/speaker-jason-prystowsky-md-mph/

Jason is on the EM faculty at Loma Linda University and currently works at Cottage Hospital in Santa Barbara.

Awesome! Sounds like a cool guy, seems like he has done a lot for various communities

And working in Antarctica? Bet that was interesting

 

[medbunny56]

do you think a 504 mcat (28 on old mcat scale)-67th percentile warrants a retake for MD schools?
my breakdown is relatively balanced so I'm hesitant to retake
chemical/physical=127 (10 old scale)
verbal=124 (8 old scale)
bio=125 (9 old scale)
psych/soc=128 (11 old scale)

i have a 3.64 cgpa, lots of research experience, CA resident but open to out of state schools

 

[Lucca]

do you think a 504 mcat (28 on old mcat scale)-67th percentile warrants a retake for MD schools?
my breakdown is relatively balanced so I'm hesitant to retake
chemical/physical=127 (10 old scale)
verbal=124 (8 old scale)
bio=125 (9 old scale)
psych/soc=128 (11 old scale)

i have a 3.64 cgpa, lots of research experience, CA resident but open to out of state schools

Yes I would retake if I were you

 

[alpinism]

There is an urgent care in my EMS service area, and the're usually good for sending out at least 3 patients via 911 during the ~12 hours they're open every day. It's always the people with a cold calling 911 for a ride to the ED, and the 50yo male with chest pain who drives himself to the urgent care. Super frustrating.

Its always funny to me how you'll see these old grizzled farmers who come in with the worst possible injuries and have to be dragged in by family then sit there quietly even though you know they're in a ridiculous about of pain. At the same time you'll also see these people who come in after the smallest possible injuries moaning and crying hysterically then freak out when I tell them we'll need to draw blood for labs.

On that note, Its very common around here for people to refuse blood draws or try to tell us that we only get one shot to before they're leaving. Its almost always its some 250lb woman with horrible lymphedema and no superficial veins who's coming in with some type of chronic pain. Surprisingly even after telling them they don't have a choice they keep coming back over and over again.

 

[alpinism]

That's good to hear. EJ IVs are always cool to see slide in.
What did you major in?

Do military residencies have the same work hours as civilian residencies?

Biochemistry for undergrad and Pharmacology for grad school.

AFAIK the hours are roughly the same since they're still covered by the same GME work hour restrictions.
You'd probably have extra non-medical duties though like required unit meetings and training sessions every month.

 

[Weirdy]

do you think a 504 mcat (28 on old mcat scale)-67th percentile warrants a retake for MD schools?
my breakdown is relatively balanced so I'm hesitant to retake
chemical/physical=127 (10 old scale)
verbal=124 (8 old scale)
bio=125 (9 old scale)
psych/soc=128 (11 old scale)

i have a 3.64 cgpa, lots of research experience, CA resident but open to out of state schools

Move to WAMC thread.

 

[alpinism]

Awesome! Sounds like a cool guy, seems like he has done a lot for various communities

And working in Antarctica? Bet that was interesting

There's 2 clinics down in Antarctica run by UTMB that recruit EM docs (https://www.utmb.edu/polar/joblisting.html). The only catch is that its a seasonal job and you're required to sign a 6 mo contract. Otherwise sounds like a great experience (https://www.acep.org/Clinical---Practice-Management/Emergency-Medicine-at-The-Bottom-of-the-World/).

 

[Commer_Knocker]

Thanks for doing this!

Can you tell me a little bit what your off-service(non-EM) months are like?

I've heard they can generally push the 80 hour limit, as those services tend to abuse residents who aren't their own.

 

[deleted647690]

There's 2 clinics down in Antarctica run by UTMB that recruit EM docs (https://www.utmb.edu/polar/joblisting.html). The only catch is that its a seasonal job and you're required to sign a 6 mo contract. Otherwise sounds like a great experience (https://www.acep.org/Clinical---Practice-Management/Emergency-Medicine-at-The-Bottom-of-the-World/).

That sounds sweet

 

[alpinism]

Thanks for doing this!

Can you tell me a little bit what your off-service(non-EM) months are like?

I've heard they can generally push the 80 hour limit, as those services tend to abuse residents who aren't their own.

Depends on the rotation.

Some are really chill like anesthesia and OB/GYN.

On anesthesia we basically go from one OR to the next tubing patients. You usually work M-F from 6am-3pm.
On OB/GYN we basically go from one room to the next delivering babies. You usually work M-F from 7am-4pm.

Others are more intense like trauma, orthopedics, medical ICU, and pediatric ICU.

On all 3 we basically spend the day rounding then see any admissions or consults. You usually work 60-80hrs per week and take q3-q4 call.

 

[alpinism]

do you think a 504 mcat (28 on old mcat scale)-67th percentile warrants a retake for MD schools?
my breakdown is relatively balanced so I'm hesitant to retake
chemical/physical=127 (10 old scale)
verbal=124 (8 old scale)
bio=125 (9 old scale)
psych/soc=128 (11 old scale)

i have a 3.64 cgpa, lots of research experience, CA resident but open to out of state schools

Post in the WAMC forum.

