Is negging our own specialty the best strategy?

[Angry Birds]

I feel like we’ve really hurt our reputations amongst other specialties by constantly dissing our own specialty. Is this really wise?

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[GatorCHOMPions]

For too many years there was an overhyping and overly optimistic view of the specialty. It convinced many like myself that it was a strong, stable, and respectable field. There is a lot of buyer's remorse for those of us who matched between like 2008-2018.

Some of it may be an over correction, but it feels necessary.

 

[HemorrhagicShock]

I feel like we’ve really hurt our reputations amongst other specialties by constantly dissing our own specialty. Is this really wise?

I ask this genuinely:

Did other specialties ever respect us?

Did we ever have a great reputation?

I'm not talking about that one-off specialist who is married to an ER doc who is sympathetic or that rare consultant who, even 20 years into their practice, still comes in to see their patient immediately.

I'm not talking about the primary care doc who is genuinely responsive and thankful when he sends a patient in for a work-up (either from clinic or because he's having issues getting it done on a timely basis via the outpatient quagmire)

I'm talking about the the specialist with an online presence who posts "I'll never trash talk the ED ever again. Thank you ED docs" during COVID (only to immediately start doing it months later when they have to go back to work seeing consultations on patients with COVID)

I'm talking about the majority of consultants who will push back, refuse to consult, deny any responsibility, and then throw you under the bus at any point during the Monday morning quarterback replay.

I'm talking about the majority of consultants who routinely call you a triage RN in the physician lounge, regardless of your training or capability.

I've worked in three different states at this point in my career, and a total of 11 EDs, and it's abundantly clear to me that we never had a good reputation, and that the path of the EM physician will always be uphill.

 

[JacobMcCandles]

Most specialties **** on every other specialty that they interact with. It just so happens that we interact with all the specialties so they all **** on EM. You should expect to get Monday morning quarterbacked in EM. It's just a part of the job. Don't listen and keep going. When people in public shout they need a doctor, they're talking about an EM doctor.

 

[Angry Birds]

I ask this genuinely:

Did other specialties ever respect us?

Did we ever have a great reputation?

I'm not talking about that one-off specialist who is married to an ER doc who is sympathetic or that rare consultant who, even 20 years into their practice, still comes in to see their patient immediately.

I'm not talking about the primary care doc who is genuinely responsive and thankful when he sends a patient in for a work-up (either from clinic or because he's having issues getting it done on a timely basis via the outpatient quagmire)

I'm talking about the the specialist with an online presence who posts "I'll never trash talk the ED ever again. Thank you ED docs" during COVID (only to immediately start doing it months later when they have to go back to work seeing consultations on patients with COVID)

I'm talking about the majority of consultants who will push back, refuse to consult, deny any responsibility, and then throw you under the bus at any point during the Monday morning quarterback replay.

I'm talking about the majority of consultants who routinely call you a triage RN in the physician lounge, regardless of your training or capability.

I've worked in three different states at this point in my career, and a total of 11 EDs, and it's abundantly clear to me that we never had a good reputation, and that the path of the EM physician will always be uphill.

I don’t disagree with you. But for me that’s all the more reason we shouldn’t be bashing our speciality so much. I actually just met a family med doc who was trash talking our specialty and I don’t think that would’ve happened a few years ago.

 

[thegenius]

I don’t disagree with you. But for me that’s all the more reason we shouldn’t be bashing our speciality so much. I actually just met a family med doc who was trash talking our specialty and I don’t think that would’ve happened a few years ago.

Did he know you were EM?

Brazenly talking smack about a specialty, in front of a representative specialist, takes lots of cojones.

 

[Apollyon]

Did he know you were EM?

Brazenly talking smack about a specialty, in front of a representative specialist, takes lots of cojones.

"There's a fine line between balls and stupidity."

 

[cyanide12345678]

For too many years there was an overhyping and overly optimistic view of the specialty. It convinced many like myself that it was a strong, stable, and respectable field. There is a lot of buyer's remorse for those of us who matched between like 2008-2018.

Some of it may be an over correction, but it feels necessary.

I second this,

2016 match year. Definitely buyers remorse 😂

 

[thegenius]

"There's a fine line between balls and stupidity."

Yea it's called the perineal raphe.

 

[hoot504]

I second this,

2016 match year. Definitely buyers remorse 😂

2015 match. If the rest of my career continues as is I'll consider myself lucky and blessed. This IF however seems to be growing larger by the day.

 

[Apollyon]

Yea it's called the perineal raphe.

That's some concrete thinking, there, buddy!

 

[EctopicFetus]

Truly part of being an EM doc is having thick skin. I have been at the same site for about 9 years was at another hospital system for a good run before that. The docs know me.. makes life so much easier. That being said some of our consultants hate some of the ED docs.. sometimes for real good reason in my opinion. Some of them are lazy and admit total nonsense cause they dont want to put forth any effort to dc the patient.

that being said some of our consultants and hospitalists are idiots and lazy themselves and many only care about the mighty dollar. When covid was ongoing the meek were so excited about the pats on the back we were getting. They foolishly thought this would last. Hopefully lessons were learned. I think i do a good job, I work hard i have few if any issues ever with consultants or hospitalists. That being said I dont expect any of them to swoon over me. Are any of your impressed by the neurosurgeon? The ophthalmologist (not like we really interact much with them), The ortho bro? I mean I think to myself, man i make more per hour than you, my quality of life is better than yours and in many cases I outearn them all together. I spend time with my family while they are in the OR. This may not be true of the eye dentists (pun intended) but it is when comparing to Gen surg, hospitalists, etc.

