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EM Future

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Backpack234 said:
Why ACEP? Why not the people in charge of accrediting these residencies? Have they put out a statement?
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The stakeholders of the RRC are the residencies and the staff of the RRC. More residencies means more revenue coming in to certify and re-certify the new residencies. As far as I can tell, their only mandate is to ensure that the residencies that are applying meet the appropriate criteria and that all residencies continue to meet the appropriate criteria on a periodic rechecks.

New residencies pumping out docs is only a problem for one specific group of EM physicians, pit docs. And fortunately, for everyone else involved, that group is largely defined by their desire not to have to deal with anything professionally outside of the shift they're working.
 
Arcan57 said:
The stakeholders of the RRC are the residencies and the staff of the RRC. More residencies means more revenue coming in to certify and re-certify the new residencies. As far as I can tell, their only mandate is to ensure that the residencies that are applying meet the appropriate criteria and that all residencies continue to meet the appropriate criteria on a periodic rechecks.

New residencies pumping out docs is only a problem for one specific group of EM physicians, pit docs. And fortunately, for everyone else involved, that group is largely defined by their desire not to have to deal with anything professionally outside of the shift they're working.
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Isn't that most EM docs?
 
miacomet said:
Isn't that most EM docs?
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Yep. It’s almost like there isn’t a large group of people that are willing to work tirelessly without personal gain so that the average ED doc doesn’t have to do anything other than show up and make lot of money. /s

We view our skill set as plug and play, which was fantastic when there was an EM shortage. Job sucks? I had 4 other offers that pay as much or more. Then it became, job sucks but you’ll make $50-100 more/hr and we jumped at that with both feet. After they realized that, it simply became a negotiation about price. The fact that we are plug and play now means they have the power because they don’t have to woo you. They can throw some new grad from one of their own residencies into the spot.
A generation of EM docs so busy fighting to just get their full complement of shifts isn’t going to have the luxury of things like demanding higher pay or decent working conditions. And of course, that means that CMGs don’t have to tiptoe around messaging the metrics improvements they promised the hospital.

And make no mistake, almost everything on the CMG side of improving metrics makes your life worse. Patient interaction went badly, here’s 30 minutes of getting it rubbed in your face. Door to doc time creeping up? Here’s a triage doc that’s producing no revenue just to stop the clock. Or a triage NP that orders workups that are labyrinthian and seem to always be exactly partially completed when patient gets back to you. CMG needs to meet their doc efficiency metrics? Say good bye to day shifts where you see your family as suddenly 2-10,3-12, and 4-1a shifts become the norm. Watch as the only morning shift is now exclusively staffed by admin docs. Extra points if that morning shift has inexplicably good scribe/competent APP coverage.
 
Arcan57 said:
And make no mistake, almost everything on the CMG side of improving metrics makes your life worse. Patient interaction went badly, here’s 30 minutes of getting it rubbed in your face. Door to doc time creeping up? Here’s a triage doc that’s producing no revenue just to stop the clock. Or a triage NP that orders workups that are labyrinthian and seem to always be exactly partially completed when patient gets back to you. CMG needs to meet their doc efficiency metrics? Say good bye to day shifts where you see your family as suddenly 2-10,3-12, and 4-1a shifts become the norm. Watch as the only morning shift is now exclusively staffed by admin docs. Extra points if that morning shift has inexplicably good scribe/competent APP coverage.
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You definitely nailed the scheduling part. Our AM shifts are staffed exclusively by the site medical directors, and the favored few who have been there 15 years and get to pick their schedule. I'm fine working the 3-11 or 4-12 shifts. The threat always hangs over me though, that if I screw up I'll be banished permanently to the FSEDs, non-desirable sites, or working night shifts forever. That's assuming I still have a job....

I did all nights for 5 years. While I loved the staff, and the lack of admin present, the constant sleep deprivation led to extreme burnout.
 
