Why do they hate us?

[Armymed2015]

I am an intern in a well respected residency program. Everywhere I go in my hospital every single other specialty acts as if we are lazy,make terrible medical decisions, and are actively hurting our patients prior to when they come in and save the patient from us.
Is this unique to my hospital? Is this because I'm admitting to residents and making their lives harder? Will my relationship with my non-er colleagues get better when I am out in the real world?

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[The White Coat Investor]

No. Yes. Yes.

That and they're jealous that I have three vacations this month.

 

[HoosierdaddyO]

They hate us cuz they ain't us

 

[pulmoblast]

In the real world these same specialists will be begging you for referrals...and sending you Christmas cards...

 

[RustedFox]

They hate us cuz they ain't us

I hate you for beating me to this reply.

 

[HoosierdaddyO]

I hate you for beating me to this reply.

Hahah ya snooze ya lose

 

[medicsb]

This occurs everywhere in academics from what I have gathered. I do not know how it is in the community, but I imagine its a little better (interested in the thoughts of attendings working in the community setting).

The EM hate sort of makes sense since we do provide our colleagues in training with more work. They're also new to this and what could be easy to admit or work-up for an attending will take the medicine or surgery intern more time to think through, and then they have to pass it by an attending (and maybe a senior resident, too), which of course comes with the potential to be berated over some small, minor detail. What could take the experienced attending 20 minutes (or much less) could take the intern 2-3 times that (or much more), and during that time calls from floor keep happening, other admissions are called in, and maybe a rapid response to attend just to spice things up.

We also don't work up patients like other services. Our care ultimately leads to admit or discharge, which is probably one of the decisions with the greatest liability, so sometimes we're more quick to admit certain patients (e.g. chest pain in anyone over a certain age) or to run certain tests (e.g. CTA for PE). Of course, the decision to admit or discharge doesn't need a definitive diagnosis, and the decision rarely requires the work-up a patient would need for a diagnosis of their problem, but they'll bitch that we didn't nail the diagnosis based on 3 hours in the department even though it took them 3 days and a couple consults to get the diagnosis themselves. They do not realize how much work we take off of them. Feel free to let them know how it used to work before EM was a specialty; remind them how they could be getting calls at home to come to the actual emergency ROOM to work the patient up themselves (though that era was before a lot of the attendings, even older ones), or how their patient could go to an "ER" and be cared for only by an intern (likely with NO oversight and little if any back-up), or worse, only a nurse until you or one of your colleagues got there. (Of course, it'd suck more to be a patient without a primary, waiting for the nurse to call around to find a doctor to see you. Or, having to wait for ortho to finish in the OR to come down to reduce your shoulder, and meanwhile the patient next to you is peri-arrest from respiratory failure because the medicine doc doesn't intubate and anesthesia is busy in the OR with the orthopedist.)

Anyhow, what it comes down to is that they'll bitch and moan about us and go on about how we're incompetent, but they literally could not imagine a world where we didn't exist and if they imagine a world, it's NOT what it was actually like when it was just them because it was actually much much much worse.

 

[filhodeinferno]

I am an intern in a well respected residency program. Everywhere I go in my hospital every single other specialty acts as if we are lazy,make terrible medical decisions, and are actively hurting our patients prior to when they come in and save the patient from us.
Is this unique to my hospital? Is this because I'm admitting to residents and making their lives harder? Will my relationship with my non-er colleagues get better when I am out in the real world?

I doubt there is a place in the academic world where this kind of hate doesn't exist. One common attribute I've noticed in the biggest haters is a dissatisfaction with their own job and a serious lack of understanding of the role of the ED in the care of a patient.

The criticism used to bother me a lot, but now I just find it entertaining because haters gonna hate.

 

[winkleweizen]

Don't sweat it, it's everywhere. They always have the benefit of 20/20 hindsight. We admit them a patient and 5% of the time we are wrong about the diagnosis, they'll always remember that 5% but they'll never remember the 95 percent we get right or the80% we send home.

 

[gutonc]

As a resident, I hated you because you made more work for me. As an an attending in the community setting, I love you because you keep me from having to come in in the middle of the night and you send me new consults that help me make the boat payment.

Suck it up for a few years and reap the rewards on the back end.

