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I know that some EM docs work 24-hour shifts, but I am curious about 36 and 48-hour shifts. Do you think that this would be plausible in a rural, low volume ED?
Graduating EM resident - ask away, anything
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I think the whole 'personality fits a particular specilaity' is an overrated trait many students look at. With that said though, I will say that many EM docs are laid back, easy going, and have some sort of interest outside of EM. Its VERY difficult to excel in this specialty if you are not laid back/easy going.... yet able to come to the fore front and bank your fists on occasion... and our free time is attractive to people that have 'other interests'.
I dont know anyone that did a dual program.
I think the bigger question is "Is there a difference in EDs under another department versus being there OWN department". I think the answer is yet. When the ED function as its own entity, the chairperson/medical director/etc is able to go directly to adminstration for funding, etc etc. When you are 'part of surgery' or 'part of IM (this is more rare)', then your chairperson is usually a surgeon and of course there primary interest will be the OR, trauma, etc and the ED will always be second tier. I dont know that its a huge difference, but at least conceptually, it stands that there would be a difference...
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One of the other guys on here went to a 4 year so he can chime in also. I interviewed at 12 places. I never even considered a dual program as I knew I wanted to do EM and only EM. The four year program I ended up at was attractive to me because we had lighter loads of rotations/shifts stretched into 4 years versus crammed into 3 years. Plus there was a GRAVY TRAIN of moonlighting which allowed me to pay off my debt while still a resident.
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I have worked up to 48 hour shifts in VERY low volume EDs during residency. It is/was VERY doable.
I will say that typically if you are trained in EM you will not end up wanting to work in such a place as your full time job. You will be trained to work in a high volume high acuity shop. Chances are, you will be wanting to poke your eyes out if you are at a place that sees 4-10 patients in a 24/hr period...
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I too wanted to know more about the IM/EM dual residency program. Are there any advantages for completing such a program?
btw this is an amazing thread.
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There are very few people that do ED combined residencies such as EM/IM and EM/FM. Most us know we want to work in the ED and therefore do an EM residency. Often if you enjoy working in the ED you don't enjoy inpatient medicine environment, but it is also difficult to work part time in two different specialties. There really is no financial gain and "just one extra year" loses you ~ $200,000 in income. It is much more common to complete a fellowship after EM residency if you wish to further your specialization.
In terms of personality in EM...EM tends to be self selecting. If you like the EM environment and thrive there you will probably fit in just fine. If your EM rotation makes you cringe and run far, far away then its probably not your cup of tea.
In terms of personality in EM...EM tends to be self selecting. If you like the EM environment and thrive there you will probably fit in just fine. If your EM rotation makes you cringe and run far, far away then its probably not your cup of tea.
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I considered a dual residency (EM/IM) but I wasn't sold on it. Mainly because I knew I wanted to practice EM and 4 years is already long enough without the additional 5th year.
BUT, if I had in a 5 year EM/IM program, I'd probably be thinking about fellowship right about now. So add on another 2-3 years to my to do list.
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So, I just wanted to balance out some of the good with some of the bad just to give you guys a little more info to chew on.
Negatives of EM from my point of view and experience:
1. Jaded. I have alluded to this several times already in my thread. You see the scum of the earth. You quickly realize that the city you lived in is not as nice as you once thought.
2. You are limited by forces stronger than you. You can never have a private practice (unless you own the urgent care or the ER group). You always have a hospital administrator watching over you.
3. You work for someone, you don't work for yourself. You are an employee.
4. It is a high malpractice environment. Probably number 3 after OB/GYN at the top and Surgery at number 2.
5. Shift work is good but the shifts are intense and you work hours that you'd rather not work as you age. Meaning you better get used to having to work night shifts at the age of 50.
6. Your reimbursement is tied to medicare/medicaid/insurance companies. They will dictate how much you make. You cannot run a fee for service model like dermatology, plastics, or other specialists.
7. You are the front line - you will be the first to be exposed to random diseases like H1N1 and anthrax (low likelihood though).
8. You will not be someone patients WANT to see - they see you because they have to see you. Unlike the pediatric cardiac transplant surgeon that parents fly to see.
9. Your attitude has to be a bit humbler. You're not the big surgeon who people are scared to piss off or whose staff walks on egg shells... you're the ER doc who works with an ancillary staff who your group does not pay (the nurses and techs are employees of the hospital). This means that the nurses and techs you work with will treat you less "royally" than in a private setting where you pay their salaries.
