Is Emergency Medicine a Primary Care Specialty?

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Ookluh

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I ask because I have received the impression that it is - I mean, emergency room physicians are essentially the first to deal with whatever ailment people have when they come to the ER. But I also mentioned this recently to a friend that is in medical school, and she balked at the idea that emergency medicine is a field of primary care.

I have been writing some of my secondary answers with mention that I want to pursue primary care, with a particular interest in emergency medicine. Should I not refer to EM docs as PCPs, or do you guys think this is fine?
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brianlh said:
I ask because I have received the impression that it is - I mean, emergency room physicians are essentially the first to deal with whatever ailment people have when they come to the ER. But I also mentioned this recently to a friend that is in medical school, and she balked at the idea that emergency medicine is a field of primary care.

I have been writing some of my secondary answers with mention that I want to pursue primary care, with a particular interest in emergency medicine. Should I not refer to EM docs as PCPs, or do you guys think this is fine?
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Most would say no, because, although they are a first point in contact with patients, they do not provide the continuity of care generally seen in the traditional primary care fields. People who use the phrase primary care usually mean FP, IM, Peds and OB/GYN.
 
Ah okay - then I better rephrase my sentence to be on the safe side. Thanks for the input!
 
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Emergency physicians provide "primary care" by virtue of being available all the time for "free." They are not trained in primary care. Refilling blood pressure meds or dabbling a bit in benign gyne is not primary care.

Primary care physicians (FP, IM, Peds) are trained in health maintainence through screening and counseling in an outpatient, ambulatory setting.
 
While I know that sometimes the ER becomes what you mentioned, I'm not sure if I am picking up on the right vibe. It sounds as if you may not view ER physicians in the same light as PCPs - which, if it's not true, I apologize. I actually am not offended, even if it is true - but now I'm curious... is Emergency Medicine something that schools may not necessarily be looking for? ie: If it is widely considered to be a relatively low level of care, or has other negative connotations, then will it hurt my chances of admission by openly expressing my interest?
 
brianlh said:
While I know that sometimes the ER becomes what you mentioned, I'm not sure if I am picking up on the right vibe. It sounds as if you may not view ER physicians in the same light as PCPs - which, if it's not true, I apologize. I actually am not offended, even if it is true - but now I'm curious... is Emergency Medicine something that schools may not necessarily be looking for? ie: If it is widely considered to be a relatively low level of care, or has other negative connotations, then will it hurt my chances of admission by openly expressing my interest?
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There is no reason a school would have a problem with someone interested in emergency medicine and it will absolutely not hurt your chances. It is not a low level of care nor does it have negative connotations. It does attract a certain quirky personality IMHO, so you should hang out with some ED docs before you decide that's you. If you are interested in it, go with it -- no school will have a problem with that.
 
Thanks for all of the quick replies, and clarification :)

Now that you mention it, some of the docs in the ER I work at can be interesting at times. But in comparison to some of the patients, everyone seems okay to me (work yesterday made me swear that a full moon had to have been out). Maybe I'm one of the quirky personalities :p

We'll see. Thanks for the information!
 
Law2Doc said:
There is no reason a school would have a problem with someone interested in emergency medicine and it will absolutely not hurt your chances.
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When I interviewed at a certain school last year that shall remain unnamed (hint: rhymes with "Ranford"), my interviewer asked what I wanted to do. When I said I was interested in Emergency Medicine, he glowered at me and said, "Oh, so you just want to be a glorified veterinarian, eh?" :eek: I could positively feel the hostility emanating from the man-- even his face turned an unpleasant crimson color. The whole interview went downhill from there. Suffice it to say, I was summarily rejected.

In talking to some Docs at my home institution, several of them explained that EM Docs sometimes get negative reputations in the medical field as mere "meat movers." This can be particularly true among Docs who do lots of long term care (my interviewer was an Oncologist).

As for me, I'm certainly not giving up EM as an interest... but it apparently can hurt you, sometimes.
 
Emergency Medicine is a religious profession where we interfere with natural selection and prove that Darwin couldn't possibly have been correct.
 
Wanna_B_Scutty said:
When I interviewed at a certain school last year that shall remain unnamed (hint: rhymes with "Ranford"), my interviewer asked what I wanted to do. When I said I was interested in Emergency Medicine, he glowered at me and said, "Oh, so you just want to be a glorified veterinarian, eh?" :eek: I could positively feel the hostility emanating from the man-- even his face turned an unpleasant crimson color. The whole interview went downhill from there. Suffice it to say, I was summarily rejected.

In talking to some Docs at my home institution, several of them explained that EM Docs sometimes get negative reputations in the medical field as mere "meat movers." This can be particularly true among Docs who do lots of long term care (my interviewer was an Oncologist).

