Can Intensivists work in the ER?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
E

ERScribe

Hi all,

I'm just wondering if an IM/Intensivist can work in an ED. Would they have had to do IM prior to the CC fellowship or could they have done Surg/Anes and still work in the ED?

Thanks

Members don't see this ad.
 
This is an often revisited topic with multiple specialties on the front end of the question. No, or at least not as well as someone trained specifically to do it.
 
Agree with kungfo.

Where is an IM/intensivist going to get peds training? OB/GYN? Experience taking care of trauma? Ortho? Neuro-surgery?

These are specialties that intensivist/internal medicine don't generally get good exposure to (if any exposure at all).

If you want to work in the ICU, you should train in the ICU. If you want to work in an office, you should train in an office. If you want to work in the ER, train in the ER.
 
Members don't see this ad :)
Many ERs that can't attract enough EM grads will hire IM docs, but only ones with significant experience in EM. I doubt there are any ERs left that will hire an IM doc without ER experience, so in order to get ER experience you're out of luck.

If you want to do EM, train in EM. IM/EM programs are only five years, and give great background for ICU fellowships.
 
If anything an intensivist would be less useful than a primary care IM doc. Seriously there isn't much of a role for glucose control, ventilator weaning, and CVVH in the ED...
 
An intensivist can work in the ER......provided he/she can see 2.5 pts/hour and resist the urge to calculate anion gaps, free water deficits, and A-A gradients on every patient....
 
If you want to work in the ICU, you should train in the ICU. If you want to work in an office, you should train in an office. If you want to work in the ER, train in the ER.
What about if you want to work at In-N-Out?

An intensivist can work in the ER......provided he/she can see 2.5 pts/hour and resist the urge to calculate anion gaps, free water deficits, and A-A gradients on every patient....
Is it a bad thing as an EM-interested student if I want to do those calculations? :laugh:
 
To work in an ED, you need to meet the credentialing standards set by the credentials committee. In 2009, most large hospitals with busy emergency departments will require, at a minimum, board certification or emergency medicine residency training with the expectation that the EM boards will be passed within 3 to 5 years.

In small rural EDs, the standards are simply lower and sometimes all you need to be allowed to work in an ED is to pass an internship. But the malpractice risk is the same as in the larger EDs and absolutely anything can walk through the door. Furthermore in these small EDs you have little to no backup in terms of rapid surgical consults, neuro, or OB. In these small EDs you are still expected to meet the standard of care as if you were practising at the best ED in the region. If you think that training as an intensivist will allow you to do that consistently in an ED, have fun and by the way, I have a good therapist I could recommend for the delusional ideation.
 
If you think that training as an intensivist will allow you to do that consistently in an ED, have fun and by the way, I have a good therapist I could recommend for the delusional ideation.

Lol relax guys, I don't mean to imply that any doc can fulfill the role of an EM doc. I've only really been exposed to EM [as a scribe] and honestly don't really know much about what intensivists do procedurally beyond seeing them the occasional Central line for an admitted patient in the ED.

After spending 2000+ hours of my life in the ED, I still really like it. But wanted to see if there were any training programs that would allow someone to work both in an ED and in another specialty. I don't see why this wouldn't be possible since the doctors I work with all have very set schedules.

|: For example, maybe work 2 weeks in a more procedural field then 2 weeks in the ED :|

[ " :| " means repeat in case you didn't know. ]

Also what is required to work in an Urgent Care?
 
Lol relax guys, I don't mean to imply that any doc can fulfill the role of an EM doc. I've only really been exposed to EM [as a scribe] and honestly don't really know much about what intensivists do procedurally beyond seeing them the occasional Central line for an admitted patient in the ED.

After spending 2000+ hours of my life in the ED, I still really like it. But wanted to see if there were any training programs that would allow someone to work both in an ED and in another specialty. I don't see why this wouldn't be possible since the doctors I work with all have very set schedules.

|: For example, maybe work 2 weeks in a more procedural field then 2 weeks in the ED :|

[ " :| " means repeat in case you didn't know. ]

Also what is required to work in an Urgent Care?

People get a bet testy around here whenever someone asks about non-EM trained docs working in EDs. It's just a sore spot. We're better than some others about it. For example go to the gas forum and ask if a CRNA can do everything an anesthesiologist can do and see what happens.

