EM Question: Why do you do it?

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TPBC

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For all you EM docs, why do you do it? Why did you choose EM opposed to some other specialty? After reading a portion of the "Things I Learned from my Patients" thread, it really magnified the differences between working in the ED where things can be hectic at times compared to a nice calm, fairly predictable FP or IM practice. I too would like to specialize in EM in a couple of years but thought I would throw out this question and ask for some responses.
Thanks!
 
Predictable is boring.
 
Dr. Will said:
Predictable is boring.
Click to expand...
agree.
primary care and prevention are very important. it's just not how I want to spend my life.
em is unpredictable and offers a great lifestyle. wnat to work 10 days in a row and take the rest of the month off without using vacation time?very doable in em. want to work just nights? very doable. want to work in interesting places like antarctica, rural solo coverage in alaska, on a helicopter medevac service, etc very doable in em.
 
I hate rounding.

And I hate fibromyalgia.

Don't get me wrong, I see some of it in the ED. But I turn a blind ear to it when I hear about it.

And I love not being on call. Yes, I have a pager, but I never wear it.... mainly because I don't need to.

Q
 
TPBC said:
For all you EM docs, why do you do it? Why did you choose EM opposed to some other specialty? After reading a portion of the "Things I Learned from my Patients" thread, it really magnified the differences between working in the ED where things can be hectic at times compared to a nice calm, fairly predictable FP or IM practice. I too would like to specialize in EM in a couple of years but thought I would throw out this question and ask for some responses.
Thanks!
Click to expand...

Although I'm only a 2nd year medical student I've spent a significant amount of time on the floors and in the ED. Most ED docs have a little (or a lot) of "adrenaline junkie" in them. They thrive on chaos and just a little bit of uncertainty. If you are looking for nice, calm, and fairly predictable then EM probably isn't for you (although I'm sure you could find some quiet, predictable rural EDs).
 
the ferraris and supermodels are what really drew me in
 
EM people have fun at work. EM people understand that you need a whole team to get things done well; there is very little room for divas in EM. EM people sincerely appreciate whatever help you can give them, as long as it's done well. EM people recognize and value talent in even the small things.

EM is all about taking big problems and breaking them down into tiny problems. EM is (in my opinion) an excellent way of conceptualizing medicine as a vital, dynamic, interesting thing. It's a way to think and a way to practice, and it makes a lot of sense to me when some other points of view leave me confused, or unimpressed.

Finally, there's a fun, irreverent attitude that prevails in EM. See my sig...
 
when the off service people rotate through they are amazed how we multitask and have fun. Most other services are just not fun at all..
 
I thought we went into it for the nasty pelvic exams and the drug seekers (aka trolls, squirrels, or groudhogs). 😀
 
Dr. Mom I saw more scabies during my 2 months in your ED as a student than I have seen in residency. One was a crazy old lady and her little poodle who kept passing them to one another (saw her 3 times). Led me to wonder which came first, the scabies or the crazy?


To the OP, EM is polarizing. Instead of a depth of specialized expertise, you are selling availability, acute competence, and versatility. This isnt to say that a depth of knowledge and procedural skill are not required - I would actually say they are prerequisite if you are to be truly versatile and worth being paid for being open 24/7.
 
Hello all. I'm a 3rd year med student, just perusing the residency forums.
So I'm going thru all the posts and am hearing a lot of great things about EM. Just had some questions.

Lots of people have said EM is great because you can pick the days you want on and set a schedule that fits you. I've been hearing this isn't so until youve become a "senior" EM doc and until then you're stuck with the worst shifts. If this is true, when do you get to the point where you become this "senior doc" and you can pick the shifts you want.

Also, would you say that in lots of big urban cities, most of the procedural work is shifted off to the sub specialities, and the EM doc doesn't do a lot of hands on work anymore?

I'm planning on doing a rotation next year (since it's not offered in our 3rd year) just wanted some input from you docs. thanks for the time!
 
Lots of people have said EM is great because you can pick the days you want on and set a schedule that fits you. I've been hearing this isn't so until youve become a "senior" EM doc and until then you're stuck with the worst shifts. If this is true, when do you get to the point where you become this "senior doc" and you can pick the shifts you want.
Click to expand...

Ill give these a shot.. This will depend on the group you join. The more democratic the more "equal" you will be. Generally, you have at least a good bit of say.

Also, would you say that in lots of big urban cities, most of the procedural work is shifted off to the sub specialities, and the EM doc doesn't do a lot of hands on work anymore?
Click to expand...

no not at all. there is a crap load of hands on.. keep in mind if someone is really sick there is no one there but you.. you do all the procedures.

Hope this helps..
 
I'm in for the junkies! They have the best stories!
 
AgentBristow said:
Lots of people have said EM is great because you can pick the days you want on and set a schedule that fits you. I've been hearing this isn't so until youve become a "senior" EM doc and until then you're stuck with the worst shifts. If this is true, when do you get to the point where you become this "senior doc" and you can pick the shifts you want.
Click to expand...

