Graduating EM resident - ask away, anything

[EM_Rebuilder]

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At work, how often do you second guess a decision you made regarding a patient?

Not very often... I think we all have something 'hit us' later about should of, could of.... there are many ways to practice medicine and to treat a problem... just because you choose one way does not mean it was the wrong way, and retrospectively its easier to think that choice B may have been better.

I suppose one nagging question I have for one of the EM attendings or residents to comment on the simple "How" factor.

1) How can you see the suffering, the death, and the scum of the earth regularly and still be able to think clearly about the other parts of your life when you're off?

2) Do you develop any psychological "sensitivity" to the thought of going into the hospital? How do you psych yourself up for a 12 hour shift there?

Some more questions I had:

1) How do you deal with malpractice? As a pre-med, I have almost no understanding of malpractice- what it is, the threat it poses, etc. But it is obviously a reality of a physician's life and evidently a major one for EMs (I knew this for OB/gyn and surgeons, but just learned it for EMs). What does malpractice practically mean for you as an EM? What do you have to deal with?

2) What, if anything, did you learn during M1 and M2 of medical school that is helpful or in any way relevant to the work you do now? What experiences during M3 and M4 are relevant?

1.) I just dont let it get to me that much...leave work at work; I probably get the most jaded about the taxs/politicial/welfare of much of the lay public. It amazes me how 'ignorant' much of the lay public is about healthcare and how many people in our society act. Sometimes I wish we could put these 'honest problems' on the nightly news..

2.) Sure, some days I roll over and wish I could just stay in the bed. Most of the time as long as I got well rested, I have no issues. We stay busy outside of work with travel and such so I usually have 'something to look forward to'...currently we have trips to Dallas, Austin, and Las Vegas booked within the next 30 days.

1.) I may still be too young in my role, but malpractice just does not 'bother' me as much as I see some of the older people on here talking about it. I am fortunate to practice in Texas which has great climate, and the hospital/group I am at has an awesome track record. Those aspects probably falsely make me comfortable... when and if I get burned, I am sure I will have a different approach. At the end of the day, be nice to the patients and do the right thing and generally things will work out well.

2.) We often joke that what was learned in med school is not helpful, but honestly there is much that gets applied in a roundabout way. I cannot pinpoint these and would just say to absorb as much as you possible can.

On a side note, someone asked what we do during downtime at work. I've seen a very septic patient and a probable appendicitis between writing this up...

 

[steppwolf]

It's "piqued". And you can read the rest of the answers in this thread, or the EM forum.

.

Uh, no it isn't "piqued," Doc. The poster used "peaked" correctly.

 

[KeyzerSoze]

Uh, no it isn't "piqued," Doc. The poster used "peaked" correctly.

No he didn't. The word is piqued.

http://public.wsu.edu/~brians/errors/peaked.html

 

[Signifier]

Uh, no it isn't "piqued," Doc

 

[Guero]

Just like my pappy always used to say, "You ***king *****!" He was usually drunk...and not so nice.






(Dramatization. For entertainment purposes only.)

 

[thesauce]

Uh, no it isn't "piqued," Doc. The poster used "peaked" correctly.

Swiiiiing and a miss

 

[gooze]

hey, thanks for all the great info. I'm def. thinking about doing EM as a career. Also interested in urology as I've shadowed a urologist and it seems like a nice gig with a nice balance of surgery and medicine...just wondering what are your thoughts on urology as a field? supply/demand for urologists? expected pay out of residency? anything else you want to share...thanks!!

 

[deleted109597]

hey, thanks for all the great info. I'm def. thinking about doing EM as a career. Also interested in urology as I've shadowed a urologist and it seems like a nice gig with a nice balance of surgery and medicine...just wondering what are your thoughts on urology as a field? supply/demand for urologists? expected pay out of residency?

Not a urologist, so I can't answer that. I can tell you that we don't have them on call every day at my hospital, but I don't know if that's a supply issue or a "not wanting to take call" issue.

anything else you want to share...thanks!!

I can say, that as I get ready to pay my quarterly taxes, I grossed more in the last 3 months of last year than I did the first two and a half years of residency.

