Anyone regret *not* doing Emergency Medicine?

[swamprat]

I am an EM attending in an anesthesia fellowship currently (there is only 2 we can do obviously) - if I had to do it all over again I would still choose EM. I love the vast knowledge base that we have. Our expertise is the undifferentiated sick patient. And the ability to multitask between multiple patients regardless of complaint, acuity etc at the same time. Dealing with the public is rough not going to lie, and that is one of the big downsides - but at the same time when I walk into a crazy busy ED I generally have a good time because I think overall the people that work down there love it. You become buddy buddy with police, EMTs, nurses, mid levels etc. I do not feel that mid levels will be taking over our jobs anytime soon. There are so few that are actually good - many over order tests, don't know basic DDx of common things etc. We are asked questions all the time.

Now what do I not like about the ED? Shift work sucks. Even though we work less hours its constantly shifting back and forth. It takes a tole on you. Some people are better at it than others. When I was a resident I hated all the BS complaints - mostly bc I had to write a note, staff it with an attending, hope they don't grill me about esoteric BS etc. Now those cases are easy, I usually have them discharged within 30 minutes of arrival. No BS. I guess I still have to write the note..

Anyway thats my 2 cents. I thought about anesthesia but CRNAs scared me off.

Oh and the one thing which is nice about being an ED doc is that I don't take **** from surgeons

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[el_duderino]

I decided on anesthesia for a lot of reasons, but as an MS4 who chose it over EM this thread interests me. I had a lot of attendings (in the ED and otherwise) tell me not to go into EM. I got a lot of grimaces when I told people in medicine that's what I wanted to do. Since I settled on anesthesia, literally no one has told me that it's not a good choice. I've had attendings from several other disciplines, like EM and Ob-gyn, flat-out tell me they wished they had done that instead.

 

[anbuitachi]

I am an EM attending in an anesthesia fellowship currently (there is only 2 we can do obviously) - if I had to do it all over again I would still choose EM. I love the vast knowledge base that we have. Our expertise is the undifferentiated sick patient. And the ability to multitask between multiple patients regardless of complaint, acuity etc at the same time. Dealing with the public is rough not going to lie, and that is one of the big downsides - but at the same time when I walk into a crazy busy ED I generally have a good time because I think overall the people that work down there love it. You become buddy buddy with police, EMTs, nurses, mid levels etc. I do not feel that mid levels will be taking over our jobs anytime soon. There are so few that are actually good - many over order tests, don't know basic DDx of common things etc. We are asked questions all the time.

Now what do I not like about the ED? Shift work sucks. Even though we work less hours its constantly shifting back and forth. It takes a tole on you. Some people are better at it than others. When I was a resident I hated all the BS complaints - mostly bc I had to write a note, staff it with an attending, hope they don't grill me about esoteric BS etc. Now those cases are easy, I usually have them discharged within 30 minutes of arrival. No BS. I guess I still have to write the note..

Anyway thats my 2 cents. I thought about anesthesia but CRNAs scared me off.

Oh and the one thing which is nice about being an ED doc is that I don't take **** from surgeons

I didn't know they offer anesthesia fellowship. It's not a residency but fellowship??

I decided on anesthesia for a lot of reasons, but as an MS4 who chose it over EM this thread interests me. I had a lot of attendings (in the ED and otherwise) tell me not to go into EM. I got a lot of grimaces when I told people in medicine that's what I wanted to do. Since I settled on anesthesia, literally no one has told me that it's not a good choice. I've had attendings from several other disciplines, like EM and Ob-gyn, flat-out tell me they wished they had done that instead.

This very institution/person specific. That's why you see some med schools produce many anesth applicants each year, while other schools hardly have any. If the department is good, people are satisfied, it will rub off on the med students. Other places may have a crappy anes department but a great EM department and you'll hear opposite things

I think we should do trachs. 1) We are the ones to respond to airways, and ENT isn't always going to be around or there in a timely fashion. 2) I'm pretty sure the literature shows that surgical trach/cric has vastly superior success rates than needle approaches in emergencies. 3) The way to maintain the required skills would probably be for anesthesiologists to do the routine trachs (like some ENT patients need before their surgery). I don't think ENT is going to complain if they don't get called at 3am to do a trach, or if we take some of the routine OR trachs. High riding innominate or difficult anatomy would still go to ENT. I know of 1 institution that the anesthesiologists do percutaneous trachs across the hospital.

I agree too. It'd be awesome if we get to do trachs and stuff, but this is so rare, i think most anesthesiologists would hand it over to a surgeon whos done many of these than to go for it themselves since if they botch it its their license on the line. Obviously if no surgeon is available you start slashing. I would say most graduating residents haven't done a single emergency trach/cric in their residency though

 

[AdmiralChz]

Oh and the one thing which is nice about being an ED doc is that I don't take **** from surgeons

Must be nice! At my gig (only have 2 more shifts left), the surgeons are much nastier when you call them over the phone for an incarcerated hernia or what have you (“did you even F’ing try to reduce it” etc...). Plus you get to take crap from IM or FM who doesn’t want to admit or argues with your diagnosis! I just did a shift Friday night and I had to fight tooth and nail on every admit with these services. Perhaps this would be better once these services got to know me, perhaps it wouldn’t. Won’t miss it AT ALL.

By far the service most complained about in general surgery ORs is EM. It’s unfortunate because there are some good, hardworking docs down there but they have minimal to no respect from service lines.

 

[drmwvr]

Oh and the one thing which is nice about being an ED doc is that I don't take **** from surgeons

Oh yes you do my friend. You just don't hear it.

