Longtime SDN member and current EM resident - AMA or don’t. Whatever.

[Cyberdyne 101]

^^^^^^^lol

Probably a stupid question, but is the ER significantly busier during the PM hours?

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[The Buff OP]

^^^^^^^lol

Probably a stupid question, but is the ER significantly busier during the PM hours?

Yes.

 

[The Buff OP]

@alpinism

• How do you handle the Oscar winning actors that come in with a pain of 20/10 and want some painkillers?
• Do you prefer regular crust or stuffed crust on your pizza?
• Coolest procedures that you get to do?
• How come most hospitals like to do manual compressions for CPR? Lucas 2 would be a life saver.
• Do you think people with an EMS background (me too) will most likely end up picking EM?
• What was your MOS in the Air Force?
• Do you think the NG or reserves would be a good idea for a pre-med (serve and help pay for school)?
• I travel all over the world, but always stay in my corner. What am I?
  
• Did you ever think of doing HPSP?
• H2O or Gatorade?
• Are EM residency slots now hard to get into?
• With your background was it a lot easier to do EM procedures for you?

 

[RogueUnicorn]

can u plz stop paging ortho

 

[FootballFoot]

Oh, I heard rumors that EM nurses are especially rude/hard to work with/mean. Have you found this to be true in your and your colleagues experience? If so, how do you feel about it and how do you deal with it?

 

[alpinism]

^^^^^^^lol

Probably a stupid question, but is the ER significantly busier during the PM hours?

Naw man not stupid.

So yeah It does tend to get busier after 5pm when work/school is over for most people. Also way more stupid and/or illegal things happen at night.
At the same time there's also an early morning rush when people wake up with chest pain or shortness of breath.

Fun fact - most heart attacks happen after people first wake up in the morning.
http://content.time.com/time/health/article/0,8599,1825044,00.html

 

[alpinism]

@alpinism

• How do you handle the Oscar winning actors that come in with a pain of 20/10 and want some painkillers?
• Do you prefer regular crust or stuffed crust on your pizza?
• Coolest procedures that you get to do?
• How come most hospitals like to do manual compressions for CPR? Lucas 2 would be a life saver.
• Do you think people with an EMS background (me too) will most likely end up picking EM?
• What was your MOS in the Air Force?
• Do you think the NG or reserves would be a good idea for a pre-med (serve and help pay for school)?
• I travel all over the world, but always stay in my corner. What am I?
  
• Did you ever think of doing HPSP?
• H2O or Gatorade?
• Are EM residency slots now hard to get into?
• With your background was it a lot easier to do EM procedures for you?

1) Anyone who says their pain is over 10/10 automatically gets points deducted. If they have a legit medical condition and objective signs of pain (HR/BP) I’ll usually give them a few norcos or percs until they can see their PCP or Pain specialist. If not I’ll offer some NSAIDs but generally most go home empty handed.

2) Stuffed crust.

3) Tough question. I’ve always loved difficult airways and getting vascular access on peds patients. There’s just something so satisfying about getting an IV/IO/CVL in a crashing kid with low blood pressure. Plus the parents are always so grateful when you talk to them afterwards.

4) There's usually tons of people around to help with compressions unlike in the field. Also I need to be able to do a quick ultrasound exam so the Lucas might get in the way. That being said, I definitely agree that most compressions suck and something similar to the Lucas in the ER could make a significant difference in survival.

5) Probably. In my experience about 90% end up doing either emergency or anesthesia.

6) 3E7X1. More specifically I worked as a rescue crew chief.

7) Maybe. If you really want to serve and don’t mind the training and deployments.

8) Damn. Had to google that one.

9) Absolutely not. Getting out was one of the happiest days of my life. Loved being able to serve and made a ton of great friends while in the military. But, the Military and MilMed has way too many problems. Unfortunately IMO the bad far outweighs the good.

10) Orange gatorade.

11) Not really. Its still relatively easy to get a spot somewhere. Pass all your classes, do well on the boards, and work hard on away rotations. That being said, it has gotten more competitive over the past few years and some of the most popular programs routinely take only top 25%/240+ students.

12) Yes and no. For things like IVs and intubations I had already done a ton so that really helped. However, I hadn’t done any laceration repairs, chest tubes, or central lines so had to learn those from scratch. Besides procedures it really helps just knowing how to talk to patients and recognize sick vs not sick.

 

[alpinism]

can u plz stop paging ortho

My bad dude.

Yo while you’re here can you see this other patient in bed 6 too??

 

[takeurmeds02]

3. Not my people.

Without offending all the surgeons on here, I'll just say that my personality is not a good fit for the field. Most surgeons tend to be more type A and serious while most emergency physicians tend to be more type B and relaxed. Its something you definitely start to notice once you start doing 3rd year rotations. That being said, I really liked working with some of the orthopedics residents.

Yea, without falling completely into generalizations and stereotypes, I would completely agree with the personality types. I worked as a scribe and I remember one night, we had a surg res consult on a case and he was being royal dick to the ER attending. Like dude, this man has been practicing medicine for the majority of your life. Where's the respect? The actual surg attendings were cool as hell though.

 

[The Buff OP]

1) Anyone who says their pain is over 10/10 automatically gets points deducted. If they have a legit medical condition and objective signs of pain (HR/BP) I’ll usually give them a few norcos or percs until they can see their PCP or Pain specialist. If not I’ll offer some NSAIDs but generally most go home empty handed.

2) Stuffed crust.