 

[deltamed]

So silly - seems like in academic environments every specialty likes to bash on other specialties. Saw the same thing when I was going into dermatology got many many comments on rotations. Usually these things are either not understanding what other specialties actually do or the "I work more hours" dick measuring contests.

 

[emergentmd]

Hahahah... get a thick skin. Everyone in residency hates each other. I have seen it, been there, done that.

IM hates ER b/c we create work.
IM hates all surgical subspecialties b/c they think everyone should be able to manage diabetes. They are right, everyone should but why when they have scuts like IM to deal with it including social issues.
Rads Hates ER/IM/Surg/everyone b/c they think everyone over orders stuff and thinks physical exams should exclude any need for any imagining

Fast forward to attending status and everyone loves me.

Ortho loves me b/c they Never come to the ED. I cant think of the last time they came in to reduce something b/c I do it all for them
CT surg loves me b/c I put in their chest tubes
Rads love me b/c I keep them busy
IM loves me b/c I feed their kids with work
OB loves me b/c I deal with all of their consults b/c they can't deal with anything other than babies
ALL other specialties loves me b/c they can dump their patients in the ED at 5pm and know they will be well cared for.

I love all specialists b/c they keep the ED busy so I can make alot of $$$$$.

 

[deleted547339]

It gets better even in residency. I'm at a major academic university. We have a strong medicine, surgery and EM department.

As you go through, you start to know everyone. The senior residents on other services know me. They've worked with me for the past 3 years. I've earned their trust and respect. And an intern isn't going to say anything to me.

 

[gro2001]

I am an intern in a well respected residency program. Everywhere I go in my hospital every single other specialty acts as if we are lazy,make terrible medical decisions, and are actively hurting our patients prior to when they come in and save the patient from us.
Is this unique to my hospital? Is this because I'm admitting to residents and making their lives harder? Will my relationship with my non-er colleagues get better when I am out in the real world?

I would add is that it not only gets better as your colleagues learn more (about their specialty, about your specialty, about life in general) and move up the totem pole but also as YOU learn more. Interns in all specialties, including EM, just don't know a lot of things. And how could they? One of the key things is learning to speak the other services' languages. So when an EM intern calls another service's intern to admit (or PGY2 resident on consults for the first time), and is trying to explain the reasoning for admitting/consulting, it's a stressful interaction for both people. The EM intern generally does a poor job explaining things using the other service's language and at their level of understanding, and the other service's intern generally does not know what he should be asking or concerned with or what is a reasonable criticism. It's a completely different conversation once both of those people (or really at least one of them) get some experience under their belt. You will learn what information each of your consults needs to hear and will have that info ready, and in turn they will learn what they can expect from you and will respect you for it. And it happens faster than you think.

 

[EskimoFriend13]

As an intern, I'm glad to hear that. Right now I feel like an idiot when I'm on the phone. I stumble over presentations (which is not a problem for me in person) and find myself mixing up patients with similar complaints when answering questions.
As far as haters, I expected that to some degree. This early in the game, it's hard to know if an off-service attending's complaints about the ED are valid or not. So if any non-EM attendings read this, we do these off-service rotations to learn from you. It doesn't bother me if you're bashing my specialty, but at least tell me what you would do different and why. Regardless of whether you're right or wrong, if you don't explain your rationale, I can't learn from it.

 

[WilcoWorld]

I try to always take criticism as an opportunity to learn, but, if after careful reflection, the criticism seems unfounded, then it should be dismissed.

One thing that should be kept in mind when an off-service resident or attending criticizes ED management is that they are not Emergency Physicians. If they make a good point, thank them and learn from it. But far more often, their criticism is just a demonstration of their ignorance of how EM should be practiced. If I were to start criticizing a spine surgeon's choice of approach to the cervical column, should my criticisms be taken seriously? No, because I'm not a spine surgeon. So, when a surgery attending (or a surgery PGY-2) criticizes my approach to working up some vague, poly-system complaint in a patient who doesn't want to participate in the H&P, I listen carefully, realize that they're out of their element in the ED and thank them for seeing the patient. After that I go take care of the pediatric fever, the seizure, and the pregnant patient with abdominal pain - all of whom they are afraid to even look at.