Hard to say without more information. If you're part of a URM group or have excellent ECs you might still have a shot at some low tier MD schools.

 

[pericardium]

I'm a former medic, do you have any advice on how to take advantage of my experience either preclinically or during rotations? Also, how can I maximize my chances for EM? I'm currently a first year DO, performing about average in my class. Apologies if my questions were answered before.

I'm interested in EM

 

[alpinism]

There's really nothing much you can do preclinically other than working/volunteering part time if your grades and schedule allow.
As far as clinical rotations go you can always help out by doing IVs, blood draws, ECGs, etc... if they need to be done quickly.

Pass all your classes, study your ass off for step 1, get involved with your EMIG, do some sort of research, and make connections with local EM residencies.

 

[The Buff OP]

There's really nothing much you can do preclinically other than working/volunteering part time if your grades and schedule allow.
As far as clinical rotations go you can always help out by doing IVs, blood draws, ECGs, etc... if they need to be done quickly.

Pass all your classes, study your ass off for step 1, get involved with your EMIG, do some sort of research, and make connections with local EM residencies.

What do you think of the PJ's?

Do they actually learn all of the stuff a civilian EMT-EMT-P learn all in just 22 weeks? Like peds, ob-gyn, meds, ekgs, etc.

 

[alpinism]

What do you think of the PJ's?

Do they actually learn all of the stuff a civilian EMT-EMT-P learn all in just 22 weeks? Like peds, ob-gyn, meds, ekgs, etc.

I've got mixed feelings about PJs.

So its not actually the length of classroom training that's the real issue, but the clinical experience requirements prior to being awarded EMT-P certification and being allowed to work independently that's the main difference between PJs and civilian paramedics.

AFAIK unless they changed things over the past few years, the PJ paramedic course is 22 weeks total divided into 4 weeks of EMT-B and 18 weeks of EMT-P. As a result, the paramedic course is actually only 18 weeks long. Now, this may sound like a short time frame but many full time civilian programs themselves only have 15 to 20 weeks of classroom instruction before starting clinical rotations. The big difference, however, is that PJs are only required to complete 6 weeks of clinical rotations (3 field and 3 hospital) while most civilian programs require 12 to 14 weeks of clinical rotations (8 field and 6 hospital). Combine this with the fact that most paramedic programs require 1-2 years of EMT-B experience before starting paramedic school, and you get a huge difference in the quality of graduates.

Now, obviously most PJs only deal with traumatic injuries on a regular basis so their scope of practice is much smaller than the average paramedic. As result, whether or not they need the extra training is a matter of debate. But, then again they are fully certified as an EMT-P so they should be expected to function at the same level. In any event they are very good at what they do (combat search and rescue) and receive great training over the course of 2 years (the famous pipeline).

 

[The Buff OP]

I've got mixed feelings about PJs.

So its not actually the length of classroom training that's the real issue, but the clinical experience requirements prior to being awarded EMT-P certification and being allowed to work independently that's the main difference between PJs and civilian paramedics.

AFAIK unless they changed things over the past few years, the PJ paramedic course is 22 weeks total divided into 4 weeks of EMT-B and 18 weeks of EMT-P. As a result, the paramedic course is actually only 18 weeks long. Now, this may sound like a short time frame but many full time civilian programs themselves only have 15 to 20 weeks of classroom instruction before starting clinical rotations. The big difference, however, is that PJs are only required to complete 6 weeks of clinical rotations (3 field and 3 hospital) while most civilian programs require 12 to 14 weeks of clinical rotations (8 field and 6 hospital). Combine this with the fact that most paramedic programs require 1-2 years of EMT-B experience before starting paramedic school, and you get a huge difference in the quality of graduates.

Now, obviously most PJs only deal with traumatic injuries on a regular basis so their scope of practice is much smaller than the average paramedic. As result, whether or not they need the extra training is a matter of debate. But, then again they are fully certified as an EMT-P so they should be expected to function at the same level. In any event they are very good at what they do (combat search and rescue) and receive great training over the course of 2 years (the famous pipeline).

Thanks for answering.

Do you have any knowledge about the AF pilot physician program?
I have been reading a lot about it. Basically if you are a rated pilot and they let you attend med school, you have to comeback and be flight surgeon/pilot. My question is after the one year flight surgeon duty, can you stop being a pilot and go for a different residency? No worries if you don't have an answer.

 

[alpinism]

Thanks for answering.

Do you have any knowledge about the AF pilot physician program?
I have been reading a lot about it. Basically if you are a rated pilot and they let you attend med school, you have to comeback and be flight surgeon/pilot. My question is after the one year flight surgeon duty, can you stop being a pilot and go for a different residency? No worries if you don't have an answer.