GeneralVeers said:
You definitely nailed the scheduling part. Our AM shifts are staffed exclusively by the site medical directors, and the favored few who have been there 15 years and get to pick their schedule. I'm fine working the 3-11 or 4-12 shifts. The threat always hangs over me though, that if I screw up I'll be banished permanently to the FSEDs, non-desirable sites, or working night shifts forever. That's assuming I still have a job....

I did all nights for 5 years. While I loved the staff, and the lack of admin present, the constant sleep deprivation led to extreme burnout.
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Well Veers, you've always been a free-market capitalist. And this is what happens in the free market.
 
Arcan57 said:
Yep. It’s almost like there isn’t a large group of people that are willing to work tirelessly without personal gain so that the average ED doc doesn’t have to do anything other than show up and make lot of money. /s

We view our skill set as plug and play, which was fantastic when there was an EM shortage. Job sucks? I had 4 other offers that pay as much or more. Then it became, job sucks but you’ll make $50-100 more/hr and we jumped at that with both feet. After they realized that, it simply became a negotiation about price. The fact that we are plug and play now means they have the power because they don’t have to woo you. They can throw some new grad from one of their own residencies into the spot.
A generation of EM docs so busy fighting to just get their full complement of shifts isn’t going to have the luxury of things like demanding higher pay or decent working conditions. And of course, that means that CMGs don’t have to tiptoe around messaging the metrics improvements they promised the hospital.

And make no mistake, almost everything on the CMG side of improving metrics makes your life worse. Patient interaction went badly, here’s 30 minutes of getting it rubbed in your face. Door to doc time creeping up? Here’s a triage doc that’s producing no revenue just to stop the clock. Or a triage NP that orders workups that are labyrinthian and seem to always be exactly partially completed when patient gets back to you. CMG needs to meet their doc efficiency metrics? Say good bye to day shifts where you see your family as suddenly 2-10,3-12, and 4-1a shifts become the norm. Watch as the only morning shift is now exclusively staffed by admin docs. Extra points if that morning shift has inexplicably good scribe/competent APP coverage.
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Alright, how do we get you to be ACEP president and/or RRC chair?
 
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Lol...
 
Franzd'Epinay said:
Alright, how do we get you to be ACEP president and/or RRC chair?
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Never mistake someone who can point out the problem with someone whose solution you’d follow. If I got to be ACEP president, I would have had a career of making compromises to get things done and would proudly tout how I still work shifts (3 heavily staffed weekday shifts a month) while having increasingly little insight and judgement into what life is like for the worker bees. I’d either be from a CMG or I’d spend many days a month sitting on committees comprised of CMG execs and academics. I would have heard that EM docs where having trouble finding jobs but it would have been a decade(s) since the last time I had to look for a job. I imagine I’d still care about the average doc but in abstract way. I’d want to study the problem because I’m used to things moving slowly and aware that big radical change is both incredibly tough and usually bad. It’d be an interesting problem in a position full of interesting problems. Meanwhile, the people I think of as my peers and stakeholders aren’t dallying in it. For them it’s deadly earnest. The loss of balance billing combined with continuing downward pressure on subsidies and the expectation of their PE masters this quarter means they have to create profit. I’ll give you one guess what the biggest line item on any CMGs budget is. Oversupply isn’t a problem for them, it’s how they survive.
 
I predict, if there is a flood, or exodus of EM, some might land in fellowships, but most will simply hang a shingle, and open their own primary care practices. Don't need to be an FM/IM to be a GP.

I'd personally choose an EM refugee as my PCP over an ARNP any day.
 
Sushirolls said:
I predict, if there is a flood, or exodus of EM, some might land in fellowships, but most will simply hang a shingle, and open their own primary care practices. Don't need to be an FM/IM to be a GP.

I'd personally choose an EM refugee as my PCP over an ARNP any day.
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OR, Unemployed ER docs will now become a thing. If I was a newly minted EM grad looking for work, I might actually apply for a stimulus check...
 