3) Tough question. I’ve always loved difficult airways and getting vascular access on peds patients. There’s just something so satisfying about getting an IV/IO/CVL in a crashing kid with low blood pressure. Plus the parents are always so grateful when you talk to them afterwards.

4) There's usually tons of people around to help with compressions unlike in the field. Also I need to be able to do a quick ultrasound exam so the Lucas might get in the way. That being said, I definitely agree that most compressions suck and something similar to the Lucas in the ER could make a significant difference in survival.

5) Probably. In my experience about 90% end up doing either emergency or anesthesia.

6) 3E7X1. More specifically I worked as a rescue crew chief.

7) Maybe. If you really want to serve and don’t mind the training and deployments.

8) Damn. Had to google that one.

9) Absolutely not. Getting out was one of the happiest days of my life. Loved being able to serve and made a ton of great friends while in the military. But, the Military and MilMed has way too many problems. Unfortunately IMO the bad far outweighs the good.

10) Orange gatorade.

11) Not really. Its still relatively easy to get a spot somewhere. Pass all your classes, do well on the boards, and work hard on away rotations. That being said, it has gotten more competitive over the past few years and some of the most popular programs routinely take only top 25%/240+ students.

12) Yes and no. For things like IVs and intubations I had already done a ton so that really helped. However, I hadn’t done any laceration repairs, chest tubes, or central lines so had to learn those from scratch. Besides procedures it really helps just knowing how to talk to patients and recognize sick vs not sick.

Thanks for answering all of my questions. More to come? Bonus points if you got the reference on number 10. lmao!

 

[alpinism]

Oh, I heard rumors that EM nurses are especially rude/hard to work with/mean. Have you found this to be true in your and your colleagues experience? If so, how do you feel about it and how do you deal with it?

The nurses I've worked with so far have mostly been very polite and respectful. There are always a few bad apples out there but that's to be expected at any hospital.
Honestly the biggest problem I've had is that some just don't work very hard and others are just downright lazy. Part of this has to do with the fact that I've spent time at mostly county/inner city hospitals which doesn't tend to attract the best and brightest of the nursing world. As a result its not uncommon to have to ask multiple times for things to get done or end up doing things myself to keep things moving.

The types of nurses you're describing tend to work at more big name academic hospitals where nurses are given more responsibility and autonomy. After a few years some tend to get this huge ego and think they know more than the residents. Obviously there are some things that they do know more about compared to a senior resident or even a junior attending, but it does make it difficult some days when they're constantly questioning your orders. I don't have much experience in this regard but if I did come across this type of nurse I'd try to let them know my reasoning behind the orders.

 

[alpinism]

Yea, without falling completely into generalizations and stereotypes, I would completely agree with the personality types. I worked as a scribe and I remember one night, we had a surg res consult on a case and he was being royal dick to the ER attending. Like dude, this man has been practicing medicine for the majority of your life. Where's the respect? The actual surg attendings were cool as hell though.

We talked about this a lot during 3rd year.

The most common explanations we could come up with were that: A) almost all of them are overworked and stressed B) many are constantly tired and sleep deprived C) some regret their decision to do surgery and D) a few are just plain nasty people.

In any event, I've also worked with some really great surgeons who were the nicest people in the world and loved to teach medical students.

 

[alpinism]

Thanks for answering all of my questions. More to come? Bonus points if you got the reference on number 10. lmao!

Fire away.

Haha oh you mean The Waterboy reference.

 

[jl lin]

The nurses I've worked with so far have mostly been very polite and respectful. There are always a few bad apples out there but that's to be expected at any hospital.
Honestly the biggest problem I've had is that some just don't work very hard and others are just downright lazy. Part of this has to do with the fact that I've spent time at mostly county/inner city hospitals which doesn't tend to attract the best and brightest of the nursing world. As a result its not uncommon to have to ask multiple times for things to get done or end up doing things myself to keep things moving.

The types of nurses you're describing tend to work at more big name academic hospitals where nurses are given more responsibility and autonomy. After a few years some tend to get this huge ego and think they know more than the residents. Obviously there are some things that they do know more about compared to a senior resident or even a junior attending, but it does make it difficult some days when they're constantly questioning your orders. I don't have much experience in this regard but if I did come across this type of nurse I'd try to let them know my reasoning behind the orders.

Funny, but the urban teaching medical centers tend to be more competitive and attract a brighter crowd; although that is generalizing. Some people get tired of the inner city competitive MCs, and later choose to go to a community hospital or so when they want to settle down more and have kids. I will say that they are usually not happy in those hospital though after working in the busier, more interesting centers. It depends.

 

[sabsaf123]

1)How much did you study during MS1/MS2? Any study advice?
2)What has been the suckiest part of training so far (pre-clinicals, clinicals, residency)?

 

[alpinism]

Funny, but the urban teaching medical centers tend to be more competitive and attract a brighter crowd; although that is generalizing. Some people get tired of the inner city competitive MCs, and later choose to go to a community hospital or so when they want to settle down more and have kids. I will say that they are usually not happy in those hospital though after working in the busier, more interesting centers. It depends.

Well for example I did one of my 4th year EM rotations at Kings County in NYC.

The hospital is well known for having arguably the worst nursing staff in the country. Now to be fair they're ridiculously understaffed and overworked. There would be shifts were we'd only have 5 or 6 nurses to cover the entire ED. And this is one of the largest and busiest EDs in the country that sees over 140,000 pts per year.

