Graduating EM resident - ask away, anything
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Nice thread. 👍 I'm an Family Med resident, also a few months away from graduation, but it's cool to see things from another specialty's perspective.
Yes. I have a couple of residency classmates who are extremely good test takers and did very well on Step 1. A few of the people in my school who were AOA ended up going into FM or peds.
This is true of all specialties, I would venture.
The sample contracts that I was shown during job interviews all specified "productivity standards" that have to be met annually. I've talked to a couple of friends who are brand-new attendings, and they were all also given "productivity milestones" that were to be met at month 3, month 6, etc.
This used to be somewhat common, but is now seen mostly in very rural EDs. Most EDs would prefer EM trained physicians.
During FM residency, there's less training in the emergent procedures that you need to know in a busy ED - chest tubes, central lines, etc. Family Med, especially with health care reform, has increased focus on outpatient management, which has less utility in the ED.
If anyone's hope is to do FM (which can be shorter, and is easier to get into than EM) and use that as a "back door" into the ED, I would strongly discourage them. Your employment options are just way too limited, and, depending on your individual FM residency's curriculum, could be a huge disservice to your patients.
Yes. I have a couple of residency classmates who are extremely good test takers and did very well on Step 1. A few of the people in my school who were AOA ended up going into FM or peds.
This is true of all specialties, I would venture.
The sample contracts that I was shown during job interviews all specified "productivity standards" that have to be met annually. I've talked to a couple of friends who are brand-new attendings, and they were all also given "productivity milestones" that were to be met at month 3, month 6, etc.
This used to be somewhat common, but is now seen mostly in very rural EDs. Most EDs would prefer EM trained physicians.
During FM residency, there's less training in the emergent procedures that you need to know in a busy ED - chest tubes, central lines, etc. Family Med, especially with health care reform, has increased focus on outpatient management, which has less utility in the ED.
If anyone's hope is to do FM (which can be shorter, and is easier to get into than EM) and use that as a "back door" into the ED, I would strongly discourage them. Your employment options are just way too limited, and, depending on your individual FM residency's curriculum, could be a huge disservice to your patients.
No, I would say its just the opposite. There are jobs everywhere..... I would say the "most desirable places to live" would be the toughest spots to find jobs, but still doable....
In my class of 10, everyone had contracts signed by mid to late winter.... I actually amend this statement; two classmates did not sign until almost the last month of graduation... it was because they had so many options and could not decide where on earth they wanted to go.
Everyplace I contacted/emailed to even inquire about urged me and had a followup conversation of 'we would love to fly you to XYZ for an interview'. I only ended up going to visit two places (different geographically) and had job offers at both and obviously took one of those.
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I'm PGY4 and I have 2 contracts - 1 for full time and 1 for part time.
I'm lucky to be in this field.
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At your hospital what kind of involvement do other specialties have in the ER when a trauma comes in? I've noticed that in one level-1 trauma center surgery runs the show while at another the EM docs run the show. What is your take on this difference? Do the residents at one institution get better training than the other? Is this a question one should ask on interviews and is it or should it be a something that sways a med student when choosing an EM residency program?
I go back and forth on this... at my shop, EM ran trauma on even days, and surgery on odd days. In reality, we had a great relationship and I think 'we' all ran most of them together.
Some EM programs have no Trauma status (not a Level 1 center) where EM would at least initially see the trauma and transfer or consult and have some lag before Trauma shows up. These places 'tend' to not actually see that much trauma and may end up sending the resident to an offsite 'trauma center'.
If you train AT a Level 1 Trauma Center.. Trauma WILL be involved in some fashion.. thats the definition of being a Level 1 center. Some places have a 'trauma area' where trauma sees the patient and EM is only involved if you are a rotator on their service. Other places, trauma comes to the regular ED where EM/Trauma somehow divide things up.
I dont know if I think the trauma aspect is a deal killer. You need to learn trauma, but the shop you are at will have some mechanism for your to experience/learn it. At the end of the day, Trauma is very cookbook type medicine.