RustedFox said:
That whole follow-up article is surreal. I have about as much idea as what he's trying to get at half the time as I do when Biden prattles on nonsensically.

"I can't get to two more; what's wrong? So I push harder."

"Healthcare disparities with Covid... robble-robble D-I-V-E-R-S-I-T-Y....."

This is pretty much what he did:

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Oh dear god! That was terrible.
 
Why don’t more people aim for the EM/some other specialty combined spots if this is a pressing issue?
 
RadsRocks! said:
Why don’t more people aim for the EM/some other specialty combined spots if this is a pressing issue?
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I hope they do.
There aren't many, they are hard to get, the training is long, and well, we all graduated!
 
RadsRocks! said:
Why don’t more people aim for the EM/some other specialty combined spots if this is a pressing issue?
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Med students are idiots. You can tell them you literally have zero chance of getting a job after residency and they'll still think positions are infinite. I.e. our 2850 matches this year.
 
Rekt said:
Med students are idiots. You can tell them you literally have zero chance of getting a job after residency and they'll still think positions are infinite. I.e. our 2850 matches this year.
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2850 🤯😳😳😳😳. I thought it was 1400 per year. I see the issue now thanks
 
Rekt said:
Med students are idiots. You can tell them you literally have zero chance of getting a job after residency and they'll still think positions are infinite. I.e. our 2850 matches this year.
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Almost everyone in medicine thinks they are special... It's hard to convince them there isn't a 400k job waiting for them in Miami, Atlanta, San Diego, NY city etc...
 
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RustedFox said:
Seriously.

"So, about not having jobs..."

ACEP Prez: "We have two ECXITING think tanks, and we're a leader in diversity."

It's like an alzheimer's patient wearing socks on his ears.
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“Addressing yesterday’s problems tomorrow.” - unofficial motto of most organizations.

The corollary is “Its hard to take credit for preventing something that never happened.”

Although to be fair, people would have looked at you like you had two heads if you were talking about physician oversupply in EM 5-10 years ago.
 
Arcan57 said:
“Addressing yesterday’s problems tomorrow.” - unofficial motto of most organizations.

The corollary is “Its hard to take credit for preventing something that never happened.”

Although to be fair, people would have looked at you like you had two heads if you were talking about physician oversupply in EM 5-10 years ago.
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But they aren't going to do something even now. This is today's problem NOW, which strengthens the case for ACEP to no longer exist.
 
bravotwozero said:
But they aren't going to do something even now. This is today's problem NOW, which strengthens the case for ACEP to no longer exist.
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Yeah, no. Of course they’re not going to address today’s problem today. That’s crazy talk, fr. I’d argue that ACEP ceasing to exist is probably not a net positive. Most of us have probably made our dues money back on ACEP’s lobbying efforts to keep billing up (the one area all the stakeholders’ interests converge). Not sure that’s going to continue to be true, but it’s not nothing either.
The problem is that most of the major problems in EM require collective action which ACEP is not, and never has been suited to organizing. We had the biggest favorable PR event in our specialty’s history, and we capitalized on it by enduring a massive loss of income and employment and cooperating with a couple of newspaper articles about how unfair things are. We could have used that to create a public uproar towards kicking PE out of EM. We didn’t, and we won’t.
 
Sushirolls said:
I predict, if there is a flood, or exodus of EM, some might land in fellowships, but most will simply hang a shingle, and open their own primary care practices. Don't need to be an FM/IM to be a GP.

I'd personally choose an EM refugee as my PCP over an ARNP any day.
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I feel like we have had the debate on this forum ad ifinitum of non-EM people practicing in the ER and ER people practicing something else.

I do not think most ER physicians would be good at primary care. There is some overlap, but overall it is a very different way of thinking and different training to do the job well.

I do not have the training, mindset, or skills to be an effective PCP.

I do not know how to manage common chronic conditions well such as asymptomatic hypertension, diabetes, or high cholesterol.

