Advice for EM rotation

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JAK2-STAT3

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I'm an M3 who has lurked this forum and thanks to everyone's sage advice, is NOT going into EM. However, my first ever rotation is in EM. I was hoping you all could give me some pearls of wisdom on how to be useful and minimize how much I annoy residents and attendings. I just to learn as much as possible and enjoy the rotation while it lasts, while knowing full well I won't be going into EM. If you all have anything you wish med students knew, pet peeves, advice on workflow, advice on surviving in general, particular resources you'd suggest a med student use while in the ER, please put it here! I hope you all have a wonderful New Year.
 
Do as many procedures as possible

It'll decrease the number of patients you have to see and we'll appreciate it because the 4,000th lac repair is a pain in the ass

There's plenty of other advice to follow but that's a good start
 
Overall, gain an appreciation for how the ED works. Likely you'll be interacting with the ED in residency and you'll invariably become frustrated with the ER. Understand how the ER works and what is an indication for admission vs what isn't and gain an appreciation for what we do so that it makes the suck less when you get an admit or consult from the ED. Get familiar with procedures, see traumas, and just get exposure to procedures/sick patients. The only way you get a spidey sense for what is sick and not sick is exposure and seeing sick patients and not sick patients.

Also just gain an appreciation for the basics of resuscitation (ABCDE) so that when you are on the floor as an intern and you get a page from the nurse saying a patient is decompensating/looks unwell, you have somewhat of a framework on how to approach these situations. Nobody will expect you to be anywhere near an expert or even a resident in resuscitating a patient but developing a broad framework for how you approach these patients will help you in residency
 
Just cement in your brain how bad the ED sucks and destroys your soul and faith in humanity so when you’re in the doc lounge one day sipping coffee watching Fox News on your break and some other docs are complaining about how dumb and useless ER docs are you can be like “Hey, cut them some slack, their job is awful and none of us can do it”.
 
Thank you all for the replies! And don't worry, between my personality not being naturally suited to the ER and my specialty of choice having a lot of patients who come to the ER, I have a ton of respect for what you all do and will strive to have a good working relationship with my future ER colleagues. And I don't watch Fox News either lol.
 
JAK2-STAT3 said:
I'm an M3 who has lurked this forum and thanks to everyone's sage advice, is NOT going into EM. However, my first ever rotation is in EM. I was hoping you all could give me some pearls of wisdom on how to be useful and minimize how much I annoy residents and attendings. I just to learn as much as possible and enjoy the rotation while it lasts, while knowing full well I won't be going into EM. If you all have anything you wish med students knew, pet peeves, advice on workflow, advice on surviving in general, particular resources you'd suggest a med student use while in the ER, please put it here! I hope you all have a wonderful New Year.
Click to expand...

Listen
If you are not going to go into EM, then please learn what we can accomplish and what we cannot.
Do not be one of those doctors that randomly sends us patients because you don't want to take care of them, don't know what to do, or are too lazy.

We are here for medical and surgical emergencies.
Nothing in-between.
We know about 150 medical and surgical diagnoses on the back of our hand.
We know little about the remaining ~50,000.

besides being affable and willing to listen, there isn't much else expected of you on the rotation.

Don't send the ER
- asymptomatic HTN
- minimally symptomatic HTN
- chronic pain
- subacute pain
- patients who say "I don't know where else to go". They should go back to you (if you go into primary care) and continue to try to figure out their problem.
- patient whose tubes fall out at 0100. Don't send them to us. Such a waste of time.
- every kid with a fever. Please manage it yourself.

The list goes on and on
 
Rekt said:
Just cement in your brain how bad the ED sucks and destroys your soul and faith in humanity so when you’re in the doc lounge one day sipping coffee watching Fox News on your break and some other docs are complaining about how dumb and useless ER docs are you can be like “Hey, cut them some slack, their job is awful and none of us can do it”.
Click to expand...

This is the piece of advice I give every medical student who infrequent my non-teaching main ED

It's the most important takeaway from an ER rotation

Sadly, while they DO take it away with them, very few internalize it long-term.

I don't blame them; humans gonna human.

Half a million a year for EM is UNDERPAID if you ask me, and you really can't get that in EM anymore outside of unicorn situations.
 
JAK2-STAT3 said:
I'm an M3 who has lurked this forum and thanks to everyone's sage advice, is NOT going into EM. However, my first ever rotation is in EM. I was hoping you all could give me some pearls of wisdom on how to be useful and minimize how much I annoy residents and attendings. I just to learn as much as possible and enjoy the rotation while it lasts, while knowing full well I won't be going into EM. If you all have anything you wish med students knew, pet peeves, advice on workflow, advice on surviving in general, particular resources you'd suggest a med student use while in the ER, please put it here! I hope you all have a wonderful New Year.
Click to expand...

For me? If you have experience with procedures, even if just lacs - ESPECIALLY lacs - offer to do them!
 
Angry Birds said:
keep crapping on your own specialty, guys. Real smart
Click to expand...