10. Anything can walk through the door. The proverbial poop can hit the fan REALLY quick. You have to be ready for chaos.
Negatives of EM from my point of view and experience:
1. Jaded. I have alluded to this several times already in my thread. You see the scum of the earth. You quickly realize that the city you lived in is not as nice as you once thought.
2. You are limited by forces stronger than you. You can never have a private practice (unless you own the urgent care or the ER group). You always have a hospital administrator watching over you.
3. You work for someone, you don't work for yourself. You are an employee.
4. It is a high malpractice environment. Probably number 3 after OB/GYN at the top and Surgery at number 2.
5. Shift work is good but the shifts are intense and you work hours that you'd rather not work as you age. Meaning you better get used to having to work night shifts at the age of 50.
6. Your reimbursement is tied to medicare/medicaid/insurance companies. They will dictate how much you make. You cannot run a fee for service model like dermatology, plastics, or other specialists.
7. You are the front line - you will be the first to be exposed to random diseases like H1N1 and anthrax (low likelihood though).
8. You will not be someone patients WANT to see - they see you because they have to see you. Unlike the pediatric cardiac transplant surgeon that parents fly to see.
9. Your attitude has to be a bit humbler. You're not the big surgeon who people are scared to piss off or whose staff walks on egg shells... you're the ER doc who works with an ancillary staff who your group does not pay (the nurses and techs are employees of the hospital). This means that the nurses and techs you work with will treat you less "royally" than in a private setting where you pay their salaries.
10. Anything can walk through the door. The proverbial poop can hit the fan REALLY quick. You have to be ready for chaos.
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Is this really true, statistically, and not just anecdotally? I ask because a posting in the EM resident forum pegged EM in the middle regarding malpractice suits, behind IM.
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Several people had asked about salary and loans, but I missed anything about the role tuition played in your medical school decision.
If you were in the shoes of an "ms-0" again, how much weight would you give to tuition vs. How much you like the school? Also when do you think we should know what we plan on doing after med school in order to have enough time to gather a strong list of the residency equivalent of "ECs" (ie research papers and/or electives in EM etc)
If you were in the shoes of an "ms-0" again, how much weight would you give to tuition vs. How much you like the school? Also when do you think we should know what we plan on doing after med school in order to have enough time to gather a strong list of the residency equivalent of "ECs" (ie research papers and/or electives in EM etc)
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1. I knew I was going to be in approx 180K debt for med school - whichever schools weren't atrociously expensive, I considered.
2. Tuition is something that goes with you until you pay it off, school is what you need to get there. So both play a role. Tough question when it's so arbitrary.
3. I would say the earlier the better. For more competitive specialties like ortho, plastics, derm - I would say by M1 year. For others, you can wait up to the first part of M4 year.
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I am an intern in one of the EM/IM programs. Generally those of us that complete an EM/IM program tend to have an fairly equal interest in both specialties but have some interest that is at the interface of the two as well (ie Critical Care, research, administration, running an observation unit, etc). Usually people lean towards EM a bit more but I have seen more IM oriented people and those are the folks that do fellowships or work primarily as a hospitalist. Most grads do end up being mainly EM docs but I have been surprised by some of the versatility.
In terms of salaries I actually am not so sure it doesn't help. I've been privy to some of the salary offers some senior EM/IM folks get and they are definitely on the higher end of EM spectrum. Like high 300s straight out of residency in places in the Midwest, south and northeast. And they haven't even all been in bumblef*** USA. This is from grads from multiple programs not even just mine. Little higher than some of the desirable jobs I hear on average from 3 year EM folks. They also get deanship offers and PD offers quicker than you would expect also. Check out some of the attendings in Maryland's program. I realize its anecdotal evidence but thought I would offer it.
A good source of info on what EM/IM folks do can be found here:
http://www.ncbi.nlm.nih.gov/m/pubmed/19673705/
Bottom line is you should have a plan for what you want to do with it.
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Also I should say that going into academics is the easiest way to do both because then weeks as a hospitalist on the Floors are easier to set up.
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I know this has been covered, but I have a slight variation.
Will having my paramedic and experience as such in a rural area where I work in the ER as a (cheap) ER nurse when I am not on calls going to make my application pop for both med school/ED residency programs (Especially considering pt contact hours, shift work/call experience, decision making skills, etc)? Bear in mind that I am from rural midwest, and I would likely try to apply to a residency with a rural emphasis i.e. Iowa and med school in South Dakota
With that, what was your experience and impression interviewing at Iowa?
