Is EM just a bubble?

[Amazingmuzmo]

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So as a lot of people know, EM is a very hot field now with ever increasing reimbursement for relatively little hours worked. Many young graduates are entering the field and it is becoming more and more competitive to match into. Is this all a bubble, will this trend continue or maintain for the next 10, 15, 25 years? I've heard that Obamacare will actually not have as great an impact on EM docs as compared to other fields, anyone have any information on this?

 

[sylvanthus]

Its all speculation at this point. But with millions more insured and a primary care "shortage" the EDs will get busier guaranteed.

 

[link2swim06]

So as a lot of people know, EM is a very hot field now with ever increasing reimbursement for relatively little hours worked. Many young graduates are entering the field and it is becoming more and more competitive to match into. Is this all a bubble, will this trend continue or maintain for the next 10, 15, 25 years? I've heard that Obamacare will actually not have as great an impact on EM docs as compared to other fields, anyone have any information on this?

The better question would be 'is medicine a bubble?' Mostly yes, some no. It unsustainable so cuts are bound to occur.

I think people aren't likely to choose a long residency (like a surgery) w/o a guarantee of a huge salary and end up choosing EM instead.

 

[Stellar Clouds]

Many fields go through cycles of competitiveness, and I have little doubt that at some point in time the competitiveness of EM will go back down--when this happens is certainly a mystery.

 

[Textbookversion]

So as a lot of people know, EM is a very hot field now with ever increasing reimbursement for relatively little hours worked. Many young graduates are entering the field and it is becoming more and more competitive to match into. Is this all a bubble, will this trend continue or maintain for the next 10, 15, 25 years? I've heard that Obamacare will actually not have as great an impact on EM docs as compared to other fields, anyone have any information on this?

No, EM is not a bubble. Most places now prefer a board certified EM doc for some pretty obvious reasons (liability being one of them...). A sizable percentage of ER's are still staffed by non-EM trained folks who just have experience (FM, IM, general surgeons, etc). So there is still a huge demand for EM docs that is not being met.

On top of that, EM has a higher burn out rate than many other specialties. It's a draining job. This isn't the case with some other fields where you can keep working until you drop dead. Stuff like path, I've seen some ridiculously old guys hanging around (we're talking >75). Sure they typically only work part-time, but still they can work. Chill out, look at slides for a few hours in the morning. After doing it for 45 years... trust me they are efficient. You are much less likely to see the older crowd still working in EM.

On top of that, the new healthcare bill should be a huge win for EM. Don't believe me, look at what the big private equity groups are buying up. Higher insured rate = more $$$. This is uniquely true for EM because it can't discriminate based on insurance status (well, sometimes it can with an MSE but that's dangerous territory). An outpatient internist that sees all insured patients right now may not notice much change in revenue come jan 1 2014. EM on the other hand should see substantial revenue increases during 2014-2015 just due to the higher insured rate. Imagine if 1/3 your patients didn't pay at all, and suddenly they started paying.

I think EM is going to get even more competitive. Also I think general surgery should pay more, but who's asking me.

 

[e30ftw]

it's kind of a bubble.. in the same way that "the dome" from the simpsons movie and a deep sea submarine are "bubbles" even though they're made of impenetrable polymers which would require massive amounts of TNT to burst.

reasonable scenarios leading to burst of EM bubble:

mass planetary extinction event
discovery of the fountain of youth and beginning of the age of immortality
the rapture (because all em docs would be gone of course, etc)

in all seriousness, the demand for ABEM (board prepared) resident trained EM docs is rising and likely will continue to rise until the baby boomers start to die out. Right now is the beginning of the "baby boomer geezer" era so we have a good 20 years of septic old people with broken hips/GIB/PNA/MI marauding the ED doors until demand starts to go down.

incidentally i plan on retiring in about 20 years.

 

[KinesStudent]

it's kind of a bubble.. in the same way that "the dome" from the simpsons movie and a deep sea submarine are "bubbles" even though they're made of impenetrable polymers which would require massive amounts of TNT to burst.

reasonable scenarios leading to burst of EM bubble:

mass planetary extinction event
discovery of the fountain of youth and beginning of the age of immortality
the rapture (because all em docs would be gone of course, etc)

in all seriousness, the demand for ABEM (board prepared) resident trained EM docs is rising and likely will continue to rise until the baby boomers start to die out. Right now is the beginning of the "baby boomer geezer" era so we have a good 20 years of septic old people with broken hips/GIB/PNA/MI marauding the ED doors until demand starts to go down.

incidentally i plan on retiring in about 20 years.

lol 👍

 

[jerseytrash]

It's like asking if primary care is a "bubble". You will always need EM docs, primary care docs, surgeons, etc.

 

[Rothbard]

It's like asking if primary care is a "bubble". You will always need EM docs, primary care docs, surgeons, etc.

If you're comparing EM to primary care, that's not very reassuring.