Bruhhh.

You started a whole thread by saying that you're an urgent care doc working in an ER and remarking "that's sad, but it is what it is" .

The sentiment that followed is "this field is dead and rotting."
 
Use it to make your presentations faster also try to schedule Radiology and Anesthesiology in so you can see if you like those

It is amazing how far ER has fallen in 2013 you had to do aways they were trying to do a standardized video interview and all the FemiEM stuff and now look at the specialty
 
Brigade4Radiant said:
Use it to make your presentations faster also try to schedule Radiology and Anesthesiology in so you can see if you like those

It is amazing how far ER has fallen in 2013 you had to do aways they were trying to do a standardized video interview and all the FemiEM stuff and now look at the specialty
Click to expand...

Yea but we have a lot of doom and gloom on this board. ER isn’t awful, at least I don’t think it’s awful.
 
thegenius said:
Yea but we have a lot of doom and gloom on this board. ER isn’t awful, at least I don’t think it’s awful.
Click to expand...
This you?

thisisfine.jpg
 
WhatJobDoIPick said:
Yeah we just have residents planning their escape before they graduate. All good here.
Click to expand...

Smart.

I've said this before on here, but I'll say it again here because it fits.

I see a future in which all EM docs *only work* 80-100 hours/month in the ER and dedicate the remaining time to their "other doctor job" (wound care, occ med, mens health, whatever) because it preserves sanity to work in an actual functional environment with actual reasonable people and not going from stroke alert to wrestling with meth-heads after hysterical-unrealistic parent with not-sick child demanding tests that don't exist.
 
Thank you all for the input! I'm just hoping to learn without annoying anyone.

Whether or not EM is awful, I will not be pursuing it unless hell freezes over. As much as I respect it, my strengths/interests aren't aligned with it and the pros don't speak to me. I'm also aware that med students are often given completely unrealistic expectations of EM--my medical school has a popular EM residency with a very charismatic PD. So I won't fall into that trap either.
 
RustedFox said:
Smart.

I've said this before on here, but I'll say it again here because it fits.

I see a future in which all EM docs *only work* 80-100 hours/month in the ER and dedicate the remaining time to their "other doctor job" (wound care, occ med, mens health, whatever) because it preserves sanity to work in an actual functional environment with actual reasonable people and not going from stroke alert to wrestling with meth-heads after hysterical-unrealistic parent with not-sick child demanding tests that don't exist.
Click to expand...

PE overlords definitely won't allow 80-100 hrs as standard. Insurance benefits are too expensive, this would mean hiring more staff. Easier to make fewer docs work more hours a month.

Unfortunately because of over supply and poor quality in the pipeline negotiating power on this is non existent.

The group I left increased their mandatory full time hours from 120 to 135.

Any way c suite can save money they will. Lawsuits are your problem, not theirs (with enough volume)
 
AlmostAnMD said:
PE overlords definitely won't allow 80-100 hrs as standard. Insurance benefits are too expensive, this would mean hiring more staff. Easier to make fewer docs work more hours a month.

Unfortunately because of over supply and poor quality in the pipeline negotiating power on this is non existent.

The group I left increased their mandatory full time hours from 120 to 135.

Any way c suite can save money they will. Lawsuits are your problem, not theirs (with enough volume)
Click to expand...

So, I had this same counterargument with myself: "Nuh-uh, no way the CMGs will go for that."

Maybe the new crop will change the calculus, thru either (1) oppositional defiance, (2) being so bad that the CMGs will need to mitigate something, or (3) -???-
 
RustedFox said:
Bruhhh.

You started a whole thread by saying that you're an urgent care doc working in an ER and remarking "that's sad, but it is what it is" .

The sentiment that followed is "this field is dead and rotting."
Click to expand...

In my defense, I never said that. You're terribly misquoting me.
I said I *enjoy* the treat and street patients. I would never denigrate our field by calling it urgent care. I routinely take care of sick, critical, crashing, and dying patients.
 
I am somewhat of a levelheaded individual with a mostly positive outlook in life. I will say EM has become depressing. Unless you are at an academic center where work really isn't work because you are chit chatting all day the community has become hell. I can't get myself to find joy at work. I only get through it like a taco bell worker at the drive thru I love. He is happy there because he enjoys the people he works with but he just looks forward to his shift ending. We don't make enough anymore for this to be worth it in my opinion. I get to pick if I want to do nights. I had even tried the part-time route before. None of it helps. This field is soul sucking. Everyone I know who graduated in the last 5 years is looking to get out in one way or another.
 
Angry Birds said:
In my defense, I never said that. You're terribly misquoting me.
I said I *enjoy* the treat and street patients. I would never denigrate our field by calling it urgent care. I routinely take care of sick, critical, crashing, and dying patients.
Click to expand...

"I realize I’m an urgent care doc working in an ER. A sad thing I suppose but it is what it is."

Bruh. That's the literal quote.
You then went on to complain about admissions.

You're not wrong.
Not at all.
I love a good resusc as well.

