ED characteristics..which ED for me?

[Archdelux]

---

Members do not see this ad.

Hi,

I get the distinct impression that a lot of EDs are very different in terms of the way that EPs an practice medicine. For example, the level of autonomy, the types of cases, etc.

Ideally, I would like to work at a place where EPs are very autonomous in the sense that they make a large majority of the diagnoses in the ED and don't consult other services extensively (obviously consults need to be made, but at certain hospitals, it seems that some EPs are more 'trigger-happy' than EPs at other hospitals)--Basically, I'd like to do the most I can for the patient myself. I want to be able to fix the problem and send them home, or to run the tests, make the diagnosis/treatment plan and then admit to medicine (to whatever extent is feasible). I want to be the one who intubates the patient, the one who runs the trauma, the one who does most of the procedures--without the need to call in other services--I think this autonomy is essential to me.

Second--I'd like a lot of variety with a lot of trauma thrown in. I think that the first and second criteria might conflict with each other a bit in terms of the hospitals that fit the molds..maybe I'm wrong..?

So--are there many programs like this? Are most programs like this? Any of particular mention? Also--probably more important, what types of programs are like this (ie large academic ones, small rural ones, etc.?)

Thanks so much!

 

[WallowaWanderer]

Hi,

I get the distinct impression that a lot of EDs are very different in terms of the way that EPs an practice medicine. For example, the level of autonomy, the types of cases, etc.

Ideally, I would like to work at a place where EPs are very autonomous in the sense that they make a large majority of the diagnoses in the ED and don't consult other services extensively (obviously consults need to be made, but at certain hospitals, it seems that some EPs are more 'trigger-happy' than EPs at other hospitals)--Basically, I'd like to do the most I can for the patient myself. I want to be able to fix the problem and send them home, or to run the tests, make the diagnosis/treatment plan and then admit to medicine (to whatever extent is feasible).

Second--I'd like a lot of variety with a lot of trauma thrown in. I think that the first and second criteria might conflict with each other a bit in terms of the hospitals that fit the molds..maybe I'm wrong..?

So--are there many programs like this? Are most programs like this? Any of particular mention?

Thanks so much!

First off, where are you in your training? I'm assuming you're a med student thinking about programs for the future.

You bring up 2 issues.

The first being ED autonomy. You are correct in your impression that each program functions differently, and is on a continuim from consult happy to good-luck-getting-your-consult-this-decade. It's hard info to find - which is which. Everyone will tell you what you want to hear. Some things that MAY (and I emphasize MAY) decrease ED autonomy and increase the white coats in the ED include: more tertiary/quaternary center, more academic, stronger other services, younger EM program, older other services, less volume but lots of residents in other strong services, and availability of subspecialists (from everpresent to nonexistent). There are certain regional patterns as well. County programs tend to have less consultants and more ED autonomy. Community programs tend to have less subspecialist residency training programs. Many people will diasgree with me, but there it is. If you're looking for what you say are looking for, then reading through the reviews thread with an eye to read between the lines will cause some programs to pop out at you.

Trauma . . . some places seperate it out and you don't see it unless you rotate with surgery. In other places it is solely the domain of the ED with surgery there just in case (more rare). A good compromise is rotating by day or odd/even MR number. Ask who does the big procedures. Sure they might be alternating chest tubes but what happens with thoracotamies? If you read through the reviews this will pop out at you as well.

Feel free to PM me and I can give you my incredibly biased opinion on these two issues as they were very important to me in my search this year.

Also, take a look at this thread and it's associated debate. - Hospitals where the ED dominates http://forums.studentdoctor.net/showthread.php?t=457377&highlight=dominates

 

[sarahinromania]

Archdelux, I just wanted to mention something briefly. Depending on the consultant, their level of comfort etc., a lot of them will let you do procedures. That is, even if your attending wants the consult, the ENT resident may walk you through draining a peritonsillar abscess on your own patient, the ortho resident may let you do your patient's reduction and casting, etc. That depends a lot on the ED's relationship with surgery (here it helps to have a more established, strong ED in a large, tertiary care center). It's cool to get to have a first crack at special procedures via Roberts & Hedges, but it's also cool to have a resident specializing in said procedure teach you. Regardless of where you end up, you can always ask a consultant to let you do the procedure. They may say no, but some will say yes.