 

[John Lannister]

So as a lot of people know, EM is a very hot field now with ever increasing reimbursement for relatively little hours worked. Many young graduates are entering the field and it is becoming more and more competitive to match into. Is this all a bubble, will this trend continue or maintain for the next 10, 15, 25 years? I've heard that Obamacare will actually not have as great an impact on EM docs as compared to other fields, anyone have any information on this?

Medicine is a bubble.

 

[John Lannister]

The better question would be 'is medicine a bubble?' Mostly yes, some no. It unsustainable so cuts are bound to occur.

I think people aren't likely to choose a long residency (like a surgery) w/o a guarantee of a huge salary and end up choosing EM instead.

Exactly.

Few if any specialties are immune.

 

[qxrt]

in all seriousness, the demand for ABEM (board prepared) resident trained EM docs is rising and likely will continue to rise until the baby boomers start to die out. Right now is the beginning of the "baby boomer geezer" era so we have a good 20 years of septic old people with broken hips/GIB/PNA/MI marauding the ED doors until demand starts to go down.

incidentally i plan on retiring in about 20 years.

Baby boomers beget more babies. It's not as if the baby boomers are a transient bolus of people who remain childless and disappear with the wind once their lives run out.

 

[e30ftw]

Baby boomers beget more babies. It's not as if the baby boomers are a transient bolus of people who remain childless and disappear with the wind once their lives run out.

thanks for clarifying! 👍

 

[FunnyCurrent]

No, EM is not a bubble. Most places now prefer a board certified EM doc for some pretty obvious reasons (liability being one of them...). A sizable percentage of ER's are still staffed by non-EM trained folks who just have experience (FM, IM, general surgeons, etc). So there is still a huge demand for EM docs that is not being met.

On top of that, EM has a higher burn out rate than many other specialties. It's a draining job. This isn't the case with some other fields where you can keep working until you drop dead. Stuff like path, I've seen some ridiculously old guys hanging around (we're talking >75). Sure they typically only work part-time, but still they can work. Chill out, look at slides for a few hours in the morning. After doing it for 45 years... trust me they are efficient. You are much less likely to see the older crowd still working in EM.

On top of that, the new healthcare bill should be a huge win for EM. Don't believe me, look at what the big private equity groups are buying up. Higher insured rate = more $$$. This is uniquely true for EM because it can't discriminate based on insurance status (well, sometimes it can with an MSE but that's dangerous territory). An outpatient internist that sees all insured patients right now may not notice much change in revenue come jan 1 2014. EM on the other hand should see substantial revenue increases during 2014-2015 just due to the higher insured rate. Imagine if 1/3 your patients didn't pay at all, and suddenly they started paying.

I think EM is going to get even more competitive. Also I think general surgery should pay more, but who's asking me.

ONE-THIRD!?!?!?

Optimism at its best

 

[FSU2013]

Boy, I hope not.

 

[da8s0859q]

On top of that, EM has a higher burn out rate than many other specialties. It's a draining job. This isn't the case with some other fields where you can keep working until you drop dead.

On top of that, the new healthcare bill should be a huge win for EM ... Imagine if 1/3 your patients didn't pay at all, and suddenly they started paying.

I think EM is going to get even more competitive. Also I think general surgery should pay more, but who's asking me.

The burnout thing is something I always wonder about. I know the 2012 "lifestyle survey" Medscape did has EM right up there in terms of burnout. And people always say/said that. But then there are things from program directors and long-time EM docs which suggest that it's not significantly higher than other specialties, not to mention differences in practice environments in that the inner-city gun/knife/crackhead clubs are probably more irritating to work in for some than are the relatively more peaceful suburban shops.

 

[gators21]

It seems to me that almost every person I talk to that wants to go into ER says they just "don't want call". I wonder if the high burnout rate is just because it tends to attract the "lazier" med students that want all the glory of being a doctor without having to work. Then they get into the field and realize that its all homeless, drug seeking, illegal immigrants, or sniffles, with the occasional true emergencies which eventually get shipped to other services.

 

[dally1025]

It seems to me that almost every person I talk to that wants to go into ER says they just "don't want call". I wonder if the high burnout rate is just because it tends to attract the "lazier" med students that want all the glory of being a doctor without having to work. Then they get into the field and realize that its all homeless, drug seeking, illegal immigrants, or sniffles, with the occasional true emergencies which eventually get shipped to other services.

work a couple of EM shifts before you call EM folks lazy...

Preferring shift work to the traditional call isn't lazy it's a preference. When I'm at work I want to stay busy so they day goes by faster. When I'm done I want to leave my work at work. Most EM folks I know live by the motto: work hard, play hard.

 

[EM2013]

It seems to me that almost every person I talk to that wants to go into ER says they just "don't want call". I wonder if the high burnout rate is just because it tends to attract the "lazier" med students that want all the glory of being a doctor without having to work. Then they get into the field and realize that its all homeless, drug seeking, illegal immigrants, or sniffles, with the occasional true emergencies which eventually get shipped to other services.

