Anesthesia vs. Emergency Medicine

[joker]

Hi all,

I've really enjoyed all the helpful info you guys post on here. I'm in my fourth year of med school and am trying to decide between EM and Anesthesia. I was wondering if any of you were in the same boat and could offer some advice.

I love the patient contact of EM but hate the idea of working nights, weekends and holidays for the rest of my career. I love procedures and the lack of continuity of care in both fields. I'm confused! I'll also post this in the EM forum to get some thoughts...

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[Mman]

I love the patient contact of EM but hate the idea of working nights, weekends and holidays for the rest of my career. I love procedures and the lack of continuity of care in both fields. I'm confused! I'll also post this in the EM forum to get some thoughts...

Nights, weekends, and holidays? Might not be much in the way of scheduled procedures on those days, but you still have to take call to cover emergencies.

 

[Beck928]

I went through some of the same questions myself. Think about this- do you like primary care? Do you have a short attention span? Do you like making diagnoses? Do you mind if your scheudle is always in flux? These seem to be some of the qualities of ED docs I am friends with, and are different from Anesthesiologist's qualities usually. Anesthesiologists on the other hand have to be patient people (ie willing to sit through a huge/long case and not go crazy), they don't do any primary care, and don't usually do much diagnositc work (occasionally they must in the OR). Lots of other stuff is similar, like airway management, procedures, thinking quickly. Of course, I am biased and find that anesthesiologists are best with airway and procedures.

Hope that helps!

 

[VentdependenT]

I liked EM. A lot.

What finally made me not drop anesthesia and nab an offered EM spot my intern year was the primary care stuff. Holy friggen cow man. If people would just go see a damn family practitioner once a damn year a great majority of patients wouldn't end up in the ED.

I liked making a diagnosis, working it up, getting stuff done fast that mattered, reading films etc. Procedures were great too. But I could easily see myself getting tired of trying to sedate some drunken a-hole while trying to suture his massive head lac at 3 am on sunday morning.

GOMERS. GOMERS!!!! BAHHHHHHHHHH!!!!! That friggen KILLED ME. It killed my ICU love to. Demented 87 year old abandonded in some unskilled facility to rot alone coming into my er with a HUGH MRSA SACRAL DECUBE thats now seeding her tunneled dialysis catheter and her implanted pacer leads. Last family relative to see her 5 yrs ago made her FULL CODE. Friggen cmon man.

 

[Gern Blansten]

You don't see many old ER docs. I don't know if it means they burn out fast or maybe it means they are smart, work hard, invest well, and retire early.

 

[TrustMe]

I came into med school wanting to do EM. I had an EM preceptor my first 2 years and quickly realized that it was not for me. Like Vent said, a large majority of what I saw was primary care stuff. The trauma stuff that I did see was cool, but most of it was because some idiot was drunk and doing something stupid (car surfing, backyard UFC crap, or gang related). I have very little sympathy for people that do absolutely nothing for their own health or people that do stupid s*&t and hurt themselves. I still wanted something that had acute interactions and lots of procedures and I luckily found anesthesia. I am very interested in CCM but Vent is scaring me by running from it now that he is looking at fellowships. We'll see what happens. My first month as an intern will be in the SICU, and I hope that it doesn't scar me for life.

TM

 

[cfdavid]

You don't see many old ER docs. I don't know if it means they burn out fast or maybe it means they are smart, work hard, invest well, and retire early.

That's an interesting point. Actually, does anyone know of any specialties that seem to have a greater number of older docs still practicing? I know it'll be anecdotal, but that's o.k.

As a non-trad dude, I want to practice for at LEAST 20 years after I finish residency, so I've often reflected on this.

