Why is it that people don't want to go in to Emergency Medicine?

[bretonnia]

Burnout and the hours (holidays, weekends, etc.) can be tough when you have a family/kids.

EDIT: There's obviously tons more reasons, but these are the two that turn me off a little from the field.

http://www.medscape.com/features/slideshow/lifestyle/2013/public#2 if you look at the first chart in the slide, it shows EM is at the top with over 50% burnout. This is smiliar to another chart i saw in another thread a couple weeks ago.

My brother is an ER doc and his experience has been completely opposite of what you described. In fact, a big reason why he chose ER was because of the hours and family friendliness of the profession. He works 4 days on, 6 days off, 10 or 11 hour shifts, and is never on call--if he chooses to cover when he's not scheduled, he gets a $1000 bonus from the group. In fact, he's picking up a part time gig at a local urgent care for his days off. He rarely works more than 15 shifts per month (usually 11 or 12). Half of the time I call him, he's at home playing with his kids.

I would imagine the turn off for people is that it pays relatively less compared to many specialties. Granted, it's not bad money -- I think he pulled in around 300K last year -- but low compared to orthopedic surgeons, cardiologists, anesthesiologists, etc. I would imagine another turn off is the hours. My brother works a rotating schedule of 6am - 3pm, 11am - 8pm, 3pm - 11pm, 8pm - 6am.

I guess prestige is probably lower than other specialties too.

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[Gauss44]

My brother is an ER doc and his experience has been completely opposite of what you described. In fact, a big reason why he chose ER was because of the hours and family friendliness of the profession. He works 4 days on, 6 days off, 10 or 11 hour shifts, and is never on call--if he chooses to cover when he's not scheduled, he gets a $1000 bonus from the group. In fact, he's picking up a part time gig at a local urgent care for his days off. He rarely works more than 15 shifts per month (usually 11 or 12). Half of the time I call him, he's at home playing with his kids.

I would imagine the turn off for people is that it pays relatively less compared to many specialties. Granted, it's not bad money -- I think he pulled in around 300K last year -- but low compared to orthopedic surgeons, cardiologists, anesthesiologists, etc. I would imagine another turn off is the hours. My brother works a rotating schedule of 6am - 3pm, 11am - 8pm, 3pm - 11pm, 8pm - 6am.

I guess prestige is probably lower than other specialties too.

Where roughly does he work? Urban? New England?
How many years roughly? 0-5? 10+?

This sounds exactly like what I want to do. And I haven't said that about anything else.

 

[LovelyBRass]

A little late to reply but I "had" to go to the ER because it was 4 in the morning and I needed stitches. Sure it wasn't life or death but I wasn't about to wait 5 hours for my PCP office to open up and try and get an appt.

Plus ER docs have to realize that dealing with non emergency situations is part of the job. I can't think of any job where you don't have to deal with trivial and menial work.

well but that's actually a real thing... you go to the ED for stitches, you don't wait around so your lac can get infected. in fact, we have "immediate care" here and "fast track" which are specifically meant for things like this. plus idk what PCP has a suture kit in their office that they know how to use but i'd love to see it

 

[thesauce]

EM is at the top of my big 3 (EM, crit care, trauma). I like the variability, pace, high acuity patients, and no on-call.

Then scratch ER off your list. There are rarely any emergencies in Emergency Medicine.

 

[Pons Asinorum]

Then scratch ER off your list. There are rarely any emergencies in Emergency Medicine.

Says the Rad Onc resident. Just saying.

 

[thesauce]

Says the Rad Onc resident. Just saying.

Enter the med student to tell us how it really is...

 

[Pons Asinorum]

Enter the med student to tell us how it really is...

I set my watch to countdown from "appeal to authority" and you just beat it, champ.

 

[JBOB]

Then scratch ER off your list. There are rarely any emergencies in Emergency Medicine.

So... where do people with real emergencies go?

 

[DrBowtie]

So... where do people with real emergencies go?

Straight to the OR/Cath lab

 

[circulus vitios]

My brother is an ER doc and his experience has been completely opposite of what you described. In fact, a big reason why he chose ER was because of the hours and family friendliness of the profession. He works 4 days on, 6 days off, 10 or 11 hour shifts, and is never on call--if he chooses to cover when he's not scheduled, he gets a $1000 bonus from the group. In fact, he's picking up a part time gig at a local urgent care for his days off. He rarely works more than 15 shifts per month (usually 11 or 12). Half of the time I call him, he's at home playing with his kids.