You should work a day in a busy emergency department before making ridiculous statements like this. You'll soon learn that a "shift" in the ED means busting your ass for 12 hours without the luxury of getting starbucks, lunch, sitting around to read uptodate, etc that most other specialties enjoy.

EM attracts "work hard, play hard" type personalities. We like to work while at work, and do other stuff while we are not. We have no interest in standing around all day with 1-2 hour gaps between stuff we have to do. It has nothing to do with laziness and everything to do with a desire for time efficiency.

 

[da8s0859q]

I wonder if the high burnout rate is just because it tends to attract the "lazier" med students that want all the glory of being a doctor without having to work.

Eh, it's all relative. I guess EM folks and all the aspiring dermatologists / radiologists / psychiatrists could be called "lazy" compared to the die-hard surgeon, obstetrician, and hospitalist types, but at some point, "interest in having a balanced life" is what gets mistaken for "laziness."

I assure you that we did not sit around in the ED at my school's hospital drinking coffee and playing water gun fight with those 10cc saline flushes.

 

[Dharma]

As an aside: "EM is NOT a lifestyle specialty" (great thread)
http://forums.studentdoctor.net/showthread.php?t=898506

 

[gators21]

You should work a day in a busy emergency department before making ridiculous statements like this. You'll soon learn that a "shift" in the ED means busting your ass for 12 hours without the luxury of getting starbucks, lunch, sitting around to read uptodate, etc that most other specialties enjoy.

EM attracts "work hard, play hard" type personalities. We like to work while at work, and do other stuff while we are not. We have no interest in standing around all day with 1-2 hour gaps between stuff we have to do. It has nothing to do with laziness and everything to do with a desire for time efficiency.

I guess my point wasn't really stressed with this. My fault. I have worked in the ED for several years. I know that the shift is not easy. I was simply stating the perception of ER by most of my classmates. The I wanna only work 13 shifts a month, not ever get woken up, have no follow up, all while getting rose buds thrown at my feet because I'm a doctor mentality. I meant absolutely no disrespect to ER docs or to actually call them lazy, but just stating my experience with my classmates.

 

[45408]

Also I think general surgery should pay more, but who's asking me.

I'm just banking on the hope that it certainly seems like an unlikely candidate to see a pay CUT relative to other specialties.

 

[FSU2013]

I guess my point wasn't really stressed with this. My fault. I have worked in the ED for several years. I know that the shift is not easy. I was simply stating the perception of ER by most of my classmates. The I wanna only work 13 shifts a month, not ever get woken up, have no follow up, all while getting rose buds thrown at my feet because I'm a doctor mentality. I meant absolutely no disrespect to ER docs or to actually call them lazy, but just stating my experience with my classmates.

👍 This is totally EM, lol.

 

[da8s0859q]

👍 This is totally EM, lol.

Hell yeah. That's what they do for us on day one of residency, isn't it?

 

[FSU2013]

Hell yeah. That's what they do for us on day one of residency, isn't it?

I don't know about you, but that's what I'm expecting July 1. Either that or a boatload of homeless or alcoholics. Definitely one of the two, lol.

 

[TooMuchResearch]

Hell yeah. That's what they do for us on day one of residency, isn't it?

Residency? No, this has been my experience as a student.

 

[gators21]

Didn't know I hit such a sore spot. Was just reiterating what I have heard word for word from some classmates. Not my opinion at all on ER, but whatever.

 

[KinasePro]

Didn't know I hit such a sore spot. Was just reiterating what I have heard word for word from some classmates. Not my opinion at all on ER, but whatever.

Yeah, those interested in EM are getting pretty butthurt in this thread for no reason.

I definitely hear the same type of rational being used for going into EM in my neck of the woods. Not everyone feels this way obviously, but a lot of M1-M3's talk about EM like it belongs in the ROAD acronym. I've even worked with a few intern's who seemed to "brag" about the shift-work mentality and how their next 2 years will be great relative to other PGY2's and 3's.

Seems like a rough field though, especially once you become an attending. Some of these folks are bound to be unhappy once they reach the end of their training and experience how difficult the day-to-day work is.

 

[Anon212]

I really think it depends on what you mean by "good lifestyle".

For some, it's all about working the minimum number of hours total. On average, EM doesn't work as many hours as a lot of other specialties- so that can be viewed as "good lifestyle".
For others, it's about having as much true "free time" (time that cannot be spent at the hospital, whether you want it to be or not) as possible- EM isn't bad in that respect either because of shift work. There's no such thing as home call, hospital call, or whatever. So when you're home, you're home. You also don't have your "own" patients so even if something happens to one of them and he/she ends up at a different ED...tough. You won't know about it and your day to day existence won't be disturbed because of it.