Also, what about anesthesiology? What's up there, in terms of people noticing lots of older docs?
(clearly this will NOT dictate my decision to enter a field....lol i'm just curious)

 

[joker]

thanks to everyone for the great advice. i definitely see both sides...keep the advice coming (not just for me, but for anyone out there facing this decision).

thanks,

joker

 

[guitarguy]

For me Emergency Medicine is akin to a busy and stressful clinic. One of the motivating factors that pushed me into anesthesia was my dislike of spending time in clinics, and I get the same queasy feelings working in the ED. In anesthesia you are dealing with 1 patient at a time, whereas in EM you are juggling between several patients. Another thing I don't like about EM, as has already been mentioned, is that working in the ED makes me feel depressed about the state of our medical system. The number of people who are forced to rely on the emergency room as their primary care physician is astounding. On the other hand, the number of psych cases (i.e., hypochondriacs) is annoying. A last point I got from a physician who practiced emergency medicine in europe. He was disappointed to find that EM is way different in the US than his country...here in the US, the ER physician is forced to practice very defensively b/c of the legal system...which for him took a lot of the fun away from the field.

 

[Trisomy13]

some of the most offensive and memorable odors i have encountered in the hospital setting were in the ED. i'll take some cautery smoke over trench feet anyday.

 

[ketafol]

I dont like ordering that CT of the head just because its the safe thing to do(for the doc, not the pt), and not the smart thing to do, on some 8 year old kid who bumped his head on a cupboard. I dont like defensive thoughtless medicine. Not that ER docs arent smart, many are, but they are forced to order so many unecessary tests just to CYA.

 

[burntcrispy]

Trisomy 13, I like that avitar. It brings me back to my old skool PR days way, way back.

To the OP:

The easiest way to determine ER vs Anes is to do a rotation in each. If you don't have the time to do that just follow the residents for a while and see what their job really consists of. Asking this question on the anesthesiology forum will get you recs skewed towards anes. Ask on the ER forum and they will probably tell you ER is the better choice. If you are looking for a good lifestyle job I'd check out radiology.

 

[Planktonmd]

GOMERS. GOMERS!!!! BAHHHHHHHHHH!!!!! That friggen KILLED ME. It killed my ICU love to. Demented 87 year old abandonded in some unskilled facility to rot alone coming into my er with a HUGH MRSA SACRAL DECUBE thats now seeding her tunneled dialysis catheter and her implanted pacer leads. Last family relative to see her 5 yrs ago made her FULL CODE. Friggen cmon man.

There are Gomers in anesthesia too, especially if you practice in one of the retirement states, you just have to learn the Gomer anesthesia rule: "The more you do to gomers the faster they die so do only what you deem absolutely necessary".
If you follow this rule you will master the art of Gomer anesthesia and Gomer medicine in general.

 

[Masseter Spasm]

I considered going into both anesthesia and emergency medicine but chose to do an emergency medicine residency. During my residency I identified a number of issues with the specialty which I could not resolve. Thus, late in my residency as my fellow residents sought employment I searched for residency positions in anesthesia. What amazed me is that none of my established attendings tried to change my mind. When I discussed with them why I was choosing this path they agreed that this was a wise decision for me.

I have friends who continue to practice Emergency Medicine and seem to enjoy it. If you have the right personality, EM could be your field. In many ways Anesthesia and EM are similar. Both specialties require that you be able to quickly interact with a patient and identify pertinant historical and clinical features that apply to your management plan.

Things I dislike about emergency medicine:
The shift-work mentality does not build professional respect
Most of your working hours are during afternoons, evenings, weekends
holidays, etc. (I used to be away from home 16-18 nights/month)
Spent alot of time talking to people on the phone
Spent alot of time waiting for other people to do things (consults,
returns pages, admit pt, etc.)
Most of time is spent seeing stuff that could/should be seen in clinic
Rarely see a critically ill patient (the type of case that draws people to
the specialty)
Production pressure ("move the meat")
As an EP you are not a "specialist" in any discipline of medicine,
despite what you may think
The nature of the work is stressfull. The multi-tasking is comparable
to being an air-traffic controller or bonds trader
I rarely did procedures, despite being at one of the busiest ER's in the
country (>110,000 visits a year)

Things I like about Anesthesis:
You get to be an expert in a specialty
You get to see an effect from your actions (pharmacology,
physiology, critical care in action)
Better hours (Quality not Quantity)
More procedures
Better interactions with patients and physicians

I do not regret my training in Emergency Medicine. I achieved board certification but chose not to practice. My training was excellent preparation for anesthesia (much better than 1 year of transitional/medicine rotations). I can not recommend that those considering both fields follow my path. That would require 6-7 years of residency training.