I don't think it's true that you can't pick the shifts you want until you're an attending. In most of the residencies where I've interviewed, you can trade around shifts to get a few days off if you want it, not just for weddings or funerals, but just because you want them. That's SO different from other specialties. I don't think you can do that every time you want it, because you can't go screwing your fellow residents, but within reason. Plus, a lot of these programs you're working about 18 8-hour shifts. That's not exactly a rough life, and that's as a resident.

You have to be an attending in order to set schedules like working 10 days in a row and taking the rest of the month off, but I don't think anyone thinks in residency they are going to be doing that. After all you have to get your education sometime!
 
Hey,
I've been interested in Emergency Medicine for quite some time now. I did some volunteer-work at my local ED and shadowed a great ER Doctor last year. Now that I'm going to be attending medical school as a 1st year this coming Fall, I have given a lot of thought to specializing in this field, though I realize that it is quite early. However, if one is truly dedicated to a field, I don't see why someone wouldn't wish to start thinking way in advance for the sake of USMLE scores, research, etc.

This forum has opened my eyes a lot on the "end-result" of E. Medicine (when you're actually done with residency and all that, gasp). Residencies look great - decent hours and 3 years in many cases. The job itself looks great; variety, procedures, interesting system of shifts, no rounding/on-call, and excitement. My question: How does a lack of patient continuity make this field different from others? Without developing relationships with patients over time, do you ever feel a bit anonymous, or perhaps the thousands of patients is all the more exciting? And how is it sharing a "communal" office as opposed to a FM physician and his/her own building (at least in the ER departments I have seen, you work from a sort of Doctor's station)?

I appreciate these forums so much and have gained a lot of understanding and useful information from reading them. When dry web-sites and infrequent contact with actual physicians are your only things to go on, hearing any information from others is greatly helpful, thanks!
 
DocYuki said:
My question: How does a lack of patient continuity make this field different from others? Without developing relationships with patients over time, do you ever feel a bit anonymous, or perhaps the thousands of patients is all the more exciting? And how is it sharing a "communal" office as opposed to a FM physician and his/her own building (at least in the ER departments I have seen, you work from a sort of Doctor's station)?
Click to expand...

As a med student (read: uninitiated) I wanted to point at that, with the exception of outpt medicine, most relationships in medicine are pretty ephemeral. In hospital as a med or surgical specialty, you know people for a few days, then they move on. In many academic depts, attendings rotate at least once a month and as frequently as once a week. Thus, they either know someone for 2-3 days and then that person is discharged or they never know the outcome of the "rock" in a coma. I have found it a lot less painful in the EM, when you can have a great relationship with someone for a few hours, then say goodbye (the optimist in me prefers this ending than many of the inpt ones 😱) As Dr. Evil says, "...we'll leave them alone and not actually witness them dying, and we'll just assume it all went to plan." 😛

The communal computer areas is what makes EM so fun, interactive, and academic - so easy to talk to each other! The only problem is when there is a paucity of space...
 
Dr. Will said:
Predictable is boring.
Click to expand...

I'll second that. To TPBC, when I was in various medicine/peds subspecialty clinics last year, the first 2 hours I thought "man, it would be nice to have a 8-5 day for life..." then 2 hours later, I'm ready to pull my hair out for the 8th diabetes that day, or the 10th keloid, or the 5th well-baby check. I find myself saying the same thing over and over again, or at least very similar things. Definitely do not want that for life. I did a radiology rotation and was ready to go back to bed by 10am everyday (and I don't show up until 9!).

Find something that interests you. If you like HTN/diabetes, etc. and want to deal with that for your entire career, then IM is right for you.
 
Sweet Tea said:
*makes mental note to never, ever visit DrMom's ED* :scared:
Click to expand...

I haven't had a scabies patient for a whole month! 😉

I *did* have a AAA with dissection and a thoracic/abdominal dissection on back-to-back shifts last week. Also had an escaped convict (recaptured, of course...we have a contract to cover medical emergencies for the jail). Add in a couple of urgent dialysis patients, stroke, and all the other miscellaneous stuff & *that's* why I love my job. 🙂

Sweet Tea said:
I like EM b/c I have the attention span of oh look tin foil *shiny*
Click to expand...

right there with you in ADD land
 
I'm an MSII spending the summer working in the ED. I love the variety and the excitement involved in taking care of really sick people. At the moment I'm just doing IV's etc but have spent a lot of time with the residents and assisted them with a lot of procedures.

For me the worst part are the pts who are violent and abusive. I can't tell you how many people come in screaming, spitting and trying to bite the staff (including me). The upswing is they are usually just suffering from a vitamin H deficiency, 5 and 2 usually does it, and if not then 10 and 4 is the trick.
 
