Acceptance of EM trained Traumatologist

[inspirationmd]

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So these questions straddle multiple disciplines so I am asking in the General Forum. Would love input from any specialty but very interested in Gas, EM, Pulm-CC and Surgeon input.

I am a EM/IM resident with an interest in critical care. It has been my intention to do a multidisciplinary critical care fellowship (MICU, SICU, PICU, NSICU) and get boarded through the EM/IM/CC track which my program is willing to design if there is interest. The MICU is cool and probably represents my best career options but is a little too chronic for me. With this in mind, I had a conversation with the director of our SCC fellowship who says that he believes that a model for a joint EM-traumatologist will become more prevalent beyond Pitt and Maryland-Shock as the shortage increases. He also thinks the ACS and anesthesia will probably get on board as well in 5-10 years since I guess the Pulm-CC docs were the loudest ones initially screaming no to EM-CC board certification (complete hearsay here but interesting if true) and categorical EM can now be boarded in CC through the ABIM.

1) What are your thoughts on the acceptance of non-surgery trained folks globally in the SICU? Do you think the ACS and ASA will eventually get on board?

2) What is the lifestyle of a SICU attending who can not operate and just manages the unit and goes down to traumas to admit at a Level I trauma center; is it any better than a Surgical Traumatologist?

3) A previous EM/IM chief I knew is doing a Pulm-CC fellowship because they didn't want to be a "Surgeon's B****"; is this realistic possibility where I would just end up taking orders and not have autonomy as an attending?

4) Am I being a little ridiculous with my interest? Quite a few people are telling me that an EM lifestyle is great and that I can get quite a bit of my critical care fix through it while not working 100 hrs a week in critical care (exaggerated for effect...). Also people say Trauma gets old which I suppose has some truth but how much?

5) Would I be able to get a job outside of academia? Anybody have any idea if the salary difference between a EM attending and a Intensivist is substantially different?

***As an aside I did think seriously about Surgery but ultimately enjoyed the diagnosis, initial management and critical care aspects more than fixing it in the OR so thats why I did not apply Surgery. This is not my attempt to be a surgeon without training but rather carve out a career that allows me to explore all of my interests. Please keep any comments along these lines to yourself***

 

[45408]

5) Would I be able to get a job outside of academia?

Probably not.

I'm interested to see other people's thoughts on the rest of your questions though.

As an aside I did think seriously about Surgery but ultimately enjoyed the diagnosis, initial management and critical care aspects more than fixing it in the OR so thats why I did not apply Surgery. This is not my attempt to be a surgeon without training but rather carve out a career that allows me to explore all of my interests. Please keep any comments along these lines to yourself

If you work somewhere without a lot of penetrating trauma, then a trauma surgeon actually won't be doing much operating (on trauma patients - they often end up doing acute care surgery on the side).

 

[PMPMD]

So these questions straddle multiple disciplines so I am asking in the General Forum. Would love input from any specialty but very interested in Gas, EM, Pulm-CC and Surgeon input.

I am a EM/IM resident with an interest in critical care. It has been my intention to do a multidisciplinary critical care fellowship (MICU, SICU, PICU, NSICU) and get boarded through the EM/IM/CC track which my program is willing to design if there is interest. The MICU is cool and probably represents my best career options but is a little too chronic for me. With this in mind, I had a conversation with the director of our SCC fellowship who says that he believes that a model for a joint EM-traumatologist will become more prevalent beyond Pitt and Maryland-Shock as the shortage increases. He also thinks the ACS and anesthesia will probably get on board as well in 5-10 years since I guess the Pulm-CC docs were the loudest ones initially screaming no to EM-CC board certification (complete hearsay here but interesting if true) and categorical EM can now be boarded in CC through the ABIM.

1) What are your thoughts on the acceptance of non-surgery trained folks globally in the SICU? Do you think the ACS and ASA will eventually get on board?

As a nonsurgery (anesthesia) CCM fellow in a SICU, what I have seen is: competence engenders acceptance.

2) What is the lifestyle of a SICU attending who can not operate and just manages the unit and goes down to traumas

Not sure, but about to find out next year.

3) A previous EM/IM chief I knew is doing a Pulm-CC fellowship because they didn't want to be a "Surgeon's B****"; is this realistic possibility where I would just end up taking orders and not have autonomy as an attending?

May be instituional.