On the other hand, others define lifestyle differently. Those hours you spend in the hospital may be the most stressful, exhausting and occasionally heart-wrenching hours ever. You probably won't have time to eat, pee, sit down or hang out with your colleagues. Unlike on other specialties where there's plenty of down-time, it's go-go-go all day (or night) long. So by the time you get home, you're likely exhausted and you probably need a day just to recuperate- vs getting home from a day in derm clinic, where you can just sit down and keep living your life.
Another issue with EM is that due to the nature of shift work, your sleep schedule is always a disaster, your weekends are by no means guaranteed, and holidays are iffy. I'd argue that this is the case for all medical specialties where no matter what group practice you're in you have to be on weekend call sometimes, but it's certainly more common for EM.

So it just depends on what you want to get out of it. In my experience, it tends to attract the high-energy personalities anyway so the whole "12 hours on my feet without a break" thing is less of an issue. I know from my perspective I'd rather be dependent on melatonin than live in fear of being called in to work when im in the middle of my daughter's recital. I'd rather be able to schedule my shifts around vacations, work more shifts one month that I'm saving for something and fewer on a month that I have the flu- I like the flexibility. As for weekends, meh, at some point I won't be in my 20s anymore and the fact that I won't be able to go clubbing on a Saturday probably won't be that heartbreaking anymore.

 

[docB]

Didn't know I hit such a sore spot. Was just reiterating what I have heard word for word from some classmates. Not my opinion at all on ER, but whatever.

But that's not what you said. You said "It seems to me...lazy..."

It seems to me that almost every person I talk to that wants to go into ER says they just "don't want call". I wonder if the high burnout rate is just because it tends to attract the "lazier" med students that want all the glory of being a doctor without having to work. Then they get into the field and realize that its all homeless, drug seeking, illegal immigrants, or sniffles, with the occasional true emergencies which eventually get shipped to other services.

Oh yeah. And you threw in glory seeking, work avoiding, and all the real patients get shipped to other services.

That's pretty insulting no matter how you slice it. You said it. Own it. Definitely don't take the bogus out of trying to say now that you just heard that somewhere.

Yeah, those interested in EM are getting pretty butthurt in this thread for no reason.

I'd say there's good reason. If you substituted any specialty into that accusation you'd get pushback from whoever was maligned.

Seems like a rough field though, especially once you become an attending. Some of these folks are bound to be unhappy once they reach the end of their training and experience how difficult the day-to-day work is.

I agree with you on this.

I really think it depends on what you mean by "good lifestyle".

For some, it's all about working the minimum number of hours total. On average, EM doesn't work as many hours as a lot of other specialties- so that can be viewed as "good lifestyle".
For others, it's about having as much true "free time" (time that cannot be spent at the hospital, whether you want it to be or not) as possible- EM isn't bad in that respect either because of shift work. There's no such thing as home call, hospital call, or whatever. So when you're home, you're home. You also don't have your "own" patients so even if something happens to one of them and he/she ends up at a different ED...tough. You won't know about it and your day to day existence won't be disturbed because of it.

On the other hand, others define lifestyle differently. Those hours you spend in the hospital may be the most stressful, exhausting and occasionally heart-wrenching hours ever. You probably won't have time to eat, pee, sit down or hang out with your colleagues. Unlike on other specialties where there's plenty of down-time, it's go-go-go all day (or night) long. So by the time you get home, you're likely exhausted and you probably need a day just to recuperate- vs getting home from a day in derm clinic, where you can just sit down and keep living your life.
Another issue with EM is that due to the nature of shift work, your sleep schedule is always a disaster, your weekends are by no means guaranteed, and holidays are iffy. I'd argue that this is the case for all medical specialties where no matter what group practice you're in you have to be on weekend call sometimes, but it's certainly more common for EM.

So it just depends on what you want to get out of it. In my experience, it tends to attract the high-energy personalities anyway so the whole "12 hours on my feet without a break" thing is less of an issue. I know from my perspective I'd rather be dependent on melatonin than live in fear of being called in to work when im in the middle of my daughter's recital. I'd rather be able to schedule my shifts around vacations, work more shifts one month that I'm saving for something and fewer on a month that I have the flu- I like the flexibility. As for weekends, meh, at some point I won't be in my 20s anymore and the fact that I won't be able to go clubbing on a Saturday probably won't be that heartbreaking anymore.

I was going to address the main topic here but this sums it up nicely.

 

[wholeheartedly]

But that's not what you said. You said "It seems to me...lazy..."

.

Honestly, that wasn't how I read gators post when I first read it. Poorly articulated I agree, but I read it as him thinking that uneducated classmates who are going for what they think will be an easier lifestyle, who he referred to as lazy (though personally I certainly don't fault anyone for wanting good work/life balance) get their butts handed to them and winding up hating it and burned out when reality strikes (homeless, drug seeking, non-emergent stuff) . I did not read that as him saying everyone who goes into the speciality was lazy, just the naive little subgroup. Perhaps instead of lazy, misinformed, would have been a better word choice.

