ER Residency hours

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holdmystethoscope

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I am planning on applying to med school and be a ER physician. I heard since ER docs/residents sees patients constantly they have to work less hours compared to internal meds/family med docs/residents. Is that true?
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WedgeDawg said:
Please tell me this isn't the main reason you want to become an ER doc
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lol.. I work as a Respiratory Therapist in many areas including ER and ICUs and I love both of them. I might do ER residency and do a fellowship later on to be a ICU attending. I am not in med school yet so I don't know a lot about different residency programs. However, the craziness(hence the adrenaline rush) in ER, the versatility of patients' conditions and the ability to treat people in most vulnerable condition is definitely exciting and a privilege. If all these come with the perks of working few hours less than other residents (hence more time for family) I can't complain.
 
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holdmystethoscope said:
lol.. I work as a Respiratory Therapist in many areas including ER and ICUs and I love both of them. I might do ER residency and do a fellowship later on to be a ICU attending. I am not in med school yet so I don't know about a lot about different residency programs. However, the craziness(hence the adrenaline rush) in ER, the versatility of patients' conditions and the ability to treat people in most vulnerable condition is definitely exciting and a privilege. If all these come with the perks of working few hour less than other residents (hence more time for family) I can't complain.
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ICU attendings are usually Internal Medicine docs who have done a fellowship in Pulmonology/Critical Care.
 
WedgeDawg said:
ICU attendings are usually Internal Medicine docs who have done a fellowship in Pulmonology/Critical Care.
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Gatchha. I believe ER docs can also do an internal med critical care fellowship but I am not too sure. Getting into med school is my priority now. But yes, I was able to speak to a PGY-4 ER residents for few minutes and she told me ER physicians/residents have better hours (although not very significant) because they are constantly seeing patients. I just wanted to know if it's true across the board.
 
holdmystethoscope said:
Gatchha. I believe ER docs can also do an internal med critical care fellowship but I am not too sure. Getting into med school is my priority now. But yes, I was able to speak to a PGY-4 ER residents for few minutes and she told me ER physicians/residents have better hours because they are constantly seeing patients. I just wanted to know if it's true across the board.
Click to expand...

My understanding is that EM is largely shift work which means you're generally not taking call, but you have a fairly heavy on-off schedule and you could very easily end up working holidays etc (which is really true for any field). There's a high burnout rate with EM compared to many other specialties. It requires a lot of energy to do, so don't think it's "easier" than another specialty just because of any hour difference. Your hours/week will also vary based on your career trajectory and practice environment.

ild15019f1.png


EM is on the low side of things, but again, don't assume that means it's easier or that you're guaranteed to be below a certain # of hours/week.

Get into med school first, then talk to some EM attendings and advisors and see what they say.
 
WedgeDawg said:
My understanding is that EM is largely shift work which means you're generally not taking call, but you have a fairly heavy on-off schedule and you could very easily end up working holidays etc (which is really true for any field). There's a high burnout rate with EM compared to many other specialties. It requires a lot of energy to do, so don't think it's "easier" than another specialty just because of any hour difference. Your hours/week will also vary based on your career trajectory and practice environment.

ild15019f1.png


EM is on the low side of things, but again, don't assume that means it's easier or that you're guaranteed to be below a certain # of hours/week.

Get into med school first, then talk to some EM attendings and advisors and see what they say.
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Thank you so much for the info. I very much appreciate it. I totally agree with you is that every residency program is intense and definitely tests your boundary, knowledge and stamina while expending it at the same time. No residency is easier and burnout is definitely scary. It happens to me sometime when i pick up 7-8 days straight 12 hours shift. Thanks again and good luck to you.
 
WedgeDawg said:
My understanding is that EM is largely shift work which means you're generally not taking call, but you have a fairly heavy on-off schedule and you could very easily end up working holidays etc (which is really true for any field). There's a high burnout rate with EM compared to many other specialties. It requires a lot of energy to do, so don't think it's "easier" than another specialty just because of any hour difference. Your hours/week will also vary based on your career trajectory and practice environment.

[IMAGE]

EM is on the low side of things, but again, don't assume that means it's easier or that you're guaranteed to be below a certain # of hours/week.