 

[takeurmeds02]

Well for example I did one of my 4th year EM rotations at Kings County in NYC.

The hospital is well known for having arguably the worst nursing staff in the country. Now to be fair they're ridiculously understaffed and overworked. There would be shifts were we'd only have 5 or 6 nurses to cover the entire ED. And this is one of the largest and busiest EDs in the country that sees over 140,000 pts per year.

I almost went to SUNY down for med and I'm still considering making my way back up there for training (given a competitive step score for EM anyway). Was it a good rotation barring the nursing staff?

 

[alpinism]

1)How much did you study during MS1/MS2? Any study advice?
2)What has been the suckiest part of training so far (pre-clinicals, clinicals, residency)?

1) I'd say on average 4 hrs/day during the week. Then another 6 hrs/day on the weekends. So roughly 32 hrs per week total. When you include time spent watching lectures, attending small group sessions, and doing clinical skills workshops it's basically like working 60 hrs/week. As far as study advice I wish I had done more practice questions (Qbank questions) during the first 2 years. IMO its by far the best way to study and also prepares you for the boards. Another thing that I found helpful was trying to do more active learning (taking notes or making flashcards) vs passive learning (watching videos or reading books). Most people tend to retain more information when they're actively taking notes instead of just passively sitting there and watching videos all day.

2) Probably M3. Hated the lack of responsibility and autonomy. I could write a whole book on all the reasons why but basically most of the year was spent doing nothing but glorified shadowing and writing fake notes on a computer. Don't get me wrong, It is helpful to rotate through all the major specialties and I did end up learning a ton on each rotation. But, nowadays most hospitals won't let you do anything meaningful for patients as a 3rd year student. There's actually a whole thread in the allopathic forum on this topic: http://forums.studentdoctor.net/threads/things-i-hate-about-third-year.861932/

 

[alpinism]

I almost went to SUNY down for med and I'm still considering making my way back up there for training (given a competitive step score for EM anyway). Was it a good rotation barring the nursing staff?

Excellent rotation. I actually didn't mind the nursing issues that much since it gave med students the opportunity to do everything for patients. Instead of many EDs where you to have to fight to do even the simplest procedures like IVs and ECGs, there you literally go grab the next patient and do what needs to be done.

Scutwork has some really good reviews although all of them are over 10 years old:
http://www.scutwork.com/cgi-bin/links/review.cgi?ID=1227&d=1

Schedule

The medical student schedule consists of about 15 twelve-hour shifts and a mandatory eight hour ride-along with the EMS. The schedule is an assortment of shifts arranged by the department and students are allowed to pick their prefered shift schedule at the beginning of the month in cooperation with all the other students rotating at the same time. The shifts are split between the departments with three each in SUNY Downstate Hospital ED, peds. ER, Critical Care, Fast Track, and Main ER. Night to day shift vary depending on the shift schedule chosen.

Because ED's (especially departments as busy as this) are so chaotic, the faculty has a arranged a very regimented system for grading and keeping track of the students where the student must hand over a grade sheet and receive an attendance confirmation signature at the end of every shift. This is a fairly successful system that has managed to eliminate most of the slackers and shift falsifiers. The nursing staff at this program has a reputation that far precedes them. Do not come here expecting any help from the nurses. They are there to fulfill the minimum part of their job requirements and have little time for scutwork or friendly conversation. IV's, NG tubes, blood draws, EKG's, wound bandaging; the rotating student becomes an expert at all these things and more by the end of the month.

Teaching

The faculty is amazing. These doctors create an amazing array of brilliant physicians from dirty inner city hospitals to brilliant physicians from pristine, big-name academic programs. A substantial chunk of the attendings here were trained in Lincoln hospital back in the eighties when Emergency medicine was just a fledgling specialty and when crack wars were rampant in a much different NYC that we see today. Watching these Dr.'s supervise a trauma resucitation is an amazing and incredibly rewarding experience. The remaining faculty come from a wide array of hospitals from across the country and offer distinctive aspects of emergency care. Only some of the attendings are graduates of the program and this helps to avoid the one-dimensional view found at some other programs. Teaching takes place here a lot more than I have experienced elsewhere. There are a few attendings that will shave-off some teaching opportunities during busy shifts, but usually the student/resident must be prepared for pimp questions on every patient presentation. The attendings are always on the look-out for intelligent residency candidates so one should come well-prepared if there is any intention of applying for the program. There are daily morning presentations that take place very informally in the trauma bay (excepting the occasional morning trauma) and student lectures occur each Tuesday and Thursday morning of every week. The didactic sessions consist of a senior resident presentation and an attending presentation and both are usually quite informative and incorporate student participation. Both the residents and faculty are very well-read and very experienced for their respective levels and can field just about any question one could pose to them.

Atmosphere

Resident relations are strong and most attendings (with some exceptions of course) are fairly social with the residents. The environment in the department is very serious however. Importance is placed heavily on both the care of the patient and appropriate emergency medicine. Patients are almost always appropriately triaged to the proper station and I never saw a procedure performed that wasn't first justified by the person who wished to perform it. They are King's Co. Hospital however (the same seen in the first few episodes of Trauma: Life in the ER). The patients are from the roughest parts of Brooklyn and don't tend to think much of the fancy "rich" doctors taking care of them. Thick skin and a strong stomach are mandatory here. The trauma bay has been number one in the country for penetrating trauma for fourteen years straight. Combat doctors come to places like this to train for war. The hospital also boasts a total number of 140,000 patients per year (one of the top in the country). With the large influx of foreign immigrants from around the globe to these parts of Brooklyn, one should expect find some very uncommon diseases and disease presentations here (if you know what to look for!). This is it, a trauma 1 hospital with heavy patient volume in one of the most international areas on the globe. Training here prepares a physician to work in just about any aspect of emergency medicine on earth. Although the first year residents/interns are worked pretty hard the senior residents seem to enjoy a lot of quality social time outside of the hospital (I believe the 4th year residents work a 15 shift/month schedule).