When applying for Med School/Residency, was a bigger emphasis placed on grades/MCAT/USMLE or the personality/motivation/experience? Could great performance in one area make up for a subpar performance in the others?
Thanks! I have learned a ton with this thread!
Will having my paramedic and experience as such in a rural area where I work in the ER as a (cheap) ER nurse when I am not on calls going to make my application pop for both med school/ED residency programs (Especially considering pt contact hours, shift work/call experience, decision making skills, etc)? Bear in mind that I am from rural midwest, and I would likely try to apply to a residency with a rural emphasis i.e. Iowa and med school in South Dakota
With that, what was your experience and impression interviewing at Iowa?
When applying for Med School/Residency, was a bigger emphasis placed on grades/MCAT/USMLE or the personality/motivation/experience? Could great performance in one area make up for a subpar performance in the others?
Thanks! I have learned a ton with this thread!
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For med school, this will be seen as good thing - just like any shadowing experience. Grades and MCAT will likely matter more.
For residency, it probably won't make much difference as everyone going into ER will have had plenty of ER experience by then. Grades, USMLE, research, LORs will be more important. Fortunately, ER is not a particularly competitive specialty at the moment so you're not likely to have much trouble coming from a US MD program with a desire to go to a rural residency.
I interviewed at Iowa for another specialty and thought it was amazing. I'm sure their ER program is equally impressive.
I noticed you said you've been reading more, and I'm sure this question has been beat to death on these forums, but I'm wondering if there are any books you'd recommend for us pre-meds? As in, any books you wish you'd read before going to med school.
Textbooks not included
Textbooks not included
Although I'm a bit late to the party, I also want to add in my thoughts. I'm in my 4th year as an attending after a 4-year program.
A few thoughts:
1. I work in a very busy community ER - relatively low trauma but the sheer volume of patients more than makes up for it.
2. We mostly work 12h shifts. I much prefer longer/fewer shifts over shorter/more shifts per month.
3. For every druggie that you have to deal with, there will be a toddler with a nursemaid's elbow that you can fix in 30 seconds. It all balances out in the end!
4. EM is a great balance of hands-on procedures and knowledge-base clinical practice.
5. We work less hours than most other specialties...but our hours are packed. Much more intense/busy than your average IM/Surgeon, etc. It more than makes up for it -- quality over quantity. 🙂
6. Remember that common things are...common. Don't go looking for zebras too often...though you WILL find them more than you would think.
A few more general thoughts:
Coolest case I had in a while: myxedema coma. VS: temp 83 F, HR 40s, BP 70/30 O2 98% on RA; despite IVF, atropine, pressors, and active rewarming...2 hours later only minimal change. TSH comes back....and I get my zebra. 🙂 Next day - almost normal in the ICU. Very cool.
4 years out and I do still get a little nervous -- but that is normal. No one wants a Peds Code or trauma. No one wants a Pregnant Code/Trauma.... The difference is, though, is that you've already been through it....and that helps somewhat.
Please feel free to pick my brain as well!
Thanks,
John
A few thoughts:
1. I work in a very busy community ER - relatively low trauma but the sheer volume of patients more than makes up for it.
2. We mostly work 12h shifts. I much prefer longer/fewer shifts over shorter/more shifts per month.
3. For every druggie that you have to deal with, there will be a toddler with a nursemaid's elbow that you can fix in 30 seconds. It all balances out in the end!
4. EM is a great balance of hands-on procedures and knowledge-base clinical practice.
5. We work less hours than most other specialties...but our hours are packed. Much more intense/busy than your average IM/Surgeon, etc. It more than makes up for it -- quality over quantity. 🙂
6. Remember that common things are...common. Don't go looking for zebras too often...though you WILL find them more than you would think.
A few more general thoughts:
Coolest case I had in a while: myxedema coma. VS: temp 83 F, HR 40s, BP 70/30 O2 98% on RA; despite IVF, atropine, pressors, and active rewarming...2 hours later only minimal change. TSH comes back....and I get my zebra. 🙂 Next day - almost normal in the ICU. Very cool.
4 years out and I do still get a little nervous -- but that is normal. No one wants a Peds Code or trauma. No one wants a Pregnant Code/Trauma.... The difference is, though, is that you've already been through it....and that helps somewhat.