 

[Bojack Horseman]

Are there any elective rotations that you wish you would've taken as a med student? What are they and why?

 

[steppwolf]

No he didn't. The word is piqued.

http://public.wsu.edu/~brians/errors/peaked.html

😳

Well, I was wrong. First time for everything, eh?

Thanks for the enlightenment.

 

[TXKnight]

Are there any elective rotations that you wish you would've taken as a med student? What are they and why?

I'm reviving his thread because it is great and I have a question similar to the above.

what rotations would you have taken in MS3/4 to prepare you better?
just curious

 

[TeddyBoomBoom]

1. EM is perfect for me but I also wonder how I'll be when I'm... say... 60. I think 50 is ok, you don't burn out then. You just have to live with the idea that unlike those who take on a less rigorous job, you peak out earlier.

Here's how I'd do it. Take a good paying job in the community. Make approx 375K, put in 64K into the 401K, invest VERY conservatively to avoid pitfalls. At age 59, I'd have approx$ $6,000,000 at avg return of 4%/yr.

In the meantime, I'd live in an apartment the first year as an attending, and save $120,000 for a rainy day fund. Buy a house a year later and mortgage it at 15years (take a doctors loan w/ down payment of 5%). Pay it off by age 45.

Take all my student loans and pay it in 10 years.

By age 45, I should have a 6 figure bank account, no more student loans, no more house payments and have nearly 2mil in the 401K account. Not only that, but I should have no credit card debt and I should still be driving nearly any car I want for the past 15 years ($60K and under).

After 45, I can do whatever I want. I can drop my hours from 40h/wk to approx 24-32/wk. I can still afford anything I want, I'd be financially bulletproof.

That's how you beat the age factor.

2. As for families, I just got married last year. And yes, my wife likes my job. It affords me time to spend at home and make a good living. Just don't work too much.

Dear God, this sounds good...

 

[boshtrich]

One of the ER docs I shadowed said that one aspect of emergency medicine he disliked was passing off patients to the ICU or hospitalist and never hearing about them again (not knowing if the patient lived or died, not knowing if his initial diagnosis was correct or not, etc.). I know that ER docs play a key role in ruling out all of the life threatening conditions, but how do you feel about the apparent disconnect between a patient's time in the ER and the rest of their care?

 

[Dr. Ducky]

Read through all of this last night. GREAT thread! Thanks for all you do!

I am about to start med school and have been considering different specialties. I really like the idea of seeing pts for acute issues, diagnosing, treating/stabilizing and moving on. Seeing a pt through routine check-up after routine check-up with the occasional referral for anything not routine doesnt interest me at this point. EM & gen surg are two possibilities I think I would enjoy (I know both are very different). I've never been attracted to the idea of super-specializing in anything (eg. Pediatric Trauma Surgeon specializing in the left ring finger). So.....

What other specialties might you suggest I consider?

Thanks in advance!

 

[syoung]

Read through all of this last night. GREAT thread! Thanks for all you do!

I am about to start med school and have been considering different specialties. I really like the idea of seeing pts for acute issues, diagnosing, treating/stabilizing and moving on. Seeing a pt through routine check-up after routine check-up with the occasional referral for anything not routine doesnt interest me at this point. EM & gen surg are two possibilities I think I would enjoy (I know both are very different). I've never been attracted to the idea of super-specializing in anything (eg. Pediatric Trauma Surgeon specializing in the left ring finger). So.....

What other specialties might you suggest I consider?

Thanks in advance!

Very enlightening thread. Bookmarked! Will keep these things in mind in the next 5 years. Just applied and we'll see how it goes!

 

[ensuii]

Read through all of this last night. GREAT thread! Thanks for all you do!

I am about to start med school and have been considering different specialties. I really like the idea of seeing pts for acute issues, diagnosing, treating/stabilizing and moving on. Seeing a pt through routine check-up after routine check-up with the occasional referral for anything not routine doesnt interest me at this point. EM & gen surg are two possibilities I think I would enjoy (I know both are very different). I've never been attracted to the idea of super-specializing in anything (eg. Pediatric Trauma Surgeon specializing in the left ring finger). So.....