 

[erdoc00]

In the real world these same specialists will be begging you for referrals...and sending you Christmas cards...

I have never found this to be the case. I remember being told this as a resident but my experience has been the specialists and hospitalists are just as lazy and bitch about every call they get from the ER.

 

[deleted245139]

I always take a min to reflect on the following:
1. did the specialist see the patient in their office that day, notice something worrisome, then panic and sent them to the ED? Yep...
2. Can the cardiologist deliver a baby? Can the dermatologist reduce that dislocation? Can X specialist fix Y problem?

We are the best at every specialties worst problems, then once stabilized, we hand them back.

No one is clamoring for the dermatologist in an emergency.
I actually wear this as a a badge of pride. They can criticize all they want

 

[gman33]

I know work in a large community center.
Pretty much everything gets admitted to a hospitalist.

Surgery and other consultants are generally very nice.
They are glad I am seeing their patients in the middle of the night (and never calling them unless absolutely needed).

 

[EctopicFetus]

Ive been out for 6+ years. Hospitalists are nice, easy to admit. I am honest with them when I have a garbage admission. They get it. I dont sugar coat it. They respect that. Im not trying to sell some social admission as something else. I do a solid job on the admits and try to dc the ones that I can. The specialists are all nice too. Last gig only urology was terrible, here all of them are nice.

 

[gman33]

Urology.
Generally they think everyone can go home.
I just preface my conversation with the statement, I've already admitted them to medicine, can you see them tomorrow morning?

 

[deltamed]

I always take a min to reflect on the following:
1. did the specialist see the patient in their office that day, notice something worrisome, then panic and sent them to the ED? Yep...
2. Can the cardiologist deliver a baby? Can the dermatologist reduce that dislocation? Can X specialist fix Y problem?

We are the best at every specialties worst problems, then once stabilized, we hand them back.

No one is clamoring for the dermatologist in an emergency.
I actually wear this as a a badge of pride. They can criticize all they want

Like I said -every specialty bashes others for no good reason. I rarely ever go to the ED (derm) but once when I went in to consult for rule-out SJS the EM physician went on a tirade about lazy dermatologists and how he was floored by "ever seeing one in the hospital." I was like.... Um, you guys called me and I'm here....

Just sayin - there are a-holes in every specialty.

 

[gro2001]

Like I said -every specialty bashes others for no good reason. I rarely ever go to the ED (derm) but once when I went in to consult for rule-out SJS the EM physician went on a tirade about lazy dermatologists and how he was floored by "ever seeing one in the hospital." I was like.... Um, you guys called me and I'm here....

Just sayin - there are a-holes in every specialty.

People bashing other specialties is a sign of any combination of the following:

1) Not understanding the role of the specialty they are bashing
2) Not understanding the role of their own specialty
3) Jealousy
4) Caffeine deficiency

 

[Birdstrike]

Everybody hates everybody in residency. Everybody is stressed, miserable and overworked. It doesn't mean anything. ---- it. Who cares. It's basically stupid high school crap. You'll be out of there soon and into the real world where things are much less petty and focused on just getting work done and you'll actually get paid for being there. I don't even think about this stuff anymore. In fact, I forgot how petty and ridiculous people can be in residency and academic nest-like environments, attendings included.

 

[pulmoblast]

ACADEMIC MEDICINE

DEPARTMENT CHAIR TO INTERN

 

[jdh71]

Hahahah... get a thick skin. Everyone in residency hates each other. I have seen it, been there, done that.

IM hates ER b/c we create work.
IM hates all surgical subspecialties b/c they think everyone should be able to manage diabetes. They are right, everyone should but why when they have scuts like IM to deal with it including social issues.
Rads Hates ER/IM/Surg/everyone b/c they think everyone over orders stuff and thinks physical exams should exclude any need for any imagining

Fast forward to attending status and everyone loves me.

Ortho loves me b/c they Never come to the ED. I cant think of the last time they came in to reduce something b/c I do it all for them
CT surg loves me b/c I put in their chest tubes
Rads love me b/c I keep them busy
IM loves me b/c I feed their kids with work
OB loves me b/c I deal with all of their consults b/c they can't deal with anything other than babies
ALL other specialties loves me b/c they can dump their patients in the ED at 5pm and know they will be well cared for.