Get into med school first, then talk to some EM attendings and advisors and see what they say.
Click to expand...

This is an interesting chart, but what exactly is being plotted?
 
As an attending, I am only scheduled to work 14 shifts a month but I usually work 15-16. Shifts for most groups range between 8-12 hours usually. I love my job and my work but not everyone does. You work less hours but if you are not someone who can handle pressure or gets stressed out this field will very quickly weed you out.
 
WedgeDawg said:
My understanding is that EM is largely shift work which means you're generally not taking call, but you have a fairly heavy on-off schedule and you could very easily end up working holidays etc (which is really true for any field). There's a high burnout rate with EM compared to many other specialties. It requires a lot of energy to do, so don't think it's "easier" than another specialty just because of any hour difference. Your hours/week will also vary based on your career trajectory and practice environment.

ild15019f1.png


EM is on the low side of things, but again, don't assume that means it's easier or that you're guaranteed to be below a certain # of hours/week.

Get into med school first, then talk to some EM attendings and advisors and see what they say.
Click to expand...

When am I going to learn that this chart doesn't include anesthesiology... I look for it every time.
 
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lol I work in the ER and I was actually talking to a resident about her schedule:

On 14 days(with occasional nights)
Off 2 days
On 18 days

Repeat.
 
holdmystethoscope said:
Gatchha. I believe ER docs can also do an internal med critical care fellowship but I am not too sure. Getting into med school is my priority now. But yes, I was able to speak to a PGY-4 ER residents for few minutes and she told me ER physicians/residents have better hours (although not very significant) because they are constantly seeing patients. I just wanted to know if it's true across the board.
Click to expand...

Correct me if I'm wrong but I thought EM residency was only 3 years? Unless maybe this is some kind of combined program.

I would be willing to wager that EM Residents work a crapton of hours (probably more than average), although I guess it would be possible that attendings have less hours overall.
 
goldy490 said:
Correct me if I'm wrong but I thought EM residency was only 3 years? Unless maybe this is some kind of combined program.

I would be willing to wager that EM Residents work a crapton of hours (probably more than average), although I guess it would be possible that attendings have less hours overall.
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IIRC some residencies are 4 years and some are 3. Am not certain which is more prevalent, though I think it's the 3 year ones.
 
EM is one of those fields that the majority of pre-meds and preclinical med students have on their short list of potential specialties but only 10-20% of each med school class actually choose to do it once the others realize that while you are working fewer hours you are going at 110% the whole time, a lot of what you do is not the sexy traumas and codes you see on tv but essentially primary care type visits, and the burnout is extremely high. Keep an open mind.
 
MeatTornado said:
EM is one of those fields that the majority of pre-meds and preclinical med students have on their short list of potential specialties but only 10-20% of each med school class actually choose to do it once the others realize that while you are working fewer hours you are going at 110% the whole time, a lot of what you do is not the sexy traumas and codes you see on tv but essentially primary care type visits, and the burnout is extremely high. Keep an open mind.
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Want to grab a steak later, Ron? I'll bring the Lagavulin whiskey

EDIT: great insights on EM, too. Thanks for that
 
ER is not for everyone. You have to be able to multitask and juggle multiple patients and keep track of their labs, imaging, consults that are needed so they don't sit in your ER for hours on top of running traumas and ACLS that come through the doors and dealing with drug seekers. It can be overwhelming for many people.
 
holdmystethoscope said:
Gatchha. I believe ER docs can also do an internal med critical care fellowship but I am not too sure. Getting into med school is my priority now. But yes, I was able to speak to a PGY-4 ER residents for few minutes and she told me ER physicians/residents have better hours (although not very significant) because they are constantly seeing patients. I just wanted to know if it's true across the board.
Click to expand...
ER physicians can do CC residencies, but they substantially limit your practice opportunities when compared with pulm/CC.