I've also definitely heard those same misinformed statements like "oh EM would be soo easy, no call, no follow up, and you work like 14 10 hour shifts a month doing badass things and saving lives" from pre-meds and some newer med students. Those particular folks do seem to want to take the easy way out and want to throw around the badass label quite a bit. But that's not anywhere near the majority of people going into EM.

So the only people I took him to suggest were lazy were the people with that misinformed mindset about the field who want to dive into it just for those reasons, not the people who go into it knowing how much hard work and stress they're about to take on.

It isn't hard to imagine that the people who go into EM with that mindset wind up burned out and hating it after discovering the reality of the situation, that the shifts are fast-paced, intense, and can be filled with patients with a lot of non-emergent/ non-badass issues.


That said, it's pretty obvious to me with my limited 6 months of experience in the ED that it wouldn't be an easy lifestyle. It's hard for me to imagine that someone could go through EM rotations, get letters for EM to apply, and still be that clueless about what it entails. Maybe that's site specific though? 😕 Most of the misinformed folks in my experience are premeds or MS1 & 2's.

I guess I just can't imagine too many of those "misinformed" folks actually getting to the point of applying to EM without getting hit with a serious reality check that makes them realize it's not what they thought it was going to be. So I'm not sure how many of those "misinformed" types actually contribute to burnout rates.

 

[gators21]

But that's not what you said. You said "It seems to me...lazy..."



Oh yeah. And you threw in glory seeking, work avoiding, and all the real patients get shipped to other services.

That's pretty insulting no matter how you slice it. You said it. Own it. Definitely don't take the bogus out of trying to say now that you just heard that somewhere.



I'd say there's good reason. If you substituted any specialty into that accusation you'd get pushback from whoever was maligned.



I agree with you on this.



I was going to address the main topic here but this sums it up nicely.

Yes, by cut and pasting what I said into segments you can make it look like I called ER docs lazy. But read that again. I said that it is attractive to the lazier students. When did I ever say that I think ER docs are lazy? I even mentioned this later but again people just saw lazy, ER, and decided to get all pissy and focused on certain words.
I don't have to own up to jack. Tell me what part of my statement is wrong? Obviously not all students that go into ER are just looking to be lazy. Ill throw the whole quote in for you from my first post. "It seems to me that almost every person(see how I don't just stop at seems to me)I talk to that wants to go into ER says they just "don't want call"."
As first and second year medical students already trying to pick a specially solely based on call, work hours, and yes I have heard directly "rose petals at my feet", then I call that lazy and glory seeking. They are trying to pick a specialty not based on interest, experience, pathology, ect... just trying to work as little as possible.

Again these are things that I have heard expressed from some people interested in ER. Not my personal feelings about ER docs.

 

[fahimaz7]

Yes, by cut and pasting what I said into segments you can make it look like I called ER docs lazy. But read that again. I said that it is attractive to the lazier students. When did I ever say that I think ER docs are lazy? I even mentioned this later but again people just saw lazy, ER, and decided to get all pissy and focused on certain words.
I don't have to own up to jack. Tell me what part of my statement is wrong? Obviously not all students that go into ER are just looking to be lazy. Ill throw the whole quote in for you from my first post. "It seems to me that almost every person(see how I don't just stop at seems to me)I talk to that wants to go into ER says they just "don't want call"."
As first and second year medical students already trying to pick a specially solely based on call, work hours, and yes I have heard directly "rose petals at my feet", then I call that lazy and glory seeking. They are trying to pick a specialty not based on interest, experience, pathology, ect... just trying to work as little as possible.

Again these are things that I have heard expressed from some people interested in ER. Not my personal feelings about ER docs.

Just quit while you're only moderately behind. There are "lazy" residents in every single field of medicine. They are also in the surgical fields. EM residencies have you in 5 ICU setttings + you have to retain knowledge about every specialty, age group, etc.

What you are referring to, and you will figure it out once you get to the clinical years, are bull**** students who like to look down upon other fields and talk smack about their profession. EM docs work as hard or harder than anyone else in the hospital, when they are at work, and will end up working every holiday, both day and night once they are out. The ED doesn't shut down for the weekend and it doesn't close when the sun goes down. It's one of the few professions where you will be working while 90% of the other healthcare providers are laying in their cozy beds trying to sex up their 3rd wife.

Most of the EM residents and soon-to-be residents on this thread are at the top of their class, AOA, great scores, etc., and could have been competitive into any other field out there. We're not lazy, we just prefer something different than you guys do... Just like the OB or the Psychiatrist who prefers something different than the ortho guy.

PS. If you want to work as little as possible do anesthesia then sign up for ad-locum gigs around the country a few months out of the year. You'll make 3x more than you would as a EM doc and you'll be "living the good life" down in the OR, where your patients aren't trying to manipulate you, lie to you, throw up on you, punch you, harass you, camp in your ED, etc.