I love all specialists b/c they keep the ED busy so I can make alot of $$$$$.

5pm? If my schedule is full. I don't care if it's 9am. The "I'm having trouble breathing" patient call get directed to the ED and thank you very much.

The other nice thing about my colleagues where I work as long as I promise to see a patient soon in the out patient setting (and I always keep that promise) I almost never have a consult in the ED.

My favorite part though is conspiring with my ED friends on the best way to turf a patient to the hospitalist.

 

[gro2001]

5pm? If my schedule is full. I don't care if it's 9am. The "I'm having trouble breathing" patient call get directed to the ED and thank you very much.

I don't get ER docs who complain about getting clinic patients sent to the ER, whether it be because they said "trouble breathing" on the phone to the PMD, or its 5PM, or the clinic doc thinks they need an emergent imaging study or whatever. It's sort of why we are there in the first place. Not to say that sometimes you have to say no to the imaging or shrug and say you can't really add anything to the care of the patient over what the outpatient specialist already did. But you can't complain about being sent clinic patients to your ER, and then also complain about consults not wanting to see patients or admitting teams not wanting to admit... they are sort of the same thing.

 

[deleted547339]

I don't get ER docs who complain about getting clinic patients sent to the ER, whether it be because they said "trouble breathing" on the phone to the PMD, or its 5PM, or the clinic doc thinks they need an emergent imaging study or whatever. It's sort of why we are there in the first place. Not to say that sometimes you have to say no to the imaging or shrug and say you can't really add anything to the care of the patient over what the outpatient specialist already did. But you can't complain about being sent clinic patients to your ER, and then also complain about consults not wanting to see patients or admitting teams not wanting to admit... they are sort of the same thing.

I get frustrated when it's a non-emergent issue. PCP has a patient that they're concerned has an appy, fx, whatever and needs a study? Great. Patient is SOB or having CP? Send em!

 

[gro2001]

I get frustrated when it's a non-emergent issue. PCP has a patient that they're concerned has an appy, fx, whatever and needs a study? Great. Patient is SOB or having CP? Send em!

But the non emergent BS helps keep the lights on in a big way. If only patients who came to the ER were ones with truly emergent conditions, most ED volumes would be a fraction of what they are now. That may sound like a good thing at first glance, but that would mean we wouldn't have nearly the job market or income we do now. Nor would we get so many toys to play with.

 

[Siggy]

I get frustrated when it's a non-emergent issue. PCP has a patient that they're concerned has an appy, fx, whatever and needs a study? Great. Patient is SOB or having CP? Send em!

Strange... the inpatient team feels the same way when it's the 13th soft admission in a row.

I only get upset at the ED when I'm coding the ED's DKA patient in the VQ scanner because PE just had to be ruled out.

 

[Daiphon]

I only get upset at the ED when I'm coding the ED's DKA patient in the VQ scanner because PE just had to be ruled out.

F that. If I'm that concerned, they get anticoagulated & the inpatient docs can worry about PE once the metabolic disaster is fixed... or bedside EUS for septal bowing/RV dilation & decide on that.

Anything that stops a unit patient in transit is a code waiting to happen.

-d

 

[emergentmd]

I don't get ER docs who complain about getting clinic patients sent to the ER, whether it be because they said "trouble breathing" on the phone to the PMD, or its 5PM, or the clinic doc thinks they need an emergent imaging study or whatever. It's sort of why we are there in the first place. Not to say that sometimes you have to say no to the imaging or shrug and say you can't really add anything to the care of the patient over what the outpatient specialist already did. But you can't complain about being sent clinic patients to your ER, and then also complain about consults not wanting to see patients or admitting teams not wanting to admit... they are sort of the same thing.

I have been with a private group, a CMG, been a director, been in hospital committees for the past 10 yrs. One thing that I have learned is some people (doctors included) are just not happy people. What astounds me is how a doc who is making 3-400K a year can be so unhappy.

When I was with a private group, we essentially eat what we killed. So the more pts, the more you see, the more you make.

- When we were short staffed and everyone worked 1-2 more days a month, docs continued to complain why we were working so much but never when their BIG check came
- When we were overstaffed and ED slow, docs complained why it was so slow and complained why their Checks were so low.... DUH

Some complained no matter the situation..... I just smiled and say we are working on it. But in truth, we were not working on anything, just to let them vent and shut up.