Wow! That's incredible! Thanks for the response 🙂
That's awesome! How many shifts do you anticipate working?
Hey I would like to know what being a resident entails. For example, when you do have free time are you on call or can you go out and be with friends/ family? Also, do you even have energy to do so? Thanks.
It depends on your residency program and it depends on what rotation you're on.
In my program, we have 65% ER months (just about), 30% off service including off service ER months, 5% electives and vacation. Those are just rough estimates off the top of my head.
During the ER months in-house (in our mothership hospital), we do 8 hour shifts, 5x a week. Add 5 hours of lectures every Wednesday and you're at approx 45h/wk... as a resident!
So you tell me if you can have a social life outside of that. 🙂
The answer to your question is YES. You can easily have a social life working 45-50h/wk. You cannot have a social life regularly if you work 80+h/wk.
On trauma service, I work a little over 80h/wk and it is tough and drains you.
On MICU, I worked probably close to 100h/wk and that was terrible (though learned a lot).
When you're applying for a job, do you apply for a group in general or for specific hospitals? For example, I'd really like to stay in Southern California, and I've heard that Kaiser pretty much dominates in that area. Would I apply for specific hospitals under Kaiser, or just apply to Kaiser in general? If its the latter and they don't take me, am I basically out of luck for all SoCal hospitals?
I was wondering if you could answer the question above. Thanks
They do perfectly fine. I think that the best students are usually those from NWestern or other top schools - but RF students are perfectly adept and they become solid residents.
Pingpig and anyone else that has been through this whole process:
OK, why is it that there seems to be only a few EM/FM combined residency programs for dual board certification in this country?
Seriously, I've seen maybe two. . .which makes it tough to go this route if you want to work more rural FM with EM. I am wondering if in part, this a turf-based thing?
I asked this of you all here b/c I was looking for fresh insight on this, and the combined residency thread hasn't really been moving--just stagnate on this one.
Thanks.
OK, why is it that there seems to be only a few EM/FM combined residency programs for dual board certification in this country?
Seriously, I've seen maybe two. . .which makes it tough to go this route if you want to work more rural FM with EM. I am wondering if in part, this a turf-based thing?
I asked this of you all here b/c I was looking for fresh insight on this, and the combined residency thread hasn't really been moving--just stagnate on this one.
Thanks.
No one is adequately trained coming out of medical school. This shouldn't even be a consideration for choosing med schools.
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I think part of the reason there are not many combined FM and ED programs is that the fields are generally very different. Many of us go into EM because we don't enjoy chronic long-term patient management which is the majority of FM (+/- OB and some input med). Many FM graduates have fulfilled a need by staffing rural EDs and urgent care centers but ideally EM offers the best training for those who wish to work in an ED. I have no desire to management long-term health issues in my patients. I enjoy the short and sometimes critical interaction with my patients and their families. FM is just not my cup of tea. The one area where the 2 fields are similar is that we both treat people from birth to death, but other than that they each offer a very different focus in residency and generally attract people with different career goals and interests. Additionally, as an EM doc there is very little financial incentive to add on 2 more years of training to be dual boarded.
Thank you so much for your reply.
I have to say that back in the day, before going to nursing school, I was taken under the wings of some nurses and doctors in the ED setting. There was a lot of the critical stuff going on, but there was also a lot medicine and acute treatment of chronic diseases. . .and a lot of folks that just didn't go to a primary FP doc and ended up being treated in the ED. I know there are many aspects that follow out into chronic and even preventative care in FM, but I was impressed by the overall crossover. I mean that was my experience.
I think another thing to consider is that in theory one might practice FM longer than ED as one gets older. I mean the ED can be exhausting. So I say this b/c I honestly do not believe people are going to be able to retire as early as they have in years past or even as people may be doing now.
I work in critical care as a RN, currently peds, and in reality, as many intensive areas in which I have worked, well, there is still a lot of acute and chronic stuff that has to be addressed.
