I'm training at Cinci now with hopes of going back to Seattle to take Copass' job with Medic One direction, Airlift NW, and Harborview ED director! Just playing, but it would be a sweet spot to have. I think the real problem is that it is a culture that Copass has created and while he is the top dog there are a lot of people under him with similar views. You have to remember that the majority of attendings at harborview are IM trained (they have a couple EM trained new grads from a few years back) and they are going to fight hard. If they lose their position there is nowhere in the country where an IM attending can walk into a level I trauma center and be an attending (for damn good reasons--how much ob/gyn do IM attendings know, how many shoulder reductions have IM attendings done, what about supervising the chest tube insertion in the trauma patient before the trauma attending arrives from home call, even better what about paging anesthesia stat to the ED overhead multiple times and waiting for the anesthesia team to arrive while your trauma patient aspirates blood because what do IM attendings know about trauma ariways?). I could go on forever! It is the craziest system you could imagine. Not to mention that about 1/2 of their attendings are new grads just putting in some hours before they do their endocrinology or gi fellowhips! just what I want, a new IM grad taking care of trauma patients in a level I trauma center. How many surgery months do you think IM residents get in training? Thankfully they shelter the new docs from the more acute resus bays. Most IM residents only do 1 or 2 months in the ED, so they should be well versed in the initial w/u of emergent patients. Yes they know medicine, but EM is much different otherwise we would just do an IM residency! UW does have a hospital on the actual UW campus that does have EM attendings that have trained at good programs. And at UW they are allowed to work as real EM docs, but their volume is low (~35k) and they see minimal trauma and no peds because children's is up the road. I'd love to come back to UW, but I'm not about to work at HMC where I have to consult out everything, can't do airways, and can't touch an ultrasound (yeah--when I rotated there 3 years ago they were doing DPLs on everyone and no FAST exams!!!!!!). It is amazing to me that one of the best med schools and hospitals in the country has a trauma center that functions in the 1960s. Ok, off my soap box for now. I can only hope that in a few years when I'm done it will be ready for change. Seattle would be an awesome city for a residency and it has some unique opportunities (I'm not sure there is another level I trauma center in the US that serves as much area as Harborview does---alaska, washington, idaho, western montana).
