Advice for incoming EM Interns

Started by IV.O2.Monitor
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IV.O2.Monitor

IV.O2.Monitor

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Very pleased to be in the position to say I matched to EM. Curious what advice the EM attendings out there - whether you are academic core faculty or non-academic community solo coverage critical access EM - knowing all that you know now, in career, in experience, in navigating the business of medicine, in navigating institutional/workplace politics, in climbing the ranks academically, in studying for exams as a resident, etc., if you could go back in time and give the intern version of yourself 1-3 key pieces of advice, what would it be?

P.S. - as a long time lurker, I'm really hoping this thread can stay positive and constructive, since the Match is a binding commitment and there's no backing out of my specialty choice anyway!
 
Always pay attention to and address abnormal vitals. Some places there's a tendency for nurses to forget to document discharge vitals, or enter them incorrectly. keep an eye on that.

If you're on the fence about ordering a test to evaluate a potential emergent diagnosis, just go ahead and order it. You'll sleep much better at night

EMS also has a tendency to not check glucose on weak/dizzy/altered patients more often than not. It makes me want to strangle them, since this is like EMS 101, and it's a problem almost across the board, not with any particular EMS outfit. Always make sure that has been done on arrival if not addressed in the field, because sooner or later you'll get burned otherwise.
 
First of all, congratulations! You've worked hard for this and you accomplished a difficult goal. It's not a small thing. Pause to celebrate the win.

1-Don't ever forget the idealistic young person that made this decision. Remember why you're there; to make a difference, even when it feels like 90% of the time spent is pleasing The Machine. The job is the other 10%. Whether you spend 3 years, 10 years or 30 years in EM, you're going make the world a better place for having done it, even though it's sometimes hard to see through the chaos.

2-Accept the absurdity of the world you're about to enter. The ER is a beautifully chaotic place, if you look at it that way. Find some way to embrace the absurdity of it all, and you'll thrive. Hobbies, time off, good friends and family are essential.

3-Honor the difficulty of the work. EM is the hardest specialty in Medicine. Acknowledge that, stay human and you'll tap into strength you didn't know you had.

You're going to do great.

Good luck!
 
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Yeah agree with black out curtains, or at least a decent padded sleep mask, given you will work nights and need to get some decent shut eye during daylight hours. Bonus if you can find a place in a quiet neighborhood. Inevitably, barking dogs and lawn mowers and amazon delivery drivers will start making noise during the day
 
Black out curtains were a game changer

I went HARD on them in my residency apartment, ended up taking them down in exchange for black industrial garbage bags and duct tape. Then put some stuff around my bedroom door. I don't think a photon of light could enter at noon in July and I slept like a baby during my night shifts

Looking back I'm shocked I did nights as an attending for so long. I'm out of EM now and the idea of staying up past 11p makes me shudder lol

Good luck!
 
WhatJobDoIPick said:
At least 2 of 4 of the replies you got above are from people who no longer practice Emergency Medicine. Should tell you aomething. Prepare your portfolio day 1 for your eventual fellowship application to either pain or ccm. Also not too late for a pgy2 switch to anesthesia or psych.
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Advice for incoming EM intern about to start residency: Plan your exit strategy now LOL
 
WhatJobDoIPick said:
At least 2 of 4 of the replies you got above are from people who no longer practice Emergency Medicine. Should tell you aomething. Prepare your portfolio day 1 for your eventual fellowship application to either pain or ccm. Also not too late for a pgy2 switch to anesthesia or psych.
Click to expand...
But we lived to tell the tale. No regrets. Everything happens for a reason.
 
PGY ~20 or so. I still practice EM. I enjoy it.

Smartest thing I ever did was plan for FI while a resident. Once you hit FI work becomes much much more enjoyable. I actually think you become a better doctor as you don’t practice scared and instead of slurping to mid level Jenny McJennerson the RN,BSN, QRSTUV etc. you push back and do what is right.

Another piece of advice which was mentioned is if a patient is gonna make y ou think about them after your shift or you are gonna worry about a test you didnt order.. just admit them or just order the test. As a young attending people will expect you to practice conservatively (aka scared), its ok.. its all part of the growing process.

