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

[alpinism]

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 I’ll try to be as helpful as I can, however, realize that some of my info is already out of date or will soon be within the next few years.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.

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[Statusintubatus]

Hi! You sound very similar to me....currently at a 3.5 gpa and am applying this cycle. Have worked the past year full time as a medic, and went to school part time.... hoping to go into EM.

Would you say that your work experience as a medic really improved your application to the point that it can make up for lower gpa and mcat scores?

 

[jlh19]

You sound very similar to me also! I am a Marine Corps vet, a medic, and starting medical school next month and I'm pretty much set on EM (I will keep my mind open of course to everything else). What would you say are some good things to do while in school to be able to match into a good EM residency? I'm trying to start figuring out what extra I want to do over these next 4 years. Thanks for your time!!!

 

[alpinism]

Hi! You sound very similar to me....currently at a 3.5 gpa and am applying this cycle. Have worked the past year full time as a medic, and went to school part time.... hoping to go into EM.

Would you say that your work experience as a medic really improved your application to the point that it can make up for lower gpa and mcat scores?

Eh it helped a little.

Wouldn't go so far as to say that it really improved my application or that it made up for a lower GPA/MCAT.

For MD schools in particular you need a solid GPA/MCAT to get your foot in the door. The exact thresholds vary from school to school but don't expect to be getting much love from schools with a low stats even as a paramedic. That being said you should be fine with a 3.5 GPA as long as you can get a decent MCAT score. DO schools on the other hand are more willing to forgive low stats if you have extensive patient care experience. Most of the ex-paramedics I know who made the jump to med school went the DO route since they didn't have great stats and wanted to start med school ASAP. For example I applied to both MD and DO schools and ended up getting interviews at 6/30 MD schools and 12/15 DO schools.

 

[alpinism]

are you actually a resident in ZA or did you do an intl away rotation at bara? how was it to set up? i am interested in trauma and cant think of a better place to rotate

I'm a US resident. Spent 2 months at Bara as a med student.

As far as setting up the rotation, all you need to do is email the rotation coordinator Mrs. Dawn Francis at [email protected]. She'll send you the application and all the required paperwork. Be aware that the rotation is very popular and generally speaking you need to apply at least a year in advance. That said, there isn't a better place to learn trauma and you'll see more trauma in one week than most places see in a whole year. The trauma unit is basically in a war zone and its very common to see upwards of 50-100 gunshots and stabbings in one day.

The Glasgow University Emergency Society has a good review for anyone else interested in the rotation:
http://www.medsurgemergencies.co.uk...ective-in-trauma-resus-and-pre-hospital-care/

Elective in Trauma Resus and Pre Hospital Care
South Africa, and in particular Soweto, sees more trauma than anywhere else in the world. The trauma comes as a mix of blunt trauma (courtesy of some of the worst taxi drivers on the planet), penetrating trauma (guns, knives, broken bottles or anything else to hand) and a seasonal specialty of thermal trauma (winter – kerosene heater injuries, boiling water, oil or chemicals). All of these and more arrived, relentlessly around the clock, totalling around 150 patients per day. Some patients even arrived twice, having been patched up and discharged; one of my favourite patients was re-stabbed within 4 hours! It wasn’t until our second day at the hospital that we were rostered into our first 24 hour on call shift. Jumping in at the deep end, my first patient, a lady of the gallstones demographic, had been set alight by her ex-boyfriend who had locked the door on his way out. We calculated her to have 60% burns including inhalational injuries. After stabilisation with an endotracheal tube and 16 litres of fluid prescriptions we moved onto the next patient. And the next, and the next. As gun shot after gun shot, car accidents and more than 20 stab wounds came in, I slowly came to grips with the ABCDE systematic approach. Some particularly gory cases stick out in my mind for various reasons. The resuscitative thoracotomy, and a young man successfully treated with mannitol and a decompressive craniotomy stand out as utter marvels of life saving modern medicine. The pregnant (32/40) lady who died of a pulmonary embolus stands out as poor postoperative care due, in part, to staggering patient numbers and a lack of resources in the developing world, resulting in two lives lost. The stabbed abdomen with bowel evisceration and the 60% burns mentioned above, who both went on to pass away during their admission, shocked me with how little humans can respect the life of another.