Conclusion

Overall, this programs seems to be the perfect meld of both dirt and glory. As one of the busiest Emergency Departments with such a heavy trauma load there is more than enough patient contact to have seen everything possible by the end of a resident's training. As a conglomerate of some of the best trained and well-read physicians as I have ever seen, there are plenty of intellectual/experienced training offered to a resident to make proper use of the extensive patient volume. Finally, the program's dedication to relevent and cutting-edge clinical as well as laboratory research rounds this program off as probably the best meld of experience and academics available in the country. No where else will you find such an awesome melange of the three. The only negative aspect are for those who are a bit timid or squemish. This is NOT the place for those who are afraid to get their hands dirty. The work is hard and the patients are harder but the pay-off is tremendous.

 

[takeurmeds02]

Excellent rotation. I actually didn't mind the nursing issues that much since it gave med students the opportunity to do everything for patients. Instead of many EDs where you to have to fight to do even the simplest procedures like IVs and ECGs, there you literally go grab the next patient and do what needs to be done.

Scutwork has some really good reviews although all of them are over 10 years old:
http://www.scutwork.com/cgi-bin/links/review.cgi?ID=1227&d=1

Schedule
The medical student schedule consists of about 15 twelve-hour shifts and a mandatory eight hour ride-along with the EMS. The schedule is an assortment of shifts arranged by the department and students are allowed to pick their preferred shift schedule at the beginning of the month in cooperation with all the other students rotating at the same time. The shifts are split between the departments with three each in SUNY Downstate Hospital ED, peds. ER, Critical Care, Fast Track, and Main ER. Night to day shift vary depending on the shift schedule chosen.

Because ED's (especially departments as busy as this) are so chaotic, the faculty has a arranged a very regimented system for grading and keeping track of the students where the student must hand over a grade sheet and receive an attendance confirmation signature at the end of every shift. This is a fairly successful system that has managed to eliminate most of the slackers and shift falsifiers. The nursing staff at this program has a reputation that far precedes them. Do not come here expecting any help from the nurses. They are there to fulfill the minimum part of their job requirements and have little time for scutwork or friendly conversation. IV's, NG tubes, blood draws, EKG's, wound bandaging; the rotating student becomes an expert at all these things and more by the end of the month.

Teaching
The faculty is amazing. These doctors create an amazing array of brilliant physicians from dirty inner city hospitals to brilliant physicians from pristine, big-name academic programs. A substantial chunk of the attendings here were trained in Lincoln hospital back in the eighties when Emergency medicine was just a fledgling specialty and when crack wars were rampant in a much different NYC that we see today. Watching these Dr.'s supervise a trauma resuscitation is an amazing and incredibly rewarding experience. The remaining faculty come from a wide array of hospitals from across the country and offer distinctive aspects of emergency care. Only some of the attendings are graduates of the program and this helps to avoid the one-dimensional view found at some other programs. Teaching takes place here a lot more than I have experienced elsewhere. There are a few attendings that will shave-off some teaching opportunities during busy shifts, but usually the student/resident must be prepared for pimp questions on every patient presentation. The attendings are always on the look-out for intelligent residency candidates so one should come well-prepared if there is any intention of applying for the program. There are daily morning presentations that take place very informally in the trauma bay (excepting the occasional morning trauma) and student lectures occur each Tuesday and Thursday morning of every week. The didactic sessions consist of a senior resident presentation and an attending presentation and both are usually quite informative and incorporate student participation. Both the residents and faculty are very well-read and very experienced for their respective levels and can field just about any question one could pose to them.

Atmosphere
Resident relations are strong and most attendings (with some exceptions of course) are fairly social with the residents. The environment in the department is very serious however. Importance is placed heavily on both the care of the patient and appropriate emergency medicine. Patients are almost always appropriately triaged to the proper station and I never saw a procedure performed that wasn't first justified by the person who wished to perform it. They are King's Co. Hospital however (the same seen in the first few episodes of Trauma: Life in the ER). The patients are from the roughest parts of Brooklyn and don't tend to think much of the fancy "rich" doctors taking care of them. Thick skin and a strong stomach are mandatory here. The trauma bay has been number one in the country for penetrating trauma for fourteen years straight. Combat doctors come to places like this to train for war. The hospital also boasts a total number of 140,000 patients per year (one of the top in the country). With the large influx of foreign immigrants from around the globe to these parts of Brooklyn, one should expect find some very uncommon diseases and disease presentations here (if you know what to look for!). This is it, a trauma 1 hospital with heavy patient volume in one of the most international areas on the globe. Training here prepares a physician to work in just about any aspect of emergency medicine on earth. Although the first year residents/interns are worked pretty hard the senior residents seem to enjoy a lot of quality social time outside of the hospital (I believe the 4th year residents work a 15 shift/month schedule).