Finally, if there is indeed a greater need for FM physicians in more rural areas, it stands to reason that a FM/EM residency may serve well the physicians that would like to fill this need.
But I ask this of those of you that have more insight into what's going on in these areas.
Thanks again.
I agree completely that there is much that crosses between EM and FM... also between EM and IM, EM and Surgery, EM and Peds, EM and Anes, etc...but where does the comparison stop?
I think the biggest difference in all these are the dogma and mentality that is formed and reinforced throughout each residency. That varies great between EM and each of these.
I agree that the very rural 'Emergency Room' is in flux as to who should/could cover this. As a trained EM physician from a Level 1 center, and who still works at a Level 1 / Tertiary Care Center... I still moonlight at 'sleepers' on occasion but would be very unsatisfied if that was my career. I like coming to work, seeing septic patients, placing chest tubes in traumas, and intubating people... I was trained to do that and my day of work is not as taxing as it would be on someone who was not trained to take care of those.
I think people have a false impression on the longevity of EM. I have said before in multiple threads that you dont expect to work as 'hard' when you are 60 or even 50 as you do straight out of residency. Moneywise, I am VERY confident I can 'retire' at 50 and live like a king. However, as long as my health is still fine, I would be happy to continue to work some. Worse case, I work the 'sleepers' where occasionally something bad comes in, but generally its urgent care clinic stuff...
The days of true 'town doctor' that does everything from OB to FM to EM to Surgery is well on its way out. If you want to live in and practice medicine in true rural America.. I would rec doing Family Medicine.
Would you mind to please give me your opinion of the "longevity" of the career of someone getting out of residency at about age 39? Active, healthy, no kids, so far most in tune with EM. Do you have any thoughts about how long they'd be able to be productive and efficient and how many years needed to work to retire comfortably? I'm not trying to have a short career by any means, just a little concerned about that EM legend of how long I'll be able to do it.
I know it's hard not knowing me, but I'd appreciate feedback, even general or anecdotal. Thank you!
I know it's hard not knowing me, but I'd appreciate feedback, even general or anecdotal. Thank you!
I know an EM resident who appears to fairly consistently work >80hrs/wk at the hospital and then take charting home. This seems quite the opposite of the Cook program that the OP is in. Are both of these on opposite ends of the bell curve, b/c I can't seem to reconcile the two?
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deleted109597
Either the appearance is deceiving, the resident is slow, or the residency is violating work hours. EM's RRC limits us to 60 hrs/wk of clinical duties in the ED. You can work 80 on the offservice rotations, but in the ED its 60 period.
Not saying anything bad about that person, but if they're charting at home, they need to learn how to do it at work. It's different if you're at a single coverage place and seeing 4pph. You may need some time afterwards to document because you can't write while you're doing stuff. But in residency, you never need to go that fast. You're there to learn, not to clean up the department.
Good perspectives. Thanks for the replies.
Well, I always said I'd keep an open mind. I will hopefully let med school and clerkship beat an impression into me first. Honestly though, EM has always been an interesting place to me. As a nurse, I have, however, enjoyed really zooming in on the intensive care patients. Seems a person doesn't always have that kind of time and luxury in the ED.
For the attendings, what is your schedule like each week? Each month?
I work 12s; here is my schedule for the month of Jan. We typically work 12 shifts, but I am working 13 this month as we have one doc out for maternity. We have 4 trips during the month; I just started this mini fellowship in Texas and that is why I am going to Dallas and Austin for meetings for that. Before the fellowship we had planned on a Vegas trip. Nashville is for fun (wife and I always have done something for new years), and Houston..my wife works there mainly from home but we make occasional visits for her to go to the office and to visit her family.