 

[Cyberdyne 101]

Is research actually a thing in EM? If so, do you expect to publish during your residency? Also, are you at a county hospital?

Thanks for doing this!

 

[CaliforniaDreamer]

bro can u delete ur info for setting up the rotation, id ont want extra competition, ive known of bara for years sicne the aljazeera piece came out. peace​

 

[FootballFoot]

Why did you decide on EM? Are you scared of burnout? Do you get tired of dealing with the patient popualtion? What do you think about all those studies that say overnight work leads to long term health problems, including increased risk of cancers? Does that deter you at all? Is EM very amenable to working at any location throughout the country? I really want to enter EM. It would be cool to save lives and the hours are very very nice, but I'm scared of the statistics.

For highly ranked EM residencies, how important is attending a top tier med school (compared to things like derm, urology, plastic)? How hard is it to get into pediatric EM? Did you do EM research during med school to improve your residency app?

What made you go into EM and what other specialties did you consider? How are your residency hours?

 

[alpinism]

You sound very similar to me also! I am a Marine Corps vet, a medic, and starting medical school next month and I'm pretty much set on EM (I will keep my mind open of course to everything else). What would you say are some good things to do while in school to be able to match into a good EM residency? I'm trying to start figuring out what extra I want to do over these next 4 years. Thanks for your time!!!

That's awesome man, no problem.

Here's a few things off the top of my head that can help with EM residency applications:

-Get involved in your EMIG as a M1, try to become an officer as an M2 (president, vice president, secretary, treasurer, etc...)
-Contact EM faculty and try to get involved in research (chart reviews and case studies are best for publishing)
-Start shadowing in the ED and get to know everyone (especially the residency leadership)
-Attend conferences and workshops (great for networking and connections)
-Volunteer in free clinics (some county programs look for this in apps)

Beyond that its all about doing well in your classes and getting a good step 1 score. Unfortunately EM is getting more competitive every year and you'll need an above average step 1 score (230+) to have a shot at some of the bigger name programs.

 

[hopefulERdoc251]

Do you think your prior experience as a paramedic influenced you to going into EM? Or did you keep your options open and just coincidentally go towards EM?

Also, going towards the idea of burnout, how did you battle burnout? I'm a ER scribe that's definitely leaning towards EM but I'm not entirely sure how I'd deal with the burnout seeing as I definitely get frustrated after some time seeing some of the patients. Thanks!

 

[iforget2]

I'm assuming the nature of EM causes there to be more deaths than most other specialties. How do you deal with this emotionally?

How many shifts do you work a month, and is it easy to set up a set number of shifts per month?

 

[alpinism]

Is research actually a thing in EM? If so, do you expect to publish during your residency? Also, are you at a county hospital?

Thanks for doing this!

No problem.

Yeah, especially at some of the "research intensive med schools" i.e. USNWR top med schools. At some of those places they definitely look for people with research experience. That being said, its nothing like other specialties where some applicants have multiple publications and presentations. In addition, there are also many programs that couldn't care less about research and take applicants who have done exactly zero research their entire lives.

I am. Let's just say it was of the first county programs founded in the 1970s.

 

[alpinism]

bro can u delete ur info for setting up the rotation, id ont want extra competition, ive known of bara for years sicne the aljazeera piece came out. peace​

Lol.

Bro you gotta chill out if you wanna do EM.

 

[FCMike11]

bro can u delete ur info for setting up the rotation, id ont want extra competition, ive known of bara for years sicne the aljazeera piece came out. peace​

answer my q man

Lol....this guy.