As for me, I'm certainly not giving up EM as an interest... but it apparently can hurt you, sometimes.
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Har har. I like that one. And, after a shift spent trying to take a history from patients who only answered in gutteral sounds or brief, non-informative sentences I can see where he's coming from.

Oh, and all of my five dogs are cleaner with better smelling breath than the majority of my patients.

P. Bear, MDVM
 
Oh, and by the way, everybody in medicine, with few exceptions, is a meat mover. You wanna' see meat being moved? Match into Family Practice. Those guys can move the meat...and they have to or they will starve.

American medicine is a combination of a goat rodeo and meat packing.
 
brianlh said:
While I know that sometimes the ER becomes what you mentioned, I'm not sure if I am picking up on the right vibe. It sounds as if you may not view ER physicians in the same light as PCPs - which, if it's not true, I apologize. I actually am not offended, even if it is true - but now I'm curious... is Emergency Medicine something that schools may not necessarily be looking for? ie: If it is widely considered to be a relatively low level of care, or has other negative connotations, then will it hurt my chances of admission by openly expressing my interest?
Click to expand...

Emergency Medicine is more competitive than General Surgery (in the match, I mean) and way, way more competitive than Internal Medicine so I am always amused when internal medicine folks look down on EM. On average, you need much higher grades and board scores to match into Emergency Medicine.
 
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Panda Bear said:
Har har. I like that one. And, after a shift spent trying to take a history from patients who only answered in gutteral sounds or brief, non-informative sentences I can see where he's coming from.

Oh, and all of my five dogs are cleaner with better smelling breath than the majority of my patients.

P. Bear, MDVM
Click to expand...

OP - See what I meant by EM types having a certain quirky personality? :laugh:
 
Panda Bear said:
Emergency Medicine is a religious profession where we interfere with natural selection and prove that Darwin couldn't possibly have been correct.
Click to expand...

lmao
 
Haha - some good responses.

While we're on the topic of Stanford.. I wonder if it's just a coincidence that wbscutty had a bad interview experience there. The friend I mentioned in the first post was also telling me about her interview experiences, and she said the guy seemed angry and unwelcoming throughout the entire interview. She was a highly qualified individual (IMHO), so I'm not sure why he would be so upset. She ended up going to Yale, so she's happy - but it's making me a bit scared of Stanford, should they even offer me a secondary. Anybody else have bad experiences with openly admitting they want to do EM, or is Stanford (or oncologists) the exception?

Law2Doc: I sort of do.. except on some days, I agree with what Panda Bear said! Haha.. maybe that does make me one of the quirky ones.
 
Panda Bear said:
Emergency Medicine is more competitive than General Surgery (in the match, I mean) and way, way more competitive than Internal Medicine so I am always amused when internal medicine folks look down on EM. On average, you need much higher grades and board scores to match into Emergency Medicine.
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Physicians never actually look at the competitiveness of a specialty when deciding its practitioners are smart or dumb. How else could one explain the reputation of orthopods as big dumb jocks? Most are big and jockish, sure...but that field is out of range for most med students.
 
8744 said:
Oh, and by the way, everybody in medicine, with few exceptions, is a meat mover. You wanna' see meat being moved? Match into Family Practice. Those guys can move the meat...and they have to or they will starve.

American medicine is a combination of a goat rodeo and meat packing.
Click to expand...
Haha, well said. Goat rodeo, meat packing, and modern medicine, never woulda put those 3 together
 
Wtf at a six year necro...

Anyways, EM is probably more competitive than GenSu because of lifestyle, workplace, financial, and legal considerations. I mean, I think surgery is cool and all, but those reasons are why I've ruled out GenSu, and would never bother with most surgical specialties.

To answer the OP, I wouldn't mention it in that context. Usually, when a school talks about "primary care," they mean "family practice." It's become the cool thing to have a mission statement that focuses on family practice, because think about it this way. Med schools receive a lot of public money. In return, med schools produce doctors and research for the public. The public knows that we don't have enough FP Docs, and they demand more. So med schools pay lip service to the primary care thing via mission statements.
 
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Ookluh said:
I ask because I have received the impression that it is - I mean, emergency room physicians are essentially the first to deal with whatever ailment people have when they come to the ER. But I also mentioned this recently to a friend that is in medical school, and she balked at the idea that emergency medicine is a field of primary care.

I have been writing some of my secondary answers with mention that I want to pursue primary care, with a particular interest in emergency medicine. Should I not refer to EM docs as PCPs, or do you guys think this is fine?
Click to expand...

