7+ Year Member
15+ Year Member
May 21, 2001
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hi there,

I've been giving a lot of thought to EM lately. I'm a third-year and haven't had the rotation yet. I'm taking EM during first period of my fourth year, but that will be at a tertiary care hospital ER in a pretty small town. I might do a second ER month, but that won't be till much later in the year. The thing I'm worried about is making my career decision to go into ER without ever really having experienced emergency medicine in the urban setting. I guess that setting seems more intimidating to me for EM. But I've always planned on moving to a big city for residency and beyond.
Do you think it would be bad to apply for EM residencies without having gotten some exposure to EM in a big urban setting?

Nov 24, 2002
High volume is sufficient. Even in small towns, you get STD's, traumatic injuries (small town = high speed on the Interstate, rural shotgun injuries, and possible - even in small town - gangs/drugs), maybe AIDS where you're at.

If the volume isn't there, whether urban or not, you might not see a lot. When you're the only game in town, you might be surprised what rolls through the door.

beyond all hope

Senior Member
7+ Year Member
15+ Year Member
Dec 18, 2003
Status (Visible)
Urban EM will demonstrate to you the highs and lows of EM. Most EM training programs are urban, so you'll have to deal with it at least 3-4 years in residency.

Urban EM is dirtier. More homeless, more primary care issues, more overcrowding, more malingering. Because of this, I think it's more challenging.

Sure, you can have a high-volume, high-acuity rural ER, but it's still pretty pristine compared to the madness of an inner city ER.
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