I would waste a lot of resources working up acute complaints because the "worst first" mindset of ER training comes in. When you see abdominal pain in a primary office, it is not likely a bowel infarction. The pre-test probability of a serious diagnosis for the same complaint in a PCP office is much lower compared to in the ER setting.

I do not know anything about how to manage preventative health such as age appropriate cancer screening. I'm only vaguely aware, which patients need a colonoscopy before age 50, or what to do with a moderately elevated PSA (or even when to get a PSA in the first place).

If the bottom really falls out for me in EM, I would find something else to do, but it wont be opening my own primary care clinic.
 
RadsRocks! said:
Why don’t more people aim for the EM/some other specialty combined spots if this is a pressing issue?
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I think they will. But why do EM/some other specialty at all instead of "some other specialty" by itself and reap the benefits of their prospects with no additional time and lost attending salary spent in additional training?

But referencing my own post from earlier in this thread, the "feedback loop" from professional attending prospects to med student is a long one, maybe ten years. So it will take a long time before high achieving USMGs start to view EM itself as an "undesirable specialty" and apply to other things.

By the time that happens, that will be useful knowledge for those students who have options (i.e. high achieving USMGs), but the market itself won't change as FMGs, IMGs, low-achieving USMGs swell into the spots that are now open to them.

This is the problem for people who are already fully trained and invested in the specialty such as myself and the other staff physician posters on this board. When you are a student, you have to do some residency. When you are an attending, going back to residency represents a huge opportunity cost, and most attending physicians functionally cant.
 
Arcan57 said:
Yeah, no. Of course they’re not going to address today’s problem today. That’s crazy talk, fr. I’d argue that ACEP ceasing to exist is probably not a net positive. Most of us have probably made our dues money back on ACEP’s lobbying efforts to keep billing up (the one area all the stakeholders’ interests converge). Not sure that’s going to continue to be true, but it’s not nothing either.
The problem is that most of the major problems in EM require collective action which ACEP is not, and never has been suited to organizing. We had the biggest favorable PR event in our specialty’s history, and we capitalized on it by enduring a massive loss of income and employment and cooperating with a couple of newspaper articles about how unfair things are. We could have used that to create a public uproar towards kicking PE out of EM. We didn’t, and we won’t.
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This is the biggest bunch of garbage Acep peddles to the masses. You remember hearing about docs making $300/hr or getting bonuses and making $500+/hr. Emergent has plenty of those stories. Why did rates come down? Simple.. supply and demand.

ACEPs lobbying helps those who own the contracts not those who are on the frontlines (unless they overlap). During COVID all these groups got 2% of all their 2019 billings paid to them by the government. EM docs lost hours, had shifts cut and some even lost their jobs. I think it is total nonsense that ACEP brought this money to EPs. As the market shrivels up like it has been doing in Texas (Supply and demand) rates have dropped. I had friends who worked in ultra low volume FSEDs out there making $280/hr plus for 24s. Now that is long gone. ACEP had nothing to do with the high rates or the low ones now (except not limiting supply of docs).
 
RoyBasch said:
I feel like we have had the debate on this forum ad ifinitum of non-EM people practicing in the ER and ER people practicing something else.

I do not think most ER physicians would be good at primary care. There is some overlap, but overall it is a very different way of thinking and different training to do the job well.

I do not have the training, mindset, or skills to be an effective PCP.

I do not know how to manage common chronic conditions well such as asymptomatic hypertension, diabetes, or high cholesterol.

I would waste a lot of resources working up acute complaints because the "worst first" mindset of ER training comes in. When you see abdominal pain in a primary office, it is not likely a bowel infarction. The pre-test probability of a serious diagnosis for the same complaint in a PCP office is much lower compared to in the ER setting.

I do not know anything about how to manage preventative health such as age appropriate cancer screening. I'm only vaguely aware, which patients need a colonoscopy before age 50, or what to do with a moderately elevated PSA (or even when to get a PSA in the first place).