What other specialties might you suggest I consider?

Thanks in advance!

Rads/Gas are a few that come to mind immediately. I'd keep the specialty decision in the back of your mind for the first few years. At most, consider joining an interest group or do some light shadowing during breaks/summer. You'll be better able to know what you want to go into after you understand the range of pathology/diagnosis/treatment each specialty deals with and you have a feel for the routine through doing a rotation. For example, you may have a conception of radiology being boring film reading but you may come to enjoy it after you learn pathophysiology and see how different disease processes manifest themselves through imaging.

Good luck!

 

[deleted109597]

One of the ER docs I shadowed said that one aspect of emergency medicine he disliked was passing off patients to the ICU or hospitalist and never hearing about them again (not knowing if the patient lived or died, not knowing if his initial diagnosis was correct or not, etc.). I know that ER docs play a key role in ruling out all of the life threatening conditions, but how do you feel about the apparent disconnect between a patient's time in the ER and the rest of their care?

The same why I feel about the disconnect in a patient's time in the ED and what happens after they go home.
I simply don't care.


Very rarely I am interested because it is an odd case, etc. Then I just look up the values. But you learn very early that not everyone does things the same as you, and if you start trying to offer to tell other people how to manage their patient, then they'll just hate you.

 

[fengsoir]

Hugely helpful - thanks for all the great insights and the questions that brought about them.

I have only been brought onto this path recently and thus am shamefully under-informed, please pardon any naivety! I have a few questions of my own.

I am non-trad, 26. I spent the last 4 years (graduated in 2008 with BS in BME) rummaging about abroad and only at the end of last year decided medicine (specifically EM) is the way to go here forth. I quickly took the MCAT, did some research and weighed my options between US schools and a few reputable foreign schools, applied and got in and I start this September at Jagiellonian (JUMC) in Poland. Is this a good idea, I wonder?

I didn't apply to US schools for several reasons:
1. My GPA was 3.2 - despite it being a difficult major, that's still quite low. Although I did score 35 on the MCAT first try, after being out of school for 4 years and spending a month studying for it.
2. I would have to wait another year to start, given that I do get accepted in the US. With JUMC I can start this year.
3. Tuition is much lower at JUMC. Less student loans.
4. JUMC is probably the most reputable in all of Eastern European schools that offer an 4-yr English program for Americans.

Question 1: I see that there are quite a few EM residents and attendings coming through this thread - do you have any experience with graduates from foreign programs applying for EM residency? What are your advices?

I would also like to try and become a professional alpine climber (hence the last 4 years rummaging about...) From my preliminary understanding, as an ER attending, one could potentially have blocks of time off (from a week to a month at a time). This would allow me to train and be part of expeditions that generally last around 2 weeks.

I am envisioning this (and please correct me if I am wrong!!): part-time work as an ER physician, 2 weeks off each month to train&recoup or go on a small expedition not far away, and a few times each year I could work out a schedule with fellow ER docs so I could have an entire month off for a major expedition, for which I would be a responsible team doctor. A fellowship in wilderness/expedition medicine would certainly be helpful after residency. Alpinism also takes quite a bit of money, so the paycheck certainly makes it all possible.

Question 2: During EM residency, how exhausted do you get? Do you have time for routine physical training? How often do you get an entire day (or two) off, if ever?! (Of course it would depend on the specific residency training program, but from your personal experience) - Do you find yourself completely overwhelmed or do you have time to retain your hobbies and relationships?

Question 3: Is it common for ER doctors to group together and work out a schedule that suits each one's personal needs? Where is this more commonly done, in hospitals or private practice? Do you have any personal experience with such scheduling?

Questions 4: Do you know any ER doctor who's also an outdoor fanatic, who spends a significant amount of time on such pursuits and has made it work for him/her? I would love to hear from that person.

thanks for reading through!

 

[pgoyal]

what up player, can you practice abroad? specifics would be appreciated i.e. charity work i'm sure you can do, but is there EM in europe/australia?

whats your take on locum tenens.

basically, since your not committed to a set of patients over time can you 1. travel around US and work and 2. travel around the world and work? i.e. on cruise ships, international locum tenens etc.