My other piece of advice. Do your best to avoid the CMG jobs. They dont care about you or your patients. You will feel like a rented mule cause thats what you are.
 
I can understand the nature of wanting to dissuade people from going into emergency medicine!!! But like we also really need future docs that are amazing and competent so hey man embrace emergency medicine… it provided me with an amazing career and a skill set that competes with anybody.

First off always trust, but verify!! Never take anything at face value whether it’s a patient a nurse or another doctor, it’s your ass if things go wrong.

You’re gonna have good days and you’re gonna have bad days, learn to accept the good days as little wins and understand that the bad days should be used as life lessons and things that you need to learn from but get over quickly.

Don’t be arrogant, be a team player, but also protect your personal space and energy… and become a little financially savvy i.e. contributing to your Roth IRA and setting up brokerage account and submitting at least $50 into a vanguard or Fidelity S&P 500 fund weekly!

also buy disability insurance don’t care the price, your future income is your biggest life asset!!!
 
I practiced EM for 15 years (HPM now). I kept this list on my phone and referred to it on hard days.


IMG_3938.jpeg
 
Already lots of solid advice here I won’t repeat.

I would purchase this course and complete it before orientation starts.

Original EM Boot Camp - Center for Medical Education

Why Have Over 8000 of Your Colleagues Taken the Emergency Medicine Boot Camp Course? • The Emergency Medicine - An Intensive Boot Camp course has been designed by a nationally recognized emergency medicine faculty to provide participants with the essential information needed to practice in a...
courses.ccme.org courses.ccme.org
 
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Major said:
Already lots of solid advice here I won’t repeat.

I would purchase this course and complete it before orientation starts.

Original EM Boot Camp - Center for Medical Education

Why Have Over 8000 of Your Colleagues Taken the Emergency Medicine Boot Camp Course? • The Emergency Medicine - An Intensive Boot Camp course has been designed by a nationally recognized emergency medicine faculty to provide participants with the essential information needed to practice in a...
courses.ccme.org courses.ccme.org
Click to expand...
Issue is the people who run that course are ****s. Honestly, rsidency is to learn. Let your faculty teach, read.. a lot.. uptodate etc. In this day and age perhaps AI can make your learning even more efficient but i would not waste my time or money on a bootcamp before residency.
 
AlmostAnMD said:
Black out curtains were a game changer

I went HARD on them in my residency apartment, ended up taking them down in exchange for black industrial garbage bags and duct tape. Then put some stuff around my bedroom door. I don't think a photon of light could enter at noon in July and I slept like a baby during my night shifts

Looking back I'm shocked I did nights as an attending for so long. I'm out of EM now and the idea of staying up past 11p makes me shudder lol

Good luck!
Click to expand...
I went with Aluminum Foil and 2 inch masking tape.
 
IV.O2.Monitor said:
Very pleased to be in the position to say I matched to EM. Curious what advice the EM attendings out there - whether you are academic core faculty or non-academic community solo coverage critical access EM - knowing all that you know now, in career, in experience, in navigating the business of medicine, in navigating institutional/workplace politics, in climbing the ranks academically, in studying for exams as a resident, etc., if you could go back in time and give the intern version of yourself 1-3 key pieces of advice, what would it be?

P.S. - as a long time lurker, I'm really hoping this thread can stay positive and constructive, since the Match is a binding commitment and there's no backing out of my specialty choice anyway!
Click to expand...

Change specialties immediately. GTFO out of EM before your realize the mistake you've made.

If you decide to stay, make sure you carefully plan an exit option, whether that's a fellowship that gives you an entirely different work environment (Pain, CCM, Sports etc) or industry/pharma/device or even a concierge/direct-to-patient niche practice.

You were warned.

EDIT: I am laughing at how I responded before reading all the other responses, and I shouldn't be surprised that this has already been said multiple times. OP you should take that to heart. I'll say it again: you were warned.
 
Dude, if the advice you get for your future job is blackout blinds, sleep masks, find a fellowship and GTFO now. Trouble. Deep trouble. I really feel for you because I’ve walked the path. I’m sorry, but maybe it’ll be different for you. I hope it is.
 
endo said:
Dude, if the advice you get for your future job is blackout blinds, sleep masks, find a fellowship and GTFO now. Trouble. Deep trouble. I really feel for you because I’ve walked the path. I’m sorry, but maybe it’ll be different for you. I hope it is.
Click to expand...
It'll be different for him.
 