No problem.

Unfortunately I don't know much about the program beyond the fact that it exists for AF pilots.

Maybe try asking on the military medicine forum?

 

[jcorpsmanMD]

How is the EM residency going? Still loving it? Anymore insight or advice for an incoming MS1 former Corpsman interested in EM? I hope you're killing it!

 

[alpinism]

How is the EM residency going? Still loving it? Anymore insight or advice for an incoming MS1 former Corpsman interested in EM? I hope you're killing it!

Thanks!

Feels good to finally be teaching again since all our new interns started. Its very fulfilling teaching emergency procedures (central lines, chest tubes, etc..) to people who have never done one before outside of a sim lab. Still love being in critical care and hate being in fast track. Not sure that will ever change since I went in to medicine and to a larger extent emergency medicine to take care of sick patients.

As far as advice for med students try to get involved with your EM department early on during M1/M2. It really does help to know what specialty you want before M3 for setting up away rotations and applying to residency. If you don't decide till after M3 you'll be at a significant disadvantage compared to other applicants. Things like being active in your school's EMIG, doing research, and shadowing if possible.

 

[popopopop]

Thank you for this thread! It's an exciting time to be an EM doctor for sure.

1. How crucial do you think personality should account for when picking EM? Do I have to be an adrenaline junkie to really thrive?
2. What's your perfect shift like?
3. What's your plan right after residency money/locationwise?

 

[jcorpsmanMD]

Thanks!

Feels good to finally be teaching again since all our new interns started. Its very fulfilling teaching emergency procedures (central lines, chest tubes, etc..) to people who have never done one before outside of a sim lab. Still love being in critical care and hate being in fast track. Not sure that will ever change since I went in to medicine and to a larger extent emergency medicine to take care of sick patients.

As far as advice for med students try to get involved with your EM department early on during M1/M2. It really does help to know what specialty you want before M3 for setting up away rotations and applying to residency. If you don't decide till after M3 you'll be at a significant disadvantage compared to other applicants. Things like being active in your school's EMIG, doing research, and shadowing if possible.

Thanks! I see, are you interested in EM/CC? I see some places are doing dual residency for both now a days, how does it work if you decide to pursue both?

Yes, I plan on getting involved in EM as soon as I start, however I can. As it is sincerely the only specialty that interests me, did you have this problem? Such focus on one specialty since day one? I've always loved the fact that EM seems to be a jack of all trades. I can't imagine being so specialized that whatever my specialty is, that's what I know, and that's about it. But maybe I'm a bit naive? Thanks for answering questions!

 

[alpinism]

Thank you for this thread! It's an exciting time to be an EM doctor for sure.

1. How crucial do you think personality should account for when picking EM? Do I have to be an adrenaline junkie to really thrive?
2. What's your perfect shift like?
3. What's your plan right after residency money/locationwise?

1. Not very crucial. The vast majority of EM isn't very exciting nowadays. I'd say most EM docs aren't really adrenaline junkies and are really just normal people. If I'm being totally honest I'm still surprised how many med students go into EM who don't fit the typical description and prefer quiet shifts with few sick patients. That being said there are still plenty of us who are truly-crazy-try-anything-once adrenaline junkies. We tend to be found more at county programs and less at the academic programs.

2. My perfect shift would be a relentless barrage of crashing patients with reversible pathology (stabbings, gunshots, assaults, overdoses, poisonings, etc...)

3. Planning on going overseas and working with doctors without borders for a few years.

 

[alpinism]

Thanks! I see, are you interested in EM/CC? I see some places are doing dual residency for both now a days, how does it work if you decide to pursue both?

Yes, I plan on getting involved in EM as soon as I start, however I can. As it is sincerely the only specialty that interests me, did you have this problem? Such focus on one specialty since day one? I've always loved the fact that EM seems to be a jack of all trades. I can't imagine being so specialized that whatever my specialty is, that's what I know, and that's about it. But maybe I'm a bit naive? Thanks for answering questions!

Eh I'm not personally.

EM/CC is basically a misnomer since its nothing more than regular EM without all the minor non EM patients that fill up emergency rooms. The problem with EM/CC is that it doesn't really exist outside of a few academic ERs at tertiary hospitals. Even if you could get a job at one you'd still be spending most of your time supervising residents rather than treating your own patients. While I like teaching I also want to keep treating my own patients.

As far as EM then CC (critical care fellowship with the goal of working part time in an ICU) you can certainly go this route after residency. There are a few EM docs who have already finished the CC pathway and now split their time 50/50 between working ER shifts and working ICU shifts. Again while I like critical care patients I only want take care of them in the ER for short periods of time not the ICU for long periods of time.

EM was always at the top of my list but I also seriously considered anesthesia and general surgery during medical school. After rotating through both during 3rd year I vastly preferred EM for a variety of reasons but mostly because both fields aren't very exciting most days and they only see patients after the initial workup and procedures have already been done by EM physicians.