Please feel free to pick my brain as well!
Thanks,
John
As far as 4y vs 3y....generally, I don't think that there is really a significant difference....but it does provide you with a foundation to start as a 2nd year EM-Resident.
The program I was at did not allow moonlighting.
The program I was at did not allow moonlighting.
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How much lifelong learning is there in EM compared to other fields? Is it difficult to be an EM physician if you aren't ok with not being an expert?
What did you look for when applying/interviewing at residency programs? Any disadvantage doing an AOA residency instead of an ACGME one for employment purposes?
How portable is a career in EM? Can you decide you want to live in NY/CA/TX/FL/etc. and just move there with relative ease?
How do you foresee the future of EM? Does more coverage lead to less ED visits? What about ED's shutting down because they're losing tons of money?
Do you fear encroachment by RN's, PA's, etc.?
Do you fear burnout by doing long shifts and also messing with your sleep pattern?
How long do you envision yourself practicing?
Sorry for asking a bunch of questions 😳....EM is a field I'm really interested in!
How compatible is EM with a research career along the lines of what you might expect from an MD/PhD graduate? As far as I know the most common fields for MD/PhDs to go in to are IM and Psych (especially in my field, Medical Anthropology). It seems like the shift work aspect of EM and lack of longitudinal patient care would lend itself well to split clinical/academic careers though.
If I wanted to do the classic 80-20 split what are the different ways I could organize my time? Can you do one shift a week/4 a month and then spend the rest doing research? Can you do 3 months of full time clinical work and 9 of research? What do you think are the benefits/drawbacks of these alternative arrangements (especially regarding rusty clinical skills from being out of the ER for months at a time)? Is it easy to pick up more shifts if you want to?
I think all the EM residents/attendings in this thread are in community practice but I'm sure you all have some insight into my question regarding academic EM anyway. (I might post this as a standalone thread in the EM subforum eventually).
Thanks in advance.
If I wanted to do the classic 80-20 split what are the different ways I could organize my time? Can you do one shift a week/4 a month and then spend the rest doing research? Can you do 3 months of full time clinical work and 9 of research? What do you think are the benefits/drawbacks of these alternative arrangements (especially regarding rusty clinical skills from being out of the ER for months at a time)? Is it easy to pick up more shifts if you want to?
I think all the EM residents/attendings in this thread are in community practice but I'm sure you all have some insight into my question regarding academic EM anyway. (I might post this as a standalone thread in the EM subforum eventually).
Thanks in advance.
D
deleted109597
House of God? Truthfully, reading will make you less likely to want to do medicine, unfortunately. And really, anything you want to read is ok. You're not going to be "better" because you read books as a premed, but you might be more normal.
I did 4 years of residency, the first being a surgery prelim. Better training? Probably not. More comfortable with procedures? Likely. The longer you do anything, the more comfortable you are. Some people only need 3, some seem like they shouldn't ever graduate. Go where you want to go is all I can say. Although if you want to work at a 4 year academic place, most require 4 years of residency (so you aren't teaching people you could have graduated med school with).
You're never an expert no matter what you do. If you feel you're an expert one day, go read some more. That's not to say you can't be good at something, but there's always more to learn.
Not a DO, but work with plenty. As long as you are board eligible/board certified, there will always be a job out there for you. Now, some places have political leanings away from DOs, but that will be true regardless of ABEM vs AOBEM. No, I don't know any of those places, but I bet if you asked some DOs they could tell you.
The hardest part of moving is getting licensed in each state. The second hardest part is packing. I can work anywhere I want to, and had a dozen job offers in multiple states prior to graduating. Now, in some cities there are too many docs, and all of Hawaii is saturated. But everywhere else?
Caveat: some places pay less because they know people want to be there. NYC, DC, LA/San Diego, etc.
Massachusetts went up in ED visits after more coverage. More coverage doesn't mean more primary care docs. EDs are acting as de facto PCPs for probably 50% of visits (more in some areas). EDs will likely become more crowded, and the socialist government will likely decline or reduce payments for non-emergent things (see Washington State). EDs rarely shut down, and if they do it is a management problem, not a money problem. Hospitals want them open because half of the admissions come from them.
No, because one day they'll hopefully prove worse outcomes. However, I do actively endorse limiting their roles, so we don't have another cRNA debacle. I can imagine cRNE's popping up, since some small places only have midlevels to begin with.