Conclusion
Overall, this programs seems to be the perfect meld of both dirt and glory. As one of the busiest Emergency Departments with such a heavy trauma load there is more than enough patient contact to have seen everything possible by the end of a resident's training. As a conglomerate of some of the best trained and well-read physicians as I have ever seen, there are plenty of intellectual/experienced training offered to a resident to make proper use of the extensive patient volume. Finally, the program's dedication to relevent and cutting-edge clinical as well as laboratory research rounds this program off as probably the best meld of experience and academics available in the country. No where else will you find such an awesome melange of the three. The only negative aspect are for those who are a bit timid or squeamish This is NOT the place for those who are afraid to get their hands dirty. The work is hard and the patients are harder but the pay-off is tremendous.

Thanks for the link! From what they've said, it sounds pretty badass. This is why I love EM. I'm trying my hardest not to get ahead of myself though haha

 

[jl lin]

Well for example I did one of my 4th year EM rotations at Kings County in NYC.

The hospital is well known for having arguably the worst nursing staff in the country. Now to be fair they're ridiculously understaffed and overworked. There would be shifts were we'd only have 5 or 6 nurses to cover the entire ED. And this is one of the largest and busiest EDs in the country that sees over 140,000 pts per year.

Sadly, I too have heard less than stellar things about nursing in various NY areas. It has made be fear working as a traveller in NY.

 

[deleted407021]

Thanks for taking the time to make this already very insightful AMA, doc.

The AAMC specialties page indicates that EM docs work approx. 46 hr/wk, average. If this is accurate to you knowledge (is it tho??), how are ERs staffed with physicians, essentially 24/7? How does scheduling work so that there's always a doc around, while also allowing for what appears to be decent working hours for the average ER physician?
Do EM residents typically work more hours than attendings?

Been curious about all that.

I'm an incoming OMS-I. So, if you could give your first-year self one piece of advice, what would it be and why?



Thanks again!

 

[deleted407021]

And two more, if you don't mind.


Do you perceive the field of EM to be generally conservative, liberal or moderate, relative to Medicine in general?
Are more or fewer of your colleagues in the field religious?

 

[Endorphins98]

Thanks for all the answers thus far! Also, props for the NeverSummer photo. They are the only boards I have ever ridden. I am moving to AL from UT and am going to desperately miss shredding that light fluffy pow.

 

[jlh19]

Did you do multiple EM rotations at various ED's during your 3rd and 4th year? What I mean is that you already knew you wanted to do EM so it's advisable to spend some rotations at places you could potentially want to apply for residency at? I'm not too familiar on how that all works with our electives during the clerkship years so I didn't know if that was a thing or not

 

[Cyberdyne 101]

What are the busiest/most hectic emergency departments in the country?

 

[takeurmeds02]

The AAMC specialties page indicates that EM docs work approx. 46 hr/wk, average. If this is accurate to you knowledge (is it tho??), how are ERs staffed with physicians, essentially 24/7? How does scheduling work so that there's always a doc around, while also allowing for what appears to be decent working hours for the average ER physician?

Would love to hear feedback from @alpinism as well but I've worked in 6 different ED's a scribe. My last shop was a level 1 trauma center with a depth chart of about 20 ER docs. There were no EM residents.

There would be about 7 or 8 day-side shifts with the earliest shift starting at 6a and the latest shift going to 2 AM. The two night docs would start at 9p and 11p and work till 6a and 7a respectively. The two night docs would be alone from 2a until 6a when the next doc comes in to start the next day.

Their shortest shifts were 8 hours and longest 10. Most of them were working 4-5 shifts/week and some low-teen shifts a month, I forget how many. They could pick up/give away/switch shift as relatively needed.

The adult side housed something like 29 beds not including hallway beds in the main ED with five extra beds on the low acuity side. There was also a Peds side that had their own roster of docs and had another set of ~14 beds.

There's obviously a lot of overlap in shift coverage and if you have that many docs working, it's easy to cover the ER 24/7 for any given week and still allow you to take days off as needed. Also some of the docs worked at other ED's as well. One doc worked on the admin side of some EMS stuff (couldn't give you specifics lol) and another doc even did emergency flight runs when he wasn't scheduled in the ED.

As far as the culture, ER is sooo chill; everyone's always been respectful of the next guy/gal. Everyone generally has a good time while still providing excellent patient care when they're not jizzing on the patients' shoulders (sorry Dave Newman). No one really takes themselves too seriously and it seems like everyone curses like sailors lol. I'm enamored.

 

[The Buff OP]

Sorry if this is a silly question. What does EM stand for?

 

[alpinism]

Thanks for taking the time to make this already very insightful AMA, doc.

The AAMC specialties page indicates that EM docs work approx. 46 hr/wk, average. If this is accurate to you knowledge (is it tho??), how are ERs staffed with physicians, essentially 24/7? How does scheduling work so that there's always a doc around, while also allowing for what appears to be decent working hours for the average ER physician?

Yeah that sounds pretty accurate. Most full time EM docs work 4 to 5 - 8 to 12 hour shifts per week. Keep in mind that the AAMC number probably includes people who work part time as well so that could be dragging down the average. At the same time there are still quite a few places in rural america that staff ERs with either FM or IM physicians or just use PAs and NPs. That being said, many of those places are actively trying to recruit board certified EM docs to work there.

As far as scheduling it varies by hospital but most places use 8 hr x 3 shifts/day or 12 hr x 2 shifts/day schedules. All the docs take turns working each shift over the course of a month. Typically you work the day shift for 2 weeks then the swing shift for a week and then the night shift for a week. Rinse later and repeat. For example the most common residency schedule is 7a -3p for day shifts, 3p -11p for swing shifts, and 11p -7a for night shifts.