4) Am I being a little ridiculous with my interest? Quite a few people are telling me that an EM lifestyle is great and that I can get quite a bit of my critical care fix through it while not working 100 hrs a week in critical care (exaggerated for effect...). Also people say Trauma gets old which I suppose has some truth but how much?

Do what interests you. I could have better hours and more pay in anesthesia

5) Would I be able to get a job outside of academia? Anybody have any idea if the salary difference between a EM attending and a Intensivist is substantially different?

Probably not.

***As an aside I did think seriously about Surgery but ultimately enjoyed the diagnosis, initial management and critical care aspects more than fixing it in the OR so thats why I did not apply Surgery. This is not my attempt to be a surgeon without training but rather carve out a career that allows me to explore all of my interests. Please keep any comments along these lines to yourself***

There is an EM trained trauma staff at UNM who did the fellowship at BST. Look him up.

 

[Winged Scapula]

I don't have much to add to the relevant responses from PMPMD above, but throwing my two cents in...

I am a EM/IM resident with an interest in critical care...

1) What are your thoughts on the acceptance of non-surgery trained folks globally in the SICU? Do you think the ACS and ASA will eventually get on board?

As noted above, if you are competent and easy to get along with, you will be accepted. Non-surgeons with similar interest to surgeons will almost always be well received. As far as "getting on board" in terms of certification, I do think it will be coming (at least from the ACS side of things).

2) What is the lifestyle of a SICU attending who can not operate and just manages the unit and goes down to traumas to admit at a Level I trauma center; is it any better than a Surgical Traumatologist?

I would imagine it would be more shift driven. The Surgical Traumatologist I am well acquainted with has great hours when he's only doing CC, but he also has to take Acute Gen Surg call AND operate on "his" patients, when they need him, on call or no. So there is q6 in house call, and q6 backup, as well as potential for being called in by one of his partners if one of his admits needs surgery. YMMV but in general I'd think CC alone would be better hours.

3) A previous EM/IM chief I knew is doing a Pulm-CC fellowship because they didn't want to be a "Surgeon's B****"; is this realistic possibility where I would just end up taking orders and not have autonomy as an attending?

Hmmm...sounds like your previous Chief had a bit of a chip on his shoulder or there was a lot of animosity amongst EM and Surgery. It isn't that way everywhere, although I will admit that academics can foster these artificial boundaries and biases that aren't seen as readily in the community.

4) Am I being a little ridiculous with my interest? Quite a few people are telling me that an EM lifestyle is great and that I can get quite a bit of my critical care fix through it while not working 100 hrs a week in critical care (exaggerated for effect...). Also people say Trauma gets old which I suppose has some truth but how much?

I don't know if you're being ridiculous - after all, life is for enjoying and living. If you aren't happy doing EM, who cares about the lifestyle? Do what you like.

As for Trauma getting old - yes, it does for almost all of us, even trauma surgeons.

5) Would I be able to get a job outside of academia? Anybody have any idea if the salary difference between a EM attending and a Intensivist is substantially different?

Probably not (job outside of academia, although there are some Level 2 centers which would probably consider you). I don't know what an EM attending makes, so cannot comment on the salary (but I'll bet its more).

***As an aside I did think seriously about Surgery but ultimately enjoyed the diagnosis, initial management and critical care aspects more than fixing it in the OR so thats why I did not apply Surgery. This is not my attempt to be a surgeon without training but rather carve out a career that allows me to explore all of my interests. Please keep any comments along these lines to yourself***

Well this is where I think your training has biased you or you were misinformed.

Surgeons do actually do diagnosis, initial management and of course, a lot of critical care. As a matter of fact, a CC/Trauma Surgeon will spend most of their time NOT in the OR. You (or whomever gave you this idea) have reduced surgeons to simple mechanics. There's a lot more to the field than that although I realize there are institutions where surgeons won't/don't see patients initially or wait for someone else to make the diagnosis. 🙄

But its too late now to change specialties. Do what makes your motor run, and the lifestyle will be enjoyable, IMHO.

 

[Mattchiavelli]

1) What are your thoughts on the acceptance of non-surgery trained folks globally in the SICU? Do you think the ACS and ASA will eventually get on board?

2) What is the lifestyle of a SICU attending who can not operate and just manages the unit and goes down to traumas to admit at a Level I trauma center; is it any better than a Surgical Traumatologist?

3) A previous EM/IM chief I knew is doing a Pulm-CC fellowship because they didn't want to be a "Surgeon's B****"; is this realistic possibility where I would just end up taking orders and not have autonomy as an attending?