If the bottom really falls out for me in EM, I would find something else to do, but it wont be opening my own primary care clinic.
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If the Fps and IM guys can do a weekend course to "become" em docs you can do a little reading. Hell maybe you hire a legion of MLPs and they can show you the way and you can profit. FWIW I oppose MLPs as replacements of EM docs (urgent care stuff only) and I think it is equally as bad for Fps to practice EM and EM docs to do PCP work. flame away
 
EctopicFetus said:
If the Fps and IM guys can do a weekend course to "become" em docs you can do a little reading. Hell maybe you hire a legion of MLPs and they can show you the way and you can profit. FWIW I oppose MLPs as replacements of EM docs (urgent care stuff only) and I think it is equally as bad for Fps to practice EM and EM docs to do PCP work. flame away
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I'm in this camp.
Give me between 1 and 2 years of some fellowship-like training program, and let me join the FM ranks.

I wouldn't be as good as the tried-and-true FM boarded folks; but I'd get there fast.
At the very least, I could stop one hell of a lot of people from "being sent to the ER" for something that the FM folk either (1) don't know how to handle, or (2) just won't handle, because reasons. Hell, I did more of that exact thing (PMD sent me here because [insert nonsense reason here]) on so many shifts than truly manage emergencies.

For the past 5 or so years, I stood with my mouth open because the FM crowd wouldn't do the simplest of things and sent these cases immediately over to me in the ER. Simple things. Tap a knee, suture a lac, apply a CDM rule for head injury, talk someone with asymptomatic HTN off the ledge, or what have you.

I don't wanna blow my own trumpet here; but my STEP-1 knowledge is still strong. I'm amazed at what my local FM docs can't remember, don't remember, or won't remember in terms of the basic sciences. It's the underpinnings of what we all do.
 
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RustedFox said:
I'm in this camp.
Give me between 1 and 2 years of some fellowship-like training program, and let me join the FM ranks.

I wouldn't be as good as the tried-and-true FM boarded folks; but I'd get there fast.
At the very least, I could stop one hell of a lot of people from "being sent to the ER" for something that the FM folk either (1) don't know how to handle, or (2) just won't handle, because reasons. Hell, I did more of that exact thing (PMD sent me here because [insert nonsense reason here] on so many shifts than truly manage emergencies.

For the past 5 or so years, I stood with my mouth open because the FM crowd wouldn't do the simplest of things and sent these cases immediately over to me in the ER. Simple things. Tap a knee, suture a lac, apply a CDM rule for head injury, talk someone with asymptomatic HTN off the ledge, or what have you.
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A guy I work, with did EM for 20 years then worked a couple years at a free standing doing urgent care type stuff, which has a lot of pseudo-primary care patients, as we all know. He then hired in with an outpatient group that took him as a PCP. He's a very smart guy, did a ton of reading over a couple of years on the preventative and chronic type stuff, and I think even did an FM board review course. He does very well with our group seeing FM patients. He doesn't call himself a "Family Practice Doctor" or claim to be board certified in it, any more than the urgent care guys do. His patients do come to them their PCP, however. Most of them think it's cool when they hear his background was in EM, and say things like, "If you can handle all those emergencies, certainly you candle hand my 'little' stuff."

If an NP can do it, an experienced ER doctor should be able to do it, and he does. It works both ways, folks!
 
Birdstrike said:
If an NP can do it, an experienced ER doctor should be able to do it, and he does. It works both ways, folks!
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Easy there, amigo.
I've yet to meet an NP who can pass organic chemistry, let alone master STEP-1 material.
The proof is in the pudding, as the Jenny McJennysons send me endless amounts of nonsensical things, and I've had discussions with them where they can't tell me even the pathophysiologic principles behind the existing disease state at hand, let alone management.

Otherwise, I'm inclined to agree. I'd argue that FM is more cerebral than EM; and therefore may be more satisfying to me.
 