Dec 29 - Jan 2: Nashville
4: 7a-7
5: 8a-8
6: 3p-3
9: 7a-7
10: 6a-6
11-13: Dallas
14: 8a-8
15: 8a-8
16: 7a-7
19: 1 hour committee meeting
20: 3p-3
21: 3p-3
22: 3p-3
23-26: Houston
27-29: Austin
30: 7a-7
31: 7a-7
I have a few 'do nothing days', but my schedule and the other people that have been posting from EM on this thread probably will tend to have busier schedules as we are young and are a few months to a few years out of residency max. We have young families and bills to pay and retirement plans to start. I would rather keep a full/busy schedule over the next 5-10 years and then be able to have a super cushness. Still, I think 4 trips requiring flights during a month is pretty darn cush. I'm happy.
Seems like you may really enjoy being an ICU doc actually. You can spend more time with each patient and follow them day after day. It's a good field, I thought about it as well.
The reason I say that is because I feel like you have a perspective that the ER sees a lot of super sick ICU level patients and that's not the case - perhaps 10-20% of what we see are ICU level. The majority are the healthy sick who come in and you end up ruling out a lot of stuff.
If you're drawn to sick sick patients - stick with ICU medicine.
Just curious, what sort of salary does this setup fetch you? And will you be living in the stereotypical "desirable" areas? Obviously it's desirable for you, but I mean the typical urban, beach, etc. type of location.
Sent you a PM.
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That's a terrible schedule and a sure recipe for burnout. He's working far more than he did in residency. Better to cut expenditures and enjoy your life, especially with a family.
I disagree. It's fine.
When my mom worked as a nurse, THAT was a terrible schedule. If you can't pull off twelve 12s, the problem is intrinsic.
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At first glance, it seemed that the trips to other towns were additional shifts. After reading his paragraph, it's not so bad. I agree.
I totally get you man... at first when I glanced at his schedule I was like... OMG... then I realized that the travel was for family trips and not for work. For a second there, I thought he was a machine!
Whenever I think I'm working an insurmountable amount of shifts - I just think of what my mom did when I was young.
She would do night shifts from monday to friday, then 16h shifts over the weekends. This was her schedule for 2 years, only a day off on Christmas Day. 1 day off over the entire year.
You think residency is bad??
My mom's schedule:
Monday = 11p-7a
Tuesday = 11p-7a
Wednesday = 11p-7a
Thursday = 11p-7a
Friday = 11p-7a
Saturday = 3p-7a (yes, a 16h shift)
Sunday = 3p-7a (yes, another 16h shift)
So when I read all these posts about how a newly minted ER doc can't handle a 40h work week - ARE YOU KIDDING ME? My mom at the age of 38 was doing 72 work weeks and I (at the age of 29) can't do a 40h work week? I know I can do a 60h work week for several years if I wanted to.
The thing is, when you're presented with a good amount of money to work 28-32h/wk, then your priorities change. Suddenly, 40h/wk seems like overkill.
I've had many people PM me about my salary and my location - because it is specific, I'd rather keep it via PM.
Just PM me if you want to know what I get paid and where I work.
Thanks!
By the way, I've had approximately 12 people PM me regarding my salary. This is something a lot you guys want to know.
I just want to lay it out there - don't let salary be the only driving factor in your choosing a specialty. There are many specialties out there who make more than what I'm signed up to make.
Don't get me wrong, I stand to make great money - but others still make more.
Just FYI.
I just want to lay it out there - don't let salary be the only driving factor in your choosing a specialty. There are many specialties out there who make more than what I'm signed up to make.
Don't get me wrong, I stand to make great money - but others still make more.
Just FYI.
I was wondering as far as compensation is concerned, do you get paid hourly in your situation and then by the patients insurance companies based upon the medical care you gave them? Also, do you do a similar amount of dictation that a primary care physician would do or less?
Thanks
My pay at my primary job is combo of factors but essentially works out to be an average hourly rate.
Documentation methods varies by your particular group/place. We have scribes that do our notes on an electronic 'T Sheet' type system. There are many ways to do documentation for EM from dictation to various EMRs to paper charts..
