Family med doc's working in ER's

[mdscuba]

Can family medicine physicians with adequate experience get jobs in ER's? Is there any sort of legal requirement mandating that ER physicians be boarded in Emergency Medicine?

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[deleted87716]

Can family medicine physicians with adequate experience get jobs in ER's? Is there any sort of legal requirement mandating that ER physicians be boarded in Emergency Medicine?

The short answer is, "Yes, but..."

If a hospital has no trouble recruiting board-certified EM physicians to staff their ED, chances are they're going to make it a requirement. Otherwise, they'll take what they can get. What this usually means is that your only chance to work in an ED will be in small, rural hospitals where board-certified EM physicians are in short supply. There aren't any laws governing this, it all boils down to hospital policy.

 

[f_w]

And the hospitals unable to recruit FP docs will hire PAs to run the ED 😉

EM is a relatively new specialty. For the longest time, their 'market penetration' was fairly low. In the meantime, they have trained a fairly large number of graduates and the 'good' EM jobs are getting scarce. As a result, you will contend with competition from EM trained docs even at smaller hospitals that a couple of years ago where still run by FP and an assortment of internists and surgeons who never finished residency.

If you want to live the exciting (laugh) life of an ER doc, do an EM residency. Just as there is no formal requirement in law as to the required training for an ER doc, there is no formal requirement for anyone who wants to run a 'GP' type office. I personally know two ER trained docs who after the excitement wore off after 10 years of shiftwork opened their own office. Now, their practice spectrum is pretty much that of a FM physician.

 

[sophiejane]

I personally know two ER trained docs who after the excitement wore off after 10 years of shiftwork opened their own office. Now, their practice spectrum is pretty much that of a FM physician.

This is just hearsay, but I've heard that 10 years is about the average burnout rate for EM. It seems to be a specialty for the young...

 

[f_w]

This is just hearsay, but I've heard that 10 years is about the average burnout rate for EM. It seems to be a specialty for the young...

10 years is the average burnout rate for any physician. The FP guys just change fields to something like growing wine in Oregon..... (I probably know as many burn-out FPs as I know burnt out EMs).

The EM docs insist that they don't burn out and that it was just the 'misc' docs that covered ERs before them that burned out....

 

[deleted87716]

The EM docs insist that they don't burn out and that it was just the 'misc' docs that covered ERs before them that burned out....

A classmate of mine from med school who went into EM burned out after five. Now she's starting up a natural foods company.

 

[sophiejane]

10 years is the average burnout rate for any physician.

Then I wonder why you see so many more older docs in nearly every field (especially FP--there's a ton of old geezers still in FP 🙂 ) but ER docs tend to be perpetually under 50? Maybe they make so much that they can retire early, but the FPs have to slave away into their 70s....🙄

 

[deleted87716]

Then I wonder why you see so many more older docs in nearly every field (especially FP--there's a ton of old geezers still in FP 🙂 ) but ER docs tend to be perpetually under 50? Maybe they make so much that they can retire early, but the FPs have to slave away into their 70s....🙄

In a word, autonomy. Most FM practices are far more controllable than EM. If you find yourself getting overwhelmed in FM, it's usually your own fault...and you can do something about it. In EM, you have very little control over your work environment. Less control/autonomy = greater risk of dissatisfaction/burnout.

 

[deleted6669]

I know lots of em docs in their early 60's. most em docs retire between 52-55 because they can afford to do so.

 

[f_w]

but ER docs tend to be perpetually under 50?

In part that perception is caused by the fact that only in the last 20-25 years there has been a significant output of EM certified physicians.

 

[erichaj]

A classmate of mine from med school who went into EM burned out after five. Now she's starting up a natural foods company.

I'm thinking of opening a subway. NO MORE INSURANCE BS. 😡

 

[deleted87716]

I'm thinking of opening a subway. NO MORE INSURANCE BS. 😡

How 'bout a Quiznos? They got a pepper bar! 😉

 

[sophiejane]

Kent, where do you get this stuff?? You are kind of starting to scare me.

