Academic and Community ED are very different, so whoever thinks we call consults all the time should work in a community hospital. The only consults I call are to tell someone to take a patient to the OR/endo suite today, or arrange for a procedure tomorrow, or just to assign a neurologist to the stroke patient. I see a consultant with patients in my ED maybe once every couple weeks. Honestly, as an ED doc, I'm tempted to pick the other field plenty of days because the personality disorder patients can't talk to you (get to deal with those a lot in the ED) and intubation's my favorite procedure, but I'd be bored to death after the first week of work. Pick the field that can keep your interest and won't burn you out with the mundane aspects.
EM doesn't have a true mastery of a body of knowledge and skills?
At non-academic hospitals, the ED docs do all of their procedures... and lots of stuff up on the floor as well because the inhouse docs aren't credentialled.
Good posts.
Depends on what attracts you to each field, what draws backs you preceive.
For me: I'd pick anesthesia over EM because anesthesia has a true mastery of a body of knowledge and skills. That appeals to me.
EM tries to have a solid level of knowledge of most things, which ends up meaning the basics. There is a lot of triage in EM, calling consults, dealing with things that primary care should be handling, and other nonsense. Granted, EM docs do take care of a significant portion of patients that walk through the door without calling consults, but many of those patients should have been seen by primary care (i.e. non-urgent). The shift work and overall low number of hours per month appeal to those applying to EM, but it still has a high level of burnout; either because it's not really that great of a lifestyle, or because those going EM have low tolerance for handwork (I suspect it's mostly the former and not the latter). Other things appealing to folks applying to EM include doing procedures. From what I've observed in our ER, procedures end up coming in the way of EM providers getting their work done, so it's more of a burden than a pleasure (e.g. calling trauma surgery to suture a simple lac).
The EM burnout thing isn't as bad as everyone makes it out to be. Yes, EM tends to rank high on burn out - but only about 10-20% higher than the rest - depending on the survey. So yes, EM has a ~ 10% increased chance of burnout compared to other challenging fields in medicine. Regardless, still anywhere from 40-60% aren't burnt out. Which isn't far off other fields that work on the front lines.
You hear this from time to time, that EM doesn't have true mastery over a body of knowledge.
Why not enjoy each field for what it is? The medical profession has become obsessed with comparisons. Who makes more money? Who is more prestigious? Who scored higher on this or that? It's no different than the man who can't appreciate his wife's beauty, he can only appreciate how much more beautiful she is than other women. Someone once said, “Pride gets no pleasure out of having something, only out of having more of it than the next man... It is the comparison that makes you proud: the pleasure of being above the rest. Once the element of competition is gone, pride is gone.”
With that said, what does EM offer? EM offers a critical service to the United States healthcare system. Let's walk through an EM shift: A pt with chest pain comes in, you get an EKG which you need to diagnose an MI on, the pt starts crashing - now you need to intubate him, start BiPAP and prep him for the Cath lab. Next a pediatric seizure comes in, you need to work up a good ddx and know if you need to admit or discharge. After that you have a dislocated shoulder walk through, you have to relocate that and send him on his way. Next? Undifferentiated abdominal pain in an elderly man. You resuscitate and work him up and dx diverticulitis, start his treatment and wrap him up. Next you have a red eye come in, you work that patient up and treat them - send them on their way. A stroke patient walks through the door, you need to diagnose this, know if you can give thrombolytics and move on. Now a drowning victim comes in, you need to actively rewarm this patient, run a code if they crash and then ensure they are stable and move along. Now you have a crashing DKA patient - you have to navigate that and ensure no major complications occur. Next you have a toxic overdose which you have to diagnose and treat, followed by a cirrhotic who is bleeding copiously through the mouth. Trauma, codes, suicidal patient, cardiac tamponade, tension pneumo... then wrap up your day with pelvic bleeding in a 23 year old female, and take care of that.
Now sure, the OB/GYN doctor would probably handle that pelvic bleed better - but does she want to intubate the first patient? How about deal with a stroke patient? Relocate a joint? Cardiac tamponade?
Sure the neurologist could handle the stroke better, but how does he deal with the DKA patient? The patient with an MI or a the pelvic bleed? How about the tension pneumo?
Sure the pediatrician could work up the febrile infant better, but how would they like to deal with the intoxicated patient who overdosed on who knows what and is crashing?
Not to mention EM has to deal with some of the most challenging personalities and social situations in medicine. Those require communications skills that will help the rest of our lives.
So sure, EM isn't as good at ______ as ________ specialist. But if you have a undifferentiated sick family member and you can only pick one doctor to take care of them in an emergency situation, then that's us.
Is that better than _________ specialty? No. It's not supposed to be better than anything. I appreciate anesthesia and every other field in medicine. So I would tell the OP to do what you like to do. EM has many benefits that are attractive to some people. So does anesthesia. EM is meant to be an all purpose doc who can be thrown into the fire with anyone. That appeals to me, that I will be someone who can be called upon in a variety of situations. In that respect, EM is the master of being the one type of doctor you want to see in an emergency where anything goes. Sure you'd rather have an anesthesia doc if you could predict the next person coming in will need to be intubated, but what if it's one of the hundreds of other undifferentiated patients that could come in?
Oh yeah, and EM is lots of fun with cool people.