Birdstrike said:
A guy I work, with did EM for 20 years then worked a couple years at a free standing doing urgent care type stuff, which has a lot of pseudo-primary care patients, as we all know. He then hired in with an outpatient group that took him as a PCP. He's a very smart guy, did a ton of reading over a couple of years on the preventative and chronic type stuff, and I think even did an FM board review course. He does very well with our group seeing FM patients. He doesn't call himself a "Family Practice Doctor" or claim to be board certified in it, any more than the urgent care guys do. His patients do come to them their PCP, however. Most of them think it's cool when they hear his background was in EM, and say things like, "If you can handle all those emergencies, certainly you candle hand my 'little' stuff."

If an NP can do it, an experienced ER doctor should be able to do it, and he does. It works both ways, folks!
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I actually agree we could be decent FM docs if we wanted. Unlike most specialties we already have training in peds, orthopedic problems, ob/gyn and some chronic illnesses. Most of what we do on a daily basis is urgent-care stuff that could and should be seen by patients' primary physicians.

With a bit of reading an study I could probably handle outpatient management of diabetes, hypertension, and high cholesterol. That doesn't mean I'd enjoy it.
 
RustedFox said:
Easy there, amigo.
I've yet to meet an NP who can pass organic chemistry, let alone master STEP-1 material.
The proof is in the pudding, as the Jenny McJennysons send me endless amounts of nonsensical things, and I've had discussions with them where they can't tell me even the pathophysiologic principles behind the existing disease state at hand, let alone management.

Otherwise, I'm inclined to agree. I'd argue that FM is more cerebral than EM; and therefore may be more satisfying to me.
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I think you read me backwards. I said, “If an NP can do it, so can a doctor,” not the other way around.
 
So, has anyone gone back and done a family medicine residency?
 
Can't stand Vandy and Emory. These two are ruining medicine.


news.vanderbilt.edu

Nurse practitioners practice “more than medicine”

Nurse practitioners are often thought of as stopgaps to mitigate the shortage of primary care physicians, but in a new book, sociologist LaTonya Trotter shows that they also work to address non-medical issues that patients face that affect their health.
news.vanderbilt.edu news.vanderbilt.edu

1616537149558.png
 
miacomet said:
So, has anyone gone back and done a family medicine residency?
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I'm pretty sure you don't need to. Your MD is enough to let you practice independently in your own shop (depending on specific state laws). Insurance providers might be an issue, but then you could adopt a direct primary care model and still make money. The other issue is not knowing what you don't know about outpatient medicine.

Would you learn that in another 3 year residency + board exam/certification? Sure. But do you need to in order to be a good outpatient doc? Probably not. I'm guessing it's more like @Birdstrike said. "If an NP can do it, so can a doctor"
 
Backpack234 said:
I'm pretty sure you don't need to. Your MD is enough to let you practice independently in your own shop (depending on specific state laws). Insurance providers might be an issue, but then you could adopt a direct primary care model and still make money. The other issue is not knowing what you don't know about outpatient medicine.

Would you learn that in another 3 year residency + board exam/certification? Sure. But do you need to in order to be a good outpatient doc? Probably not. I'm guessing it's more like @Birdstrike said. "If an NP can do it, so can a doctor"
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Don't be so sure since I know one individual who did...
 
EctopicFetus said:
This is the biggest bunch of garbage Acep peddles to the masses. You remember hearing about docs making $300/hr or getting bonuses and making $500+/hr. Emergent has plenty of those stories. Why did rates come down? Simple.. supply and demand.

