Is there a benefit training with an underserved population?

[MsFutureDoc123]

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Hey guys!

I'm doing some last-minute second guessing with my rank list! I was curious what ya'll thought about training and the ideal population.

Is there a benefit in training in underserved and poor areas? I always figured you would see greater diversity in pathology, more procedures, and more trauma exposure. Would this better prepare me to be my best vs. training in the suburbs?

Thanks and good luck everyone! 🙂

 

[jslo85]

I don't know if there is an "ideal population" to train from. Our profession deals with patients from all walks of life so it is important to be able to have exposure to patients of differing socioeconomic backgrounds presenting with a wide variety of complaints, period. That said, if you had to choose I would pick the population that you are most likely to deal with post residency for your employment in my opinion. If you plan to live in a large urban city, I would lean toward being exposed to a population that is reflective of that as there are certain complaints/situations/problems that come with those areas. Again from my own experience, underserved communities aren't necessarily any more difficult or harder to deal with than others they just have their own particular nuances and things to be aware of. You will tend to run into many low acuity primary care issues such as med refill/checkups for kids, etc. as well as the result of noncompliance and end stage chronic illnesses which can lead to interesting pathology. If you trained with only the "underserved" and "county" population for 3-4 years through residency and say you ended up practicing in a community shop with middle/working or upper middle class patient population, you would find yourself ill prepared to deal with many of their problems.

Long story short and sorry for the long winded response, there is no "ideal population" for everyone. All programs will most likely prepare you to become a competent EM physician, pick the one that you feel that you will be happiest at (overall) and if you had to choose based on population, the one that most resembles where you want to practice in the future (this may change over time fyi).

 

[Dr Mantis Toboggan]

Hey guys!

I'm doing some last-minute second guessing with my rank list! I was curious what ya'll thought about training and the ideal population.

Is there a benefit in training in underserved and poor areas? I always figured you would see greater diversity in pathology, more procedures, and more trauma exposure. Would this better prepare me to be my best vs. training in the suburbs?

Thanks and good luck everyone! 🙂

In general you will see sicker patients and gain increased procedural exposure but often that comes at a cost of a less efficient system with possibly increased scut.

 

[deleted547339]

You need diversity. If you only see underserved patients, you’re not going to get experience with VADs and bone marrow transplant patients. If you only see affluent patients, you probably wont see as much knife and gun shot wounds. There’s benefits to county and community and academic. It’s best to find a place that provides all three.

 

[GonnaBeADoc2222]

Need mix of both. Not so much for the experience of working with different populations, but more for your training opportunities IMO.

Would avoid "county" places with scut like placing high numbers of IVs (non ultrasound), drawing labs, pushing patients around to radiology, etc. You are in residency to learn how to be a physician, not a nurse or a tech, no matter how much some people on here extol the virtues of a resident doing these things.

Would similarly avoid country club type places where the first sentence out of people's mouths is "Where's Dr. Smith, he is my (insert subspecialist), he said he would meet me as soon as I got to the ER!!!". You will likely miss out on procedures in these places as patients will demand this or that doctor do them or consultants will elbow you out of the way.

A lot of programs luckily rotate you through a few sites where there might be a little of this or a little of that.

 

[Lexdiamondz]

Need mix of both. Not so much for the experience of working with different populations, but more for your training opportunities IMO.

Would avoid "county" places with scut like placing high numbers of IVs (non ultrasound), drawing labs, pushing patients around to radiology, etc. You are in residency to learn how to be a physician, not a nurse or a tech, no matter how much some people on here extol the virtues of a resident doing these things.

Would similarly avoid country club type places where the first sentence out of people's mouths is "Where's Dr. Smith, he is my (insert subspecialist), he said he would meet me as soon as I got to the ER!!!". You will likely miss out on procedures in these places as patients will demand this or that doctor do them or consultants will elbow you out of the way.

A lot of programs luckily rotate you through a few sites where there might be a little of this or a little of that.

100% agree.

Honestly, dealing w an exclusively county or exclusively affluent population would likely lead to burnout, as the particularities of each practice setting would make most normal people insane.

 

[GonnaBeADoc2222]

100% agree.

Honestly, dealing w an exclusively county or exclusively affluent population would likely lead to burnout, as the particularities of each practice setting would make most normal people insane.

Yes.

Entitlement transcends socioeconomic boundaries. It is a pleasure, albeit somewhat rare, to care for someone that is truly appreciative of my services.

 

[deleted859535]

Will never forget the chronic back pain patient who saw me coding someone just down the hall who then accosted myself and the nurses for her Lidoderm patch while we're still getting things squared away for the helicopter.