Sent from my Nexus 6P using SDN mobile

 

[alpinism]

Why did you decide on EM?

EM was by far my favorite rotation of med school. Considered general surgery and orthopedics for a while but hated both for various reasons. Basically I love taking care of sick crashing patients and doing resuscitations. Also like the pace and variety of EM.

Are you scared of burnout?

Sometimes. I think the whole issue is a little overblown though. IMO most EM docs suffering from burnout fall into 1 of 2 categories: A) old timers who trained in another specialty and just started working in the ER and B) youngsters who didn't know what they were getting themselves into and picked the wrong specialty.

Do you get tired of dealing with the patient popualtion?

Not really. I mean some days are worse than others but overall it doesn't bother me too much. You really have to have thick skin in EM and accept that you're often dealing with the worst of society. My personal view is that these people are adults and can make their own decisions. If they want to change I'll be here to help and if not then they'll have to deal with the consequences.

What do you think about all those studies that say overnight work leads to long term health problems, including increased risk of cancers? Does that deter you at all?

Well if that's the case I'm royally f*cked. Plus its probably too late at this point. I've been doing overnight work my whole life. Being in the military and working as a firefighter are even worse when it comes to crazy schedules and sleepless nights.

Is EM very amenable to working at any location throughout the country?

Yes. The current job market is wide open. From what I've heard its fairly easy to get a job in most cities.

For highly ranked EM residencies, how important is attending a top tier med school (compared to things like derm, urology, plastic)?

Its one of many factors that program directors take into consideration. Some places (mostly top tier schools) value it more than others.

How hard is it to get into pediatric EM?

Not hard at all. Its funny but most peds EM attendings make significantly less than regular EM attendings.

Did you do EM research during med school to improve your residency app?

I did trauma surgery research over the summer. Ended up getting a poster and a presentation.

What made you go into EM and what other specialties did you consider?

Seriously considered general surgery and orthopedics until 3rd year. See my first post.

How are your residency hours?

Depends on the service. In the ED its usually about 50 to 60 hours per week which is 5 or 6 shifts plus conference and journal club.

 

[Cyberdyne 101]

EM was by far my favorite rotation of med school. Considered general surgery and orthopedics for a while but hated both for various reasons. Basically I love taking care of sick crashing patients and doing resuscitations. Also like the pace and variety of EM.



Sometimes. I think the whole issue is a little overblown though. IMO most EM docs suffering from burnout fall into 1 of 2 categories: A) old timers who trained in another specialty and just started working in the ER and B) youngsters who didn't know what they were getting themselves into and picked the wrong specialty.



Not really. I mean some days are worse than others but overall it doesn't bother me too much. You really have to have thick skin in EM and accept that you're often dealing with the worst of society. My personal view is that these people are adults and can make their own decisions. If they want to change I'll be here to help and if not then they'll have to deal with the consequences.



Well if that's the case I'm royally f*cked. Plus its probably too late at this point. I've been doing overnight work my whole life. Being in the military and working as a firefighter are even worse when it comes to crazy schedules and sleepless nights.



Yes. The current job market is wide open. From what I've heard its fairly easy to get a job in most cities.



Its one of many factors that program directors take into consideration. Some places (mostly top tier schools) value it more than others.



Not hard at all. Its funny but most peds EM attendings make significantly less than regular EM attendings.



I did trauma surgery research over the summer. Ended up getting a poster and a presentation.



Seriously considered general surgery and orthopedics until 3rd year. See my first post.



Depends on the service. In the ED its usually about 50 to 60 hours per week which is 5 or 6 shifts plus conference and journal club.

Could you elaborate on why you ended up disliking ortho and gen surgery?

 

[jlh19]

Have you heard/have any interest in the new EMS subspecialty of EM? What are you future plans in the field of EM? Any interest in continuing working with EMS crews and possibly become a medical director?

 

[Cyberdyne 101]

What should I do before I start EM residency in 2 weeks

Video game binge!!