ACEPs lobbying helps those who own the contracts not those who are on the frontlines (unless they overlap). During COVID all these groups got 2% of all their 2019 billings paid to them by the government. EM docs lost hours, had shifts cut and some even lost their jobs. I think it is total nonsense that ACEP brought this money to EPs. As the market shrivels up like it has been doing in Texas (Supply and demand) rates have dropped. I had friends who worked in ultra low volume FSEDs out there making $280/hr plus for 24s. Now that is long gone. ACEP had nothing to do with the high rates or the low ones now (except not limiting supply of docs).
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Of course TX rates weren’t because of ACEP. But the ceiling on EM salaries is set by what can be charged in our name, so preventing across the board cuts (like banning balance billing without a fair and equitable requirement on payors) would nerf both CMG and SDG pay.

Incidentally, a lot of the pay in TX also had to do with the fact that private and Medicaid both paid high rates. Usually they’re inversely correlated, so that made TX a gold mine augmented by explosive (10-15% year over year) growth in ED visits for years in places like Houston which meant that everybody had to distribute that largess to the docs in order to keep their contracts staffed. And then all those positive forces on wages either started stalling out or where actively reversed starting in 2018ish and accelerating in 2020.
 
miacomet said:
Tell us more....
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He is a PGY3 now and I don't think he wants people to know that he completed an EM residency.

I rotated with him in the ICU when we both were PGY1. He is FM and I am IM PGY3 now... He was answering insanely difficult questions that attendings asked. We were like 3-4 months into residency and it was supposedly our 1st ICU rotation. I found that very unusual and then I googled him. Bingo! I found that he completed EM residency 2 yrs prior starting FM residency. Still hold a license in the state where he completed residency but I don't know if he ever worked as an EM doc.

Amazingly, we ran into each other a few months ago and he told me he was was looking for a hospitalist medicine job.
 
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Splenda88 said:
He is a PGY3 now and I don't think he wants people to know that he completed an EM residency.

I rotated with him in the ICU when we both were PGY1. He is FM and I am IM PGY3 now... He was answering insanely difficult questions that attendings asked. We were like 3-4 months into residency and it was supposedly our 1st ICU rotation. I found that very unusual and then I googled him. Bingo! I found that he completed EM residency 2 yrs prior starting FM residency. Still hold a license in the state where he completed residency but I don't know if he ever worked as an EM doc.

Amazingly, we ran into each other a few months ago and he told me he was was looking for a hospitalist medicine job.
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Wow. I would love to know more about his story and how this transpired.
 
Splenda88 said:
It's a strange story... I did not ask him anything since I thought he did not want people to know about it.
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Sounds like he rather had issues practicing EM instead of jumping from the burning plane that is EM.
 
Splenda88 said:
Probably... EM looks sexy when you are not the one in the ED dealing with these patients.
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I alway wonder what students see in it.

After my ED shifts I was exhausted and I barely had to do anything. 1/2 of it was substance use, then trauma which got old fast, constant alarms going off, no set schedule, seeing the defeated residents try to justify consults and having people fight back admissions...

But I was older. Some young 24 year old may view it differently
 
RadsRocks! said:
I alway wonder what students see in it.

After my ED shifts I was exhausted and I barely had to do anything. 1/2 of it was substance use, then trauma which got old fast, constant alarms going off, no set schedule, seeing the defeated residents try to justify consults and having people fight back admissions...

But I was older. Some young 24 year old may view it differently
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I hated any clinic work with set appointments, so EM was a logical choice. Also being able to take a 1-2 week vacation whenever you want is great.
 
RadsRocks! said:
I alway wonder what students see in it.

After my ED shifts I was exhausted and I barely had to do anything. 1/2 of it was substance use, then trauma which got old fast, constant alarms going off, no set schedule, seeing the defeated residents try to justify consults and having people fight back admissions...

But I was older. Some young 24 year old may view it differently
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I love it. You get to fix some problems, help soothe the worry of other patients, do procedures, diagnose many other problems (even if you aren’t the definitive answer), and connect with so many patients. When I am at work, it is me, the techs, and the nurses all as one team and we get to know each other as we deal with the onslaught of the day. There are few other specialties where the team camaraderie is the same as EM. When I go home, I am done. I’m not on call and I can spend my free time however I want. I don’t mind being tired at the end of a shift IF (and that is a big IF) I know I was able to deliver high quality care in a supportive environment. These places exist.