Do EM residents typically work more hours than attendings?

Ohhh yes. We usually average about 50 to 60 hours per week.

I'm an incoming OMS-I. So, if you could give your first-year self one piece of advice, what would it be and why?

Start using first aid from day one along with course materials.

Thanks again!

No problem

 

[alpinism]

And two more, if you don't mind.


Do you perceive the field of EM to be generally conservative, liberal or moderate, relative to Medicine in general?
Are more or fewer of your colleagues in the field religious?

Hmmm good question.

Can’t say I’ve noticed a difference compared to other specialties. I’ve met ER docs of all different political affiliations. Plenty of liberals especially in academic hospitals and in big cities. Also plenty of conservatives especially in community hospitals and in small towns. As far as religion, there does seem to be trend of more new docs being less religious compared to their older colleagues. Its very similar to the general population as a whole and I wouldn’t say its EM specific though.

 

[Cyberdyne 101]

Sorry if this is a silly question. What does EM stand for?

 

[alpinism]

Thanks for all the answers thus far! Also, props for the NeverSummer photo. They are the only boards I have ever ridden. I am moving to AL from UT and am going to desperately miss shredding that light fluffy pow.

Dude that sucks (well the moving away from Utah's perfect powder).

There's some halfway decent resorts in NC not too far away. Beech and Sugar Mountain are 2 favorites. Both are just outside of Boone which is this really fun college town with tons of cool bars and restaurants. Definitely worth checking out if you get the chance.

 

[alpinism]

Did you do multiple EM rotations at various ED's during your 3rd and 4th year? What I mean is that you already knew you wanted to do EM so it's advisable to spend some rotations at places you could potentially want to apply for residency at? I'm not too familiar on how that all works with our electives during the clerkship years so I didn't know if that was a thing or not

Yep. I did 1 home rotation and 2 away rotations during 4th year. For EM you want to do at least 1 away rotation and some people do as many as 3 or 4 depending on their med school and what their schedule allows. Basically you want to do away rotations for 2 main reasons: 1) to check out programs you're interested in possibly applying to for residency and 2) to get letters of recommendation from faculty.

 

[alpinism]

What are the busiest/most hectic emergency departments in the country?

Haha we argue about this all the time over in the EM forum.

Off the top of my head:

Jackson in Miami
Grady in Atlanta
Elmhurst in NYC
Kings in NYC
DRH in Detroit
Cook in Chicago
Parkland in Dallas
BTH in Houston
UMC in Las Vegas
LAC in Los Angeles

(The above all see over 100K patients per year and serve very poor inner city communities)

 

[ZorkDork1]

Short background:

Spent 4 years in the Air Force and 4 years as a Firefighter/Medic before deciding to go to med school.
Went to a large state university on the west coast for undergrad, did okay and graduated with a 3.5 GPA.
Went to a private research university on the east coast for grad school, did well and graduated with a 3.9 GPA.
Attended a well regarded med school in the midwest on a scholarship before matching into EM at my top choice.

A few people have asked me to do this recently and I’ve finally got some free time this month. As far as experience with medical school admissions, I worked extensively with our adcom during med school including organizing pre-interview socials, leading hospital tours, and conducting interviews. I’ll try to be as helpful as I can, however, realize that some of my info is already out of date or will soon be within the next few years. Anywho, hoping to give back to SDN since it’s helped me a lot over the years.

Hello! Thank you for taking the time out to do this!
EM sounds very interesting, but unfortunately I haven't been able to shadow an ER physician.
So please forgive me if I ask dumb questions.

1) How broad are the procedures you perform on a given day? What appeals to me about ER is that you never know what you'll encounter with a patient. Do you find yourself doing mostly the same 3-5 procedures, or do you routinely practice the diverse amount of procedures you learn in MS and residency?

2) What percentage of your patients have ACTUAL emergencies? Is it difficult to deal with the ones that do not?

3) How often do you find yourself unable to treat a patient because it is beyond your training/scope? Because at some point, I imagine there's a line that patients cross where they simply can't be treated in an ER. Like if someone comes in with blown off legs, do you immediately send them to the OR, or do you deal with it first before sending them away? Do you ever wish you could follow those patients when they cross that line, or do you simply move on to the next patient?

Thank you!

 

[alpinism]

Sorry if this is a silly question. What does EM stand for?

EM = earning millions

EMS = earn money sleeping

 

[RogueUnicorn]

My bad dude.

Yo while you’re here can you see this other patient in bed 6 too??

XD rekt!

 

[Astra]

Is the ER busiest during july 4th?

 

[The Buff OP]

EM = earning millions

EMS = earn money sleeping

Thank you, I was about to look it up on urban dictionary.

For me in EMS we always dropped a call minutes after starting our shift, then its sleep time until 12pm. -__- then run calls all night.

 

[alpinism]

1) How broad are the procedures you perform on a given day? What appeals to me about ER is that you never know what you'll encounter with a patient. Do you find yourself doing mostly the same 3-5 procedures, or do you routinely practice the diverse amount of procedures you learn in MS and residency?

We do all types of different procedures. The most common ones we do on a day to day basis would be intubations, central lines, laceration repairs, abscess drainages, joint aspirations, nerve blocks, reductions, and splinting. Other less common procedures include chest tubes, lumbar punctures, paracentesis, thoracentesis, escharotomy, fasciotomy, thoracotomy, cricothyroidotomy, lateral canthotomy, electrocautery, trephination, burr holes, limb amputations, and peri mortem cesarian sections.