Keep in mind that, as a former RT like myself, you would also make a good hospitalist or anesthesiologist. The former has you generally working 7 on/7 off, no nights, minimal to no call, while the latter generally will net you a 350k salary, open the door for surgical critical care after a one year fellowship, have you working 7-5 with no nights, very few weekends, and minimal to no call, and net you 8 weeks of vacation a year. EM is a high liability environment, in which you have little control over your patients after you transfer them, you're frequently overwhelmed, and you'll have to rotate days, nights, weekends, and holidays until you die. There's IM programs that clock less hours than EM programs, and anesthesia programs that are on par with EM. So choose wisely, as nights may not seem bad in your youth, but they get harder as you age and will literally kill you (look up the research of shift work on cardiac health and cancer rates- night shifts are about as bad for your health as smoking).
 
WedgeDawg said:
My understanding is that EM is largely shift work which means you're generally not taking call, but you have a fairly heavy on-off schedule and you could very easily end up working holidays etc (which is really true for any field). There's a high burnout rate with EM compared to many other specialties. It requires a lot of energy to do, so don't think it's "easier" than another specialty just because of any hour difference. Your hours/week will also vary based on your career trajectory and practice environment.

ild15019f1.png


EM is on the low side of things, but again, don't assume that means it's easier or that you're guaranteed to be below a certain # of hours/week.

Get into med school first, then talk to some EM attendings and advisors and see what they say.
Click to expand...
Paging @Birdstrike lol
 
goldy490 said:
Correct me if I'm wrong but I thought EM residency was only 3 years? Unless maybe this is some kind of combined program.

I would be willing to wager that EM Residents work a crapton of hours (probably more than average), although I guess it would be possible that attendings have less hours overall.
Click to expand...
Something around half of EM programs are three years, but there is a big push toward four year programs, and the three year ones tend to be fairly competitive since they get you into practice quicker. Don't count on a three year program, basically.
 
Mad Jack said:
Something around half of EM programs are three years, but there is a big push toward four year programs, and the three year ones tend to be fairly competitive since they get you into practice quicker. Don't count on a three year program, basically.
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This is actually not entirely true. The government basically said several years ago that the 4th year of EM residency is useless and will not be paid for. Thus, 4 year programs got decreased funding from the government and more programs started switching to 3 years not the other way around.
 
Tenk said:
This is actually not entirely true. The government basically said several years ago that the 4th year of EM residency is useless and will not be paid for. Thus, 4 year programs got decreased funding from the government and more programs started switching to 3 years not the other way around.
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Per EMRA, you seem to be correct.
 
getdown said:
ER is not for everyone. You have to be able to multitask and juggle multiple patients and keep track of their labs, imaging, consults that are needed so they don't sit in your ER for hours on top of running traumas and ACLS that come through the doors and dealing with drug seekers. It can be overwhelming for many people.
Click to expand...
EM runs the traumas at your program?
 
RogueUnicorn said:
EM runs the traumas at your program?
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Trauma usually runs the traumas but the EM resident will be involved and occasionally the senior EM will run the traumas if the trauma service is tied up with other traumas in the next bay. My hospital is the only trauma in the county and with multiple interstates crossing near us we get tons of traumas back to back and the trauma service will often get swamped. EM does intubations and lines occasionally though they do a piss poor job and we have to redo lines when the patients get to the OR.
 
hopefulERdoc251 said:
Both exist, but it's recommended to do 4
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I'll ask you this:
Would you rather have a physician with 4 years of residency treating you?
Or would you rather have a physician with 3 years of residency, and 1 year of experience on their own treating you?

Why would doing a 4-year residency be better?
 
Hospitalized said:
I'll ask you this:
Would you rather have a physician with 4 years of residency treating you?
Or would you rather have a physician with 3 years of residency, and 1 year of experience on their own treating you?

Why would doing a 4-year residency be better?
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Well when you're a 4th year, you practically are doing everything on your own. But it's more experience and teaching. You do learn more even as a 4th year resident, and you'll have a "fall back" with your attending if you need help. I would absolutely prefer a 4th year over a 3rd + 1 year of experience because that 1 year of experience is more than likely going to be a really bumpy year. The residency at my hospital used to be 3 years but they changed it to 4 a while back and they said every doc that graduated 4 years was significantly more prepared and confident when they became attendings. Think about it, you have more time to spend doing ER, ICU, critical care, and other rotations such as Trauma, Ortho, ect. More time = more experience = better doctor.
 