EctopicFetus said:
Issue is the people who run that course are ****s. Honestly, rsidency is to learn. Let your faculty teach, read.. a lot.. uptodate etc. In this day and age perhaps AI can make your learning even more efficient but i would not waste my time or money on a bootcamp before residency.
Click to expand...
Agreed. Don’t do anything before residency

From now till July 1st, chill, relax and enjoy. The next 3 years are hard enough. Take a break.

You’ve already been given plenty of advice.

But in general - don’t be afraid to scan. Be humble. Doesnt matter How experienced you are, the ER can humble you. Save up and invest aggressively and prepare to cut down since burn out is very real.

Good luck and congratulations
 
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cyanide12345678 said:
Agreed. Don’t do anything before residency

From now till July 1st, chill, relax and enjoy. The next 3 years are hard enough. Take a break.

You’ve already been given plenty of advice.

But in general - don’t be afraid to scan. Be humble. Doesnt matter How experienced you are, the ER can humble you. Save up and invest aggressively and prepare to cut down some burn out is very real.

Good luck and congratulations
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"To thine own self be true". If someone else (who isn't there) is telling you to not do this or that, that is not their call to make. You're the one with skin in the game. Do the right thing, and I would MUCH rather be right than popular. What's right is right.
 
IV.O2.Monitor said:
Very pleased to be in the position to say I matched to EM. Curious what advice the EM attendings out there - whether you are academic core faculty or non-academic community solo coverage critical access EM - knowing all that you know now, in career, in experience, in navigating the business of medicine, in navigating institutional/workplace politics, in climbing the ranks academically, in studying for exams as a resident, etc., if you could go back in time and give the intern version of yourself 1-3 key pieces of advice, what would it be?

P.S. - as a long time lurker, I'm really hoping this thread can stay positive and constructive, since the Match is a binding commitment and there's no backing out of my specialty choice anyway!
Click to expand...

youhavechosen-indianajones.gif


With that knowledge in hand.

(1) Practice defensive medicine. You don't get brownie points for conserving resources. You get sued for missing things.
(2) Choose your job and your state wisely. See the thread about the Georgia malpractice suit. There are very real dfifferences.
(3) If you like critical care medicine, plan on a critical care fellowship. The machine exists to drive everything to your door. It exists to keep as much out of the ICU as possible.
(4) If you don't like critical care medicine, plan on a different kind of fellowship.
(5) Your goal is to minimize your time as a pit doc...whether that exit is through a fellowship, academics, wise investing, or a different career.
(6) With regards to wise investing, continue to live like you are a resident. If you're just starting out, your goal should be around $5 million to pull the rip cord.

Here's a link to a really good FIRE calculator: FIRECalc: A different kind of retirement calculator

Always remember, the goal of getting into clinical medicine is...to get out.
 
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1. Assume you can’t make it past 10 years - probably true. Plan your finances accordingly.
2. I would locums at like 5 different places and sell your soul to the highest bidder, constantly adding / dropping companies to milk as much as possible.
3. Order everything on every patient and don’t GAF. Once you’ve been sued you’ll understand.
4. Try for cush rural gigs - probably have to travel.
5. Start a social media channel to talk all about EM and how great it is so you don’t actually have to work in the ER
6. Pay attention to malpractice caps / state malpractice environments.
7. Finish residency and go directly into fellowship / something else
 
Old_Mil said:
I'm going to disagree on one point. Either before residency or before your anesthesia rotation - sign up for this.

www.theairwaysite.com

The Difficult Airway Course: Emergency™

www.theairwaysite.com www.theairwaysite.com

Get some knowledge and get your hands dirty doing this in a low risk situation up front.

Regular refreshers in this area are probably more valuable than BLS/ACLS.
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My anesthesia rotation in residency, I was told the first day that it WASN'T an airway or intubation rotation, but, anesthesia. You know what that meant? Having to stand at the head of the bed (while the gas resident sat) for entire surgeries. I didn't learn a thing.
 
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