The best thing you can do to assist your decision is to talk to as many practicing physicians in both fields as possible. This means trying to talk to those in the community as well. (Don't limit your discussions to the academic practioners alone.) Go shadow a community hospital EP or Anesthesiologist for a few days if you can. Do an elective in either specialty in a non-academic environement. Think deeply about what type of personality you have, what brings you professional fulfillment, and how you want to spend your professional time. Hope this helps.

 

[joker]

Thank you so much. That was a great post - super helpful and informative. I'm glad you found happiness in Anesthesia.

I considered going into both anesthesia and emergency medicine but chose to do an emergency medicine residency. During my residency I identified a number of issues with the specialty which I could not resolve. Thus, late in my residency as my fellow residents sought employment I searched for residency positions in anesthesia. What amazed me is that none of my established attendings tried to change my mind. When I discussed with them why I was choosing this path they agreed that this was a wise decision for me.

I have friends who continue to practice Emergency Medicine and seem to enjoy it. If you have the right personality, EM could be your field. In many ways Anesthesia and EM are similar. Both specialties require that you be able to quickly interact with a patient and identify pertinant historical and clinical features that apply to your management plan.

Things I dislike about emergency medicine:
The shift-work mentality does not build professional respect
Most of your working hours are during afternoons, evenings, weekends
holidays, etc. (I used to be away from home 16-18 nights/month)
Spent alot of time talking to people on the phone
Spent alot of time waiting for other people to do things (consults,
returns pages, admit pt, etc.)
Most of time is spent seeing stuff that could/should be seen in clinic
Rarely see a critically ill patient (the type of case that draws people to
the specialty)
Production pressure ("move the meat")
As an EP you are not a "specialist" in any discipline of medicine,
despite what you may think
The nature of the work is stressfull. The multi-tasking is comparable
to being an air-traffic controller or bonds trader
I rarely did procedures, despite being at one of the busiest ER's in the
country (>110,000 visits a year)

Things I like about Anesthesis:
You get to be an expert in a specialty
You get to see an effect from your actions (pharmacology,
physiology, critical care in action)
Better hours (Quality not Quantity)
More procedures
Better interactions with patients and physicians

I do not regret my training in Emergency Medicine. I achieved board certification but chose not to practice. My training was excellent preparation for anesthesia (much better than 1 year of transitional/medicine rotations). I can not recommend that those considering both fields follow my path. That would require 6-7 years of residency training.

The best thing you can do to assist your decision is to talk to as many practicing physicians in both fields as possible. This means trying to talk to those in the community as well. (Don't limit your discussions to the academic practioners alone.) Go shadow a community hospital EP or Anesthesiologist for a few days if you can. Do an elective in either specialty in a non-academic environement. Think deeply about what type of personality you have, what brings you professional fulfillment, and how you want to spend your professional time. Hope this helps.

 

[VolatileAgent]

I love the patient contact of EM but hate the idea of working nights, weekends and holidays for the rest of my career.

well, choosing anesthesiology isn't going to fix that problem.

 

[VentdependenT]

There are Gomers in anesthesia too, especially if you practice in one of the retirement states, you just have to learn the Gomer anesthesia rule: "The more you do to gomers the faster they die so do only what you deem absolutely necessary".
If you follow this rule you will master the art of Gomer anesthesia and Gomer medicine in general.

Every now and again I gotta trach/g-tube combo some ICU peeps who will never EVER get outta the long term vent facility. What you gonna do man. Flip on the sevo .5% give a little fent, little versed, maybe a touch of ketamine, what the hell. Mine as well enjoy the ride I suppose. Poor fellas.

 

[joker]

Yes, but working weekends, nights and holidays in Anesthesia is only if you're on call. In EM your regular work schedule will regularly include nights, weekends and holidays. Most fields in medicine require to at least cover call on nights/wkends/holidays.

well, choosing anesthesiology isn't going to fix that problem.

 

[joker]

Yes, but working weekends, nights and holidays in Anesthesia is only if you're on call. In EM your regular work schedule will regularly include nights, weekends and holidays. Most fields in medicine require to at least cover call on nights/wkends/holidays.

well, choosing anesthesiology isn't going to fix that problem.