hopefulERdoc251 said:
Well when you're a 4th year, you practically are doing everything on your own. But it's more experience and teaching. You do learn more even as a 4th year resident, and you'll have a "fall back" with your attending if you need help. I would absolutely prefer a 4th year over a 3rd + 1 year of experience because that 1 year of experience is more than likely going to be a really bumpy year. The residency at my hospital used to be 3 years but they changed it to 4 a while back and they said every doc that graduated 4 years was significantly more prepared and confident when they became attendings. Think about it, you have more time to spend doing ER, ICU, critical care, and other rotations such as Trauma, Ortho, ect. More time = more experience = better doctor.
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But the experience of being on your own is much more valuable. At least in the words of a physician I have worked with who did a 3-year residency and got out just over a year ago now. Personally, I think the nature of an ER benefits a 3-year residency. Once you get on your own you start to develop your own flow, which will likely have slight differences compared to when you were a resident. By your logic, let's just make ER residencies 5-8 years, because they will be "more prepared." Eh, I really don't think so. EM physicians know a little about a lot; 4 years of medical school + 3 years of residency type hours is easily sufficient to learn how to make medical decisions in the ED. There's a trade off here and being an attending and not having that fallback is much more valuable. It's not like most doctors go straight out of residency to a rural hospital where there is single coverage, anyway. That's one scenario where I would say a 4-year residency may be appropriate. Obviously, YMMV.
 
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hopefulERdoc251 said:
Well when you're a 4th year, you practically are doing everything on your own. But it's more experience and teaching. You do learn more even as a 4th year resident, and you'll have a "fall back" with your attending if you need help. I would absolutely prefer a 4th year over a 3rd + 1 year of experience because that 1 year of experience is more than likely going to be a really bumpy year. The residency at my hospital used to be 3 years but they changed it to 4 a while back and they said every doc that graduated 4 years was significantly more prepared and confident when they became attendings. Think about it, you have more time to spend doing ER, ICU, critical care, and other rotations such as Trauma, Ortho, ect. More time = more experience = better doctor.
Click to expand...

Another perspective that hopefully highlights my point: A 1-year attending last night said he had an adult patient with a bilirubin of 13.7. The attending I had been working with, who has been in practice for over 10 years, said she had never seen one that high.
 
MeatTornado said:
I'm assuming you meant they know a little about a lot. They are the epitome of Jack of all trades in medicine. They know a bit about every organ system and the first step of many treatments.
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Whoops, silly me. Yes. Edited my post to reflect that.
 
There's a ton of people in my class right now (M1) who have blatantly said, "EM all the way! Lower hours than every other specialty!"

EM really does intrigue me but I don't know if the full bore, 12-hr rotating shifts into eternity make it completely palatable for me...
 
hopefulERdoc251 said:
lol I work in the ER and I was actually talking to a resident about her schedule:

On 14 days(with occasional nights)
Off 2 days
On 18 days

Repeat.
Click to expand...
yeah, this is absolutely not her schedule unless that program is super malignant and breaking work hours. The ER residents do not work that much at my very large, academic center.
 
tiedyeddog said:
yeah, this is absolutely not her schedule unless that program is super malignant and breaking work hours. The ER residents do not work that much at my very large, academic center.
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haha hey man I'm just reporting what I heard
 
hopefulERdoc251 said:
haha hey man I'm just reporting what I heard
Click to expand...
Like I explained earlier, she is lying to you.

We know you are just "reporting what you heard" but others may read your comment and assume those are realistic hours for an EM resident.
 
hopefulERdoc251 said:
haha hey man I'm just reporting what I heard
Click to expand...
You have to average one day off a week over a month span at any ACGME program. The chick you talked to averaged two? That would be really hard for a program to fake. Most of the EM residents average 50-60 hours per week and they work 12 hour shifts. That would be working 5-6 days a week on average.
 
tiedyeddog said:
You have to average one day off a week over a month span at any ACGME program. The chick you talked to averaged two? That would be really hard for a program to fake. Most of the EM residents average 50-60 hours per week and they work 12 hour shifts. That would be working 5-6 days a week on average.
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Its no longer an average; ACGME rules specify 1 day off per week which cannot be averaged over the month. See section VI.E1.C: http://www.acgme.org/acgmeweb/portals/0/pfassets/2013-pr-faq-pif/110_emergency_medicine_07012013.pdf

It also states that they should not work more than 60 hrs per week in direct patient contact and cannot work more than 72 hrs.