I would imagine the turn off for people is that it pays relatively less compared to many specialties. Granted, it's not bad money -- I think he pulled in around 300K last year -- but low compared to orthopedic surgeons, cardiologists, anesthesiologists, etc. I would imagine another turn off is the hours. My brother works a rotating schedule of 6am - 3pm, 11am - 8pm, 3pm - 11pm, 8pm - 6am.

I guess prestige is probably lower than other specialties too.

$300k/yr for 120 hours of work per month.

 

[sinombre]

So... where do people with real emergencies go?

lol... patients with emergencies still go to the ER, but the majority of patients don't have emergencies. My favorite chief complaint of all time: hang nail.

 

[thesauce]

I set my watch to countdown from "appeal to authority" and you just beat it, champ.

You must be psychic. No one else could have predicted you'd have gotten that response.

 

[thesauce]

So... where do people with real emergencies go?

They go to the ER alongside the 50 other people without an emergency. For very serious issues, they go to the trauma bay/OR or off to the ICU.

 

[Pons Asinorum]

You must be psychic. No one else could have predicted you'd have gotten that response.

All is proceeding as I predicted. No doubt.

 

[JBOB]

They go to the ER alongside the 50 other people without an emergency. For very serious issues, they go to the trauma bay/OR or off to the ICU.

Sure, but if 1 in 50 cases an ER doc sees is an emergency, that's a lot more emergencies than most other specialties see, except maybe trauma surgery. Isn't a big part of the ER physician's job figuring out which cases are and which cases are not emergency situations?

 

[sinombre]

Sure, but if 1 in 50 cases an ER doc sees is an emergency, that's a lot more emergencies than most other specialties see, except maybe trauma surgery. Isn't a big part of the ER physician's job figuring out which cases are and which cases are not emergency situations?

Yeah, but you'll never be saturated with emergencies. Unless you work in a war zone, or a cath lab in the south.

 

[medic86]

They go to the ER alongside the 50 other people without an emergency. For very serious issues, they go to the trauma bay/OR or off to the ICU.

I've never seen anyone admitted to an ICU without a visit to the ER.

 

[KinesiologyNerd]

Then scratch ER off your list. There are rarely any emergencies in Emergency Medicine.

I disagree. We're on the other side of town from the knife and gun club, but we get enough arrests/traumas/STEMIs/assorted other stuff to keep it interesting. Also, the docs' schedule is pretty slick. That makes up for a lot in my book.

 

[thesauce]

Sure, but if 1 in 50 cases an ER doc sees is an emergency, that's a lot more emergencies than most other specialties see, except maybe trauma surgery. Isn't a big part of the ER physician's job figuring out which cases are and which cases are not emergency situations?

Absolutely, but the emergencies are still rare. The ERs that I've worked in were essentially fast-paced primary care clinics. Compared to things like ICU and trauma surgery, the job itself is not what I'd describe as high acuity.

 

[thesauce]

I've never seen anyone admitted to an ICU without a visit to the ER.

No question. They do come into the ER where a code might be called if they need it. They stay there just long enough to reserve an ICU bed, then move up to the ICU stat.

 

[thesauce]

I disagree. We're on the other side of town from the knife and gun club, but we get enough arrests/traumas/STEMIs/assorted other stuff to keep it interesting. Also, the docs' schedule is pretty slick. That makes up for a lot in my book.

No one said it wasn't interesting. Significant trauma can and should go to a trauma center, where they will be seen by a trauma surgeon. MI's are diagnosed by ER docs, but cards do the emergent interventions. Arrests are not emergencies at all, unless associated with a trauma, in which case see above.

The schedule itself looks great on paper, but those hours are typically packed. There's a reason they only work 3-4 shifts/week.

 

[username456789]

plus idk what PCP has a suture kit in their office that they know how to use but i'd love to see it

What??

Just about every PCP does.

