Future of EM

[kam730]

I am highly considering EM as a specialty, but have a few concerns that I was hoping some of you with more knowledge/experience could address. First of all, is there any truth to the rumors I have heard that PA's will begin to run EM docs out of jobs? Also, I think that residency at a level 1 would be awesome, but I wonder how it is out in the "real world", ie. regular community hospital. I am afraid I would be bored if all I saw was non-life-threatening stuff (I know that kinda sounds bad, but you know that's the fun stuff) like kids with colds and old fat people with chest pain from GERD. If anyone could give me some insight into the day-to-day in a community ER that would be great.

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[12R34Y]

I am highly considering EM as a specialty, but have a few concerns that I was hoping some of you with more knowledge/experience could address. First of all, is there any truth to the rumors I have heard that PA's will begin to run EM docs out of jobs? Also, I think that residency at a level 1 would be awesome, but I wonder how it is out in the "real world", ie. regular community hospital. I am afraid I would be bored if all I saw was non-life-threatening stuff (I know that kinda sounds bad, but you know that's the fun stuff) like kids with colds and old fat people with chest pain from GERD. If anyone could give me some insight into the day-to-day in a community ER that would be great.

First off there are a TON of things you can do a search on this forum.....also look at the stickies above. full of info.

Secondly......there is no worry about PA's taking over the profession.

Thirdly, if you DON"T like seeing old fat people with chest pain from GERD, muscle strains, kids with colds, homeless folks who'd like a meal, foot pain, belly aches, tooth pain, low back pain for 2 years, abrasions, neck pain, sprained knees, sore throats etc...

then EM is NOT FOR YoU AT aLL!!

I don't know of an EM residency or EM program (community or other) that doesn't involve doing LOTS of the above.

Even your residency at a level I trauma center will be very little trauma compared to all of the other mundane vaginal bleeders, and chest pains, asthma exacerbations etc...

just something for you to think about.

later

 

[BKN]

Thirdly, if you DON"T like seeing old fat people with chest pain from GERD, muscle strains, kids with colds, homeless folks who'd like a meal, foot pain, belly aches, tooth pain, low back pain for 2 years, abrasions, neck pain, sprained knees, sore throats etc...

then EM is NOT FOR YoU AT aLL!!

I don't know of an EM residency or EM program (community or other) that doesn't involve doing LOTS of the above.

Even your residency at a level I trauma center will be very little trauma compared to all of the other mundane vaginal bleeders, and chest pains, asthma exacerbations etc...

just something for you to think about.

later

We try to keep much of that stuff to a minimum for the residents by having faculty see it in UCC, pediatric UCC and nonteaching service. We'd rather that learning time be spent on diagnostic and management dilemmas.

But you are completely right. If you can't handle tedium, you don't belong in EM. And it's gonna put your kids thorugh college and send you on cruises.

Can't think of a specialty that doesn't include a fair amount of boring or unpleasant patients. At least our pulses get to race every shift.

BKN

 

[SoCuteMD]

We try to keep much of that stuff to a minimum for the residents by having faculty see it in UCC, pediatric UCC and nonteaching service. We'd rather that learning time be spent on diagnostic and management dilemmas.

But you are completely right. If you can't handle tedium, you don't belong in EM. And it's gonna put your kids thorugh college and send you on cruises.

Can't think of a specialty that doesn't include a fair amount of boring or unpleasant patients. At least our pulses get to race every shift.

BKN

You know what's funny? I think I will really enjoy these "boring" patients. I still remember the night I went to the ED (urgent care portion ) for a sinus infection-induced conjunctivitis. I was absolutely miserable and wanted to go see my cancer-stricken (she recovered) grandma the next day so I wanted to get on antibiotics as soon as I realized that I did have a sinus infection so that my parents would let me go. The doctor there that night was this sweet older gentleman. Given the low acuity level and quietness of the ED I wouldn't be surprised at all if he were not EM boarded, but I didn't know the difference then and it wouldn't have made any difference that night anyways. He asked me where I was in college, I told him, he asked what I was studying, I told him and after that he was really cool and showed me everything he could about the anatomy of my sinuses and why I was getting conjunctivitis, etc. I think we both left that patient/physician encounter happy!!!

 

[BKN]

You know what's funny? I think I will really enjoy these "boring" patients. I still remember the night I went to the ED (urgent care portion ) for a sinus infection-induced conjunctivitis. I was absolutely miserable and wanted to go see my cancer-stricken (she recovered) grandma the next day so I wanted to get on antibiotics as soon as I realized that I did have a sinus infection so that my parents would let me go. The doctor there that night was this sweet older gentleman. Given the low acuity level and quietness of the ED I wouldn't be surprised at all if he were not EM boarded, but I didn't know the difference then and it wouldn't have made any difference that night anyways. He asked me where I was in college, I told him, he asked what I was studying, I told him and after that he was really cool and showed me everything he could about the anatomy of my sinuses and why I was getting conjunctivitis, etc. I think we both left that patient/physician encounter happy!!!

Glad you got good service. I'll probably be that older gentleman in another 5 years. Of course, you're probably talking about a guy 10 years younger than me. It usually takes about two or three reports like this before a new EM 1 gets the message:

EM 1: I've got this old guy who the family brought in because of altered mental status. They say it's acute but I think he's just demented.

BKN: How old is he?

EM 1: Uhh. . .(looks at chart, appears surprised). . .53.

BKN: You know doctor, some people think the definition of old guy should be at least 5 years older than your supervisor.

 

[Realtime]

Yeah, its all relative BKN. My 92 year old grandmother was in the ED last week (she's fine-she'll live to 100 because she's too stubborn to die) and told me about the very nice young man who took care of her at her local community hospital. My mom told me the doc was at least in his late 40s.

 

[BKN]

Yeah, its all relative BKN. My 92 year old grandmother was in the ED last week (she's fine-she'll live to 100 because she's too stubborn to die) and told me about the very nice young man who took care of her at her local community hospital. My mom told me the doc was at least in his late 40s.

I like her already.

 

[southerndoc]

You know, there are plenty of days where I see nothing but bogus complaints all day or night long... and then there are days in the critical care section where I intubate three or four patients, throw in a few central lines, etc. When all you're getting are critically ill patients at 1.5-2 per hour, it gets hard to keep up with the procedures, calling admitting teams (and private physicians, consultants), and trying to document well. Oh yea, and on top of that, we have to take time out to fill out our ultrasound log, CQI intubation forms, procedure notes, AND log it into the computer. Oy, I love the procedures, but sometimes the mundane patients are a welcomed relief!

 

[docB]

In the past couple of months I had on day where I did 7 tubes and one where I did 13 pelvics (thank God not on the same day). Neither were much fun. After a while you get saturated on the critical stuff and are really happy with a day of smooching the butts of the worried well.

 

[SoCuteMD]

You know, there are plenty of days where I see nothing but bogus complaints all day or night long... and then there are days in the critical care section where I intubate three or four patients, throw in a few central lines, etc. When all you're getting are critically ill patients at 1.5-2 per hour, it gets hard to keep up with the procedures, calling admitting teams (and private physicians, consultants), and trying to document well. Oh yea, and on top of that, we have to take time out to fill out our ultrasound log, CQI intubation forms, procedure notes, AND log it into the computer. Oy, I love the procedures, but sometimes the mundane patients are a welcomed relief!

You can prescribe my Z-pak any time .

Oh, and BKN - both my parents are in their late 50s. "Old" is anyone a generation older than them!!!