DrMom said:
I haven't had a scabies patient for a whole month! 😉

I *did* have a AAA with dissection and a thoracic/abdominal dissection on back-to-back shifts last week. Also had an escaped convict (recaptured, of course...we have a contract to cover medical emergencies for the jail). Add in a couple of urgent dialysis patients, stroke, and all the other miscellaneous stuff & *that's* why I love my job. 🙂



right there with you in ADD land
Click to expand...

Another vote for ADD. 😀
 
I really hate the terms "adrenaline junkie" " Trauma Junkie" when describing EM types. It overtly implies addiction and/or dependence. Its usually used by rookies or EMS types who really have no idea about the profession. Its a job - nothing more - nothing less. If it is indeed approaching the "junkie" status in your life: Get help then get a real life


I have a good friend who really likes his job as an OB-GYN - lets call him a "vagina junkie". Lets no even go with the GI.............
 
I agree with the ADD. I just don't think they'd put up with me in the other specialties.
 
quinsy said:
You have to be an attending in order to set schedules like working 10 days in a row and taking the rest of the month off, but I don't think anyone thinks in residency they are going to be doing that. After all you have to get your education sometime!
Click to expand...

Not true. My wife is due in November, and I have arranged my shifts (we get our schedule for the whole year in May) such that I have 4 weeks off, and am only using 1 week of "vacation." I will still have to go for conference, but that's it...

Not too bad for a resident... 🙂
 
FISKUS said:
I really hate the terms "adrenaline junkie" " Trauma Junkie" when describing EM types. It overtly implies addiction and/or dependence. Its usually used by rookies or EMS types who really have no idea about the profession. Its a job - nothing more - nothing less. If it is indeed approaching the "junkie" status in your life: Get help then get a real life
Click to expand...

As an EMS type, I take exception to that. I'm in it for the chicks. :d
 
turtle said:
Not true. My wife is due in November, and I have arranged my shifts (we get our schedule for the whole year in May) such that I have 4 weeks off, and am only using 1 week of "vacation." I will still have to go for conference, but that's it...

Not too bad for a resident... 🙂
Click to expand...

Hey, I thought you were a lady (no offense)! 😳

Hopefully I will clear up these misconceptions when I meet you - now I'll know you are the one expecting (by proxy)!
 
Real impact on patients lives.
A perspective into life that few people ever get the opportunity to see.
Defined work hours.
A combination of mental and physical challenge.
Great colleagues.
Good money for hours worked.
Easy to get time off.
 
Sweet Tea said:
I like EM b/c I have the attention span of oh look tin foil *shiny*
Click to expand...

:laugh:

My personal research has shown the ADD friendly environment and the lifestyle as the most popular reasons.
 
The same four reasons everyone does: Chicks, money, power and chicks
 
because I couldn't get into veterinary school.
 
DocYuki said:
Hey,
I've been interested in Emergency Medicine for quite some time now. I did some volunteer-work at my local ED and shadowed a great ER Doctor last year. Now that I'm going to be attending medical school as a 1st year this coming Fall, I have given a lot of thought to specializing in this field, though I realize that it is quite early. However, if one is truly dedicated to a field, I don't see why someone wouldn't wish to start thinking way in advance for the sake of USMLE scores, research, etc.

This forum has opened my eyes a lot on the "end-result" of E. Medicine (when you're actually done with residency and all that, gasp). Residencies look great - decent hours and 3 years in many cases. The job itself looks great; variety, procedures, interesting system of shifts, no rounding/on-call, and excitement. My question: How does a lack of patient continuity make this field different from others? Without developing relationships with patients over time, do you ever feel a bit anonymous, or perhaps the thousands of patients is all the more exciting? And how is it sharing a "communal" office as opposed to a FM physician and his/her own building (at least in the ER departments I have seen, you work from a sort of Doctor's station)?

I appreciate these forums so much and have gained a lot of understanding and useful information from reading them. When dry web-sites and infrequent contact with actual physicians are your only things to go on, hearing any information from others is greatly helpful, thanks!
Click to expand...


I did not see any reponses to your concerns so I will chime in here.

You are right that some people may view 'no continuity of care' as a big negative in Emergency Medicine...but again that is a probable needed based upon your personality that you will hopefully soon discover if you are ok without. Below is my take on this..

My little experience in FM and other clinics are filled with patients that honestly I do not care to have continued care with. I did meet the occasional old timer that I had nice conversations about life/family/etc with and I would think about how nice it would be to continue this persons care forever. However, I found that in the emergency department you still will occasionally run into such a patient that you spend a few extra minutes talking about nothing with. To me, that satisfies the desire, and as a positive... I may never get to see the person again that comes in the ED again, however, I have a much greater chance to meet thousands of such people over my career... many more than I think a PCP would ever get to see.


During my first month in the ED, I received a hug from a patient, was invited to a fellows bar where he bartends at, and was told by someone that Texans really are nice people after they dealt with me. Those are things that PCPs harp on, and I recieved all of that in the ED......

I ran to lunch and throught of something else to add. Only 14 shifts and I have lost count on the number of "Doctor, can I get a card so I can see you at your office" or something of that effect....
 
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