When a pt is sent from the Office I hear - Why don't they just admit them. I see Easy $$$$. Level 4 or 5, takes me 5 min to talk, order labs, and call the admitting team.
When a pt is sent from the office to be Ruled out for something I hear - They are just dumping on the ED. I see Easy $$$. Level 3-4, takes me 5 min and I order labs
Don't these Docs realize that its easy $$$, insured patients, and keeps the Volume High?

Without these easy admissions, easy referrals, easy work ups our insured pts would drop like a rock. Complain enough and these docs will send it down to the competing hospital.

I hear complaints about why pts with minor stuff are coming to the ED. Well guess what doc, if you had it your way, my day would be stuck dealing with complicated pts all day long. I would be in a single coverage ED, still seeing 2 pts an hr but now have no easy cases to deal with. If this was the case, No doc would take this job.

Complainers..... Step back. See how good you have it. See how these easy pts have essentially made you a very rare commodity, made you alot of $$$, made your job so much easier.

Guys, We have it good. Ride the good times b/c it will not last forever.

 

[gro2001]

When a pt is sent from the Office I hear - Why don't they just admit them. I see Easy $$$$. Level 4 or 5, takes me 5 min to talk, order labs, and call the admitting team.
When a pt is sent from the office to be Ruled out for something I hear - They are just dumping on the ED. I see Easy $$$. Level 3-4, takes me 5 min and I order labs
Don't these Docs realize that its easy $$$, insured patients, and keeps the Volume High?

Also just doing something that another doc is worried about or helping them out, helps build relationships that will help you down the road. Today that doc sends his patient asking for some tests I don't agree are necessary but aren't dangerous. I do them, call him back, chat about it, he is happy. Especially if this happens a couple of times, we've now built a friendly, professional relationship and he will probably not give me crap for another soft admission, or will actually come to the ER when I really need him to.

To bring it back to the OP's question, this works in residency too. I know the temptation is there to chew out other services sometimes in a very self righteous way about abusing the ER, or for asking for inappropriate stuff... but if you just help them out they tend to remember it, and help you out in return when you need them to.

 

[jdh71]

I get frustrated when it's a non-emergent issue. PCP has a patient that they're concerned has an appy, fx, whatever and needs a study? Great. Patient is SOB or having CP? Send em!

Ha! One good turn deserves another does it not? How many times last month did you admit a gomer who really wasn't THAT sick but really just couldn't go home. Social admit? Failure to ambulate enough? Lol.

 

[jdh71]

Also just doing something that another doc is worried about or helping them out, helps build relationships that will help you down the road. Today that doc sends his patient asking for some tests I don't agree are necessary but aren't dangerous. I do them, call him back, chat about it, he is happy. Especially if this happens a couple of times, we've now built a friendly, professional relationship and he will probably not give me crap for another soft admission, or will actually come to the ER when I really need him to.

To bring it back to the OP's question, this works in residency too. I know the temptation is there to chew out other services sometimes in a very self righteous way about abusing the ER, or for asking for inappropriate stuff... but if you just help them out they tend to remember it, and help you out in return when you need them to.

Yup. Sometimes the work up I need really has to be done in the ED to expedite the decision tree - in these cases I'll have the patient tell the ED to page me and I let them know what I'm concerned about and how they can help. Sometimes I just need a doc I can trust to lay eyes and be like "oh no my friend you're coming in!" Or "we ruled out all the scary stuff and you can go home! Call dr jdh tomorrow and he says he'll get you worked in soon"

 

[erdoc00]

I have been with a private group, a CMG, been a director, been in hospital committees for the past 10 yrs. One thing that I have learned is some people (doctors included) are just not happy people. What astounds me is how a doc who is making 3-400K a year can be so unhappy.

When I was with a private group, we essentially eat what we killed. So the more pts, the more you see, the more you make.

- When we were short staffed and everyone worked 1-2 more days a month, docs continued to complain why we were working so much but never when their BIG check came
- When we were overstaffed and ED slow, docs complained why it was so slow and complained why their Checks were so low.... DUH

Some complained no matter the situation..... I just smiled and say we are working on it. But in truth, we were not working on anything, just to let them vent and shut up.