I don’t mind the alcoholic, psychotic, malingering, etc. patients. They are relatively easy to deal with if you realize you can’t solve all their problems.

What I don’t love is working with minimal medical director support, constant flipping from nights to days especially as the new guy in a hierarchical group, getting to work with 10 patients to see because the last person checked out hours ago, and PCPs who send patients to the ED to be admitted who clearly don’t need to be admitted and get mad when you d/c them (again, this is a bigger issue if your medical director isn’t an advocate for you or good care).

EM is a great field from a practice of medicine standpoint especially when your colleagues appreciate your expertise. However, I can’t in good conscious say it is a field that has good job security, will give you the option to practice in that supportive environment as CMGs and private equity grow their influence, or will be a good financial choice given the way the current market is going.
 
Anyone wanna get in on a roving RV/sailboat concierge practice? Do an oxygen bar, iv fluids for “hydration”, botox, etc? Only partly kidding. Im at a total loss on my future. The hospital is hiring more NP hospitalists. Only a matter of time before im gone. EM is toast, my backup plans are running thin.

Ive always been the type to plan far ahead and anticipate things. No f’ing clue what to do down the road. I had dreams of admin, wasted a crapton of time in med school and residency doing “leadership” stuff. What a waste, now Ive lost all faith in the powersthatbe and have lost the itch to do admin. I dont want to join the rank selling out docs. What now?
 
sylvanthus said:
Anyone wanna get in on a roving RV/sailboat concierge practice? Do an oxygen bar, iv fluids for “hydration”, botox, etc? Only partly kidding. Im at a total loss on my future. The hospital is hiring more NP hospitalists. Only a matter of time before im gone. EM is toast, my backup plans are running thin.

Ive always been the type to plan far ahead and anticipate things. No f’ing clue what to do down the road. I had dreams of admin, wasted a crapton of time in med school and residency doing “leadership” stuff. What a waste, now Ive lost all faith in the powersthatbe and have lost the itch to do admin. I dont want to join the rank selling out docs. What now?
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Aren’t you in like northern CA or something? If so, might be time to head to the sticks amigo...
 
sylvanthus said:
Anyone wanna get in on a roving RV/sailboat concierge practice? Do an oxygen bar, iv fluids for “hydration”, botox, etc? Only partly kidding. Im at a total loss on my future. The hospital is hiring more NP hospitalists. Only a matter of time before im gone. EM is toast, my backup plans are running thin.

Ive always been the type to plan far ahead and anticipate things. No f’ing clue what to do down the road. I had dreams of admin, wasted a crapton of time in med school and residency doing “leadership” stuff. What a waste, now Ive lost all faith in the powersthatbe and have lost the itch to do admin. I dont want to join the rank selling out docs. What now?
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Sure. Virgin Islands are sounding better every day.
 
Birdstrike said:
If an NP can do it, an experienced ER doctor should be able to do it, and he does. It works both ways, folks!
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An NP can't do it. But I get your point. The question is can an experienced ER doctor do it?
In Sweden FM residency is 5 years.
I guess the EM doctors can't harm a patient doing primary care because you know the emergencies.
But not harming the patient is just one part of doing PC.
The other question is can you solve the patient's problem? Can you do it in an efficient way in terms of money and time? Are you fast enough? Can you make a diagnosis using only your clinical gestalt after a short history taking? How comfortable are you with diagnosing chest pain patients without ordering troponin? How comfortable are you not sending that patient to the ER.
People tend to think that primary care is easy. Until they start to do it. Also people thing that PC only sends patients to secondary level but the thruth is different. One doctor refers patients rarely maybe once every three days but you see many patients from many different FM docs.

On the other hand a FM doctor is never scared of midlevels. They can never do our job.
 
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