Maybe it's time for a vacation, hmmm? 😉

 

[deleted87716]

Kent, where do you get this stuff?? You are kind of starting to scare me.

I guess you never saw those commercials. 😉

 

[sophiejane]

I guess I've really been out of it...not having a TV in medical school might have something to do with it. But those things are very disturbing. 😱

 

[WestcoastMedicine]

Another reason you may only see younger EM boarded physicians is that the American College of Emergency Physicians has only been around for roughly thirty years. If the docs got board certified when they were say 30, the oldest they can be is around 60....

 

[Marigold]

How 'bout a Quiznos? They got a pepper bar! 😉

Those were the strangest commercials!!! What ARE those little rodents, anyway??

 

[JackBauERfan]

Then I wonder why you see so many more older docs in nearly every field (especially FP--there's a ton of old geezers still in FP 🙂 ) but ER docs tend to be perpetually under 50? Maybe they make so much that they can retire early, but the FPs have to slave away into their 70s....🙄

Thought i'd chime in this em discussion. I think it is because of the relative 'newness' of the field, and also maybe you are at an academic institution where most of them have to be new? I think you find the really older ones in the rural areas and in about 15 years you will see ton of goldie oldies in the academic centers.

Also about the burnout, I think it really has to be due to the 'not being residency trained'. Most of the older generation that got board certified in EM came from a different field than EM because they got 'burned out' of that field, so I don't think its astonishing that they burned out of EM too. I think people that are going into residency now know what they are getting into beforehand so are able to tolerate it and the burn out rate is equal to other specialties....

either way i know jackbauer loves the ED!

 

[andwhat]

Thought i'd chime in this em discussion. I think it is because of the relative 'newness' of the field, and also maybe you are at an academic institution where most of them have to be new? I think you find the really older ones in the rural areas and in about 15 years you will see ton of goldie oldies in the academic centers.

Also about the burnout, I think it really has to be due to the 'not being residency trained'. Most of the older generation that got board certified in EM came from a different field than EM because they got 'burned out' of that field, so I don't think its astonishing that they burned out of EM too. I think people that are going into residency now know what they are getting into beforehand so are able to tolerate it and the burn out rate is equal to other specialties....

either way i know jackbauer loves the ED!

ER is just way too demanding. I know of someone who grew up here, working about 30 hours per week in EM per week, and he is already sick of it. I have not heard of too much satisfaction in this career. Taking crap each and every single day from every specialist imagineable, I am a resident and I even got away with being excessively blunt in a rude way with an ER doc who did a half ass workup on an admission I was involved in, and wasted my time once when I was on call. The Ortho guys some of them are the worst, and ENT absolutely impossible to get a few of them to come into the ER here. Man I swear, you must have something in your genes to want to do EM, and it is still yet probably one of the top three at least competitive wise to get in. Makes no sense to me man. Money is nice though, that is about the only good thing that I will say about it. And shift work and no pager, aside from that, would say that the negatives outweigh the positives. And have not seen too many older EM docs, the ones that are happen to be arrogant as hell and not nice at all, thats just where I am from, that obviously is a personal thing here.

 

[8744]

ER is just way too demanding. I know of someone who grew up here, working about 30 hours per week in EM per week, and he is already sick of it. I have not heard of too much satisfaction in this career. Taking crap each and every single day from every specialist imagineable, I am a resident and I even got away with being excessively blunt in a rude way with an ER doc who did a half ass workup on an admission I was involved in, and wasted my time once when I was on call. The Ortho guys some of them are the worst, and ENT absolutely impossible to get a few of them to come into the ER here. Man I swear, you must have something in your genes to want to do EM, and it is still yet probably one of the top three at least competitive wise to get in. Makes no sense to me man. Money is nice though, that is about the only good thing that I will say about it. And shift work and no pager, aside from that, would say that the negatives outweigh the positives. And have not seen too many older EM docs, the ones that are happen to be arrogant as hell and not nice at all, thats just where I am from, that obviously is a personal thing here.