 

[utmey07]

I chose gas over ED for ALL of the above reasons. Let me emphasize:

1) ED is the new FP for SO MUCH of the cases I dreeeeaaaaddddd seeing. These include, and i hope you know what i mean by using quotes: "migraines", "back pain", "nerves", "belly pain", etc....

2) The shift work lifestyle WAS NOT for me. Try it out for yourself.


I highly recommend trying out a month or two of ED. Not only is it a great place to learn about medicine, but also about what YOU want out of medicine.

 

[chrisjohn]

Gas Gas Gas! I don't mean going to MOPP4.

 

[amyl]

There are Gomers in anesthesia too, especially if you practice in one of the retirement states, you just have to learn the Gomer anesthesia rule: "The more you do to gomers the faster they die so do only what you deem absolutely necessary".
If you follow this rule you will master the art of Gomer anesthesia and Gomer medicine in general.

Is this the 11th of the rules according to The House of God?

 

[phillyfornia]

the ED is a very interesting place. have you worked there yet? do you like the environment?

i was pretty set on doing EM at the beginning of my 4th year. i liked the fact the docs worked relatively few hours/week, made good money, and didn't have to deal with the hassle of being "on call". the idea of working with patients in acute settings and performing procedures was also appealing. based on these qualities, i was pretty confident that i was going to go into EM. i even scheduled the first 2 months of my 4th year with EM blocks.

halfway into my first EM rotation, i realized that EM was not the field for me. first of all, i really didn't dig the shiftwork. even though i had a lot of time off (i worked only 15 shifts/month), i felt like i had little actual free time since most of my time off was spent trying to adjust my sleep schedule. in addition, the time that you're actually in the hospital is stressful. patients are often pissy (understandably) b/c they've waited hrs to see anyone, and there is always a pressure to move patients. an 8 hr shift in the ED is more taxing than a 12 hr day in most other specialties (including anesthesiology)

the other thing that bothered me was that i didn't feel that EM docs were really experts at anything. when it came down to it, i felt that the role of the EM doc was essentially triage which i didn't really enjoy. when a patient comes into the ED, you do one of two things: discharge them or admit them. if the patient isn't going to die, you give them a "loose" diagnosis (e.g. almost every rash was "scabies") and tell them to follow up with their primary care doc. if you think the patient is serious, it is up to you to consult the specialists so that they can do the "real" workup. i realize i sound a little harsh but i am not knocking EM docs (they're very intelligent people in my experience). it's just that the specialty requires you to be a jack of all trades so you never really get a chance to become an expert at anything.

this is all, of course, my personal opinion based on my personal experiences. i know many people who love EM and are very happy doing it. it really depends on whether the specialty fits your personality. so definitely do a rotation and make sure that you enjoy the work.

 

[cfdavid]

philly, did you end up going anes??

 

[brains]

The trauma stuff that I did see was cool, but most of it was because some idiot was drunk and doing something stupid (car surfing, backyard UFC crap, or gang related). I have very little sympathy for people that do absolutely nothing for their own health or people that do stupid s*&t and hurt themselves.
TM

I KNOW!!! Oh my god. I work at the front desk in the ER and that's basically all we see in here. What really pisses me off is all the people that think this is primary care for their kids. You won't see any clinic visits, just ER stuff. And they think it's ok to do it because, hey, Medicaid is going to pay for it anyway.....oh wait WE are going to pay for it, that's right

 

[fakin' the funk]

I've really enjoyed all the helpful info you guys post on here. I'm in my fourth year of med school and am trying to decide between EM and Anesthesia. I was wondering if any of you were in the same boat and could offer some advice.

My understanding (as an MS3) is that there are a lot of students in this position, weighing EM vs. anesthesiology. There are some superficial similarities (call/schedule, procedures, wearing scrubs), but more than a second's thought shows that they are very very different.

I always try to point out the really significant differences between the fields, and (as I've learned from people on this forum) emphasize the "Imagine what you'll be happy doing when you're 50" angle (which to me is really a no-brainer )

 

[carn311]

Can anyone make a generalization about the personality of an EP versus that of an Anesthesiologist?