If you are seeking any reassurance from others in the house of medicine it will be a fruitless journey. The original question remains.. should we dump on ourselves? In my opinion the answer is yes. We still have far too many old farts who shouldn’t be in medicine anymore, too many *****s graduating from HCA residencies or other hospitals that have no business training a surgical tech let alone a physician. As long as this is going on then I say go for it. If you trained at a site with under 40k visits I’m including you. Sorry.. no matter the acuity you cant see the volume needed of everything to learn what you need. I’ll stand by that imperfect argument. If you trained at HCA understand they dont care about you at all and you are nothing more than a profit center meant to create the next liability sponge for their gang of MLPs.

 

[WhatJobDoIPick]

Truly part of being an EM doc is having thick skin. I have been at the same site for about 9 years was at another hospital system for a good run before that. The docs know me.. makes life so much easier. That being said some of our consultants hate some of the ED docs.. sometimes for real good reason in my opinion. Some of them are lazy and admit total nonsense cause they dont want to put forth any effort to dc the patient.

that being said some of our consultants and hospitalists are idiots and lazy themselves and many only care about the mighty dollar. When covid was ongoing the meek were so excited about the pats on the back we were getting. They foolishly thought this would last. Hopefully lessons were learned. I think i do a good job, I work hard i have few if any issues ever with consultants or hospitalists. That being said I dont expect any of them to swoon over me. Are any of your impressed by the neurosurgeon? The ophthalmologist (not like we really interact much with them), The ortho bro? I mean I think to myself, man i make more per hour than you, my quality of life is better than yours and in many cases I outearn them all together. I spend time with my family while they are in the OR. This may not be true of the eye dentists (pun intended) but it is when comparing to Gen surg, hospitalists, etc.

If you are seeking any reassurance from others in the house of medicine it will be a fruitless journey. The original question remains.. should we dump on ourselves? In my opinion the answer is yes. We still have far too many old farts who shouldn’t be in medicine anymore, too many *****s graduating from HCA residencies or other hospitals that have no business training a surgical tech let alone a physician. As long as this is going on then I say go for it. If you trained at a site with under 40k visits I’m including you. Sorry.. no matter the acuity you cant see the volume needed of everything to learn what you need. I’ll stand by that imperfect argument. If you trained at HCA understand they dont care about you at all and you are nothing more than a profit center meant to create the next liability sponge for their gang of MLPs.

This plus I will also add we should self bash as we need to decrease the amount of students matching EM as it's the only way to reverse course of what's happening now.

 

[Mount Asclepius]

I stick up for and defend EM as a specialty when discussing with other fields. I can’t say this comes up a whole lot anymore in the real world though. It’s a hard job and occasionally hospitalists, general surgeons or other specialists see that when they come talk to me about a patient in the ED and see all that I’m juggling at the same time including emergencies/‘urgencies’ in other fields. It’s hard to be respected amongst colleagues in other fields if we don’t respect ourselves. We may not always receive a lot of respect as EPs, but I think with EM having become filled with residency trained, board certified EPs the tide has shifted where we no longer are viewed as the black sheep in the house of medicine. We need to protect quality training to maintain respect as a field, yet that isn’t being done currently.

That being said, internally amongst EPs I think airing frustrations with the field is important for healthy venting. I also think discouraging medical students from naively over hyping the specialty is equally important. Those that go into EM are better served if they know what they are getting into. When others understand some of the negativity of EM then they better understand what we have to deal with, perhaps respecting the challenges we face a little more. They know maybe the reason a patient wasn’t perfectly managed was that we were simultaneously dealing with a lot of other patients or distractions. Not because we didn’t know what we were doing.

 

[Angry Birds]

Did he know you were EM?

Brazenly talking smack about a specialty, in front of a representative specialist, takes lots of cojones.

Yeah, he did. I think he had a huge chip on his shoulder as he had applied EM and scrambled into FM some years ago. But honestly, I’m used to specialists dunking on EM at family gatherings, and they dunk on it when I tell them I’m EM, only for them to say, “but you must be one of the good ones.”

Gotta admit. This annoys me.

 

[Angry Birds]

This plus I will also add we should self bash as we need to decrease the amount of students matching EM as it's the only way to reverse course of what's happening now.

Is this really going to work? I don’t think so. I think it will lead to FMGs taking over, thereby furthering the reputational damage to our field.

 

[thegenius]

That's some concrete thinking, there, buddy!

Haha yea it’s the fine, thin line between the balls.

 

[Apollyon]

Haha yea it’s the fine, thin line between the balls.

