Emergency Medicine OR Trauma Surgery

bc3699

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Hello, Ive been reading mixed views on which residency is harder to get into. Is EM or General Surgery harder to land a spot in? Which one do you think would be better, EM or Trauma Surgery. Any feedback will be helpful. Thanks!!

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Besides the fact that high school is in no way the time to think about competitiveness:

There are stats available which paint competitiveness of the programs (I am a week or two from completing an EM residency, so I'm biased). I'm sure someone else will pull Match numbers. EM has been increasingly competitive. Both are more competitive than family medicine, internal medicine as a whole, pediatrics, a few other things. They are not as competitive as, say, orthopedic surgery or dermatology.

There is no "better." Just what you like and don't like, and what fits you. For many of us who have gone through all this, our opinions of medical specialties changed and shifted in important ways over the years.
 
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Besides the fact that high school is in no way the time to think about competitiveness:

There are stats available which paint competitiveness of the programs (I am a week or two from completing an EM residency, so I'm biased). I'm sure someone else will pull Match numbers. EM has been increasingly competitive. Both are more competitive than family medicine, internal medicine as a whole, pediatrics, a few other things. They are not as competitive as, say, orthopedic surgery or dermatology.

There is no "better." Just what you like and don't like, and what fits you. For many of us who have gone through all this, our opinions of medical specialties changed and shifted in important ways over the years.

Actually, IM as a whole is more competitive than EM. Just look at the applicants: IM applicants on average have higher step 1 scores, higher step 2 scores, more research experiences, more abstracts/posters/papers, and higher percentage of AOA than EM... And this includes all those crap-tastic community programs in IM. It tends to be a mantra that IM is exceptionally non-competitive but it has higher step 1 scores than anesthesia, EM, child neuro, neuro, OBGYN, and is within 1 point of general surgery.

As to the OP's question, EM and trauma are very different. Realize the time committment for trauma both in training and out are much, much higher than EM. Quite frankly the lifestyle for trauma traditionally has been terrible, although improving as some places go to shifts. You are truly the boss and truly a master of your domain but sometimes that domain involves taking care of the city's scum. Unlike EM, you spend a large portion of your time in the OR.

EM tends to be shift work where you only work ~12-20 shifts per month, although each shift can be a major drain. You are a jack of all trades but a master of none and are often treated as such. The pay for EM is reasonable but there also tends to be a lot of burnout in EM because of the population they treat and the BS they have to deal with each day. While it does have procedures, the main proportion of your time is not spent doing procedures. Neither EM nor trauma has longstanding relation with patients (i guess except the frequent fliers who tend to be more of a PIA than not)

You however have plenty of time, and were I to bet, I'd bet you don't even end up in either of these specialties.
 
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Actually, IM as a whole is more competitive than EM. Just look at the applicants: IM applicants on average have higher step 1 scores, higher step 2 scores, more research experiences, more abstracts/posters/papers, and higher percentage of AOA than EM... And this includes all those crap-tastic community programs in IM. It tends to be a mantra that IM is exceptionally non-competitive but it has higher step 1 scores than anesthesia, EM, child neuro, neuro, OBGYN, and is within 1 point of general surgery.

As to the OP's question, EM and trauma are very different. Realize the time committment for trauma both in training and out are much, much higher than EM. Quite frankly the lifestyle for trauma traditionally has been terrible, although improving as some places go to shifts. You are truly the boss and truly a master of your domain but sometimes that domain involves taking care of the city's scum. Unlike EM, you spend a large portion of your time in the OR.

EM tends to be shift work where you only work ~12-20 shifts per month, although each shift can be a major drain. You are a jack of all trades but a master of none and are often treated as such. The pay for EM is reasonable but there also tends to be a lot of burnout in EM because of the population they treat and the BS they have to deal with each day. While it does have procedures, the main proportion of your time is not spent doing procedures. Neither EM nor trauma has longstanding relation with patients (i guess except the frequent fliers who tend to be more of a PIA than not)

You however have plenty of time, and were I to bet, I'd bet you don't even end up in either of these specialties.

IM has higher scores because many of those IM applicants are striving for competitive fellowships after their residency (GI/Cards). EM tends to attract a certain personality.

The ED is not a place where you are often looking for definitive care. You are a triage expert in EM. You see trauma in EM, but the goal is not to cure all a patient's problems, but to stabilize a patient until they can get to definitive care or the ward for recovery. It's awesome if you can get a definite diagnosis in the ED, however your primary job is to rule out life threatening conditions and then refer as indicated.

I think it is unfair to say that you are a "master of none" in EM. While the you must know a very broad amount of knowledge to be an ED provider, you are still an expert in what you do. Maybe my viewpoint is skewed because I am in the Army, and EM training is vital to our mission and training of our medics.

I will also add that any future trauma surgeons must also be willing to spend a good deal of their time outside of the OR, and in the ICU. Many trauma issues that used to be handled in the OR are now handled conservatively, and many trauma surgeons who used to slice/dice now find themselves spending a bulk of their time in the TICU.
 
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Agree with above: trauma is increasingly non-operative and there are even some indications for such in penetrating trauma.




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A positive development, no?

What's lead to the reduction of operations? Certainly the injuries haven't changed, so maybe it's something to do with pre-hospital care, stabilization, imaging, etc?
 
A positive development, no?

For patients, yes but not for surgeons who like to operate (i.e., most of us).

What's lead to the reduction of operations? Certainly the injuries haven't changed, so maybe it's something to do with pre-hospital care, stabilization, imaging, etc?

Its a combination of better imaging, patient monitoring and recognition of the complications associated with the high rate of negative laparotomies as well as lower costs and length of stay.
 
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