Thank you so much for that explanation
@gamerEMdoc !!
Just one follow-up: what was the reason that procedures were high on your list when you were choosing a residency? Also, in terms of number of shift hours etc. I've heard attendings say that you can't get good training if you are working 8-9hr shifts 5-6 days a week vs. 12hr days. Do you believe the training hours should be extended or do you think it largely depends on the type of person.
I disagree. I dont think its good training to get overworked and working 20 12 hr shifts is just too much in my personal opinion. The sweet spot for me when I was looking for a residency was 9-10 hr shifts, between 18-20 depending on year of residency. Maybe it would be different if it was at a residency where productivity wasnt a big deal, but if you go to a place where you were going to see two patients an hour, it’s pretty brutal doing that 12 hours a day 20 days a month.
As for why I wanted to go to a place with a lot of procedures, it’s because it’s important to know how to do procedures when you’re out on your own. Unless you are going to be practicing in a large university setting, you need to know how to do a lot of procedures. You need to know how to pick a foreign body out of someone’s cornea, reduce the fracture, reduce just about any dislocation, put in a chest tube, get an airway or venous access on trainwreck that comes in the door, do an LP on a 300 lb patient, do an lp on a 6lb neonate, etc. Real life EM is not having a fellow in every subspecialty to bail you out. Its just part of the job to know how to do just about everything because chances are, when something needs to be done RIGHT NOW, you aren’t going to have a specialist coming in to help you out if its considered within your scope of practice.
I trained in a busy community EM program with a subspecialty on call list for just about anything, but almost no one in house other than the other residencies; there were no fellows. No other attendings in house during call, all attending subspecialists were on call at home. It was very similar to my current job. Despite having someone on call, I had to do a lateral canthotomy as a resident bc ophtho couldn’t get there in time. I have been part of a perimortem csection as an attending with another em doc while OB was on their way. Ive opened a chest waiting for trauma to arrive. Did an emergent pericardiocentesis for tamponade. You will deliver babies (one of our attendings delivered breach twins moonlighting in the middle of nowhere). The list goes on and on and anyone who has worked in EM out in the community can tell you, this is just part of our job. Take a look at the procedure book Roberts and Hedges and all the crazy procedures that are in there. That’s an EM textbook; knowing how to do just about any bedside procedure is in our scope of practice and you will be expected to do a ton of procedures without people holding your hand and/or bailing you out. Unfortunately, when you get out, that’s your job to know how to do those procedures because sometimes, somewhere, you just aren’t going to have backup.
Longwinded explaination, but that’s why it was important to me when I trained and why I think its super important to know wherever you go as a resident what the procedural experience is like. Afterall, you can learn what to order on an abdominal pain patient anywhere but if you graduate and can’t hold your own procedurally, you are going to have a tough time adjusting when you enter the community.