 

[roja]

joker-

You have gotten some great gas opinions here. The similarities are really superficial. I think you will find that most people either love or hate each field once you actually get into it. You need to do a shift or two in the ED to see if you like it. I have rarely met an individual that didn't either love it or hate it. Its rarely somewhere in the middle.

What do I love about EM (and I didn't pick it until the end of my third year... I was peds rheum all the way! ):
-diversity. I liked some of everything but not enough of anything to do it alone. I like gyn, fp, IM, critical care, ortho, surgery, intubations, trauma, peds.
-pace. I like multitasking. I never realized it but I hate sitting and contemplating for hours on end. The or only interested me when I had my hands in a belly or was putting a tube down a throat. You either love this or it drives you crazy.
-shift work. this has plusses and minuses. I worked today (memorial day) but I am off for 7 days in a row. this is nice. Many people I know iwll take a month of at a time. Very few fields allow this. Gas might (don't know...) Shifts are not as bad as you think. search it in the EM forum
-Longevity: the burn out issues is a dead issue (look in the EM thread and search). It came about from IM/FP/surgeons in the ED. The reason there aren't a ton of 'old EM docs' is that its a young field (25 years of board certification). We have plenty of 'senior docs' in EM. Just not as many as others because its younger.
-job security- there is a severe shortage of EM docs. its only getting worse. More and more hospitals are not wanting FP/IM docs in the ED for liability reasons. Also, we are somewhat 'protected' agains all the healthcare issues. Emtala ensures that we get to practice the way we want without considering overtly insurance status etc.
-acuity- I like sick patients. I don't want all sick patients but I like a mix. the level of acuity will vary where you train and practice. I work in an urban ED that sees 100K+ a year. We see tons of sick patients. We do see non-acute. doesn't bother me to much. Mostly because I make sure there is nothing life threatening and then send them to thier doc for follow up. Plus, while I didn't want to be an FP, I didn'tn hate it.
-interdisc. work- the level of consults again depends on where you are. I like dealing with consults. (find me a field of medicine that doesn't deal with it and you are working with dead people...) gas works with surgeons, surgeons work with gas, etc etc. My consults only did procedures I can't do: cath a patient, open thier belly, etc. Everything else, I did. Admitting privelages vary but I don't ask for admissions. I have direct admitting privelages. This will vary where you go.....

Regarding respect, etc: your sense of respect shouldn't be garnered from other fields. Your respect will come from you knowing you are doing what is right and being well trained. EM docs are experts at dealing with acute issues. Fields shift. Where I am, the surgeons are horrible at acute abdominal pain because they don't see it any more. They see our patients after they are diagnosed and are ready for the OR. Are cards people don't see ACS. They see acute ST elevation MI's. As an EM doc, you are an expert at dealing with Emergency medicine. You stabilize, treat and manage acutely ill patients. It is VERY different. If you haven't spent much time in the ED, its hard to get. But watch a senior IM resident in the ED. You must think quickly and act. The best advice is to get int here and see if you like it.

/ramble.

 

[turtle md]

Emergency Medicine Physicians, while the "jack of all," are experts in resuscitation. No other field can resuscitate the variety of patients that an EMP can.

 

[Coastie]

Emergency Medicine Physicians, while the "jack of all," are experts in resuscitation. No other field can resuscitate the variety of patients that an EMP can.

Anesthesiologists?

 

[pillowhead]

Emergency Medicine Physicians, while the "jack of all," are experts in resuscitation. No other field can resuscitate the variety of patients that an EMP can.

That's what the emergency medicine department told us at my medical school. Then I did my ER rotation. In only 14 eight hour shifts, I saw anesthesiology called twice because the emergency physician got not get the patient intubated after three tries. The anesthesiologists did it on the first try. One patient was a neonate. The other was an adult. While I understand there's more to resuscitation than intubation, Airway does come first in the ABCs. And after doing a month of cardiothoracic anesthesiology, I can't imagine anyone more adept at resuscitation than a CT trained anesthesiologist.

 

[joker]

Thanks to everyone for their insight. I think this will help not just me, but everyone else out there with the same question (and i know there are a lot!).