You just have to understand that one only gets as much crap as one is willing to take. You need to be even-tempered but you don't have to take crap from anybody, least of all from specialists, fellow residents, and even attendings. The very idea that some pencil-necked geek of a third-year IM resident is going to presume to treat you like an idiot is both obnoxious and completely beyond the pale.

I have gone through five years of medical training so far and apart from a few instances of well-deserved ribbing, nobody at any level of authority has said "boo" to me. They may have wanted to unload on me but for whatever reason they have held back.

On the other hand I have witnessed behavior towards others from people in authority which would have earned a severe and well-justified ass-kicking in any other than the medical profession.

 

[The White Coat Investor]

ER is just way too demanding. I know of someone who grew up here, working about 30 hours per week in EM per week, and he is already sick of it. I have not heard of too much satisfaction in this career. Taking crap each and every single day from every specialist imagineable, I am a resident and I even got away with being excessively blunt in a rude way with an ER doc who did a half ass workup on an admission I was involved in, and wasted my time once when I was on call. The Ortho guys some of them are the worst, and ENT absolutely impossible to get a few of them to come into the ER here. Man I swear, you must have something in your genes to want to do EM, and it is still yet probably one of the top three at least competitive wise to get in. Makes no sense to me man. Money is nice though, that is about the only good thing that I will say about it. And shift work and no pager, aside from that, would say that the negatives outweigh the positives. And have not seen too many older EM docs, the ones that are happen to be arrogant as hell and not nice at all, thats just where I am from, that obviously is a personal thing here.

Hmmm....Interesting to hear this from an FP resident. I don't ever recall seeing an FP resident on call who actually looked happy. Let's see, more money than FP, less paperwork, fewer hours...unless someone is really into being someone's doctor, or managing chronic diseases, why would they go into FP over EM (unless they really hate nights or drunks or something) I work with 5 FPs in an urgent care/minor free-standing ED. All 5 of them are being sent back to clinic next month and all of them are dreading it.

 

[deleted87716]

Let's see, more money than FP, less paperwork, fewer hours...unless someone is really into being someone's doctor, or managing chronic diseases, why would they go into FP over EM (unless they really hate nights or drunks or something)

There's plenty of paperwork in EM, and most ER docs are working more hours than I am. Are they making more money? Probably (not that much more)...but then, I'm off every night, weekend, and holiday, and I have complete control over my schedule and how my office is staffed and run. Nobody in EM can say that.

Oh, yeah...and the "no drunks" part is good, too. 👍

 

[8744]

There's plenty of paperwork in EM, and most ER docs are working more hours than I am. Are they making more money? Probably (not that much more)...but then, I'm off every night, weekend, and holiday, and I have complete control over my schedule and how my office is staffed and run. Nobody in EM can say that.

Oh, yeah...and the "no drunks" part is good, too. 👍

You see? It's a difference of perspective. Holidays and weekends are just arbitrary days as far as I'm concerned. If I get Tuesday and Wednesday off that's just like a weekend as far as I'm concerned. And we can open the presents on Christmas Eve or Christmas day for all my children care.

I'd also rather do four 12-hour shifts a week and get three days off then work five days a week and get two days off plus the occasional call.

Oh, and Ilike drunks, crack-******, and other colorful patients.

 

[bkpa2med]

Oh, and Ilike drunks, crack-******, and other colorful patients.

 

[erichaj]

How 'bout a Quiznos? They got a pepper bar! 😉

You know I saw those commercials. Still can't figure out what those creatures are.

Quiznos is to expensive to franchise.

I like their sandwiches. mmmmmmm.

 

[sophiejane]

Oh, and Ilike drunks, crack-******, and other colorful patients.

You forgot "aromatic"...it's a feast for the senses in the ED...🙂

On a side note, why do we continue to debate things that are clearly a matter of personal preference, as PBs post illustrates? Would we have long threads about whether green was better than blue, or chocolate better than vanilla? I hope not. Then why are we so obsessed with proving our specialty is the best?