4) Am I being a little ridiculous with my interest? Quite a few people are telling me that an EM lifestyle is great and that I can get quite a bit of my critical care fix through it while not working 100 hrs a week in critical care (exaggerated for effect...). Also people say Trauma gets old which I suppose has some truth but how much?

5) Would I be able to get a job outside of academia? Anybody have any idea if the salary difference between a EM attending and a Intensivist is substantially different?

***As an aside I did think seriously about Surgery but ultimately enjoyed the diagnosis, initial management and critical care aspects more than fixing it in the OR so thats why I did not apply Surgery. This is not my attempt to be a surgeon without training but rather carve out a career that allows me to explore all of my interests. Please keep any comments along these lines to yourself***

Based on my 2 months of ICU with a department that has a 2 year EM-CC fellowship (the fellows didn't do clinic b/c they weren't Pulm-CC if that's an issue for you, mix of IM GAS and EM matriculating to fellowship)

1) I think surgeons like it if you really know what you're doing. If they're working on traumas in the OR it's good to have someone on the floor with a clue that can triage very well and only the absolutely necessary things.

2) Dunno about pay but it's basically a slightly beefed up hospitalist schedule that's pretty regular for the attendings. A few worked nocturnist type hours too, those attendings were usually all EM. The shifts were very EM-ish in that you work your shift, a certain time comes where new stuff is someone else's problem, you wrap up your old stuff, then you head out.

3) it is possible if you work with awful surgeons. You will need them to be good, and they usually come around when they realize you are allowing them to stay in the OR more and do surgery while you do the medical part. Depending on the fellowship you will have some medical tricks and knowledge that augments the surgeon's skill set, like knowing where the medicine ends and the surgery begins.

4) eh not really, I think as medical practice advances we're going to see a lot more trauma patient transfers into facilities with appropriate care where as 20 years ago they would have been dead. Like battlefield medicine, a lot less dying, a lot more morbildity and stabilizing/recovering. There is going to be growth in this as long as there is EtOH on this earth for trauma admits :b

and

5) IDK, but military medicine might work. I know a fellow that was training so he can be a flight critical care physician with the Air Force, he was full EM b/c the AF doesn't do EM-IM.

 

[45408]

WS - I think the OP was saying he just doesn't like the OR, but everything else was interesting.

 

[Smurfette]

Interesting question. Here's my two cents:

Given that the trend right now is going towards the "acute care surgery" model, many (most?) trauma centers have the trauma surgeon both covering the ICU and covering surgical emergencies (which may be traumas only or every surgical emergency). Some places may not want to have to have TWO people on call simultaneously if the guy covering the traumas isn't a surgeon, since a surgeon would need to be available for surgical issues. It's a big PITA to have to get additional coverage for surgeries when they could otherwise have one guy (and thus pay only one guy) who does both surgeries AND ICU. Finding a job where you are doing exclusively trauma stuff as a non-surgeon will be tough, especially in a community or lower trauma volume setting. Certainly there are plenty of jobs out there where the ICUs get a mix of patients to include traumas as well as med/surg patients. However, most of these places wouldn't have you running the initial trauma in the ER.

 

[Winged Scapula]

WS - I think the OP was saying he just doesn't like the OR, but everything else was interesting.

Ahhh....gotcha. I see that I probably misinterpreted it on first read. Thanks.

 

[inspirationmd]

I've gotten a lot of great advice and insight and I appreciate everyone's thoughts. Its very good to hear that if I am competent and earn respect then an opportunity will exist even though it sounds like the overall consensus is that a job outside of academia would be very hard to come by. I guess the big questions that I need to answer are if I want to be in academia and, if not, then where can I best practice the kind of medicine I envision? Another consideration is that my idea of medicine is changing daily and the practice I envision now may very well change as I progress through training. In thinking about what you planned to do when you first became an intern, did you actually do that or do a 180 and go a completely different way?

Oh and Winged Scapula I definitely meant no disrespect for Surgeons. I loved everything about my Surgery rotation. The problem was I just started to drift about 2-3 hrs into the procedure after the wonder of the anatomy started to wear off a bit. Diagnosis, Management and critical care are certainly a part of the surgical skill set and I don't think Surgeons are just techs at all.

Thanks everyone for the input.

 

[Buzz Me]

Just keep your mind open as you go through residency. It may well be the case that what you're interested in now (4 months into your intern year) will be very different by the time you're entering your last 12-18 months of residency.