Trauma Surgery vs Emergency Medicine

[colonial]

Can anyone tell me the difference betwen a Trauma Surgeon and an Emergency Medicine Physician?
Can I know their difference in terms of responsibility, training and which particular program should I enter for the two titles?

---

Members don't see this ad.

 

[Castro Viejo]

It depends on the institution and the politics involved -- particularly the relationship between the two departments (surgery and EM).

I had a lot written on how the two areas of trauma care differ, but after reading what I wrote, I didn't want to give you an inaccurate view of either field. I'll defer this to my seniors (Kim, Dr. Oliver, or womansurg).

EM residency programs vary in length from 3 years to 4 years.

Trauma surgeons do a five-year General Surgery residency and then do a Critical Care/Trauma fellowship for a year.

You can't get the two titles because you can't do two residencies. However there are trauma surgeons (or just plain ol' surgeons) who stake out in the ER full-time, so I guess they can be considered "EM physicians."

 

[fourthyear]

Well, you CAN do both residencies if you really wanted to, but I doubt someone would want to do all that. It is true that you can work in most Emergency Departments after surgical training, since most EM residency programs are relativiely new - so many ED's in this country are staffed by docs from all specialties, not just board certified EM docs. EM programs would like to eventually change this, but right now there is quite a shortage of residency trained EM doctors.

To answer your orignal question, an EM doctor does a lot more medicine, not just surgical work. A surgeon can also handle medical problems, but usually they only work with patients who might need surgery or already had surgery. So in the ER, a EM doc will evauate patients with pneumonia, MI's, strokes, as well as coughs, colds, headaches.

In a trauma situation, both EM and surgery usually work together, but the surgeons usually have primary responsibility for evaluating whether the patient need surgery, putting in any invasive central lines, chest tubes, etc. EM physicians more often control the airway (anesthesia does this in some hospitals too). ER docs get to do some procedures - lines, LP's, minor suturing, sometimes depending on the hospital, but they never get to do acutal surgery in the OR like surgeons do.

I had the big dillemma between EM and surgery. I chose surgery, mostly b/c to me it seemed the surgeons get to do all the cool stuff in trauma. Ok, there's more to it than that. Another HUGE difference I see between the two is that in the ER there is not much long-term follow up. ER docs work shifts, so they never have there own patients they follow up on beyone the shift. Surgeons, on the other hand, take a patient through from the diagnosis to treatment and to follow up care - often seeing the same patient for years (especially in an oncology case) and developing that long-term relationship. Trauma surgeons even have this relationship - if they fix up a gunshot wound, they see the guy in clinic weeks and months later to make sure they are healing well.

Another big difference: surgery is a longer residency with a lot more on-call time and much more demanding hours in general.

 

[Castro Viejo]

Originally posted by fourthyear
Well, you CAN do both residencies if you really wanted to, but I doubt someone would want to do all that.

Oh, really? Tell HCFA that and see whether or not they'll fund your second residency once you become BE or BC.

 

[njbmd]

Originally posted by ******
Oh, really? Tell HCFA that and see whether or not they'll fund your second residency once you become BE or BC.

Hi there,

You can do another residency if you are accepted into the particular residency program. I have a couple of friends who did five years of surgery only to turn around and do internal medicine because they did not like the surgery lifestyle. Both trained at Georgetown.

Many residency programs rather than not filling would gladly accept a fully trained physician among their ranks. The bigger question is why would you want to spend more time at such a low income? Why would you want to spend another two to three years at the under-$40K income level?

One thing that you come to realize (usually about 6 months into your PGY-1 year) is that you have a very short period of time to make a life-changing decision while in your third year of medical school. Most folks can decide if they are a surgeon or non-surgeon. Sometimes the difficulty comes in finding out that you really crave the pace of something like Emergency Medicine after you have finished an Internal Medicine residency or that you love having a long-term relationship with your patients and you have finished something like EM.

Many folks are drawn to a particular residency because of perceived income potential or prestige. This is particularly true of some of the surgical specialties. If you end up learning to love what you do, you have made a good decision. If not, you have a miserable career ahead of you. You may reach a point where you really don't enjoy your prestigous career.

The bottom line is that the answer to the original post about Trauma Surgery vs Emergency Medicine is that Emergency Medicine physicians do not take the trauma patients to the OR and repair the damage. The Trauma Surgeon is first a surgeon and then trained in Trauma/Critical Care. The Emergency Medicine physician(who is trained in critical care) will often be the first to see, resuscitate and attempt to stabilize a critically injured patient but the Trauma Surgeon will ultimately take the patient to the OR and attempt to fix the problem.

If you love the adrenalin rush and then to the OR, Emergency medicine is not going to satisfy your needs. If you like the adrenalin rush and then the hand-off, Emergency Medicine will be your bag. Ultimately, you have to decide if you are a surgeon or a non-surgeon.

njbmd (the surgeon)

 

[droliver]

I thought that Tim Wu was right(?). As I understand it, the feds will not pay for your training in a second specialty & that cost would have to be absorbed by the training program, which they are increasingly loathe to do. Do you know different?

 

[fourthyear]

RPW, i think the salaries are somewhat comparable - like avg around 180-300K/yr. Yes, that's a wide range, b/c it depends on the area, supply and demand issues, etc.