When a pt is sent from the Office I hear - Why don't they just admit them. I see Easy $$$$. Level 4 or 5, takes me 5 min to talk, order labs, and call the admitting team.
When a pt is sent from the office to be Ruled out for something I hear - They are just dumping on the ED. I see Easy $$$. Level 3-4, takes me 5 min and I order labs
Don't these Docs realize that its easy $$$, insured patients, and keeps the Volume High?

Without these easy admissions, easy referrals, easy work ups our insured pts would drop like a rock. Complain enough and these docs will send it down to the competing hospital.

I hear complaints about why pts with minor stuff are coming to the ED. Well guess what doc, if you had it your way, my day would be stuck dealing with complicated pts all day long. I would be in a single coverage ED, still seeing 2 pts an hr but now have no easy cases to deal with. If this was the case, No doc would take this job.

Complainers..... Step back. See how good you have it. See how these easy pts have essentially made you a very rare commodity, made you alot of $$$, made your job so much easier.

Guys, We have it good. Ride the good times b/c it will not last forever.

We train to be resuscitation specialists and then spend our days taking care of the worried, well-off well in community ERs where unobtainable and often oppositional metrics are forced onto us. I have no idea why people would be unhappy in such a setting. It should be a privilege that CMGS allow us to make them so much money while seeing 2-3pph working nights, weekends, and holidays and not being able to eat, drink, or go to the bathroom during a 12 hour shift.

The business of medicine has destroyed the foundation of health care in this country. Coupled with the ridiculous malpractice environment, its no surprise that we're all watching this system crumble. The ER just happens to be ground zero for this disaster.

Every dumb ER referral, useless admission, unnecessary procedure, and having to pander to unreasonable patients is a result of this ridiculous system we work in. If you can't see why people might be burned out by this, then youre probably in denial while making money off the backs of your colleagues or have an enviable level of optimism.

 

[GeneralVeers]

We train to be resuscitation specialists and then spend our days taking care of the worried, well-off well in community ERs where unobtainable and often oppositional metrics are forced onto us. I have no idea why people would be unhappy in such a setting. It should be a privilege that CMGS allow us to make them so much money while seeing 2-3pph working nights, weekends, and holidays and not being able to eat, drink, or go to the bathroom during a 12 hour shift.

The business of medicine has destroyed the foundation of health care in this country. Coupled with the ridiculous malpractice environment, its no surprise that we're all watching this system crumble. The ER just happens to be ground zero for this disaster.

Every dumb ER referral, useless admission, unnecessary procedure, and having to pander to unreasonable patients is a result of this ridiculous system we work in. If you can't see why people might be burned out by this, then youre probably in denial while making money off the backs of your colleagues or have an enviable level of optimism.

Once you separate your emotions from all the "dumb metrics" and ridiculous patient complaints, you will attain inner peace. If you treat it as a job, and not your life you will be happier. I've become MUCH happier once I realized this. Just had the hospitalist on my shift tonight admit a chronic pain, drug-seeking crazy lady after she flagged him down (I told her I was going to discharge her). Do I argue and put a block on the admission? Nope, I just said "Thank you very much for seeing her" to the hospitalist, admitted the patient to him and moved on. The very large checks I get every month also help ease the pain. Additionally, I recommend frequent vacations every 2-3 months or so. Laying on a beach at a 5-star resort certainly helps ease the pyschological discomfort caused by our moral dilemmas, and ethical quandries that are forced on us.

 

[emergentmd]

We train to be resuscitation specialists and then spend our days taking care of the worried, well-off well in community ERs where unobtainable and often oppositional metrics are forced onto us. I have no idea why people would be unhappy in such a setting. It should be a privilege that CMGS allow us to make them so much money while seeing 2-3pph working nights, weekends, and holidays and not being able to eat, drink, or go to the bathroom during a 12 hour shift.

The business of medicine has destroyed the foundation of health care in this country. Coupled with the ridiculous malpractice environment, its no surprise that we're all watching this system crumble. The ER just happens to be ground zero for this disaster.

Every dumb ER referral, useless admission, unnecessary procedure, and having to pander to unreasonable patients is a result of this ridiculous system we work in. If you can't see why people might be burned out by this, then youre probably in denial while making money off the backs of your colleagues or have an enviable level of optimism.