 

[K31]

Will never forget the chronic back pain patient who saw me coding someone just down the hall who then accosted myself and the nurses for her Lidoderm patch while we're still getting things squared away for the helicopter.

By “Lidoderm patch” you mean “Dilaudid” right? Because if I ever met a chronic back pain patient that requested a Lidoderm patch I think I’d hug them.

 

[Tenk]

By “Lidoderm patch” you mean “Dilaudid” right? Because if I ever met a chronic back pain patient that requested a Lidoderm patch I think I’d hug them.

I think I’d discharge them.

 

[deleted859535]

By “Lidoderm patch” you mean “Dilaudid” right? Because if I ever met a chronic back pain patient that requested a Lidoderm patch I think I’d hug them.

Actually no. Not that one. Can't decide if it makes it worse.

 

[BoardEligibleEventually]

In general you will see sicker patients and gain increased procedural exposure but often that comes at a cost of a less efficient system with possibly increased scut.

I love your user name.

 

[WYALALMOMG]

I would also be careful about thinking out patient populations in terms of "benefits." These are people, not test rabbits. Work in a population and community that you feel fulfilled working with. It's a great disservice to patients when we glamorize 'county' for the acuity and procedures but then complain about taking care of people with needs that often extend beyond medicine.

 

[TheComebacKid]

I never understand why med students are so enamored by "county" places. I don't think "county" training equates to "better" training. I also don't think that "county" equates to "knife and gun club". A ton of the county patients I saw just had disgusting feet or dental pain and needed to see a podiatrist and/or dentist, but couldn't afford one. I rotated at an academic center that saw more GSWs on one shift than I did the entire month at the county facility. Luck of the draw? Maybe. But I think the generalizations that are made about county versus academic programs, are IMO largely misinformed.

Taking care of county patients and underserved population means you will be spending A LOT of time dealing with patients homelessness, their malingering, and their financial issues that put them back in the ED for low acuity issues.

This is not to say that academic/university hospitals always provide better training, because there are certainly downsides to these programs as well.

There are a handful of places that have a very diverse patient population that combine county feel with academic resources, research opportunities, and more complex patient issues. There are places where you can treat someone's gross foot and then simultaneously learn about ECMO, cytokine storm after initiation of CAR T-cell therapy, and LVAD failure. For me personally, this was the right balance.

Furthermore, while I respect the humanitarian aspects of being an EM physician, I remember interviewing at some places where I got this "holier-than-thou" vibe from the residents making themselves out to be Mother Theresa because of their focus on the underserved, which I personally found off putting. That's just me, I know there are med students that are all about that, so whatever floats your boat. As long as you are satisfied with your training experience, that's all that matters.

My philosophy regarding residency is to learn the medicine well. Take good care of both the poor and the wealthy. Find some small sense of satisfaction in your work, which can be hard during residency. And find some time off to keep your sanity.

 

[GonnaBeADoc2222]

Furthermore, while I respect the humanitarian aspects of being an EM physician, I remember interviewing at some places where I got this "holier-than-thou" vibe from the residents making themselves out to be Mother Theresa because of their focus on the underserved, which I personally found off putting. That's just me, I know there are med students that are all about that, so whatever floats your boat. As long as you are satisfied with your training experience, that's all that matters.

I did an away rotation at one of these type of places back in the day and I was SOOO happy I didn't match there.

 

[DeadCactus]

County hospital is dealing with chronic medical complaints and cab vouchers. Academic center is just playing triage for patient's who were told to come in by their left index finger cancer surgeon. Community medicine is just treating coughs and colds that should have gone to an urgent care. Pick your poison, but it has little to do with how good your training is or how good of a doctor you will be.

 

[deleted859535]

County hospital is dealing with chronic medical complaints and cab vouchers. Academic center is just playing triage for patient's who were told to come in by their left index finger cancer surgeon. Community medicine is just treating coughs and colds that should have gone to an urgent care. Pick your poison, but it has little to do with how good your training is or how good of a doctor you will be.

Well, every stereotype has a little bit of truth behind it.

These things punctuated by reasonable cases -- the gentleman with the kidney stone in room 12, the chest pain rule out next door, the appendicitis down the hall -- and with the occasional critical situation are collectively just part of the job.

I remind myself of that more and more these days to try and keep from being more burned out.

Every specialty has its pros and cons, some of which are unique to the specialty. I would say that for the M4s reading this, "pick your poison" applies just as much if not more so to choosing EM in the first place as it does the kind of training and subsequent practice environment one pursues.