It's so kindergarten, and I'm so tired of it....

We are all different and have different goals. What is the point of arguing one specialty is better than the other? I should hope that one will always be better than all the others for the person who chose it.

 

[iatrosB]

You forgot "aromatic"...it's a feast for the senses in the ED...🙂

On a side note, why do we continue to debate things that are clearly a matter of personal preference, as PBs post illustrates? Would we have long threads about whether green was better than blue, or chocolate better than vanilla? I hope not. Then why are we so obsessed with proving our specialty is the best?

It's so kindergarten, and I'm so tired of it....

We are all different and have different goals. What is the point of arguing one specialty is better than the other? I should hope that one will always be better than all the others for the person who chose it.

chocolate vs. vanilla...come on, no contest!


I agree with you though, that is why so many DIFFERENT people are drawn into medicine, there is something for everyone. 👍

 

[deleted87716]

You know I saw those commercials. Still can't figure out what those creatures are.

According to the article I linked to, they're called "spongmonkeys" by their creator, and they're based on a Photoshopped pygmy marmoset.

On a side note, why do we continue to debate things that are clearly a matter of personal preference, as PBs post illustrates? Would we have long threads about whether green was better than blue, or chocolate better than vanilla? I hope not.

No contest, indeed...blue and chocolate. 😉

 

[rina33]

I was very interested to read this since I've been planning on EM but having 2nd thoughts. When it comes down to it though, I hate all the bickering between specialties. We're all doctors! I totally agree that we should just respect each other's personal decisions and leave it at that. To each their own, right?

 

[8744]

I was very interested to read this since I've been planning on EM but having 2nd thoughts. When it comes down to it though, I hate all the bickering between specialties. We're all doctors! I totally agree that we should just respect each other's personal decisions and leave it at that. To each their own, right?

I think you get most of the bickering at academic medical centers where the egos have their own reserved parking spaces. I am at a community program (after leaving Duke, the Queen Mother of big egos) and people are a lot more level-headed and even-tempered.

I mean, seriously, at Duke the specialist you consult probably wrote the definitive work on the obscure disease that you missed in your differential. Of course he's going to snort and roll his eyes that you missed something as obvious as Bardet-Biedl Syndrome.

 

[andwhat]

Hmmm....Interesting to hear this from an FP resident. I don't ever recall seeing an FP resident on call who actually looked happy. Let's see, more money than FP, less paperwork, fewer hours...unless someone is really into being someone's doctor, or managing chronic diseases, why would they go into FP over EM (unless they really hate nights or drunks or something) I work with 5 FPs in an urgent care/minor free-standing ED. All 5 of them are being sent back to clinic next month and all of them are dreading it.