Uh, yeah, I know. Taint lying!

 

[WhatJobDoIPick]

Yeah, he did. I think he had a huge chip on his shoulder as he had applied EM and scrambled into FM some years ago. But honestly, I’m used to specialists dunking on EM at family gatherings, and they dunk on it when I tell them I’m EM, only for them to say, “but you must be one of the good ones.”

Gotta admit. This annoys me.

I mean, honestly they hate us cause they ain't us. As someone alluded to, we are the stereotypical "doctor" people think of when **** goes awry. Most hospitalists / general surgeons have no real world doctoring skills.

 

[RustedFox]

Haha yea it’s the fine, thin line between the balls.

GOOOCH.

 

[RustedFox]

"Do you think that negging our own specialty is the best strategy?"

 

[Apollyon]

GOOOCH.

Grundle. Chode.

 

[sylvanthus]

2015 match. If the rest of my career continues as is I'll consider myself lucky and blessed. This IF however seems to be growing larger by the day.

2013, EM was The Speciality at that time. Whoops.

 

[EctopicFetus]

Another way to phrase this question is should we tell the truth about our specialty ? I think in general the truth is always better.

 

[nVictus]

I don't give two shts about what other specialties think or say. I know what I do and who I am. EM is a bad deal and it's a good service to let hard working students, who are sacrificing their 20s, know it's a shtty deal that's getting shttier.

 

[gro2001]

Working in both the ER and inpatient side of things I now realize that while there is some additional EM specific grief these consultants dish out, mostly it's just how they are.

By far the biggest factor is the pay incentive though. Our hospital is a little weird in that for a lot of specialties there is both a hospital employed group and one or more private practice options (except for a couple of specialties that are either all private or all hospital employed). So for a patient with insurance (particularly during business hours) I have the option of consulting either the person on call or one of the privates. I started keeping a list of preferred consultants for each specialty that me and some colleagues have started using. So if it's not the middle of the night, the patient has insurance, and I want a cards consult that's not a STEMI, I text the guy I like. Same for when I say need a GI consult (either genuinely or because it would smooth the admission to say "yes I've talked to GI, they agree patient doesn't need to be scoped tonight, will see in AM"). This has dramatically improved my quality of life because for most interactions now I have someone genuinely thanking me for the consult. I've actually had another private doc reach out to me after I gave a few patients in a row to his colleague to say he's also there if I need anything.

 

[RustedFox]

Working in both the ER and inpatient side of things I now realize that while there is some additional EM specific grief these consultants dish out, mostly it's just how they are.

By far the biggest factor is the pay incentive though. Our hospital is a little weird in that for a lot of specialties there is both a hospital employed group and one or more private practice options (except for a couple of specialties that are either all private or all hospital employed). So for a patient with insurance (particularly during business hours) I have the option of consulting either the person on call or one of the privates. I started keeping a list of preferred consultants for each specialty that me and some colleagues have started using. So if it's not the middle of the night, the patient has insurance, and I want a cards consult that's not a STEMI, I text the guy I like. Same for when I say need a GI consult (either genuinely or because it would smooth the admission to say "yes I've talked to GI, they agree patient doesn't need to be scoped tonight, will see in AM"). This has dramatically improved my quality of life because for most interactions now I have someone genuinely thanking me for the consult. I've actually had another private doc reach out to me after I gave a few patients in a row to his colleague to say he's also there if I need anything.

Must be nice.
We can't keep half the IM/surg specialties on staff.
I regularly have to transfer out GI, ENT, Uro.
Things we used to have.
I wonder why all our subspecialists left.
Hmm.
Couldn't be administrative incompetence, no. No waaay.

 

[The Knife & Gun Club]

One thing I’d add from working both ED and inpatient is as many ways as we can get EM trained people into other rolls in the hospital we should be - it helps the speciality’s cred infinitely more than the unidirectional ED to specialist consult pipeline.

When I’m available inpatient for whatever my defined non-EM role is but I help out a colleague with some EM knowledge that the other docs aren’t familiar with it’s almost always met with “oh I’m so glad we’ve got an ED doc here!”

I sit on a few non-EM M&M and quality committees and am the sole person there who can say if the ED did the standard of care or not in a case. I’ll be rounding with the surgeons and am the only person in the room who can read an EKG or do an echo when their patient is crashing. The other day I taught the cardiology fellow how to tap a knee. I showed the neuro-crit fellow how to reduce a shoulder that dislocated after a seizure. There’s an orthopod that texts me EKGs all the time just to get my thoughts. He also sends me splint images to ask if this would be an acceptable splint from an EM doc or if it’s worth addressing with the ED.

This isn’t to say we should all be rounding inpatient - we shouldn’t - but the more situations EM docs can put themselves in where they’re working with other services and showcasing the unique skill set we have the more clout it builds in the hospital. Get on committees and M&M boards and be active. Have EM docs offering palliative, pain, addiction, corrections, critical care, hyperbarics, wounds and every other service we can offer in a hospital ecosystem outside of the ED.

This all takes time but I think is crucial to other specialities taking Emegency Medicine seriously as a discipline.