Ultimately the number and variety of procedures you do as an EM doc depends on where you end up working. At most academic medical centers there are tons of residents, fellows, and sub specialists available so many of the less common procedures on the list above end up being done by them instead of the EM doc. On the other hand at most community and county hospitals the EM doc is the one who ends up doing the procedure since there’s usually no one else available. Same thing goes for if you end up doing international work since there’s usually no one else around to do procedures.

I’ve personally done everything on the list above with the exception of a peri mortem cesarian section. That being said, I’ve done way more than most other American EM residents and many of the procedures where done in South Africa.

2) What percentage of your patients have ACTUAL emergencies? Is it difficult to deal with the ones that do not?

Depends on who you ask. According to ACEP (our professional college) its around 90%. Now, anyone who’s ever spent more than 5min in an actual ER will tell you that number is total BS. Truthfully it all depends on how you define an emergency. If you think its any medical condition that may result in death or disability in the near future then its probably 25%. If you think its any medical condition that requires immediate life or limb saving treatment then its probably 10%.

Honestly, that’s the worst part of the job IMO. I love taking care of sick and crashing patients but I spend most of the time dealing with urgent care and primary care patients. It does get frustrating some shifts but as long as I can get 1 or 2 resuscitations per shift I’m usually pretty happy. At the same time there is a reason why I’m planning on doing international work after residency.

3) How often do you find yourself unable to treat a patient because it is beyond your training/scope? Because at some point, I imagine there's a line that patients cross where they simply can't be treated in an ER. Like if someone comes in with blown off legs, do you immediately send them to the OR, or do you deal with it first before sending them away? Do you ever wish you could follow those patients when they cross that line, or do you simply move on to the next patient?

So for your blown off legs example (I’ve taken care of a few overseas) the patient needs to be resuscitated and stabilized before they can go to the OR. They need to have bleeding controlled with tourniquets, clamps, and direct pressure. They need vascular access with large bore IVs and maybe a central line. They need to be intubated. They need to be ventilated. They need an NG tube. They need a foley catheter. They need fluids and blood. They need pain and sedative medications. We do all of those things. For EM docs our treatment consists of resuscitation and stabilization of patients. We do not however normally provide definitive management for patients.

Personally speaking, I prefer the intensity and excitement of the ER compared to the OR. I have followed some patients back to the OR and even assisted in operations when needed, but its always been quite frankly boring IMO. In the OR you're generally moving slowly and deliberately, making small incisions and dissecting through tissues. Its very long tedious work and most operations end up taking hours. In the ER we’re always moving quickly and efficiently, rapidly assessing and treating patients. Its very short intense work and most procedures are over in a matter of minutes.

 

[Cyberdyne 101]

-Favorite Schwarzenegger movie?
-Was Doug Quaid actually dreaming in Total Recall?
-Favorite Bruce Willis movie?
-How long could Zed survive with that gunshot wound?
-How did Bruce Wayne recover so quickly from that spinal procedure in The Dark Knight Rises?
-How long before Cara Delevingne gets a Thug Life tattoo?
-Top 5 favorite rappers?
-What if Ice Cube had not gone solo?
-What if Shaq were riding with Biggie on March 9th?
-What if Biggie had used the E-40 Sacramento incident as a cautionary tale?
-Favorite supermodel?
-How do you feel about Taylor's platinum blonde look?
-Was Sophie Turner a good choice for Jean Grey?
-Favorite comic book character?
-What if Dave Mustaine were less reckless during his Metallica days?
-Snickers or Hershey's?
-Haagen Dazs or Ben & Jerry's?
-Coke or Pepsi?
-Favorite Beer?
-Is Bill Walton actually a Guinness drinker?
-Favorite video games?
-Which GTA character do you identify with the most?
-Favorite Firefly episode(s)?
-Aliens or Terminator 2?

 

[The Buff OP]

Since you like doing resuscitations, do you plan on doing a critical care fellowship?

 

[taco152]

Honestly, that’s the worst part of the job IMO. I love taking care of sick and crashing patients but I spend most of the time dealing with urgent care and primary care patients. It does get frustrating some shifts but as long as I can get 1 or 2 resuscitations per shift I’m usually pretty happy. At the same time there is a reason why I’m planning on doing international work after residency.

Why not intensivist then?
If you did want to do critical care, what route would you advise?
Em>cc
Im >cc[pulm]
Gas>cc
Surgery>cc

I've had an interest in em for awhile but I've been thinking I'd enjoy cc better. Would you advise one way over the other? (Starting school in August.


Biggest surprises in medicine. As in ideas or expectation going into it vs what it was really like?

 

[alpinism]

-Favorite Schwarzenegger movie?

Tough choice. Predator.

-Was Doug Quaid actually dreaming in Total Recall?

Yes.

-Favorite Bruce Willis movie?

Easy Choice. Die Hard.

-How long could Zed survive with that gunshot wound?

Depends on if his femoral or iliac arteries were hit. You'd be surprised how many people survive GSWs.

-How did Bruce Wayne recover so quickly from that spinal procedure in The Dark Knight Rises?

He used the Lazarus Pits to restore his strength.

-How long before Cara Delevingne gets a Thug Life tattoo?

That girl still owes me 20 bucks.

-Top 5 favorite rappers?

Dylan, Dylan, Dylan, Dylan, Dylan.