 

[gators21]

Just quit while you're only moderately behind. There are "lazy" residents in every single field of medicine. They are also in the surgical fields. EM residencies have you in 5 ICU setttings + you have to retain knowledge about every specialty, age group, etc.

What you are referring to, and you will figure it out once you get to the clinical years, are bull**** students who like to look down upon other fields and talk smack about their profession. EM docs work as hard or harder than anyone else in the hospital, when they are at work, and will end up working every holiday, both day and night once they are out. The ED doesn't shut down for the weekend and it doesn't close when the sun goes down. It's one of the few professions where you will be working while 90% of the other healthcare providers are laying in their cozy beds trying to sex up their 3rd wife.

Most of the EM residents and soon-to-be residents on this thread are at the top of their class, AOA, great scores, etc., and could have been competitive into any other field out there. We're not lazy, we just prefer something different than you guys do... Just like the OB or the Psychiatrist who prefers something different than the ortho guy.

PS. If you want to work as little as possible do anesthesia then sign up for ad-locum gigs around the country a few months out of the year. You'll make 3x more than you would as a EM doc and you'll be "living the good life" down in the OR, where your patients aren't trying to manipulate you, lie to you, throw up on you, punch you, harass you, camp in your ED, etc.

Holy crap you literally just stated the same exact thing that was the intent of my post. The "concept" of ER is attractive to those type of people (that you just mentioned in your post). Then you proceeded to tell everyone to choose another field. Your examples are just different. I used homeless, drug seekers, and sniffles. You used physical violence. Of course there are going to be those types in every field. Of course not everyone is like this. Of course thats not all your going to see in the ER. This thread was about why ER is becoming so popular. I was just making a point about things I have witnessed
Im done with this thread as boards are rapidly approaching. Good luck to all future ER docs. I mean no disrespect

 

[TooMuchResearch]

holy crap you literally just stated the same exact thing that was the intent of my post. The "concept" of er is attractive to those type of people (that you just mentioned in your post). Then you proceeded to tell everyone to choose another field. Your examples are just different. I used homeless, drug seekers, and sniffles. You used physical violence. Of course there are going to be those types in every field. Of course not everyone is like this. Of course thats not all your going to see in the er. This thread was about why er is becoming so popular. I was just making a point about things i have witnessed
im done with this thread as boards are rapidly approaching. Good luck to all future er docs. I mean no disrespect

em.

 

[da8s0859q]

PS. If you want to work as little as possible do anesthesia then sign up for ad-locum gigs around the country a few months out of the year. You'll make 3x more than you would as a EM doc and you'll be "living the good life" down in the OR, where your patients aren't trying to manipulate you, lie to you, throw up on you, punch you, harass you, camp in your ED, etc.

Really? Why aren't all of us signing up for THAT?

 

[fahimaz7]

Really? Why aren't all of us signing up for THAT?

We're not bright. If we were, we would have gone to dental school.

 

[Anon212]

For what it's worth, gators, I really do get what you were trying to say. I don't think you were insulting EM as a specialty at all, more implying that it's really misunderstood out there and that it can attract some of the lazier personalities due to the lack of call/ mellow demeanor of a lot of EM folks, and those people are then in for a world of hurt when they realize that it really is very hard. I do think a lot of those folks get "weeded out" when they spend a lot of time in the ED as fourth years though. That happens a lot at my school- it seems like everyone's EM, then fourth year hits, and half those people end up in anesthesia when they realize they're actually kind of exhausted at the end of the day and they're sick of talking to people all the time (not to rag on anesthesia- critical care is a bitch of a specialty as well). And if they don't get weeded out by then, tough I guess, they can work in urgent care or something, or rural ED's where nothing ever happens. Leave the fun stuff to the rest of us.

The whole reality not meeting expectations thing happens all the time in medical practice though. Just talk to a lot of old school docs nowadays. The reason so many of them are disgruntled and will tell you that medicine "isn't worth it anymore" is that when they entered it, it just was different- the expectations were different. Nowadays the bureaucracy is different, the paperwork demanded of us is different, and certainly all physicians- some specialties in particular- have taken a huge pay cut. It's about managing expectations. No specialty is perfect, EM especially. But if you love it, and it's the only one that makes sense to you, then who cares.

 

[tantacles]

For what it's worth, gators, I really do get what you were trying to say. I don't think you were insulting EM as a specialty at all, more implying that it's really misunderstood out there and that it can attract some of the lazier personalities due to the lack of call/ mellow demeanor of a lot of EM folks, and those people are then in for a world of hurt when they realize that it really is very hard. I do think a lot of those folks get "weeded out" when they spend a lot of time in the ED as fourth years though. That happens a lot at my school- it seems like everyone's EM, then fourth year hits, and half those people end up in anesthesia when they realize they're actually kind of exhausted at the end of the day and they're sick of talking to people all the time (not to rag on anesthesia- critical care is a bitch of a specialty as well). And if they don't get weeded out by then, tough I guess, they can work in urgent care or something, or rural ED's where nothing ever happens. Leave the fun stuff to the rest of us.