 

[KinesiologyNerd]

No one said it wasn't interesting. Significant trauma can and should go to a trauma center, where they will be seen by a trauma surgeon. MI's are diagnosed by ER docs, but cards do the emergent interventions. Arrests are not emergencies at all, unless associated with a trauma, in which case see above.

The schedule itself looks great on paper, but those hours are typically packed. There's a reason they only work 3-4 shifts/week.

We're a level 1 center so yeah we get our fair share. Our docs are still in on the case managing the airway/doing assorted other stuff. Bringing back an arrest is some of the coolest stuff I see. To each their own, eh?

I've said it elsewhere in the thread, but our guys do 7 on / 7 off, mostly 8 hour shifts between a level 1 and a couple smaller hospitals.

 

[sylvanthus]

I have no interest in just superficial knowledge of medicine applicable to only putting a band-aid on a problem for someone else to actually fix. On top of that, I don't want to be "treating" drunks and junkies 90% of my time. If at least all of them were true emergencies, it would be bearable.

Please tell me you are not serious. The depth in one particular specialty may not be equivalent to a specialist obviously, but EM docs have to have a much much broader knowledge base. Essentially 2nd best in nearly every specialty about sums it up.

 

[45408]

So... where do people with real emergencies go?

If you want a lot of high-acuity patients, be an intensivist. Sure, the patients almost all go through the ED first, but the per capita ratio is low.

I've never seen anyone admitted to an ICU without a visit to the ER.

None of our trauma patients are seen by the ED at all. We evaluate them in the ED, but the ED physicians aren't involved.

Please tell me you are not serious. The depth in one particular specialty may not be equivalent to a specialist obviously, but EM docs have to have a much much broader knowledge base. Essentially 2nd best in nearly every specialty about sums it up.

No.

CT surgeons know more cardiology than EM, general surgeons know more GI than EM, and so on. That's just a completely inaccurate rule of thumb.

 

[bretonnia]

Where roughly does he work? Urban? New England?
How many years roughly? 0-5? 10+?

This sounds exactly like what I want to do. And I haven't said that about anything else.

He's in NW Washington State. He finished residency in 2007, but didn't begin working with this group until 2009 or 2010. While 300K is awesome for the number of hours worked, one downside to his situation is he has to pay for all of his benefits himself (insurance, CMEs, etc. which can add up.) All in all, it's a great gig and he would rather be doing nothing else.

 

[Pattycake25]

It seems like it will always be a stable job. People will always be in need of the emergency room no matter what break through we have. Where as Cardiac Surgeons will likely fade away because of preventive and non-invasive procedures.

Personally, I don't think I'm quick-witted enough to make those split-second decisions. =/

 

[sylvanthus]

If you want a lot of high-acuity patients, be an intensivist. Sure, the patients almost all go through the ED first, but the per capita ratio is low.


None of our trauma patients are seen by the ED at all. We evaluate them in the ED, but the ED physicians aren't involved.


No.

CT surgeons know more cardiology than EM, general surgeons know more GI than EM, and so on. That's just a completely inaccurate rule of thumb.

Peds, optho, derm, psych? Have examples for that also? EM has a huge knowledge base regardless, you absolutely cannot argue with that.

 

[45408]

Peds, optho, derm, psych? Have examples for that also? EM has a huge knowledge base regardless, you absolutely cannot argue with that.

Who cares? It was an inaccurate statement that may hold up in some situations, but it clearly fails on many other levels. They maybe #2 for ophtho, but I would not bet on the EM physician for derm/psych over an internist, or the EP over an FP for peds.

I would say they have a broad knowledge base, perhaps the broadest, yes, but it's not any huger than many other specialties.

 

[da8s0859q]

Who cares? It was an inaccurate statement that may hold up in some situations, but it clearly fails on many other levels. They maybe #2 for ophtho, but I would not bet on the EM physician for derm/psych over an internist, or the EP over an FP for peds.

I would say they have a broad knowledge base, perhaps the broadest, yes, but it's not any huger than many other specialties.

I think one of my favorite things about EM, seeing as how I matched into it, is that most of the people like being a jack of all trades and are too laid back to get into pissing matches about it.

 

[Akail]

No question. They do come into the ER where a code might be called if they need it. They stay there just long enough to reserve an ICU bed, then move up to the ICU stat.