No, ED docs in my opinion and most people you ask would not be considered Primary Care docs. Primary care physicians tend to follow patients long-term whereas ED docs treat patients on an acute basis and refer them to others for management of chronic conditions.
 
HughMyron said:
Anyways, EM is probably more competitive than GenSu because of lifestyle, workplace, financial, and legal considerations.
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wrong. it isn't more competitive. avg step 1 for surgery is 227, for EM 223. also gen surg is a much smaller field with fewer residents per program.

the "lifestyle" argument is also disputable. the irregular schedule with night and day shifts interspersed and no down time when you're on isn't my idea of a lifestyle specialty.

HughMyron said:
Usually, when a school talks about "primary care," they mean "family practice." It's become the cool thing to have a mission statement that focuses on family practice, because think about it this way. Med schools receive a lot of public money. In return, med schools produce doctors and research for the public. The public knows that we don't have enough FP Docs, and they demand more. So med schools pay lip service to the primary care thing via mission statements.
Click to expand...

wrong again. primary care usually refers to IM, FM, ob/gyn, peds
 
HughMyron said:
Anyways, EM is probably more competitive than GenSu because of lifestyle, workplace, financial, and legal considerations.
Click to expand...


HughMyron said:
Usually, when a school talks about "primary care," they mean "family practice." It's become the cool thing to have a mission statement that focuses on family practice, because think about it this way. Med schools receive a lot of public money. In return, med schools produce doctors and research for the public. The public knows that we don't have enough FP Docs, and they demand more. So med schools pay lip service to the primary care thing via mission statements.
Click to expand...

:laugh: ohhhhh, Myron, the things you say....
 
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Also...I know this may be a little off topic from OP's question but FWIW this EM FAQ thread has an incredible wealth of information regarding all aspects of EM for just about any one at any level. It's essentially been the single most valuable resource on SDN for me thus far.
 
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skinMD said:
wrong. it isn't more competitive. avg step 1 for surgery is 227, for EM 223. also gen surg is a much smaller field with fewer residents per program.

the "lifestyle" argument is also disputable. the irregular schedule with night and day shifts interspersed and no down time when you're on isn't my idea of a lifestyle specialty.



wrong again. primary care usually refers to IM, FM, ob/gyn, peds
Click to expand...

Depends on what you're looking for I suppose. I would gladly accept weird hours and an "always on" workday if it meant that I was actually home when I'm at home. Everyone has their preferences. There's also the fact that most EM docs I've spoken to seem to work right around 40-45 hours/week when averaged over the course of the month with a pretty excellent salary given the hours.

(sent from my phone)
 
Law2Doc said:
Most would say no, because, although they are a first point in contact with patients, they do not provide the continuity of care generally seen in the traditional primary care fields. People who use the phrase primary care usually mean FP, IM, Peds and OB/GYN.
Click to expand...

I have always heard primary care as Family Practice, IM, EM, Pediatrics, OB/GYN, and Psychiatry.
 
NickNaylor said:
Depends on what you're looking for I suppose. I would gladly accept weird hours and an "always on" workday if it meant that I was actually home when I'm at home. Everyone has their preferences. There's also the fact that most EM docs I've spoken to seem to work right around 40-45 hours/week when averaged over the course of the month with a pretty excellent salary given the hours.

(sent from my phone)
Click to expand...

you're right it does come down to preference but throwing around the term "lifestyle specialty" and adding the E for EM at the end of the "ROAD" acronym makes it seem more universally considered a lifestyle specialty than it actually is.
 
NickNaylor said:
Depends on what you're looking for I suppose. I would gladly accept weird hours and an "always on" workday if it meant that I was actually home when I'm at home. Everyone has their preferences. There's also the fact that most EM docs I've spoken to seem to work right around 40-45 hours/week when averaged over the course of the month with a pretty excellent salary given the hours.

(sent from my phone)
Click to expand...

Try 30 for a lot of partners. Oh, and no nights. Ever.
 
skinMD said:
typical SDN.... a pre-med jumps in to try and refute a statement by someone more experienced by mentioning something extremely rare as if it's common.
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So the group I work with is "extremely rare"?

Edit: I agree for most EP you can generalize to 40 hours/week with nights, but the lifestyle can be as good as 30 hours/week with no nights (>300K). That is what I was saying. Very high lifestyle potentional.
 
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No. EM is not primary care. Many patients seem to think so, but it's not.
 
Geebeejay said:
No. EM is not primary care. Many patients seem to think so, but it's not.
Click to expand...

Sadly this.

"So who's your primary care doc?"

"What's that? I just run to the ED whenever I feel the sniffles! Plus it's free!"
 
MiracleforMD said:
So the group I work with is "extremely rare"?