 

[NightGod]

Hugely helpful - thanks for all the great insights and the questions that brought about them.

I have only been brought onto this path recently and thus am shamefully under-informed, please pardon any naivety! I have a few questions of my own.

I am non-trad, 26. I spent the last 4 years (graduated in 2008 with BS in BME) rummaging about abroad and only at the end of last year decided medicine (specifically EM) is the way to go here forth. I quickly took the MCAT, did some research and weighed my options between US schools and a few reputable foreign schools, applied and got in and I start this September at Jagiellonian (JUMC) in Poland. Is this a good idea, I wonder?

I didn't apply to US schools for several reasons:
1. My GPA was 3.2 - despite it being a difficult major, that's still quite low. Although I did score 35 on the MCAT first try, after being out of school for 4 years and spending a month studying for it.
2. I would have to wait another year to start, given that I do get accepted in the US. With JUMC I can start this year.
3. Tuition is much lower at JUMC. Less student loans.
4. JUMC is probably the most reputable in all of Eastern European schools that offer an 4-yr English program for Americans.

Question 1: I see that there are quite a few EM residents and attendings coming through this thread - do you have any experience with graduates from foreign programs applying for EM residency? What are your advices?

I would also like to try and become a professional alpine climber (hence the last 4 years rummaging about...) From my preliminary understanding, as an ER attending, one could potentially have blocks of time off (from a week to a month at a time). This would allow me to train and be part of expeditions that generally last around 2 weeks.

I am envisioning this (and please correct me if I am wrong!!): part-time work as an ER physician, 2 weeks off each month to train&recoup or go on a small expedition not far away, and a few times each year I could work out a schedule with fellow ER docs so I could have an entire month off for a major expedition, for which I would be a responsible team doctor. A fellowship in wilderness/expedition medicine would certainly be helpful after residency. Alpinism also takes quite a bit of money, so the paycheck certainly makes it all possible.

Question 2: During EM residency, how exhausted do you get? Do you have time for routine physical training? How often do you get an entire day (or two) off, if ever?! (Of course it would depend on the specific residency training program, but from your personal experience) - Do you find yourself completely overwhelmed or do you have time to retain your hobbies and relationships?

Question 3: Is it common for ER doctors to group together and work out a schedule that suits each one's personal needs? Where is this more commonly done, in hospitals or private practice? Do you have any personal experience with such scheduling?

Questions 4: Do you know any ER doctor who's also an outdoor fanatic, who spends a significant amount of time on such pursuits and has made it work for him/her? I would love to hear from that person.

thanks for reading through!

If you plan to practice in the US, this is an utterly awful path to do so. Your stats are very competitive for US DO schools and you wouldn't be totally out of reach for some US MD schools. Having to wait another year is a bad reason-you're very likely to lose much more than that trying to get into the US medical system as an FMG. Loans is a silly excuse, too, your earnings will more than make up for any concerns there.

Of course, if you're not planning to practice state-side, this is all moot.

 

[dally1025]

what up player, can you practice abroad? specifics would be appreciated i.e. charity work i'm sure you can do, but is there EM in europe/australia?

whats your take on locum tenens.

basically, since your not committed to a set of patients over time can you 1. travel around US and work and 2. travel around the world and work? i.e. on cruise ships, international locum tenens etc.

There is EM in Australia and New Zealand. I'm not sure how easy it is to work in Australia, I've heard it's difficult. My husband is Australian so I am considering working there after residency but have heard it's not easy, however, I'm not sure if that includes locum tenens or just a permanent license. NZ is pretty popular for locum tenens. Europe varies by country (I know they don't have an EM specialty in Germany-they don't have ED's like we do). If you do a search for locum tenens you'll find a lot of positions all over the world.

 

[fengsoir]

If you plan to practice in the US, this is an utterly awful path to do so. Your stats are very competitive for US DO schools and you wouldn't be totally out of reach for some US MD schools. Having to wait another year is a bad reason-you're very likely to lose much more than that trying to get into the US medical system as an FMG. Loans is a silly excuse, too, your earnings will more than make up for any concerns there.