The whole reality not meeting expectations thing happens all the time in medical practice though. Just talk to a lot of old school docs nowadays. The reason so many of them are disgruntled and will tell you that medicine "isn't worth it anymore" is that when they entered it, it just was different- the expectations were different. Nowadays the bureaucracy is different, the paperwork demanded of us is different, and certainly all physicians- some specialties in particular- have taken a huge pay cut. It's about managing expectations. No specialty is perfect, EM especially. But if you love it, and it's the only one that makes sense to you, then who cares.

This is how I interpreted it as well.

 

[PrideNeverDie]

medicine is a bubble

also, demonstrating need isn't enough to justify job security and compensation

for example, it doesn't matter how badly we need people in EM if politicians keep EM residency spots fixed, lower medicare reimbursement for EM, and fill the spots with midlevels

the midlevels deal with the homeless and alcoholics and the attendings handle the real cases

 

[OCDEMS]

I think calling EM a bubble is premature, but I don't think it's a field immune to disruptive innovations.

Absent the concern regarding enough board certified emergency physicians, we should consider the physical limitations of this country's emergency departments to handle the influx of millions of new insured. But I would argue that people use the emergency department when they need to, regardless if they are insured. I would also hypothesize that most people are currently using emergency departments for "true" emergencies. If your hand is missing, well, the only place with a solution is the local ED. If you're having severely distressing chest pain, you'll eventually come around to calling an ambulance or driving to the ED. People who traditionally use the ED as a form of primary care will at first encounter difficulty obtaining a PCP, but they will eventually filter into primary care practices as new ones are opened. As mid-levels and primary care docs are produced, this need will theoretically decrease. If I saw anything being profitable in the next decade: urgent care centers.

We must also not count out the innovation surrounding in-home healthcare, particularly the development of community health and mid-level paramedics. Other countries have experimented with this with some success. Diagnostic equipment is shrinking. Ultrasound is already being utilized by some EMS systems in the U.S. The lowering cost of technologies like the iStat have prompted lab analysis to be slowly integrated into the paramedic curriculum. Imagine a master's trained mid-level paramedic (physician assistant maybe) who could suture, prescribe antibiotics, and run basic laboratory work in the home. There are other concerns as well: why heal in a hospital when you can heal in your home, relatively free of hospital acquired infections. When you consider that 60-80% of eventual hospital admissions come in by ambulance then you start to see how truly disruptive that could be.

The reality is that if there is a market, someone will come up with a solution. Maybe the answer is more BC EM physicians. Maybe the answer is mid-levels. Maybe nothing will change at all. I think anyone going into a specialty in hopes of some ultimate job security or big pay and low hours is silly, especially when EM does remain a difficult specialty with unique demands on its practitioners. As other respectable posters have pointed out, it's not fun and games 24/7. The bright side is that EM is a relatively new specialty that seems to be pretty innovative. The addition of the EMS subspecialty shows that they consider it an important part of their scope of practice and are not ignoring the development.

 

[John Lannister]

Always interesting when pre-meds chime in.

 

[Textbookversion]

I would also hypothesize that most people are currently using emergency departments for "true" emergencies.

And you would be dead wrong.

People who traditionally use the ED as a form of primary care will at first encounter difficulty obtaining a PCP, but they will eventually filter into primary care practices as new ones are opened.

And where are these PCP's coming from? Your magic hat? Also you ignore the convenience of a 24/7 ER is > convenience of scheduling an appointment and having to wait.

If I saw anything being profitable in the next decade: urgent care centers.

Congratulations on further reinforcing you don't know what you are talking about.

We must also not count out the innovation surrounding in-home healthcare, particularly the development of community health and mid-level paramedics. Other countries have experimented with this with some success. Diagnostic equipment is shrinking. Ultrasound is already being utilized by some EMS systems in the U.S. The lowering cost of technologies like the iStat have prompted lab analysis to be slowly integrated into the paramedic curriculum. Imagine a master's trained mid-level paramedic (physician assistant maybe) who could suture, prescribe antibiotics, and run basic laboratory work in the home.

This is where you started to give me a migraine. PA's are not "midlevel paramedics" and nothing you are talking about is anywhere on anyone's radar. Paramedics are pretty clueless btw they are high school graduates who they teach how to ABC someone to the ER in return for some community college credits and maybe a mickey mouse degree.

So no, I'm not going to imagine that.

There are other concerns as well: why heal in a hospital when you can heal in your home, relatively free of hospital acquired infections.

Because you are sick as stink and need to be hooked up to IV's and have constant monitoring? Hospitals are not day spa's for the mildly ill. Also THIS HAS NOTHING TO TO DO EM THANKS. If anything you are somehow talking about disrupting hospital medicine with home hospitals run by paramedics????