But the big difference is surgeons work many more hours for this pay. In both fields, the more you work, the more you make, but for EM the "standard" hours after residency are about 40/wk (usually 12-18 shifts per month, 10-12 hours/shift) wheras surgery would go more to at least 60+ hours, on the very low end, with many surgeons working more near 90 hrs/wk even after residency.

 

[Iron Horse]

Another factor, if you're concerned with net salary, is your malpractice premium, which can be very costly as we are learning from striking docs.

I believe the range for gen surgeons is about 37K to 170K, depending on the state. I don't know what EM docs can expect.

 

[Apollyon]

Originally posted by ******
Oh, really? Tell HCFA that and see whether or not they'll fund your second residency once you become BE or BC.

If a program wants you, they'll take you. Even if they say they don't take people with prior training, any program may take anyone they want.

I know a guy that did 2 years of categorical surgery (5 yrs HCFA - 2), then a full rads residency (1 unfunded year), then EM (3 years) - for 4 unfunded years total.

There are some nitwits that seem aversive to EVER going into practice, bouncing from residency to residency - someone will ALWAYS pay to scut you around.

 

[Castro Viejo]

As Dr. Oliver stated, programs that take residents who have already trained to BE/BC in another discipline will end up paying for that resident's salary.

I didn't mean to imply that it was IMPOSSIBLE, but that because no one's paying the hospital to hire this guy to re-train, they're not particularly willing to do it. Under certain circumstances, of course, some institutions will and that's probably because of staffing issues and needing an additional scut monkey.

Like some of you, I've known people to train to board eligibility in one discipline only to realize they want to do something different (in medicine) with their lives. They went looking for another position, but faced the issue of being unfunded, or not paid for their work. Some guys did it anyway (those who were independently wealthy) and others went off to smaller, more desperate hospitals and trained there.

 

[Apollyon]

Originally posted by ******
Some guys did it anyway (those who were independently wealthy) and others went off to smaller, more desperate hospitals and trained there.

University program for ophtho (FMG!). Community program for EM (3 residents). University program for EM. University program for surgery (SUNY-Downstate, in fact). Another university program for EM.

Desperation plays a small part, if any. Beneath the surface, the shiny veneer of "one student, one Match, one spot" is very jumbled. The system does not favor US Senior graduates as heavily as it seems at first glance.

A friend mentioned a program with open, unfunded positions for rads this coming year, 3. No takers yet.

I know, it's off topic, but, the numbers are the numbers.

Even so, on topic, yeah, you can do both residencies, but why?

One reason why I love EM is that you have all the fun, and, once you can't screw up any more, you turf the patient.

At Mt. Sinai, surgery seems to spend more time keeping patients OUT of the OR, than IN the OR. All the more for the EP's.

 

[hotbovie]

I started med school thinking I would do emergency medicine. Currently I'm interviewing for general surgery residency slots, and will likely follow that with a trauma fellowship.

So what made me change my mind? First and foremost, I realized that I don't want a career that keeps me out of the OR. Second, when I was thinking about what being an ER physician at a large hosptial would be like, I was thinking mostly of trauma, with a few heart attacks and strokes thrown in. My school has a very active emergency medicine interest group and through my participation in that I learned all the drawbacks of that specialty. Bottom line is I don't have the patience to deal with those. Most notably, most of an ER docs time is spent dealing with minor problems that really aren't emergencies. Patients will come to the ER at 2am on Sat morning with a cough, sore throat, pain in the knee, or some other thing that has been going on for weeks and then they become irate because they have to wait while you deal with the chest pain patients. There is a huge debate among insurance companies (who don't want to pay for an ER visit for a non emergency, and rightly so) vs hospitals, who want to be reimbursed for everything, contending that the lay person can't tell what is and is not an emergency (I say that any idiot should know that a cough of 6 weeks duration is NOT and emergency). Plus ER docs are on a salary, often employees of the hosptial, and can be dismissed if too many patients complain about you (and the complaint could be bogus like you didn't apologize profusely enough to the patient who comes in with the 6 week old cough at 2 am and had to wait 3 hours)

That plus the fact that the trauma surgeon is in charge of the trauma in the trauma bay, as well as the fact that you take them to the OR and fix the problem and manage non operative trauma in the ICU, put me into the trauma camp. It also worked out that I like other kinds of surgery as well. And I like the ICU. So if you are thinking that you may do trauma surgery, realize that much of trauma is non operative, and becoming increasingly more so. Also, the surgey board is looking at changing the ways to shorten the duration of training by going to a 4+2 program..4 years of general surgery and 2 years of some specialty. In the case of trauma, it may turn out to be trauma and emergency surgery and would include the appys, perforated colons, ulcers, etc. This is NOT definite yet and is a considerable source of debate in surgery circles (as well as interesting conversation during interviews)

If you are trying to decide between the two, talk to as many folks in both fields as you can. Also ask yourself the question, "How would I feel if I never got to go to the OR again?" after you do your surgery rotation. That should help you decide.

 

[droliver]

hotbovie,

I don't think trauma/critical care is one of those considering an abbreviated training program. In fact, the ideal training is a constant subject for discussion in academic trauma. There is a real good editorial that is coming out in the Journal of Trauma by J. David Richardson & Frank Miller that discusses this at length.