MS2 EM questions

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zurc2014

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Hey guys,

I am very interested in EM and surgery but leaning a lot more toward EM. I have a few questions that concern me. Are there plenty of procedures in the field of EM (since there are a lot of mid levels doing procedures now)? Is research very important for EM? Any advice for an aspire EM doc?

Thanks!

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In my experience as an ER tech, the mid-levels are often put in the "fast-track" or urgent care parts of the ER. I never saw a mid-level do any procedure in the ER (intubation, central line, chest tube, etc). If anything, they did laceration repairs.
 
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In my experience as an ER tech, the mid-levels are often put in the "fast-track" or urgent care parts of the ER. I never saw a mid-level do any procedure in the ER (intubation, central line, chest tube, etc). If anything, they did laceration repairs.
This is how it is in my ER. Not sure if it resembles the situation similar to CRNAs in anesthesia. I really like doing procedures :)
 
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This is how it is in my ER. Not sure if it resembles the situation similar to CRNAs in anesthesia. I really like doing procedures :)

You'll like it a lot less when your procedures are keeping you from seeing a department full of other patients!

The short version: yes, you'll have procedures.

The long version: yes, you'll have procedures, but what you do and how much you do will depend on (a) your department structure, (b) setups like the aforementioned "fast track" where lacerations frequently get done by your MLPs, (c) if you work with residents who again will be doing lacerations and other relatively minor procedures, (d) coverage setup, (e) acuity, etc.

I work in a private group across multiple hospitals of varying but overall high volume and moderate acuity for the larger ones. I tend to do my own lacerations, epistaxis management, I&Ds, and the like only at the smaller facilities just as a matter of practicality. It's not good department management for me to burn my time repairing that leg laceration when I could see three other patients in the time it'd take me to do so if there's someone else available who can do it.

However, your more major procedures -- the emergent cardioversion patients, intubation, if you work somewhere where you do your own central lines frequently (I haven't done one in quite some time because of our ICU setup and a move away from doing so in an ED setting), running codes -- are your domain.

Your sig says you're a UTSW student. You've got a solid residency there, and I have a friend or two who trained there. If you haven't already, I'm sure there would be an attending or two who could help give you an idea of what to expect.
 
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You’ll be fine. Plenty of other things to worry about in EM like finding time to eat and pee.
 
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You'll like it a lot less when your procedures are keeping you from seeing a department full of other patients!

The short version: yes, you'll have procedures.

The long version: yes, you'll have procedures, but what you do and how much you do will depend on (a) your department structure, (b) setups like the aforementioned "fast track" where lacerations frequently get done by your MLPs, (c) if you work with residents who again will be doing lacerations and other relatively minor procedures, (d) coverage setup, (e) acuity, etc.

I work in a private group across multiple hospitals of varying but overall high volume and moderate acuity for the larger ones. I tend to do my own lacerations, epistaxis management, I&Ds, and the like only at the smaller facilities just as a matter of practicality. It's not good department management for me to burn my time repairing that leg laceration when I could see three other patients in the time it'd take me to do so if there's someone else available who can do it.

However, your more major procedures -- the emergent cardioversion patients, intubation, if you work somewhere where you do your own central lines frequently (I haven't done one in quite some time because of our ICU setup and a move away from doing so in an ED setting), running codes -- are your domain.

Your sig says you're a UTSW student. You've got a solid residency there, and I have a friend or two who trained there. If you haven't already, I'm sure there would be an attending or two who could help give you an idea of what to expect.
This was awesome thanks! And I will definitely pick my school faculty brains as well!
 
You'll figure this out more during MS3, but there is a huge difference between EM and Surgery.

You will do procedures in EM, but not like the "operations" you will do if you are a Surgeon.

EM is more about risk stratification, stabilization, and disposition.

I love intubating. I've done 200 or more in my young career (2nd year attending) and I still get an adrenaline rush.
 
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No NP/PA will ever do any critical procedure in an ED setting where I'm working. The goal is to keep patients alive as long as possible. :laugh:

The procedures in EM that matter i.e. intubations, central lines, chest tubes, etc are all yours. Letting someone else do them who isn't residency trained would be malpractice. I've heard of a few shops where the EM attending will "let" the midlevel intubate under supervised conditions, but again, I think that is madness.
 
No NP/PA will ever do any critical procedure in an ED setting where I'm working. The goal is to keep patients alive as long as possible. :laugh:

The procedures in EM that matter i.e. intubations, central lines, chest tubes, etc are all yours. Letting someone else do them who isn't residency trained would be malpractice. I've heard of a few shops where the EM attending will "let" the midlevel intubate under supervised conditions, but again, I think that is madness.
I did my paramedic clinicals in an ED that was run by family docs and OB/GYNs and the respiratory therapist did the (very scary) intubations.
 
No NP/PA will ever do any critical procedure in an ED setting where I'm working. The goal is to keep patients alive as long as possible. :laugh:

The procedures in EM that matter i.e. intubations, central lines, chest tubes, etc are all yours. Letting someone else do them who isn't residency trained would be malpractice. I've heard of a few shops where the EM attending will "let" the midlevel intubate under supervised conditions, but again, I think that is madness.

I've supervised a midlevel intubating before. Then I realized later that this person doesn't even know how to treat otitis media. So that won't be happening again.
 
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Hey guys,

I am very interested in EM and surgery but leaning a lot more toward EM. I have a few questions that concern me. Are there plenty of procedures in the field of EM (since there are a lot of mid levels doing procedures now)? Is research very important for EM? Any advice for an aspire EM doc?

Thanks!

Yes you will do procedures like intubations, Central lines, a lines, LP, chest tubes. You may grow to hate them, as someone else said, in a busy emergency department, you may spend 20-30 minutes in a room doing a procedure and you'll walk out to multiple people not having been seen. Then you get to play catch up.

Research depends on the program. My training program doesnt care, large academic centers care about it.

I'm also a UTSW med school grad, pgy 3 in EM now. Feel free to DM me for more specific questions you may have.
 
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