-What if Ice Cube had not gone solo?

There'd be no more reason to watch Law and Order.

-What if Shaq were riding with Biggie on March 9th?

Shaq would have heroically tried to shield his body, ultimately failing and suffering multiple GSWs in the process. While recovering in the ICU he would discover his deep love for medicine and later enroll in Harvard Medical school. During 3rd year rotations he would discover a talent for cognitive behavioral therapy and ultimately decide to go into Psychiatry. He would later go on to host his own daytime talk show and become the black Dr. Phil. Using his fame and fortune acquired from television he would run for president in 2016 winning the republican nomination and ultimately defeating Hillary Clinton in the general election.

-What if Biggie had used the E-40 Sacramento incident as a cautionary tale?

Biggie would live another 10 years before ultimately overdosing on a combination of Purple Drank and Nacho Cheese Dorritos.

-Favorite supermodel?

Gemita Samarra - https://www.redbulletin.com/us/us/culture/gemita-samarra-is-the-perfect-package

-How do you feel about Taylor's platinum blonde look?

Don't get me started about T-Swift's new look.

-Was Sophie Turner a good choice for Jean Grey?

Emma Stone would have been a better choice.

-Favorite comic book character?

Iron Man.

-What if Dave Mustaine were less reckless during his Metallica days?

Their music would probably suck.

-Snickers or Hershey's?

Snickers.

-Haagen Dazs or Ben & Jerry's?

Ben & Jerry's.

-Coke or Pepsi?

Neither.

-Favorite Beer?

Guinness.

-Is Bill Walton actually a Guinness drinker?

Yes.

-Favorite video games?

Metal Gear Solid and Call of Duty.

-Which GTA character do you identify with the most?

Never played.

-Favorite Firefly episode(s)?

Objects in Space.

-Aliens or Terminator 2?

Both are great movies.

 

[Cyberdyne 101]

Shaq would have heroically tried to shield his body, ultimately failing and suffering multiple GSWs in the process. While recovering in the ICU he would discover his deep love for medicine and later enroll in Harvard Medical school. During 3rd year rotations he would discover a talent for cognitive behavioral therapy and ultimately decide to go into Psychiatry. He would later go on to host his own daytime talk show and become the black Dr. Phil. Using his fame and fortune acquired from television he would run for president in 2016 winning the republican nomination and ultimately defeating Hillary Clinton in the general election.

Biggie would live another 10 years before ultimately overdosing on a combination of Purple Drank and Nacho Cheese Dorritos.

There'd be no more reason to watch Law and Order.

I think you have them mixed up haha.

Emma Stone would have been a better choice.

Agreed.

Objects in Space.

Yessss! Reminded me of Alien. Ariel and Trash are my other faves.

 

[alpinism]

Since you like doing resuscitations, do you plan on doing a critical care fellowship?

I'll let Gomer Blog explain my feelings towards critical care.

http://gomerblog.com/2016/06/lion-king/

 

[Hospitalized]

1.) Will you use a scribe once you finish residency?

2.) How many patients does a resident typically see in a 8-hour (or 12-hour) shift?

3.) Do you think ERs will see the same volume of patients in 10 years as they are now? (for reference, the ER I work in sees just under 200 patients a day in an area where primary care is pretty garbage)

 

[ZorkDork1]

Wow, thanks for all of the enlightening answers! Here's a few more

In your opinion, what are the right reasons to join EM? The wrong reasons? Anything you learned in practice that you didn't know before you committed?

Does the EM physician work irregular shifts (changing from night and day) forever? Or is it more lenient as you get older?

In a tertiary care center, what is the role of the EM physician exactly? How does it differ from the on-call trauma surgeon/general surgeon?
As in, is the EM still in charge of stabilizing the patient while the trauma/general surgeon waits?

Do you spend all of your time in the ER, or some parts of it elsewhere, such as the ICU?

What sort of international work? Docs without borders?

Haha, thanks again!


Sent from my iPhone using SDN mobile

 

[alpinism]

Why not intensivist then?
If you did want to do critical care, what route would you advise?
Em>cc
Im >cc[pulm]
Gas>cc
Surgery>cc

I've had an interest in em for awhile but I've been thinking I'd enjoy cc better. Would you advise one way over the other? (Starting school in August.

I also thought I would like critical care until I did an ICU rotation.

The amount of unnecessary and futile care in most ICUs nowadays is beyond ridiculous and downright depressing. Maybe I've just had bad experiences but in all the ICUs i've spent time in 90% of patients are either elderly and demented or suffer from some incurable chronic disease. Most have little to no hope of ever making a full recovery assuming they don't pass away during their ICU admission.

As far as pursuing a career in critical care, I'd figure out what speciality you like the most first then decide on CC after doing an ICU rotation as a resident. At the present time there really is no advantage to choosing one specialty over another since all of them allow you to sit for board certification. Each one brings different strengths and weaknesses to the ICU however you'll learn everything you need to know during your CC fellowship.

Biggest surprises in medicine. As in ideas or expectation going into it vs what it was really like?

The amount of paperwork an average US physician does during a typical day. If you like sitting at a computer and typing notes all day then you'll love being a doctor. Even after shadowing extensively before med school I had no idea how bad it was until doing clinical rotations. Some specialties are worse than others but no matter what you go into you'll have to spend hours in front of a computer every day.

 

[alpinism]

I think you have them mixed up haha.

Hahaha.

In my defense there's too many rappers named ice these days.