 

[roja]

That's what the emergency medicine department told us at my medical school. Then I did my ER rotation. In only 14 eight hour shifts, I saw anesthesiology called twice because the emergency physician got not get the patient intubated after three tries. The anesthesiologists did it on the first try. One patient was a neonate. The other was an adult. While I understand there's more to resuscitation than intubation, Airway does come first in the ABCs. And after doing a month of cardiothoracic anesthesiology, I can't imagine anyone more adept at resuscitation than a CT trained anesthesiologist.

Resuscitation goes beyond tubing someone. Often times, it entails trying to do everything but tube them if you can help it. Obviously, in a patient in severe resp. distress, it is the first step. And since we aren't to smart down here in the ER, we do like our algorithms, so yes, A comes first.

Resuscitation can entail central lines, chest tubes, EGDT, bipap, shocking,thrombolytics, yadda yadda yadda. Its ridiculous to compare the two. Gas is better in the OR. EM is better in the ER. Neither of us would perform well in the others house. Occasionally we overlap. As for your own experience in the ED, making broad statements about ALL EM doctors based on your one experience in one ED is a little overreaching. And just like *every* specialty, there are some practitioners not as solid as others. In mine and many others, (and in the emergency intubation literature) EMP's are very competent at RSI intubations. (http://www.aemj.org/cgi/content/full/6/1/31) {our own 1000+ database confirms this}

Even with confidence in my own and my colleagues skills, I still have no issue calling anesthesia for a very difficult airway. Despite a small n, the three times I have called, all ended up in emergency surgical airways done by me (aka airway resuscitation). Others have had anesthesia get the airway on the rare occasion we, as a group, call (we see about 150K a year total and average about 6-10 calls a year, with an average of 6-8 surgical airways required).

No one is saying that anesthesia aren't airway experts. Without a doubt they are. (My stepmother blows my mind every time she tells me she intubates regularly with a mac 2 in the OR *boggles*) But to say because you can intubate, you are a resuscitation expert is a far leap in my mind. These two fields are vastly different with one very small area of overlap.

All of medicine is interdisceplenary, and thankfully, we don't all want to be gas, or EM or surgeons, etc. Doing the 'best at' is detrimental to all fields as it ultimately undermines us all.

The OP wanted to see both sides. I expressed why *I* personally love EM. Nothing more.

 

[pillowhead]

Resuscitation goes beyond tubing someone. Often times, it entails trying to do everything but tube them if you can help it. Obviously, in a patient in severe resp. distress, it is the first step. And since we aren't to smart down here in the ER, we do like our algorithms, so yes, A comes first.

Resuscitation can entail central lines, chest tubes, EGDT, bipap, shocking,thrombolytics, yadda yadda yadda. Its ridiculous to compare the two. Gas is better in the OR. EM is better in the ER. Neither of us would perform well in the others house. Occasionally we overlap. As for your own experience in the ED, making broad statements about ALL EM doctors based on your one experience in one ED is a little overreaching. And just like *every* specialty, there are some practitioners not as solid as others. In mine and many others, (and in the emergency intubation literature) EMP's are very competent at RSI intubations. (http://www.aemj.org/cgi/content/full/6/1/31) {our own 1000+ database confirms this}

Even with confidence in my own and my colleagues skills, I still have no issue calling anesthesia for a very difficult airway. Despite a small n, the three times I have called, all ended up in emergency surgical airways done by me (aka airway resuscitation). Others have had anesthesia get the airway on the rare occasion we, as a group, call (we see about 150K a year total and average about 6-10 calls a year, with an average of 6-8 surgical airways required).

No one is saying that anesthesia aren't airway experts. Without a doubt they are. (My stepmother blows my mind every time she tells me she intubates regularly with a mac 2 in the OR *boggles*) But to say because you can intubate, you are a resuscitation expert is a far leap in my mind. These two fields are vastly different with one very small area of overlap.

All of medicine is interdisceplenary, and thankfully, we don't all want to be gas, or EM or surgeons, etc. Doing the 'best at' is detrimental to all fields as it ultimately undermines us all.

The OP wanted to see both sides. I expressed why *I* personally love EM. Nothing more.