cool perspective....interesting.. well umm.... so lets see here. First of all I guarantee you that I was almost never ever happy on first year call, nor is any doctor "happy" while on call, from what I have directly observed, unless his in laws are in town. No I am not by any means "bashing" ER, as the best and brightest students as I recall got accepted into this field, it remains highly competitive. No money is never ever an issue, and a few of my prior preceptors working in Family Practice make 200K slightly + actually, working 9-5, occasional weekends on call, and no Ob. Thats pretty cush actually to me. And I also like the continuity of care aspect of this as well as the procedures. Name me one doctor who is on call and is happy??? I mean second year versus first year, a world of difference let me tell you. Extremely happy to not be on call in first year. Surgery residents on call? happy? No and that was a given when I was rotating in that in med school in NY. I guess that it is personal preference. I dont like ER, mainly because of the experience my ER here has given me. It was just miserable at times, I was once stuck with a nosebleeder at 3 am after being in clinic all day - had to present my new admissions at 7:00 and preround on all 9 of my patients, as I was covering my classmate's patients it is the weekend (this kind of thing was typical let me tell you while on call). Well this guy also had HTN that was out of control, and I had to cauterize it myself (never ever came close to doing this procedure before, maybe watched it on tv - the ER doc finally came in and helped a bit at this point), freakin wearin all of that crazy equipment, ER doc almost completely blew me off - although finally did end up helping minimally, ENT doc sitting at home blew me off, nurse was a b+tch and didnt want to help me at all because she had to do charting and had to finish up her shift even though it was her patient literally profusely bleeding from his mouth and nose - surprised not his eyes and ears and head. (man that is another thing some of those ER nurses oh my goodness, always trying to take advantage and harrass a resident at any given moment). Finally stabilized the patient, and this is when war broke out. It was determined that the patient needed to get admitted. Oh my God! Its 4:15 am and everyone wants to come in and admit this guy! Yeah right lol. My upper level was so distraught at the thought of it, decided to call our ex (thank goodness ex) program director who happened to be on call, who was worthless as usual, made me call the ENT doc to come in and admit, that went horribly and we ended up admitting the guy onto the FM service, wasted almost an hour on just that. The game called Keep-away, keep me away from coming in to the ER in the middle of the night to actually admit a patient. Remember that game from grade school? Now does that sound like some great ER fun or what at this point?
I just feel as if patient care at times is not a priority in the ER. For instance people working there at times feel like, ok, I did 2 things really really well, let me half ass the next 6 things that I do because my shift is almost over and I am exhausted. This was the general attitude that I saw down there. People triaging stuff man. Granted there are excellent ER docs as well. Just the bad are horrible, thankfully one of them left and quit.
Just saying, that majority of ER docs that I know of eventually cannot stand it anymore and get out of it. Primary care is the answer? Well no, not necessarily, not unless you love patient care. And as I understand FM docs who work in the ER do their jobs very well. Also money is not a consideration in my opinion. Yeah ER docs make slightly more here, and the women take alot of crap, albeit they are not very nice to begin with. I have seen Ortho guys just basically cussing them out.
Dude sounds like mudslinging, comparing salaries? not even getting into that man.... I am not here to argue. Less paperwork? Electronic records, and dictations wow thats a killer. I do not understand less paperwork, not at all. If anything I did more paperwork in the ER.
Also ER is more work and stress in my opinion. I can breeze through like 10 or 12 patients in FM clinic in a couple hours, as compared to dealing with annoying drug seekers in the ER (albeit yeah seen my fair share in clinic as well unfortunately, as well as my typical genetic anomalies who almost always come in with multiple legitimate complaints) FM clinic is not easy at times either, but comparatively much better than ER pressure. ER is great though in the sense that once you fix a patient, they go on usually, or should go on, to their primary care provider and then thats the end of it.
Shift work, no pager, good money, positive things. I really liked ER until I did my ER rotation here let me tell you though. Completely changed my attitude and/ or perspective. Nonetheless, would I rather do stitches in the ER rather than pap smears for a Gynecologist? Hell yeah. Would I live in the ER and work for free, rather than do another day on call on the Ob floor? Hell yes, Ob is the worst, again personal experience made me hate it.

 

[Marigold]

No contest, indeed...blue and chocolate. 😉

Sorry, Kent....I'm gonna have to go with green and vanilla! 😀

 

[DocWagner]

What is this even about? Who is better? Who is worse? Since when did a FP resident ever have an idea of the "life expectency" of an EM attending...maybe you knew one...or two? I mean really, everyone has a pretty bleak look at other specialties while in residency.
I hated FP residents (thought they were worthless), hated surgery (ego ego then a bit more ego), IM residents ("hi I'm a FMG, thank you for letting me in your wonderful country"), peds residents (too scared of anything with pubic hair to be useful), orthopedics ("no call unless bone broke is to be surgerized")...etc

But when you get out, eventually you all are friends. Yeah, I save their asses daily, and I still take some of their ****...but I ain't on call EVER and I made over 200k my first year out of residency...so life aint really that bad. I know that THEY know that if there is a difficult airway or something just plain bizarre...they will come to me.