12 hours is long, but 10s are pretty good. Sleep? I do ok, sleep hygiene is important, but working 12-14 shifts per month makes it ok. I will practice until I don't want to anymore. I don't know when that will be. Likely 30 years or so.
It's "piqued". And you can read the rest of the answers in this thread, or the EM forum.
Sorry, but you're not going to like my answer. The general answer is no, you're not going to be able to do that likely.
If you're part of an academic program, they usually want you to do research that helps their department, and not just your own ends. Thus, any research you do that is paid for by them will be at their discretion. If you get grants to do your own thing, you might be able to do it, but then you have to find a job that lets you not work for months on end. It's pretty rare, and you would likely have to do locums. Just like international medicine, just because you can do it, or want to do it, doesn't mean somebody will pay you to do it (Occupy EM). You can read about it in the international medicine thread in the EM forum.
With the amount of knowledge available today, it is very difficult to be an "expert" in anything..no matter how much you have specialized.
ER docs are experts in:
1. Resuscitating critical ill patients (both trauma and medical).
2. Multitasking (managing a dozen or more patients at a time is a true skill!)
3. Recognizing sick vs. not-sick very quickly.
For instance, I just saw someone who was complaining about passing out once per day for the last 3 days after a trip and fall. Vitals were fine...no specific complaints at all. Exam benign. ..except he was diaphoretic...and just didn't look right. There wasn't anything tangibly wrong with him...but the internal alarm bell was going off. I told the nurse my concern about him and she got things cooking quickly. He went for an immediate head CT...and bam...large SDH (subdural hematoma).
Not really...I guess it depends on where you want to practice in the country. A few areas are more concerned with that.
As far as what to look for in residency programs:
- a well established one. Walk away for brand new programs. Lots of issues to iron out/finalize.
- a good mixture of trauma/medically ill. You'll be glad that you had 100 blunt trauma resuscitations when it is just you practicing at 0200 in the AM and a car wreck rolls in the door. Gun shots are easier to manage.
- strong US rotation. There is just about NOTHING that you cannot do with an US machine!
- well known faculty/staff.
- if possible, make sure the faculty is a good mixture between younger attendings and older attendings.
- how many residents stay at the program and become attendings
- cost of living in the area. Residents don't make much comparatively speaking.
- added bonuses/perks to the residency program (ie: like eating free at the hospital cafeteria, free parking, etc.).
- how strong are the supporting services (labs, radiology, etc.)
- relationship with the trauma service (a BIG BIG point...it can either be great or horrific!)
I'm sure there are a lot more...those are just a few off the top.
Very portable. It is easy to work across the state...and not too difficult to have multiple state licenses. I know a few attendings who are pilots and do just that...like a constant vacation!
There will always be a HUGE demand for EDs. More insurance just means a higher payout rate. There will always be a demand!
Midlevel providers (NPs, PAs) have a distinct place in the emergency room. They are needed to move the flow.
Burnout is a real possibility...but I don't look at the long term in that manner. 1 month at a time!
Ideally, I'd love to retire by the time I'm 50..but likely mid-50s or until I'm 60. I'd get bored if I didn't work.
No problem! If I didn't want to answer questions...I wouldn't. 🙂 I'd glad you are interested!
John
This actually isn't accurate. ED visits in Massachusetts after healthcare reform did not increase any more than in other states without reform.
Source: http://www.nejm.org/doi/full/10.1056/NEJMp1109273
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This.
I got 50 pages in and had to stop before I pulled my AMCAS app. Too depressing.
D
deleted109597
Other sources disagree, but this article didn't state they went down either, so at best it's a wash, at most it gets worse.
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Regarding people doing fellowships, does someone finishing residency typically go straight into a fellowship or do they work as an attending for a few years then do a fellowship? Do both situations occur?
Also, do fellows usually work on the side to make some more cash, or do they not have time for that? Thanks for any info.
Also, do fellows usually work on the side to make some more cash, or do they not have time for that? Thanks for any info.
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Just to give you a quick answer, yes, both situations occur. Even though I'm not an attending, I work with residents, fellows, and attendings regularly. I recently met a long-time attending pathologist (~57y/o) that got tired of his specialty and transitioned into a PGY2 psychiatry slot, but was getting a PGY5 stipend; a chief IM resident that transitioned into a PGY5 (1st year fellow) interventional cardiology slot, meaning right out of residency; and an attending internist that just finished her 3rd year as an attending when she was accepted to a PGY5 slot in a hospital medicine fellowship. (PGY stands for post-graduate year, with PGY1 being your intern year. Stipends increase with each year of residency and fellowship, but usually top out at PGY7 around 45k, depending on locale.)