That's great. I think it's wonderful everyone loves different specialties. Seriously, I really really do because of us don't want to do most of them. And I did say that there's more to resuscitation than intubation. But I've been most impressed in my n=1 expriences with seeing CT anesthesiologists both in the OR but more importantly in the CT ICU when it comes to resuscitating coding patients (including managing acute PEs, shocking, bipap, etc). Perhaps I should have been more clear about meaning the ICU and not the OR. ER and ICU patients have a lot of differences and the ER patient is undifferentiated.

I went to a school with a very good EM residency where we rotated through a very busy level 1 urban county hosptial and a tertiary peds hospital. While there's going to be widely varying skills between programs and between physicians within a program, I still think given my minimal exposure to the ED, I was very surprised to see anesthesia called twice for helping out with patients. Maybe it was a fluke but given just how much EM attendings told us in didactics that they were experts in resuscitation, I was suprised by my own experiences.

No hate for EM. It's hard and I was exhausted at the end of my shifts from running around. Just as you were personally giving your experiences and background for going into EM, I'm simply trying to explain my ED experiences which were very unexpected for me. If I called myself the expert in something, I wouldn't want to be calling another service twice a month for help in the ABCs. Again, maybe it was a fluke. There are tons of other great reaons to be going into EM if that's what one likes, and I swear I was not trying to create any kind of flame war. The ED can be a chaotic environment and is certainly not an easy place to work.

 

[MCAT guy]

Epic bump for a good thread.

 

[PMPMD]

And after doing a month of cardiothoracic anesthesiology, I can't imagine anyone more adept at resuscitation than a CT trained anesthesiologist.

Critical care trained anesthesiologist?

 

[jetproppilot]

Emergency Medicine Physicians, while the "jack of all," are experts in resuscitation. No other field can resuscitate the variety of patients that an EMP can.

.

 

[jetproppilot]

Emergency Medicine Physicians, while the "jack of all," are experts in resuscitation. No other field can resuscitate the variety of patients that an EMP can.

Slim,

Just as a teeny weeny example of the plethora of facts I could lay on you to retract your statement that said "no other field can rescuscitate the variety of patients that an EMP can..."

Has an ER doctor ever been called to the operating room?

 

[sarcoid]

Slim,

Just as a teeny weeny example of the plethora of facts I could lay on you to retract your statement that said "no other field can rescuscitate the variety of patients that an EMP can..."

Has an ER doctor ever been called to the operating room?

Have you intubated thousands of people? Can you effectively mask ventilate someone? Both are crucial skills if you claim to be the king of rescuscitation. You remember, right? AIRWAY, BREATHING, CIRCULATION. ABC. Airway is first and foremost. Gotcha smoked on that while distracted thinking about having spaghetti for dinner. I don't haffta think about managing an airway. It's as innate to me as taking a whiz.

Can you do other crucial skills of resuscitation in your sleep? like central lines, a lines, figuring out which inotrope/vasopressor is called for and hanging it yourself (since you can do it faster than anyone and have the doses of every inotrope/vasopressor permanently etched in your long term memory) to save time (after all we're resuscitating somebody right? So time is essential, right?), starting IV's quickly and deftly with large bores, knowing the tricks of getting crystalloid/blood in really fast (I'll bet your ER patients...even the trauma patients...have those stupid pigtails attached to their IVs...don't you ER guys remember physics? Lemme break it down for you...small IV pigtails makes volume resuscitation difficult)...

I could go on and on. Chest tube? Done many. Crich? Yep.

Sorry, man. I've gotcha covered TWICE OVER when it comes to resuscitation.

When you make a statement like the one you made above, well,

The truth hurts sometimes.

I'm telling you the truth.

I'm better than you at rescuscitation, and I'm not an ER doctor.

And when I've said "I", I'm really referring to me, the anesthesiologist.

Yeah, that kinda sounds like I'm trying to get into a dick swinging contest with you. I'm not.

I'm correcting your arrogant, erroneous post.

To this rebuttal, no comeback is possible. Its as indefensible as this:

http://www.youtube.com/watch?v=9pA0TJWqre8&feature=youtube_gdata_player

 

[jetproppilot]

To this rebuttal, no comeback is possible. Its as indefensible as this:

http://www.youtube.com/watch?v=9pA0TJWqre8&feature=youtube_gdata_player

Yeah, it was a little too strong so I'll revise what I said. I was talking more to the dude that posted it rather than the whole specialty. I took his post like a broad, arrogant statement.