Uh...what world do you live in?

 

[thesauce]

Uh...what world do you live in?

The same as Prowler apparently. Did you read the context of that post?

 

[thesauce]

Uh...a lot of people want to do EM. It's become considerably popular and increasingly competitive.

Based on what? The charting outcomes certainly don't suggest that. Here's a synopsis from the WashU residency website showing that's it has been remarkably stable over the last 4 years (2009-2012) - http://residency.wustl.edu/Choosing/SpecDesc/Pages/EmergencyMedicine.aspx

 

[username456789]

Based on what? The charting outcomes certainly don't suggest that. Here's a synopsis from the WashU residency website showing that's it has been remarkably stable over the last 4 years (2009-2012) - http://residency.wustl.edu/Choosing/SpecDesc/Pages/EmergencyMedicine.aspx

I think the confusion stems from what people consider "competitive." For some, they look at last year's match and say "oh boy, there were no open spots in the SOAP for EM, they all filled, so EM must be getting super competitive." In as much as it's become more POPULAR, I may tend to agree.

However, you have to also consider the quality of these applicants among whom EM has become more popular. For instance, take a random 3rd year med student who's in the top 50% of his class with a 235 Step I. To this person, based on the numbers, he will likely not have to "compete" much at all for a spot [and yes I realize EM tends to value some subjective/intangible things more than other fields, but you get the general idea).

But take that same student and compare him to the population of students applying in a litany of other "competitive" specialties (Plastics, Derm, Ophtho, RadOnc, ENT, Ortho, etc), and it's a very different story.

The other issue is the larger number of spots in the country for EM vs some of the more classically "competitive" fields. As my one friend who matched into EM put it, "as a pretty average student, all I really have to worry about is 'boxing out' a couple bottom of the barrel students if I want to match somewhere." Now, matching at a very desirable program might be a different story. But if I had the numbers in front of me, I would hazard a guess that the people who did NOT match into EM are, collectively, fairly uncompetitive, 'lower-stat' type students.

EM probably is gaining among popularity (and has been for a while based on TV shows and on the fact that it's a relatively new specialty so it has had nowhere to go but up), but for me I still view it subjectively as similar to IM in the fact that there are a good number of spots (although certainly nowhere near as many as in IM), and there is a wide enough array of programs available so that most students who are fairly competent can likely find a spot somewhere.

 

[nysegop]

I've heard that police will often send drunk people to the Emergency Room. Personally I think they may as well just send them to the prison nurse. You don't need a doctor with 12 years of post-secondary education to diagnose someone who's drunk. Any time someone over the age of 60 trips, it's straight to the ER for them. That's a bit more complicated though since it's possible they could have had a TIA. My father had a TIA, but it makes sense that he went to the emergency room because he had slurred speech after he fell.


Edit: Whoa, I didn't know academic ER doctors earn more than clinical.

 

[6svette]

I've heard that police will often send drunk people to the Emergency Room. Personally I think they may as well just send them to the prison nurse. You don't need a doctor with 12 years of post-secondary education to diagnose someone who's drunk.

If the person is quacked out enough and needs to be intubated/ventillated, then maybe you would like a doc there.

Not to mention just 'being drunk' often has similar symptoms to other, more serious issues

 

[6svette]

Edit: Whoa, I didn't know academic ER doctors earn more than clinical.

This isn't true. Most of the higher paid EP's are in community hospitals in the middle of nowhere.

 

[nysegop]

This isn't true. Most of the higher paid EP's are in community hospitals in the middle of nowhere.

AAMC:
Median, Academic Salary $258,000
Median, Clinical Salary $220,000

 

[music2doc]

AAMC:
Median, Academic Salary $258,000
Median, Clinical Salary $220,000

I doubt this is actually the case. The numbers may be close but it would be a bit odd for academic EM to pay more than clinical EM if working full-time in each. I might guess, however, that the AAMC got a better response from full-time Academic EM physicians and part-time community EM guys. (Keep in mind EM is a very part-time favorable field.)

 

[NontradCA]

Who cares how competitive it is? Popular= more folks going into it = addressing the OP

 

[da8s0859q]

However, you have to also consider the quality of these applicants among whom EM has become more popular.