Again, There are some people in this world that will never be happy. Every job in every field have their issues. You can dissect it and have a similar statement for almost any job. The people who are happy are the ones who can look at the good and deal with the bad in their jobs. I feel I am one of them. I am sure I can do most jobs and still be happy otherwise you will be miserable. But at the end of the day, they call a job work for a reason. I work to make money, so I can enjoy my life outside work.

I try to look at the good side of issues, some look at the bad sides. Even if I had a day full of drug seekers, drunks, silly transfers.... at the end of my 8-9 hr dy, I am still making 4-500K a year enjoying the fruits of my work. If I had a day full of critical patients, CPRs, intubations, central lines, Critical thinking, Crashing patients..... at the end of my 8-9 hr day, I am still making 4-500k a year. In truth, I would rather be paid for seeking drug seekers, drunks, silly transfers than a stressful day dealing with 8 crash rooms at once. I think even you would chose the former.

Again, I am sure there are unhappy surgeons who thought their lives would be filled with exciting/life threatening cases but realize its full of gallbladders, biopsies, Wound care, and follow ups in clinic.

EM medicine has their issues, but I would say 99.9% of this world would gladly be in our shoes.

 

[gro2001]

We train to be resuscitation specialists and then spend our days taking care of the worried, well-off well in community ERs where unobtainable and often oppositional metrics are forced onto us.

I think this kind of thinking leads to a lot of unhappiness, starting very early in EM residency. I used to totally buy into the mythos of EM being the specialty that's there to see the sick and the rest be damned. I wanted to be the resuscitationist cowboy, intubating every trachea and cracking every chest. But that's not the reality of EM, and it never was. It's just a story that we were told as medical students to impress us, before we had the maturity to realize why EM was really awesome.

In reality, we are there to deal with whatever happens. Not in the heroic, "special forces of medicine" way, but not in the "I am the hospital's $200/hr bitch" way either. Someone needs to deal with the patients that JUST SHOW UP. Someone needs to deal with them if they are very sick. Someone needs to deal with them if they are worried that they are sick. Someone definitely needs to deal with them if they are drunk or are drug seeking. Someone needs to deal with them if they are the administrator's mother in law. Someone needs to deal with them if they need an LP. Someone needs to deal with them if they are a blue baby. Someone needs to deal with them if they are sent in by some community doc asking for a second opinion. Someone needs to deal with them if they don't have a doc.

The reason we have jobs is because we've proven that we can deal with ALL of those things, and do it efficiently and courteously 24/7/365. If we don't deal with ALL of it, we are out of a job. If the only part of our job that mattered was taking care of the critically ill, they'd just put the intensivist or the trauma surgeon in the ER. But they don't. Because ALL of it is important, every little bit.

 

[Psai]

I think this kind of thinking leads to a lot of unhappiness, starting very early in EM residency. I used to totally buy into the mythos of EM being the specialty that's there to see the sick and the rest be damned. I wanted to be the resuscitationist cowboy, intubating every trachea and cracking every chest. But that's not the reality of EM, and it never was. It's just a story that we were told as medical students to impress us, before we had the maturity to realize why EM was really awesome.

In reality, we are there to deal with whatever happens. Not in the heroic, "special forces of medicine" way, but not in the "I am the hospital's $200/hr bitch" way either. Someone needs to deal with the patients that JUST SHOW UP. Someone needs to deal with them if they are very sick. Someone needs to deal with them if they are worried that they are sick. Someone definitely needs to deal with them if they are drunk or are drug seeking. Someone needs to deal with them if they are the administrator's mother in law. Someone needs to deal with them if they need an LP. Someone needs to deal with them if they are a blue baby. Someone needs to deal with them if they are sent in by some community doc asking for a second opinion. Someone needs to deal with them if they don't have a doc.

The reason we have jobs is because we've proven that we can deal with ALL of those things, and do it efficiently and courteously 24/7/365. If we don't deal with ALL of it, we are out of a job. If the only part of our job that mattered was taking care of the critically ill, they'd just put the intensivist or the trauma surgeon in the ER. But they don't. Because ALL of it is important, every little bit.

Very interesting perspective.