The reality is that if there is a market, someone will come up with a solution.

That's cute, but not true.

The bright side is that EM is a relatively new specialty that seems to be pretty innovative. The addition of the EMS subspecialty shows that they consider it an important part of their scope of practice and are not ignoring the development.

Academia loves to add filler fellowships. Doesn't really mean anything. And EM has been around since the 70's and the board formed in 1979. It's not THAT young.

 

[jerseytrash]

Eh, I think there's a lot of security in EM. I enjoyed my rotation in it a lot more than I expected to.

The only reason I ruled out EM had nothing to do with the supposed "laziness" of the field or whatever people are claiming - which is frankly nonsense. I chose IM because I wanted to be the expert in a specific field while having a broad knowledge (hence why I am considering a number of different fellowships) of both acute care and long-term care. I didn't like dealing with a lot of the patients EM sees (the drunks, s/p bar fights, the "i'm hungry so I came to the ER" patients, which were probably 50% of my EM patients). And frankly speaking the number of misdiagnoses that I had seen coming from my school's ER were... well, not to my liking. And I like diagnosing, not simply stabilize and dispo.

There's plenty to like about EM though that I totally understand. The lack of "call" as it exists in other fields (though honestly I feel like a lot of fields are moving increasingly closer to shift work models such as hospitalist gigs), the "do it and forget it" mentality, the lots of different procedures, etc. And it's a necessary job in this day and age. So let's stop bashing on each others' choices for careers mkay?

 

[45408]

I would also hypothesize that most people are currently using emergency departments for "true" emergencies.

Honestly, no one will take the rest of your thoughts seriously after this. It's completely incorrect. Most EDs are treated by patients as a "Sort of Important Department." Most emergencies will make their way to the ED, but they're surrounded by an avalanche of sniffles, toothaches and chronic pain.

 

[FSU2013]

Honestly, no one will take the rest of your thoughts seriously after this. It's completely incorrect. Most EDs are treated by patients as a "Sort of Important Department." Most emergencies will make their way to the ED, but they're surrounded by an avalanche of sniffles, toothaches and chronic pain.

Nice. Mind if I use that? lol.

 

[da8s0859q]

Most EDs are treated by patients as a "Sort of Important Department." Most emergencies will make their way to the ED, but they're surrounded by an avalanche of sniffles, toothaches and chronic pain.

You're okay, man. I don't care what anyone says about you.

 

[45408]

Nice. Mind if I use that? lol.

It's all yours, man. I bet you'd love some of the material from Panda Bear's now defunct blog from his med school and ED residency days. He was a real wordsmith. http://www.studentdoctor.net/pandabearmd/

 

[45408]

It's all yours, man. I bet you'd love some of the material from Panda Bear's now defunct blog from his med school and ED residency days. He was a real wordsmith. http://www.studentdoctor.net/pandabearmd/

Nail on the head right here, just three posts from the top:

Competition

It's a rare Emergency Department that does not advertise some kind of thirty-minute-or-less guarantee and many even have electronic billboards flashing their current wait times into the night like a bug light to attract the casual seeker of late night medical care. Because we have not yet taken complete leave of our senses the guarantees are loaded with small print disclaimers negating them in the case of, laughable as it seems, an actual emergency. And it's a "Door to Provider" time, not a guarantee of your actual stay in the department.

My hospital implemented one of these guarantees and I found out about it like everybody else, from the billboard. To date I have never received any official guidance on it which is just as well because it's not as if I'm slacking off and I pretty much work as fast as I safely can anyway. I arrived the other day to find four ambulances just pulled up so let's just say that the disclaimers are often operating in full force and I don't usually worry about my "Door to Doctor Time" because I simply cannot work faster than I already do.

Still, I've occasionally dealt with patients who throw the guarantee in my face as an opening move in the chess match that is the modern patient encounter. One even angrily thrust the newspaper advertisement at me when I walked in the door which is not the best way to establish a relationship with a guy who is a little more educated than the cashier at Wal Mart taking your coupon for fifty-cents-off a can of string beans.

So lately I've been asking the usual question, some variation on, "Have you been to your own doctor about this seemingly chronic and minor complaint?" and I get the special look reserved for not-so-bright ER doctors. Patients are not stupid. Going to your own doctor involves a phone call, an appointment at some later date, a wait of at least an hour after your appointment time and then even more waiting or worse yet, a trip across town for any studies the doctor might order and then the interminable wait for results.

You'd be foolish to go to your own doctor, especially if someone else is footing the bill as is the case with most of our patients. Even if you're privately insured the extra co-pay doesn't seem like that much of a deterrent. In this respect Emergency Departments have now unabashedly set themselves up in direct competition with the local primary care physicians for the paying customers. We might as well start booking appointments.

http://www.studentdoctor.net/pandabearmd/2011/12/23/random-notes/