Her claim that she works 14 days straight (with some nights thrown in for good measure), has 2 days off, and then works 18 days straight is preposterous.
 
Winged Scapula said:
Its no longer an average; ACGME rules specify 1 day off per week which cannot be averaged over the month. See section VI.E1.C: http://www.acgme.org/acgmeweb/portals/0/pfassets/2013-pr-faq-pif/110_emergency_medicine_07012013.pdf

It also states that they should not work more than 60 hrs per week in direct patient contact and cannot work more than 72 hrs.

Her claim that she works 14 days straight (with some nights thrown in for good measure), has 2 days off, and then works 18 days straight is preposterous.
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Oh, wow, I had no idea ED residents had different rules for work hours. Why are their hours so limited?!?
 
holdmystethoscope said:
Thank you so much for the info. I very much appreciate it. I totally agree with you is that every residency program is intense and definitely tests your boundary, knowledge and stamina while expending it at the same time. No residency is easier and burnout is definitely scary. It happens to me sometime when i pick up 7-8 days straight 12 hours shift. Thanks again and good luck to you.
Click to expand...
Just want to let you know buddy,that chart has been on the net since long,and it's meant for post residency.
 
I work at a major level 1 trauma center in a highly populated area and I have to say -- EM here is a joke. Their patient/provider time is ridiculously low -- so low that I've been consulted before they actually seen the damn patient..." -- their PAs handle 90% of the paper-work, general surgery runs all their traumas and does most of the intubations/chest tubes/thoracotomies, and yet somehow, it's "high stress."

Is it just cultural for surgeon to hate the ED? Probably. But ED hours to difficulty ratios are a joke.
 
caffeinemia said:
I work at a major level 1 trauma center in a highly populated area and I have to say -- EM here is a joke. Their patient/provider time is ridiculously low -- so low that I've been consulted before they actually seen the damn patient..." -- their PAs handle 90% of the paper-work, general surgery runs all their traumas and does most of the intubations/chest tubes/thoracotomies, and yet somehow, it's "high stress."

Is it just cultural for surgeon to hate the ED? Probably. But ED hours to difficulty ratios are a joke.
Click to expand...

:corny:
 
hopefulERdoc251 said:
Well when you're a 4th year, you practically are doing everything on your own. But it's more experience and teaching. You do learn more even as a 4th year resident, and you'll have a "fall back" with your attending if you need help. I would absolutely prefer a 4th year over a 3rd + 1 year of experience because that 1 year of experience is more than likely going to be a really bumpy year. The residency at my hospital used to be 3 years but they changed it to 4 a while back and they said every doc that graduated 4 years was significantly more prepared and confident when they became attendings. Think about it, you have more time to spend doing ER, ICU, critical care, and other rotations such as Trauma, Ortho, ect. More time = more experience = better doctor.
Click to expand...

Literally every ER doc I have talked to has said 4 year programs are pointless. A really bumpy year is a good thing, you learn from bumpy years. I heard an EM attending recently say that "I learned more in my first 3 months as an attending than my last 6 months as a resident," and that was from a 3 year residency.

Now obviously you can make some type of rational argument for a 4th year, otherwise it wouldn't exist. Your overrating the benefit of doing additional rotations too vs more experience in the ED.
 
caffeinemia said:
I work at a major level 1 trauma center in a highly populated area and I have to say -- EM here is a joke. Their patient/provider time is ridiculously low -- so low that I've been consulted before they actually seen the damn patient..." -- their PAs handle 90% of the paper-work, general surgery runs all their traumas and does most of the intubations/chest tubes/thoracotomies, and yet somehow, it's "high stress."

Is it just cultural for surgeon to hate the ED? Probably. But ED hours to difficulty ratios are a joke.
Click to expand...

How do you know?
 
Pro tip: don't refer to the specialty as ER.
 
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