Edit: I agree for most EP you can generalize to 40 hours/week with nights, but the lifestyle can be as good as 30 hours/week with no nights (>300K). That is what I was saying. Very high lifestyle potentional.
Click to expand...

being a partner in a group is rare and to achieve that you have to put in years (10+?) of working crappy hours that the partners aren't working so that your group can actually function. many don't get to the point of making partner.
 
skinMD said:
being a partner in a group is rare and to achieve that you have to put in years (10+?) of working crappy hours that the partners aren't working so that your group can actually function. many don't get to the point of making partner.
Click to expand...

It's not really "extremely rare", but overall I agree.
 
MiracleforMD said:
So the group I work with is "extremely rare"?

Edit: I agree for most EP you can generalize to 40 hours/week with nights, but the lifestyle can be as good as 30 hours/week with no nights (>300K). That is what I was saying. Very high lifestyle potentional.
Click to expand...

Some practices allow docs older than 50/55 to not work nights but most emergency docs work a decent amount of nights/evening shifts unless there are several nocturists working in the group. The busiest times in the ED are times are outside of business hours so they need more docs during those hours. You may work less hours than a lot of specialties but you are also transitioning during the week from days/night which EM folks often refer to those as DOMA (day off my A%$) because you're tired and not really going to get much done.

EM is the step child of primary care. Not really related but brought into primary care.
 
HughMyron said:
Wtf at a six year necro...

Anyways, EM is probably more competitive than GenSu because of lifestyle, workplace, financial, and legal considerations. I mean, I think surgery is cool and all, but those reasons are why I've ruled out GenSu, and would never bother with most surgical specialties.

To answer the OP, I wouldn't mention it in that context. Usually, when a school talks about "primary care," they mean "family practice." It's become the cool thing to have a mission statement that focuses on family practice, because think about it this way. Med schools receive a lot of public money. In return, med schools produce doctors and research for the public. The public knows that we don't have enough FP Docs, and they demand more. So med schools pay lip service to the primary care thing via mission statements.
Click to expand...
Yeah...couldn't help but to comment :) its funny how it picked up again, gotta love SDN
 
Ookluh said:
I ask because I have received the impression that it is - I mean, emergency room physicians are essentially the first to deal with whatever ailment people have when they come to the ER. But I also mentioned this recently to a friend that is in medical school, and she balked at the idea that emergency medicine is a field of primary care.

I have been writing some of my secondary answers with mention that I want to pursue primary care, with a particular interest in emergency medicine. Should I not refer to EM docs as PCPs, or do you guys think this is fine?
Click to expand...

Primary Care = IM/FM/Peds. Done.
 
It looks like other people make it through a rough night by giving out the "Darwin Award" at their respective [Non} Emergency Department. I love it. I'd like to print that up STAT along with the "I don't do med-refills" certificate in under a 90 minute ink to paper time for these idiots.

EDs are well within their rights to tell patients that have been evaluated medically and not determined to be in at acute risk (a good triage nurse playing bouncer will handle most of these) to leave or pay cash to have their request for HCTZ to be refilled by one of the ED doctors that apparentely, just for today, has nothing better to do. Take your specialty back guys; you have a ton of training to do just about anything and these people are stealing your sanity away.
 
8744 said:
Emergency Medicine is a religious profession where we interfere with natural selection and prove that Darwin couldn't possibly have been correct.
Click to expand...
Rofl; so worth the 6 year bump XD
 
Ookluh said:
I ask because I have received the impression that it is - I mean, emergency room physicians are essentially the first to deal with whatever ailment people have when they come to the ER. But I also mentioned this recently to a friend that is in medical school, and she balked at the idea that emergency medicine is a field of primary care.

I have been writing some of my secondary answers with mention that I want to pursue primary care, with a particular interest in emergency medicine. Should I not refer to EM docs as PCPs, or do you guys think this is fine?
Click to expand...

A factoid is that in Canada emergency medicine can be a FM fellowship
 
qbobdole said:
Interesting, didn't know that. In smaller cities? Are they still called EM docs then?
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Semantics. They are FM board certified, but practice the same medicine as the other EPs (for the most part, might not be as comfortable with as many procedures). Usually rural areas, sometimes smaller cities, rarely big urban hospitals/trauma centers.
 
qbobdole said:
Interesting, didn't know that. In smaller cities? Are they still called EM docs then?
Click to expand...

By whom? I mean I dunno the ones I know refer to themselves as ER docs. Up until a couple of years ago you could even become a fellow of the ACEP if you worked in EM and had completed an FM residency.

http://www.aafp.org/online/en/home/policy/policies/e/emposition.html

Really interesting write up on the history of EM/FM.

The TLDR is there are a LOT of FM docs working in EM.
 
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