 

[Lucca]

Best butt box story go

 

[alpinism]

Do you think your prior experience as a paramedic influenced you to going into EM? Or did you keep your options open and just coincidentally go towards EM?

Also, going towards the idea of burnout, how did you battle burnout? I'm a ER scribe that's definitely leaning towards EM but I'm not entirely sure how I'd deal with the burnout seeing as I definitely get frustrated after some time seeing some of the patients. Thanks!

Yeah definitely. EM was always one of my top choices but I did try to keep an open mind during rotations.

So here's the thing. For me personally, seeing the same alcoholics, drug seekers, and gang bangers day after day isn't that big of a deal. I guess it all has to do with expectations. I know they're going to be difficult patients and I probably won't be able solve all their problems. As a result I just try to focus on doing the basics - treating any life threatening emergencies and offering to help if they change their mind. Beyond that I'm not going to waste time worrying about them or arguing with them about why they're in the ED.

That being said, I have found that oftentimes just doing something kind and considerate for the patient can make a huge difference. Even something as simple as offering to get them water or find a blanket. One of my favorite patients was this huge tatted up Salvadorian MS-13 gangster who refused to cooperate with anyone and kept on threatening our staff. He had gotten into a drunken fight and in the process broke the frame on his glasses. I managed to find some Coban tape and fixed the frame so that he could wear the glasses again. Ended up claiming down just enough to let me suture his laceration and actually said thank-you before he left.

 

[alpinism]

I'm assuming the nature of EM causes there to be more deaths than most other specialties. How do you deal with this emotionally?

I'm a huge fan of Sir William Osler and the concept of Aequanimitas.

http://www.medicalarchives.jhmi.edu/osler/aequessay.htm

How many shifts do you work a month, and is it easy to set up a set number of shifts per month?

We work 20 shifts per month. Our chief residents make the schedules so that they are as fair as possible and try to give everyone their vacation requests.

 

[Inspector JacquesClouseau]

1) What was your favorite rotation in med school?
2) What kind of personality type do you encounter most in EM? What personality type do you think is most geared towards a successful EM career?

Thanks for doing this!

 

[hopefulERdoc251]

Yeah definitely. EM was always one of my top choices but I did try to keep an open mind during rotations.

So here's the thing. For me personally, seeing the same alcoholics, drug seekers, and gang bangers day after day isn't that big of a deal. I guess it all has to do with expectations. I know they're going to be difficult patients and I probably won't be able solve all their problems. As a result I just try to focus on doing the basics - treating any life threatening emergencies and offering to help if they change their mind. Beyond that I'm not going to waste time worrying about them or arguing with them about why they're in the ED.

That being said, I have found that oftentimes just doing something kind and considerate for the patient can make a huge difference. Even something as simple as offering to get them water or find a blanket. One of my favorite patients was this huge tatted up Salvadorian MS-13 gangster who refused to cooperate with anyone and kept on threatening our staff. He had gotten into a drunken fight and in the process broke the frame on his glasses. I managed to find some Coban tape and fixed the frame so that he could wear the glasses again. Ended up claiming down just enough to let me suture his laceration and actually said thank-you before he left.

Haha that is awesome thank you so much!

 

[The Knife & Gun Club]

Hey thanks for doing this!

I'm curious about your view on the future of EM as a field.

When I read some of the threads in the EM physician forum, the older attendings seem to think our current system is unsustainable and headed for a collapse. What are your opinions on this? Could the change be so large that many ER docs find themselves either out of work or forced to work for a greatly reduced rate?

Thanks and sorry if my question seems stupid

 

[alpinism]

Could you elaborate on why you ended up disliking ortho and gen surgery?