I can't answer the second question. Hope this helps while we wait for the busy attendings and residents. ;-)
D
deleted109597
Partially accurate, partially wildly inaccurate. Many places PGY1 is now 45K (I made 50K), and our scale went to PGY10.
To the above, you can go into fellowship directly after residency, or work. For the competitive fellowships, you're often doing yourself a disservice to "go out and work". For the others, it really doesn't matter.
PGY does not always equal PGY pay grade either. I was paid as a PGY3 when I was a PGY4. IM fellowships usually start at PGY4 pay grade, regardless of how many years of residency they've done. I knew plenty of PGY5(time) Med/Peds grads getting paid PGY4 salaries as fellows.
This is all way above the original questions head though.
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I stand corrected. It must've been a while since I last looked:
July 1, 2011 - June 30, 2012
PGY Level Stipend Amount Monthly Stipend
1 $48,198.00 $4,016.50
2 $49,644.00 $4,137.00
3 $51,878.00 $4,323.16
4 $54,213.00 $4,517.75
5 $56,652.00 $4,721.00
6 $59,202.00 $4,933.50
7 $61,866.00 $5,155.50
8 $64,650.00 $5,387.50
9 $67,559.00 $5,629.91
Sorry, it won't post any neater for some reason. Source: http://www.mc.vanderbilt.edu/root/vumc.php?site=gme&doc=18354
July 1, 2011 - June 30, 2012
PGY Level Stipend Amount Monthly Stipend
1 $48,198.00 $4,016.50
2 $49,644.00 $4,137.00
3 $51,878.00 $4,323.16
4 $54,213.00 $4,517.75
5 $56,652.00 $4,721.00
6 $59,202.00 $4,933.50
7 $61,866.00 $5,155.50
8 $64,650.00 $5,387.50
9 $67,559.00 $5,629.91
Sorry, it won't post any neater for some reason. Source: http://www.mc.vanderbilt.edu/root/vumc.php?site=gme&doc=18354
D
deleted109597
Depends on the fellowship, but if you do EM, then do an EM fellowship, often a fair chunk of your time is spent staffing the ED in which you're a fellow as an attending over the residents (not true in all cases, however). Other places may or may not have moonlighting policies. It's pretty broad. Best answer is to look at the places you may think of going.
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Ok, so a fellow might split their time 50/50 between attending and PGY-whatever in terms of pay?
Also, if someone (was crazy and) did EM/Peds residency, would they be able to get jobs in Peds EDs without doing EM->Peds fellowship or Peds->Peds EM fellowship?
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any truth to the chill laid-back personality portrayal of the EM doctor in Scrubs' "My Nightingale" episode? if so, i love this specialty and think medicine may just have a place for me.
ie
around 0:35
http://www.youtube.com/watch?v=jkUWQ5zZFfQ&feature=related
Elliot: [frazzled] Look, I just thought we'd talk to you up here about it so you could see that we don't have any more beds and we really can't handle any more patients.
EM Doc: Okay. You talk way too fast.
Elliot: If you could just keep one person downstairs, we'd be willing to throw a parade for you!
Carla: She needs you to give her a break.
EM Doc: Oh. Well, tell her that we're really swamped.
Carla: She can understand you!
Elliot: Uh-huh! Yeah!
EM Doc: Well then, uh, understand this; Chill out, biddie.
ie
around 0:35
http://www.youtube.com/watch?v=jkUWQ5zZFfQ&feature=related
Elliot: [frazzled] Look, I just thought we'd talk to you up here about it so you could see that we don't have any more beds and we really can't handle any more patients.
EM Doc: Okay. You talk way too fast.
Elliot: If you could just keep one person downstairs, we'd be willing to throw a parade for you!
Carla: She needs you to give her a break.
EM Doc: Oh. Well, tell her that we're really swamped.
Carla: She can understand you!
Elliot: Uh-huh! Yeah!
EM Doc: Well then, uh, understand this; Chill out, biddie.
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1) Are there DO EMs?
2) Do you "residents" think that MDs are better than DOs (curious as to what these doctors think)?
3) Do you guys ever have a life not involving blood, people in pain, or people dying?