Of course, if you're not planning to practice state-side, this is all moot.

but is going to a foreign school really that bad? there are plenty of IMGs that do residencies in the States.

 

[NightGod]

but is going to a foreign school really that bad? there are plenty of IMGs that do residencies in the States.

This topic has hundreds of threads already covering it but, in short, the answer is yes, it really is that bad. Not 'kind of' bad, not 'a little bit' of a problem, it's really about the worst possible path you can take to becoming a practicing US-based doctor. It should really only even be considered as an option by US citizens if they absolutely can not get into a school in the States and even then you have to realize that it's a last-ditch, hail Mary choice. With your not completely awful GPA and very good MCAT and a broad application cycle, your chances at getting in somewhere would be good.

 

[dally1025]

This topic has hundreds of threads already covering it but, in short, the answer is yes, it really is that bad. Not 'kind of' bad, not 'a little bit' of a problem, it's really about the worst possible path you can take to becoming a practicing US-based doctor. It should really only even be considered as an option by US citizens if they absolutely can not get into a school in the States and even then you have to realize that it's a last-ditch, hail Mary choice. With your not completely awful GPA and very good MCAT and a broad application cycle, your chances at getting in somewhere would be good.

I think this answer is a bit dramatic. Yes, going abroad for your degree will usually prevent you from matching into certain specialties but if you're interested in the noncompetitive specialties you have a fairly good chance of matching assuming you do well on your boards. You probably won't be going to the more competitive programs but you're not completely doomed. Exhaust your US options 1st then consider other options just in case you decide that orthopedics is the only thing you want to do. You might be in less debt going to a non-US school but being able to go into the field you want is far more important than more debt. It was a few years back but I was accepted to 2 US MD programs with a 3.2 GPA and a 33 MCAT. You might not be accepted your 1st cycle but keep trying.

 

[Catman21]

Anesthesia had this whole midlevel provider issue and they do not diagnose or treat patients.

Thanks again for your answers/time this is an insanely awesome thread to read! 😀

I'm a long way off of final decision of specialty, but i've been looking into anesthesia... How bad is the AA/CRNA situation that really deterred you from going gas?

 

[fengsoir]

I think this answer is a bit dramatic. Yes, going abroad for your degree will usually prevent you from matching into certain specialties but if you're interested in the noncompetitive specialties you have a fairly good chance of matching assuming you do well on your boards. You probably won't be going to the more competitive programs but you're not completely doomed. Exhaust your US options 1st then consider other options just in case you decide that orthopedics is the only thing you want to do. You might be in less debt going to a non-US school but being able to go into the field you want is far more important than more debt. It was a few years back but I was accepted to 2 US MD programs with a 3.2 GPA and a 33 MCAT. You might not be accepted your 1st cycle but keep trying.

Much thanks! I will weigh your words.

 

[deleted109597]

Question 1: I see that there are quite a few EM residents and attendings coming through this thread - do you have any experience with graduates from foreign programs applying for EM residency? What are your advices?

I've never met an FMG in an EM residency. Doesn't mean it doesn't happen, but I don't know any.

Question 2: During EM residency, how exhausted do you get? Do you have time for routine physical training? How often do you get an entire day (or two) off, if ever?! (Of course it would depend on the specific residency training program, but from your personal experience) - Do you find yourself completely overwhelmed or do you have time to retain your hobbies and relationships?

Person specific, but generally I had plenty of time

Question 3: Is it common for ER doctors to group together and work out a schedule that suits each one's personal needs? Where is this more commonly done, in hospitals or private practice? Do you have any personal experience with such scheduling?

Groups make the schedule regardless of who employs them. If you work the dates nobody else wants (ie nights), then generally you can do whatever off dates you want. But if you're the guy that doesn't want to work nights or weekends, and you want a month off every now and then, no, you won't be well liked.

Questions 4: Do you know any ER doctor who's also an outdoor fanatic, who spends a significant amount of time on such pursuits and has made it work for him/her? I would love to hear from that person.