For me personally it came down to 3 main reasons:

1. Lack of diversity.

General surgery and especially orthopedics are becoming more and more specialized every year. As an attending you basically do the same 4 or 5 procedures over and over again day after day. In orthopedics its even worse and you essentially become a "shoulder guy" or a "knee guy" or a "spine guy." Its bad enough that you have to give up seeing cardiac, respiratory, and neurologic conditions (all the things I loved taking care of as a medic) but on top of that you don't even get to operate within your full scope of practice (one of the main reasons I considered surgery in the first place). That being said, there are still some "true general surgeons" out there but you pretty much have to work in a rural town out in the middle of nowhere.


2. Lack of acuity.

Most surgeries nowadays are performed on a scheduled or elective basis. With the exception of trauma and a few other emergency conditions, you're not rushing an unstable patient to the OR to save their life. This is because as general rule surgeons want their patients to be as stable as possible before undergoing an operation (which makes sense from a surgical standpoint). Unfortunately, as a result its not like on TV where patients are crashing and bleeding to death on the operating table. Most cases end up being pretty routine and monotonous (which is obviously good for the patient).


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.

 

[alpinism]

Have you heard/have any interest in the new EMS subspecialty of EM? What are you future plans in the field of EM? Any interest in continuing working with EMS crews and possibly become a medical director?

Maybe.

At the moment I'm planning on working with MSF or IRC for a couple years after residency.

 

[iforget2]

We work 20 shifts per month. Our chief residents make the schedules so that they are as fair as possible and try to give everyone their vacation requests.

And how many shifts per month do attendings usually have?

 

[alpinism]

What should I do before I start EM residency in 2 weeks

Definitely read Rosens and Tintinnalli at least twice

 

[saltypug]

Hey, thanks for doing this! Would any kind of research fly in helping with EM residency apps? Or should research be EM-focused?

 

[FootballFoot]

For me personally it came down to 3 main reasons:

1. Lack of diversity.

General surgery and especially orthopedics are becoming more and more specialized every year. As an attending you basically do the same 4 or 5 procedures over and over again day after day. In orthopedics its even worse and you essentially become a "shoulder guy" or a "knee guy" or a "spine guy." Its bad enough that you have to give up seeing cardiac, respiratory, and neurologic conditions (all the things I loved taking care of as a medic) but on top of that you don't even get to operate within your full scope of practice (one of the main reasons I considered surgery in the first place). That being said, there are still some "true general surgeons" out there but you pretty much have to work in a rural town out in the middle of nowhere.


2. Lack of acuity.

Most surgeries nowadays are performed on a scheduled or elective basis. With the exception of trauma and a few other emergency conditions, you're not rushing an unstable patient to the OR to save their life. This is because as general rule surgeons want their patients to be as stable as possible before undergoing an operation (which makes sense from a surgical standpoint). Unfortunately, as a result its not like on TV where patients are crashing and bleeding to death on the operating table. Most cases end up being pretty routine and monotonous (which is obviously good for the patient).


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.

Thank you. I think surgery and EM is really cool too.

Considering you are interested in acute cases, why did you not try for trauma surgery? Would you still say they lack diversity in their procedures?

 

[alpinism]

Best butt box story go

??

 

[alpinism]

1) What was your favorite rotation in med school?
2) What kind of personality type do you encounter most in EM? What personality type do you think is most geared towards a successful EM career?

Thanks for doing this!

1) Besides EM probably anesthesia.

2) Most of us are very laid back and love to joke around.

3) Able to think on your feet, remain calm under pressure, and roll with the punches.

 

[jlh19]

Maybe.

At the moment I'm planning on working with MSF or IRC for a couple years after residency.

I'm a bit hazy on the acronyms, what is MSF and IRC?


Sent from my iPad using SDN mobile app

 

[Mad Jack]

What is your least favorite flavor of Doritos?

 

[alpinism]

Hey thanks for doing this!

I'm curious about your view on the future of EM as a field.

When I read some of the threads in the EM physician forum, the older attendings seem to think our current system is unsustainable and headed for a collapse. What are your opinions on this? Could the change be so large that many ER docs find themselves either out of work or forced to work for a greatly reduced rate?