4) Are there at least quality nurses around? Do they help you with all that stress relief? 😉
2) Do you "residents" think that MDs are better than DOs (curious as to what these doctors think)?
3) Do you guys ever have a life not involving blood, people in pain, or people dying?
4) Are there at least quality nurses around? Do they help you with all that stress relief? 😉
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They answered the DO question a while ago, to sum it up, no difference (cept in SDN land).
Thank you for this informational thread. Im just a lowly nontrad premed student, but my current profession (athletic trainer, NOT personal trainer) has me leaning toward EM (I know I know, not ortho as one would expect)
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Varies significantly by institution. Our PGY2s are at ~$58k and increases ~$2.5k/yr thereafter.
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1.) Yes; many. Some of the best EM docs I have met/known/worked with are DOs
2.) No difference. I would liken it to race or gender disparity. Until some of the older folks tend to farm out of the system, DOs will overall be considered less attractible applicants.
3.) This is an odd question? Of course, outside of the hospital I do not see those. As far as on a shift.. I think its rare I do not see 'blood, pain, or death'. I know its sounds a bit weird from the outside looking in, but once you do this a while... a bloody lac is no different than a piece of trim to a carpenter, etc. There will always be the very unfortunate deaths that you file away somewhere... someones daughter killed in car wreck on prom night, etc..
4.) ER nurses are some of the best in the hospital. ER nurses have to see tons of patients and do difficult IVs, etc etc. If you are at a high acuity, 'quality hospital', you will have quality nurses in the ERs and ICUs... As far as stress relief; that can be taken different ways.. I am certain that happens but I hung that hat up years ago before I was in this situation...
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D
deleted109597
Not usually. The institution usually makes them work as an attending for a handful of shifts per month during their fellowship. This is included in the fellowship salary of $70K-100K. After a certain number of hours, extra hours worked above those required by the contract are reimbursed at some nominal rate, again, depending on the site.
Some people are able to moonlight outside of their institution, others are forbidden.
I will be working in a Peds ED in a standalone children's hospital, and didn't do EM/Peds, or Peds EM fellowship. I'm not alone either. It is tougher, and not as common simply because the peds ED doesn't pay as well, but it's there if you want it (usually).
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What do you do for fun in the ER to pass the time when the ER is very slow?
1. Yes, there are DO ER docs...we have 1 at the moment and he is a good doc.
2. I never really even thought about it when I was a resident. You guys on here make a much bigger deal about it than anyone in real life, in my honest experience.
3. I don't understand the question.... I very much have a great life! I leave work at work and that is where it stays. No calls in the middle of the night, etc.
4. My ED is staffed with quality nurses - generally, ERs have the strongest nurses in the hospital. They have to deal with multiple patients completely across the spectrum of acuity.....if you are meaning are they "hot," then, yes, a number of my nurses are hot. 🙂
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If you are in a truly super slow 'sleeper' ED...then there is usually a room you can chill/sleep/watch TV in... this is NOT the job most of us EM trained people on this board have, but I am sure there are a few. I work a few extra shifts each month in such a place.
Most of us work in an ED that are RARELY slow.... sometimes you have to take a few moments for yourself and check email, facebook, SDN, news, etc. Sometimes, espically very late at night or very early mornings we have down time; often its used to play catch up on stuff, use the bathroom, or grab a bite to eat...
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It seems that all of the physicians contributing to this thread love their job, but I had a question nonetheless. Knowing what you know now about medicine, the life of a physician, and the uncertainty with where healthcare (specifically with how it affects physicians directly) is going to go in the next 5-10 years would you still choose the same career path? and would you advise current hopeful future physicians to continue to pursue their goals?...As long as they're wanting to be doctors for all the right reasons. Thanks.
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Yes..Finacially, I could not be more happy. I would hate for my income to cut in half, but in all honesty, I would still be more than happy at half my income and I honestly dont see it getting much worse than that.... at some point, people would leave medicine. The government is not going to let that happen; if it does, we have much larger problems such as complete finacial collapse, etc etc. Even then, in EM, I could still deal with acute problems and get like chickens and bread as payment..hehe.
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You work with residents who are even more miserable than a few of the residents on these boards. How are they different from you (or from "slightly happier" residents)? Is it experiences, outlook, mismatch between expectation and reality, overall personalities?
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At work, how often do you second guess a decision you made regarding a patient?
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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) 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?
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