Certainly have no desire to start some ER vs Anesthesia bashing war.

There are some great ER docs out there.

But to come in here and announce you are the KING of rescuscitation is a little much.

 

[Birdstrike]

Bashing other specialties is a sign of a small penis.

 

[coldweatherblue]

I'm an MS3 applying to Emergency Medicine for the upcoming match. My reasons for going into EM are well described by roja's first post in this thread. Love the diversity of patients, love seeing undifferentiated CCs. Don't mind the primary care aspect (right now at least). Etc. I also don't feel the need to compete with any other medical specialty for the glory of having "ultimate skillz". Very glad they are there to help! Residency will give me training to ensure that my patients get the care they need while in the ED and are given access to appropriate care after they leave.

I went into med school interested in anesthesia but after time in the OR found it wasn't for me. Enjoyed intubating and the procedural aspect very much but ultimately feel more at home outside of the OR, or on the other side of the drapes.

It's also important to note that the post about EPs being experts at resuscitation was written four years ago. If no one is trying to start a war, what is the point in responding with the claim that anesthesia is twice as good at blah blah blah? Seems inflammatory given the age of the post.

 

[jetproppilot]

Bashing other specialties is a sign of a small penis.

Yes thats true. Well it's not true, but your message is true.

My bad.

I apologize.

 

[RemyMcswain]

Bashing other specialties is a sign of a small penis.

Couldnt find anything on pubmed that supports that claim. Can you please post a link?

 

[sarcoid]

Yeah, it was a little too strong so I'll revise what I said. I was talking more to the dude that posted it rather than the whole specialty. I took his post like a broad, arrogant statement.

Certainly have no desire to start some ER vs Anesthesia bashing war.

There are some great ER docs out there.

But to come in here and announce you are the KING of rescuscitation is a little much.

Yeah, it was a little too strong so I'll revise what I said. I was talking more to the dude that posted it rather than the whole specialty. I took his post like a broad, arrogant statement.

Certainly have no desire to start some ER vs Anesthesia bashing war.

There are some great ER docs out there.

But to come in here and announce you are the KING of rescuscitation is a little much.

Jet, I for one wasn't taking your post as being out of line, rather I saw it as a doc taking pride in his expertise, nothing wrong with that. This is the anesthesiology forum and you are the foremost experts in resuscitation, period. It's not like you were posting that in the EM forum and out to bash EP's. Simple pride and defending that's all. But way to display some professional etiquette. Sets a good example. More ppl could use some of that on sdn. Funny how some of these old posts keep going... It makes me wonder if once I'm an attending if the same discussions will be taking place (crna's, specialty comparisons, etc.) or if newer issues will supplant them.

 

[roja]

Bashing other specialties is a sign of a small penis.

I wish there was a like button.

 

[Gern Blansten]

I wish there was a like button.

If only there was some way for you to let us know you agree with the other poster's comment. There must be some way you could do that. Let me think on it a while and I will see if I can come up with something. Seriously, there must be some way to alter the website's software to allow you to agree with someone. Anyone have any ideas on how roja could let us know that he also has a similar belief? Hopefully someday we will find a solution.

 

[Doctor4Life1769]

If only there was some way for you to let us know you agree with the other poster's comment. There must be some way you could do that. Let me think on it a while and I will see if I can come up with something. Seriously, there must be some way to alter the website's software to allow you to agree with someone. Anyone have any ideas on how roja could let us know that he also has a similar belief? Hopefully someday we will find a solution.

 

[jetproppilot]

Jet, I for one wasn't taking your post as being out of line, rather I saw it as a doc taking pride in his expertise, nothing wrong with that. This is the anesthesiology forum and you are the foremost experts in resuscitation, period. It's not like you were posting that in the EM forum and out to bash EP's. Simple pride and defending that's all. But way to display some professional etiquette. Sets a good example. More ppl could use some of that on sdn. Funny how some of these old posts keep going... It makes me wonder if once I'm an attending if the same discussions will be taking place (crna's, specialty comparisons, etc.) or if newer issues will supplant them.

'preciate the support, Dude.