But to see you then fingershaking others for related complaints... That's just not congruent.

90% of EM in this day and age is adult babysitting. You know it. I know it. We know it. You even got so fed up with it that you left EM to try your hand at something else. I got so fed up with it that I burned out and didn't do medicine for almost a year. At least you had the smarts to walk away before you caught ablaze. I didnt.
 
Last edited:
I popped into the Em docs FB jobs group recently and saw multiple posts looking for program directors for new and upcoming opening residencies still.

EM is dead as ****. It’s beyond saving. Run away fast.
 
RustedFox said:
"I realize I’m an urgent care doc working in an ER. A sad thing I suppose but it is what it is."

Bruh. That's the literal quote.
You then went on to complain about admissions.

You're not wrong.
Not at all.
I love a good resusc as well.

But to see you then fingershaking others for related complaints... That's just not congruent.

90% of EM in this day and age is adult babysitting. You know it. I know it. We know it. You even got so fed up with it that you left EM to try your hand at something else. I got so fed up with it that I burned out and didn't do medicine for almost a year. At least you had the smarts to walk away before you caught ablaze. I didnt.
Click to expand...
Well, egg on my face if I said that. You got me
 
Rekt said:
I popped into the Em docs FB jobs group recently and saw multiple posts looking for program directors for new and upcoming opening residencies still.

EM is dead as ****. It’s beyond saving. Run away fast.
Click to expand...

I got a phone call the other day from an IM friend of mine.
She is mad smart. Diagnoses zebras all the time.
She works at a few places. Mine is one of them.
One of them has an HCA EM residency.
She says: "These new ER docs coming out... they're beyond garbage.
No consideration for even the things they really should care about in the initial phase of the hospital stay.
Things like ordering the correct initial abx (all the rezzies know is "Rocephin for sepsis protocol and call IM").
Things like correcting lytes in the correct order and when (all the rezzies know is "click elec.replace protocol and admit").
She went on for a good half an hour or so. I let her get it out.
EM residencies really really have been "pirated" as cheap labor for the corporate overlords.
Sad.
I used to think I had at least passable IM chops as a younger doc.
Sure, I don't really follow cases like I used to out of curiosity and such.
I don't think it would take long to jog my remembery if I needed to.
The new ones just never cared to even learn, apparently.
 
RustedFox said:
I got a phone call the other day from an IM friend of mine.
She is mad smart. Diagnoses zebras all the time.
She works at a few places. Mine is one of them.
One of them has an HCA EM residency.
She says: "These new ER docs coming out... they're beyond garbage.
No consideration for even the things they really should care about in the initial phase of the hospital stay.
Things like ordering the correct initial abx (all the rezzies know is "Rocephin for sepsis protocol and call IM").
Things like correcting lytes in the correct order and when (all the rezzies know is "click elec.replace protocol and admit").
She went on for a good half an hour or so. I let her get it out.
EM residencies really really have been "pirated" as cheap labor for the corporate overlords.
Sad.
I used to think I had at least passable IM chops as a younger doc.
Sure, I don't really follow cases like I used to out of curiosity and such.
I don't think it would take long to jog my remembery if I needed to.
The new ones just never cared to even learn, apparently.
Click to expand...

The IM docs I work with are shiit too. they only care about the numbers. There are shiit surgeons, allergists, IM docs, and everywhere else.
 
Apollyon said:
This you?

thisisfine.jpg
Click to expand...

Yup

It is true that there is an excessive amount of poo flinging here. It gets tiresome. Every 3rd thread is about why someone wants to leave and they can't, blah blah. THEN JUST ****ING LEAVE. or stop posting on why you want to leave but you can't.
 
thegenius said:
Yup

It is true that there is an excessive amount of poo flinging here. It gets tiresome. Every 3rd thread is about why someone wants to leave and they can't, blah blah. THEN JUST ****ING LEAVE. or stop posting on why you want to leave but you can't.
Click to expand...


I'm allowed to complain because I did leave lol

I still hate em for what it became

Was cool before covid
 
RustedFox said:
I see a future in which all EM docs *only work* 80-100 hours/month in the ER and dedicate the remaining time to their "other doctor job" (wound care, occ med, mens health, whatever) because it preserves sanity to work in an actual functional environment with actual reasonable people and not going from stroke alert to wrestling with meth-heads after hysterical-unrealistic parent with not-sick child demanding tests that don't exist.
Click to expand...

RustedFox said:
So, I had this same counterargument with myself: "Nuh-uh, no way the CMGs will go for that."

Maybe the new crop will change the calculus, thru either (1) oppositional defiance, (2) being so bad that the CMGs will need to mitigate something, or (3) -???-
Click to expand...

Even if PE/CMGs were to allow it, I don't think this is a stable endgame. If things are bad enough that most people can only tolerate part-time work, then the environment will steadily worsen to the point where everyone with another gig like you mentioned will just move to that. The end result is that EM becomes the specialty of last-resort for physicians.
 
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