I see that the OP already addressed this question, but I wanted to add a few points. Students from RFUMS/CMS do their required 3rd year EM clerkships at one of three locations, including Cook County, Mt Sinai, and Advocate Condell. I think that many schools don't have EM as a core clerkship, and some (such as Northwestern) have it as a 4th year clerkship. So it may be difficult to compare students from various schools when you are often comparing M3s vs M4s, and required clerkships vs electives.
In any case, a large number of students from CMS go into EM, possibly partly due to it being a required clerkship so everyone is exposed to it. Last year 28 students matched, about 1/6 of the class, and the two years before that had 22 and 20. 5 students over the past 3 years have matched into EM at Cook County.
That's a large number. I think only 10 went into EM from RUSH from my batch.
Wow! Your mom is the machine. That's a lot of work hours alone, but when you factor in also having a young kid....that's impressive.
Yeah, she was a machine. That's why I find it ridiculous when people say that ER docs can't handle 40h work weeks.
Yes, I'd rather work 24 or 32 hours a week especially if I still make a decent living - but if I can work 40, you bet that I'm going to work that 40. I look at it this way, at least I don't have to pull the 72s that my mom had to pull just to get me through life.
Why do so many EM docs feel the profession is somuch more taxing than every other field of medicine? You would never here a surgeon, internist, cardiologist, etc. complaining about 40 hr weeks (most are working upper 50s-early 60 hrs per week).
But almost every EM physician I talk to (besides you) tells me it's naive to think I could realistically work greater than 36 hours a week because the field is so taxing physically/mentally.
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deleted109597
Truthfully, it's because every shift is basically like carrying the cross cover pager for the entire shift. There is no downtime at most shops. Even when you get a chance to sit down you're being handed an ekg or a nurse is asking if room 5 can have some water. You're always having to wait on pages or results. While this isn't physically demanding it is mentally and emotionally taxing. My surgical internships hardest call still isn't in the top ten of days.
Put it this way. On a busy day I may see 3 patients per hour. That is 20 minutes on average per patient over 10-12 hours. 20 minutes for h&p, documentation, ordering and interpreting labs and images, and disposition to either admit or discharge. On somebody I've never seen before (usually). And with a razor thin margin of error for missing anything.
This is why we say it is taxing. It's like taking call 3 nights a week every week you work.
Believe me, it's taxing. But it's doable.
Great thread.... we need more like these based on other specialties. Hopefully this will be an inspiration for others! 😀
Question: How do your female peers who have a family, or are starting a family, deal with the work load and then subsequent time off during residency? This is not a topic that is discussed in medical school...
Question: How do your female peers who have a family, or are starting a family, deal with the work load and then subsequent time off during residency? This is not a topic that is discussed in medical school...
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1. I think I woke up and while I was getting ready for work, I found that I was a little early. I was perusing the threads and I found an "Ask a general surgery resident anything" thread. That was my inspiration.
2. Yeah, I don't think it's that bad. It's bad if you don't like your work and you have to come in 40h a week. That's bad. But I think if you find a good gig, it's ok.
Seems like my female peers are just as Type A personality - or even moreso - than I am. Some delay kids until post-residency, some take it as they come.
What I do notice is that the females that are in my EM program are very headstrong and independent.
Do you think there is a certain personality that fits into EM better than others? Or maybe it would be better for me to ask, do you feel like most of the people who find success and happiness in EM share similar personality traits?
Do you know anyone who has done a EM/IM dual residency? If so, what would their work lives be like working in a hospital?
Is there a difference between emergency departments that are listed under the surgical department vs those listed under internal medicine?
Do you know anyone who has done a EM/IM dual residency? If so, what would their work lives be like working in a hospital?
Is there a difference between emergency departments that are listed under the surgical department vs those listed under internal medicine?
Also, since you went to a four year program, did you consider doing a dual residency? After all, it would only be one extra year. If so, why did you chose not to?