That's kind of what we were told all through this interview season. EM's more competitive because the kinds of applicants the PDs and APDs are seeing are more competitive overall but are choosing EM.

I've heard that police will often send drunk people to the Emergency Room. Personally I think they may as well just send them to the prison nurse. You don't need a doctor with 12 years of post-secondary education to diagnose someone who's drunk. Any time someone over the age of 60 trips, it's straight to the ER for them. That's a bit more complicated though since it's possible they could have had a TIA. My father had a TIA, but it makes sense that he went to the emergency room because he had slurred speech after he fell.


Edit: Whoa, I didn't know academic ER doctors earn more than clinical.

From the Careers in Medicine page which itself takes its information from one of the most reputable salary surveys (need a medical school login for CiM), even full professors in academia make a bit less than community docs who have been out for a year or two. In general, community > academic docs.

The ED is a dumping ground for a lot of nonsense, not to mention other problems with EM. Traditional primary care fields are a dumping ground for specialists. And I've met my share of bitter radiologists and anesthesiologists. No specialty is without its crappy parts.

 

[Pons Asinorum]

No specialty is without its crappy parts.

The only unassailable truth in this three-page thread.

 

[sinombre]

No specialty is without its crappy parts.

Agreed. Especially GI.

 

[nysegop]

Agreed. Especially GI.

OHHHHHHHHH.



good one

 

[Bacchus]

Agreed. Especially GI.

Aye. It should be DOT for the colon cleanse. Ha.

 

[thesauce]

Who cares how competitive it is? Popular= more folks going into it = addressing the OP

The only increase in the number going into it has been due to the expansion of residency positions and possibly the creation of new programs. Increases in trainees due to these are not really in the spirit of how "popular" the specialty is among medical students. I'm sure you're aware that essentially all programs fill eventually - if not in the match itself, then through other routes (SOAP, etc).

Anyway, even by your definition, it hasn't gotten any more "popular" over the last couple of years (http://residency.wustl.edu/Choosing/SpecDesc/Pages/EmergencyMedicine.aspx).

 

[thesauce]

That's kind of what we were told all through this interview season. EM's more competitive because the kinds of applicants the PDs and APDs are seeing are more competitive overall but are choosing EM.

According to the charting outcomes from 2011 (http://www.nrmp.org/data/chartingoutcomes2011.pdf) it appears that. by most objective criteria, the (successful) EM applicant is less competitive than the average (successful) applicant across the board. Compare pages 10 and 62.

 

[Pons Asinorum]

According to the charting outcomes from 2011 (http://www.nrmp.org/data/chartingoutcomes2011.pdf) it appears that. by most objective criteria, the (successful) EM applicant is less competitive than the average (successful) applicant across the board. Compare pages 10 and 62.

I think his point was that the "quality" of match applicants is improving relative to past years, not relative to other specialties. You guys are talking past one another.

 

[da8s0859q]

I think his point was that the "quality" of match applicants is improving relative to past years, not relative to other specialties. You guys are talking past one another.

Nah, it's not that I'm not getting it -- I just think that it's a little of both.

EM applicants are getting more and more competitive on paper with each other. Have been for the past few years. I suspect that the new Charting Outcomes later this year is going to have a nice little bump in the stats of those who successfully matched into EM.

Not just saying that because of fill rates. The fact that the 2012 Match had dozens of new EM PGY1 spots over 2011 and still had a 100% fill rate, and the fact that the 2013 Match had dozens of new spots over 2012 and had only a few unfilled spots, only tells part of the story.

At the same time, I do think that there's going to be a little trend in EM over the next several years where it does become increasingly competitive relative to other specialties. Compared to the usually-not-so-competitive specialties like FM, peds, and psych, it already has over the last ten years or so. There are some lifestyle/market aspects of EM that attract people who are going to do what they can to have their best chances at a "lifestyle" field of some sort. EM will never be dermatology, but still.

 

[jw3600]

The downside is, you're a hospitalist . . .

Ok.

Not sure why you're telling me that.

The downside is still the whole "being a hospitalist" thing.

You said this twice. Don't you think this is a little condescending? I have seen hospitalists get dumped on time and time again by many specialties, but that doesn't mean there aren't gratifying parts to working as a hospitalist.