The term significant is pretty specific to each person. I know a guy who is climbing Kilimanjaro soon. I also knew a guy who was really into mountain climbing, and he died during his last year of residency while climbing in South Africa. So be prepared to have very high disability and life insurance premiums. Do what you want though.

basically, since your not committed to a set of patients over time can you 1. travel around US and work and 2. travel around the world and work? i.e. on cruise ships, international locum tenens etc.

You can work anywhere that will A) let you work, and B)get a license. Nothing except cost and time prevent you from getting licenses in every state in the union (or working at VAs in every state with only one license).
Cruise ship medicine and international locums generally don't pay well though. Otherwise, everyone would do it.

 

[ShenanigansMD]

I'm not sure if this has been answered in this ginormous thread.

What do you think of ER/OR/whatever-Trauma Surgeons? Is their lifestyle terrible like everyone claims it to be? I thought it could be cool, but I'm just a naive pre-med.

 

[myshisha]

This thread, literally, is the reason I joined SDN. Thank you so much for all of the wonderful information and insight. I'll be forever grateful, and if I am lucky enough to make it into and through med school, will most certainly pay it forward.

 

[dally1025]

I'm not sure if this has been answered in this ginormous thread.

What do you think of ER/OR/whatever-Trauma Surgeons? Is their lifestyle terrible like everyone claims it to be? I thought it could be cool, but I'm just a naive pre-med.

The lifestyle of a trauma surgeon varies like most specialties after residency and fellowship. Here they don't work but about 50-60h/week unless they want to work more. However, most of them have teaching and research responsiblities on top of that but the amount of time varies by the degree that they want to get involved.

 

[sganjam91]

Hi there,

I've enjoyed reading this thread and wanted to thank all the EM guys for contributing. Firsthand accounts provide a far better view of the profession than any book, TV show/movie, or documentary could ever hope to.

I was curious about malpractice insurance: How does it work once you're an attending? Are you covered by the hospital or do you have to purchase your own? If the latter, around how much does malpractice insurance cost (just a ballpark would be great)?

Thanks!

 

[45408]

I'm not sure if this has been answered in this ginormous thread.

What do you think of ER/OR/whatever-Trauma Surgeons? Is their lifestyle terrible like everyone claims it to be? I thought it could be cool, but I'm just a naive pre-med.

This is the thread you want to read - http://forums.studentdoctor.net/showthread.php?t=907172

 

[iforget2]

Is there time during your residency to raise a family and get married? How much sleep did you get as a resident?

 

[deleted109597]

What do you think of ER/OR/whatever-Trauma Surgeons? Is their lifestyle terrible like everyone claims it to be? I thought it could be cool, but I'm just a naive pre-med.

EM does not equal trauma surgery. Thus, your question isn't a question.

I was curious about malpractice insurance: How does it work once you're an attending? Are you covered by the hospital or do you have to purchase your own? If the latter, around how much does malpractice insurance cost (just a ballpark would be great)?Thanks!

Your malpractice is explained in whatever contract you have. Some buy their own (rare), most set aside a certain number per hour to cover malpractice. Each place is different as far as malpractice, so that question can't be answered by one person.

Is there time during your residency to raise a family and get married? How much sleep did you get as a resident?

Residents sleep just fine. I had a kid in residency. Well, my wife had it, but she was in residency too.

 

[kgpremed11]

1. Worst part is not the burn out. I think that the worst part is that you become jaded and you see the scum of the earth walk through your doors. You begin to wonder if humanity is truly good or somewhat selfish/greedy/abusive/evil.

That's the worst part about EM. It took me halfway through my intern year to realize that my perception of people in general had changed for the worse.

I already think people are scum so.......

Surprisingly... Better than most residencies, but this is dependent on program. Some programs do 12h shifts x 20 in 1 month (that's ROUGH!).

My program was sweet. 4 years but 8h shifts x 5 shifts a week.

I work 40h weeks + lectures. Not bad for a resident.

But that's in the ER... I pull call when I'm on trauma, icu, floors.

sweet

That's way too low bud.

I mean location has some influence on your pay. DC pays the worst but Wisconsin pays the best. However, the payer mix is most influential.

In a community hospital with a 80/20 (insured/uninsured) mix... It is not uncommon to make between 350K to 400K right out of residency at 40h a week.

Emergency medicine here I come.