We also see so many questions about how one can train in some area and still have lots of options for practice settings such as folks hoping they can do EM and an office based practice or EM and work in the ICU etc. The real answer is that if you want to do both you should train in both. Otherwise you are shorting something in your knowledge base.

It's also important to know that throughout med school (really from high school on) everyone is forced to make decisions that progressively limit their options. You have to make choices about what electives you do which will really determine what specialties you can be competitive for. Once in residency trying to switch is very painful. As has been said before you just can't be a stem cell forever.
 
The answer is yes, but it depends. I trained in family medicine in southern california and spent countless nights working in the county ED (our first year call consisted of numerous 24hr and 12hr shifts in the ED) and eventually working single coverage alone on the weekends as a senior resident. We were trained to intubate, place central lines, insert chest tubes, run trauma codes (atls cert) etc. Those with whom I trained tended to prefer working in 3rd world countries and sought surgical and various procedural proficiencies.

The ED group did employ the hospital's intensivist who only saw adults. I believe he was paid the same as the ED docs and he didn't see any kids or OB pt's. The reason was because there was a need. I guess, it all depends where you are. I agree with the previous posters in that you should never work in an environment in which you weren't trained. Period. The ED is entirely different from the wards and clinic-there's a reason it is shift work. Those who train exclusively in the ED are truly specialists and one should not consider the nature of the work an extension of their basic training. It is nothing close. (try to keep cops, ma's, paramedic's, rn's, rt's, schizo's, drunk's, etc. content at the same time...) I have training in ED, but I'm not an ED physician. I am content with that distinction, but I think that it is under-appreciated.
 
In the peds setting this type of thing may be easier (or even more common, I don't know). We have a couple intensivists who cover the ED, but they're always a double coverage, working with an ER fellowship trained attending. But in a dedicated pediatric ER, you're cutting out a lot of the diversity that you would see in an adult ER where anything can walk in (if that makes sense).
 
To answer Scribe's second post, there are IM/EM/CC training programs out there. So you can get the appropriate training in both if that's your chosen career path.

On a side note, do the critical care/IM/FP forums ever have "Can you do X as an EM doc?" Couldn't you just consult out the difficult patients to a subspecialty? ::D
 
|: For example, maybe work 2 weeks in a more procedural field then 2 weeks in the ED :|

[ " :| " means repeat in case you didn't know. ]

Also what is required to work in an Urgent Care?

As far as I know, the intensivist isn't really more procedural than the EP. And I don't really see any combination that would allow you to practice EM + "a more procedural field" in the real world.

Urgent care? Depends on location, I'm sure, but I guess EM/IM/FP all suffice.
 
simply i think EM is different... so i dont think an intensivist could work in the ER without significant ER experience ..

and intensivist can work in an ER if he FINISHED an EM residency program and then had a Fellowship in Intencive care medicine.
:)
 
simply i think EM is different... so i dont think an intensivist could work in the ER without significant ER experience ..

and intensivist can work in an ER if he FINISHED an EM residency program and then had a Fellowship in Intencive care medicine.
:)

Yes, that would be obvious.
 
I'm pretty intense sometimes, does that count?
 
Man, you are a like a boy scout troop in the summer.....

In tents.

(intense)
 
What residencies allow for felloship training in Intensive Care? I've heard of Internal med, surg, Anes. EM too?? cool. Are there any others?
 
"Many ERs that can't attract enough EM grads will hire IM docs, but only ones with significant experience in EM. I doubt there are any ERs left that will hire an IM doc without ER experience, so in order to get ER experience you're out of luck."

Sadly, I think the only level 1 trauma center in Washington State only takes IM grads. Im not quite sure the political BS behind that decision.

Edited to add a link showing the lack of EM trained providers

http://seattletimes.nwsource.com/html/localnews/2002177303_erdocs11m.html
 
Last edited:
"Many ERs that can't attract enough EM grads will hire IM docs, but only ones with significant experience in EM. I doubt there are any ERs left that will hire an IM doc without ER experience, so in order to get ER experience you're out of luck."

Sadly, I think the only level 1 trauma center in Washington State only takes IM grads. Im not quite sure the political BS behind that decision.

Edited to add a link showing the lack of EM trained providers

http://seattletimes.nwsource.com/html/localnews/2002177303_erdocs11m.html

This article is dated about 4 years ago, is harborview still like this?
 
Top