Thanks and sorry if my question seems stupid

Nope perfectly reasonable question.

Part of me agrees with them. At least with regards to EDs functioning as primary care clinics but charging emergency room prices. Sooner or later the government will start to crack down and reimbursement rates will get cut across the board. I don't think however that the system will collapse. It will just be harder to find jobs in competitive markets and you won't be seeing as many of those "I'm making 500K in Texas" posts that show up from time to time in the EM forum.

 

[alpinism]

And how many shifts per month do attendings usually have?

That's one of the great things about EM. There's a ton of flexibility with regards to scheduling shifts as an attending. Generally speaking most attendings work anywhere from 12 to 16 shifts per month which comes out to roughly 120-160 hours per month. That being said some attendings choose to work more to make extra money and some choose to work less to spend more time with their friends or family.

 

[alpinism]

Hey, thanks for doing this! Would any kind of research fly in helping with EM residency apps? Or should research be EM-focused?

EM focused is always better but any research will help your application.

 

[Lucca]

??

Haha it's a Scrubs reference. Their ED had a "butt box" filled with stuff they took out of patients rectums in the ER.

 

[alpinism]

Thank you. I think surgery and EM is really cool too.

Considering you are interested in acute cases, why did you not try for trauma surgery? Would you still say they lack diversity in their procedures?

For the most part trauma is managed non-operatively these days. At my medical school's hospital and most other trauma centers about 95% of patients never see the inside of an operating room. When they do need an operation its usually done by a specialist (orthopedics or neurosurgery) weeks after the patient has been admitted.

http://www.physiciansweekly.com/trauma-surgeons-role/

 

[FootballFoot]

For the most part trauma is managed non-operatively these days. At my medical school's hospital and most other trauma centers about 95% of patients never see the inside of an operating room. When they do need an operation its usually done by a specialist (orthopedics or neurosurgery) weeks after the patient has been admitted.

http://www.physiciansweekly.com/trauma-surgeons-role/

Oh wow, I didn't know that (premed). That does not really sound exciting, like what I imagined. EM is seeming more and more cool to me. I appreciate your responses.

 

[alpinism]

I'm a bit hazy on the acronyms, what is MSF and IRC?

Médecins Sans Frontières and International Rescue Committee.

 

[alpinism]

What is your least favorite flavor of Doritos?

Crispy Salmon.

Number 35 looks interesting though.

https://www.buzzfeed.com/mjs538/35-...ound-the-world?utm_term=.avyyyaYOp#.addDDX2jV

 

[alpinism]

Haha it's a Scrubs reference. Their ED had a "butt box" filled with stuff they took out of patients rectums in the ER.

Ahhh duh. Haha haven't seen that episode in years.

I actually don't think we have a butt box.

 

[alpinism]

Haha it's a Scrubs reference. Their ED had a "butt box" filled with stuff they took out of patients rectums in the ER.

To be honest I've never had to remove a rectal foreign body.

I have had plenty of vaginal and urethral foreign bodies though.

 

[Lucca]

To be honest I've never had to remove a rectal foreign body.

I have had plenty of vaginal and urethral foreign bodies though.

Weirdest one?

 

[Mad Jack]

Crispy Salmon.

Number 35 looks interesting though.

https://www.buzzfeed.com/mjs538/35-...ound-the-world?utm_term=.avyyyaYOp#.addDDX2jV

I think they're orgasm flavored Doritos, but can't quite tell.

 

[The Buff OP]

Ended up claiming down just enough to let me suture his laceration and actually said thank-you before he left.

"Thenks, foooo." "Come by my crib suumetime, holmes."

 

[alpinism]

Weirdest one?

Snapple bottle filled with a creamy white fluid.

 

[alpinism]

I think they're orgasm flavored Doritos, but can't quite tell.

Well at least they're high in protein.

 

[alpinism]

"Thenks, foooo." "Come by my crib suumetime, holmes."