 

[Psai]

Must be nice! At my gig (only have 2 more shifts left), the surgeons are much nastier when you call them over the phone for an incarcerated hernia or what have you (“did you even F’ing try to reduce it” etc...). Plus you get to take crap from IM or FM who doesn’t want to admit or argues with your diagnosis! I just did a shift Friday night and I had to fight tooth and nail on every admit with these services. Perhaps this would be better once these services got to know me, perhaps it wouldn’t. Won’t miss it AT ALL.

By far the service most complained about in general surgery ORs is EM. It’s unfortunate because there are some good, hardworking docs down there but they have minimal to no respect from service lines.

Having been on both sides, it's a lot more annoying to have people pushing back against legitimate admissions than admitting bs. I do like writing the discharge summary right in front of the ******* ED doc (or much more often the midlevel) when they force me to admit bull**** that is getting discharged as soon as the attending sees them.

 

[swamprat]

Must be nice! At my gig (only have 2 more shifts left), the surgeons are much nastier when you call them over the phone for an incarcerated hernia or what have you (“did you even F’ing try to reduce it” etc...). Plus you get to take crap from IM or FM who doesn’t want to admit or argues with your diagnosis! I just did a shift Friday night and I had to fight tooth and nail on every admit with these services. Perhaps this would be better once these services got to know me, perhaps it wouldn’t. Won’t miss it AT ALL.

By far the service most complained about in general surgery ORs is EM. It’s unfortunate because there are some good, hardworking docs down there but they have minimal to no respect from service lines.

Yeah I think negotiating soft admits is an art you inevitably pick up. Its selling someone a ****-sandwich of sorts. But I also only work in shops where I have full admitting authority. Medicine can argue all they want if I choose to admit them they are admitted. Can't do that with surgery or other services but I can make their lives hell - esp if they give me crap even for calling for an opinion (like not an official consult) in which case if I know they are on ill officially consult them and then they must come see the patient in a certain amount of time and put a consult note in. For the most part though haven't really had too many issues in the community. Its academic centers I feel where a lot of this stuff goes down and people get bitter and irate. Case and point below:

Having been on both sides, it's a lot more annoying to have people pushing back against legitimate admissions than admitting bs. I do like writing the discharge summary right in front of the ******* ED doc (or much more often the midlevel) when they force me to admit bull**** that is getting discharged as soon as the attending sees them.

I'd appreciate you not use such foul language to refer to us. Your also a resident - chill out.

 

[Dr.Jekyll75]

So im gonna throw my 2 cents in this thread real quick. Every doc in the ER over the age of 45 says don't do it, shift work is great if you can put up with it and not taking anything home with you. Every anesthesiologist ive met says the money isnt what it used to be. From my understanding so far, anesthesia doesnt self hate the profession as much as er docs do.

 

[Gern Blansten]

I am on my third glass and can’t put this together. But clearly 20 others before me have.

The typist only has one hand, so he has trouble hitting the shift key to make capital letters. Thus, it's mostly shift work. Dad joke, for sure.

 

[Aether2000]

OMG no! No regrets, not having to serve as a personal private physician for the poor that don't want to schedule an appointment with their pcp for their rash of 6 months or runny nose. I have less chance of getting gunned down in the OR and don't have to deal with the crazies for more than a few mintes until I slam them to sleep. Anesthesiology may be corporate cog in a wheel work, but my patients get back to baseline, and best of all, they don't remember me at all unless they are frequent flyers

 

[deleted547339]

Having been on both sides, it's a lot more annoying to have people pushing back against legitimate admissions than admitting bs. I do like writing the discharge summary right in front of the ******* ED doc (or much more often the midlevel) when they force me to admit bull**** that is getting discharged as soon as the attending sees them.

You must be great to work with...

 

[deleted547339]

I didn't know they offer anesthesia fellowship. It's not a residency but fellowship??

Not a fellowship I’m anesthesia, per se.

Pain or CCM fellowships through anesthesia.

 

[turnupthegas]

I have many EM attending friends. Few are a couple years out and already taking about burnout. I could never do EM. That rapid clinic work is a pain in arse for me. I like the limited interview we have with patients Calling consultants and primary docs just made me feel like I was going to be a forever intern. Many of the cool procedural parts of EM end up being time wasters when you’re trying to move meat out of the ED. NP/PAs are the same problem as CRNAs. That problem is everywhere.

I have a few friends who are in less busy EDs that enjoy it. Too each their own.


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[Man o War]

I have many EM attending friends. Few are a couple years out and already taking about burnout. I could never do EM. That rapid clinic work is a pain in arse for me. I like the limited interview we have with patients Calling consultants and primary docs just made me feel like I was going to be a forever intern. Many of the cool procedural parts of EM end up being time wasters when you’re trying to move meat out of the ED. NP/PAs are the same problem as CRNAs. That problem is everywhere.

I have a few friends who are in less busy EDs that enjoy it. Too each their own.


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I’m always puzzled when I see or hear people say they chose EM over anesthesia due to mid levels. The NPs in the ER are no less rabid and think they’re equivalent too.

 

[seebelcherrun]

EM married to anesthesia. It really just depends on your personality. I enjoy talking to people and the puzzles in the ED. Trying to figure out an undifferentiated patient or why this person is here at 3 am makes the job more interesting. I also like managing multiple things at the same time and no shift is ever the same as the last.

Notes and the nights can be a drag. But you know what youre getting into.

Don't mind the vague complaints. If they're non emergent, you discharge to pcp. done deal.

I see kids and adults fairly comfortably. both emergent and non emergent complaints. not many docs that do that anymore.

I'm comfortable enough with myself that I don't really care what other specialties think.

My wife doesn't like talking to people and likes to focus on one patient. Anesthesia was ideal for her.

Also when your family or friends have a medical question, you're the person they come to. You have a good idea of what every specialty knows, have a good idea of the standard of care, know what constitutes an actual emergency and can help them navigate a very convoluted system.