 

[andwhat]

What is this even about? Who is better? Who is worse? Since when did a FP resident ever have an idea of the "life expectency" of an EM attending...maybe you knew one...or two? I mean really, everyone has a pretty bleak look at other specialties while in residency.
I hated FP residents (thought they were worthless), hated surgery (ego ego then a bit more ego), IM residents ("hi I'm a FMG, thank you for letting me in your wonderful country"), peds residents (too scared of anything with pubic hair to be useful), orthopedics ("no call unless bone broke is to be surgerized")...etc

But when you get out, eventually you all are friends. Yeah, I save their asses daily, and I still take some of their ****...but I ain't on call EVER and I made over 200k my first year out of residency...so life aint really that bad. I know that THEY know that if there is a difficult airway or something just plain bizarre...they will come to me.

goes the exact same way with managing Stroke, MI, DKA or CHF exacerbation over say a week in the hospital on the floor - doesnt that count for anything? This thread is way way out of hand.... FP residents are worthless??? lol..... in our program, we see ALL patients in the ER, fortunately and unfortunately, including non admissions in the ER who need a refill for their Vicodin, and juggling two ERs miles apart while on call..... have heard of much worse, but its bad enough at times......
I dont have any life expectancy of an ER physician, I am sure that its much much better in larger teaching institutions, with like 70 beds and a huge hospital. ER in itself is not easy whatsoever though in my opinion.

 

[DocWagner]

I think overall, EMP's do well to last 20-30 years in the specialty. Generally at that point many switch to part time or move on to "fast track" or "urgent care" or purely administrative roles. At that stage, it is generally thought that one would have enough to look at that "second" career. That is my plan. I have no intention to practice into my 60s...that is what IRA's and 401k's are for!
As for FP docs in the ED...it just depends on the state you live in. It is reasonable to say FP docs in the ED are a dying breed and I wouldn't bet on it in the future. In our group, we employ some FP moonlighters but they are paid less and cannot become partners in the group. That is fairly consistent across the board.

 

[deleted87716]

This thread is way way out of hand.

Nah...it's all good.

Differing opinions are fine. Just no hair-pulling, no eye-poking, and no hitting below the belt. 😉

 

[andwhat]

Nah...it's all good.

Differing opinions are fine. Just no hair-pulling, no eye-poking, and no hitting below the belt. 😉

yeah that was an overexaggeration, was just hoping that I didnt piss anybody off.....

hospitalists are in high demand though, as far as I understand nation wide, I dont know that lifestyle seems nice to me.... other than no doc call, man that sounds like some scary stuff sometimes. Outpatient clinic can be fun too, but if you see like 30 or 40 patients per day, I imagine that that can actually lead to burn out eventually, and its not good patient care as I understand.... the 40 patient per day mark that is... I cannot even imagine it....from 8 to 5, esp the new patients, like 80 years old, with a history of Stroke, MI with stents, DM, HTN, coming from a different city to establish with you.. but those guys making 225K+ saw like 30 to 35 or so patients per day... that would very tough esp with procedures in my opinion. But these guys did it. Then again, who knows... FM docs in the ER, mainly in rural areas, not major cities like Chicago and NY city etc.

 

[JackBauERfan]

I think you get most of the bickering at academic medical centers where the egos have their own reserved parking spaces. I am at a community program (after leaving Duke, the Queen Mother of big egos) and people are a lot more level-headed and even-tempered.

I mean, seriously, at Duke the specialist you consult probably wrote the definitive work on the obscure disease that you missed in your differential. Of course he's going to snort and roll his eyes that you missed something as obvious as Bardet-Biedl Syndrome.

haha is that really a syndrome. gonna have to look it up!
i'm at a community type ed right now and its similar. The only folks that bicker about admissions is the two residency programs (family med and IM). and also a few specialties have physicians that are unfriendly, otherwise, getting folks admitted isnt' too big of a problem.

 

[NKMU]

The original spongemonkey clip:

http://www.rathergood.com/moon_song/

check out some of the others on the site too, they're pretty funny. Some are NSFW.