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Military EM

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Dr. Wexler

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Anyone if the hours worked in a military ER are similary to those in civilian ERs? Also, where are some of the programs out there? Not neccessarily facilities with residencies, just military hospitals with Emergency Departments.

Thanks.
 

chicagomd

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yes, the hours are similar
most medical centers and smaller community type hospitals do have eds

army:
residencies
madigan-tacoma,wa
brooke-san antonio, tx
darnall - ft hood,tx
non-residency ed
ft belvior, va
walter reed, dc
tripler, hi
ft bragg, nc
most army centers

navy:
san diego naval, ca

air force
combined with army brooke, san antonio

i know many graduates from all the army programs and they are all outstanding. practice in these settings are similar to civilian except everyone has health insurance and follow-up is a bit easier.

good luck
 

anonymousEM

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there are 4 air force spots to complement the 8 civilian spots at Wright State/Wright Patterson Air Force Base in Dayton, Ohio for residency as well. They follow the same curriculum although I think there are a few extra military requirements as far as physical training etc.
 

Azalo

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From what I have seen at Keesler AFB, the hours can be significantly longer in the military. If half of the doctors get deployed, which does happen here, the other half have to pick up the slack which can mean working 15+ 12 hr shifts a month, not to mention the hours you will work as a deployed physician.
 

blackcat

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azalo - true for staff docs. residents, by definition, are non-deployable.
 

futrEDdoc

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There is also a Navy EM residency at Portsmouth Naval Hospital in Portsmouth, Virginia (near Virginia Beach)
 

sundermannr

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Hey
I heard that the hours up in Seattle can be pretty brutal...like 24's? But I was in the service down in SA at Ft Sam and it was pretty awesome. They as well as Lakland's program contract with the city to take all the gang related trauma at no cost until they are stabilized. At least that's how it was back in the early 90's. I think it is still that way and that's why they don't have an civilian EM residency down there. It would be a sweet spot regardless of military or civilian. The only thing bad about SA is that its reeeeaaaaally hot in July and August.
 

kickbackdude

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Madigan's hours can be pretty bad, but they can also be pretty good. True, they do work 24 on-24 off (with no days off in between) for a few months at Harborview. That's just awful. Also, Harborview is very behind the times in their ED. There's a medicine side and a surgery side. The same doc has been running the show for many years and apparently is not willing to change his ways (too bad, according to many of the attendings and residents). On the flip side, you do get great trauma exposure at Harborview.
While at Madigan, you work 9 hour shifts (but don't turn over your patients so they usually end up as 10s) and work about 19 of them (pretty average compared to other residencies). However, they spend 6 months at University of Washington Medical Center and they work 14 12 hour shifts there (great hours).
So, if you take the horrible Harborview hours, average Madigan hours and great UW hours, the hours are overall about average. But, add the commute to this and the overall hours are quite heavy compared to other residencies.
 

blackcat

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i've heard that the system at harborview is going to change soon. they are going to be getting em trained docs in there. should be an improvement.
madigan is also, reportedly, taking over the va emergency room, thus older, sicker patients.
 

kickbackdude

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Blackcat,

Yes, they are saying it should change soon, but they have been saying that for years. The real answer is that it probably won't change until Dr. Copus retires (according to the attendings and residents I talked with). And when it does change, the Madigan residents may get shafted. The people at UW want to start a residency of their own separate from Madigan's, but are waiting for Dr. Copus to retire. If UW has a residency, how will that affect the Harborview and UW rotations for the Madigan residents? One of the strengths of the program is that the diversity comes from great rotations at all three institutions (inner city and trauma at HB, tertiary care univ setting at UW and bread and butter at Madigan). I don't know the answer to that (but do know that lots of politics will be involved) and it may be a couple of years before that happens. But, if the change is soon, it will be a chaotic situation for residents at Madigan no matter what change is made. Don't get me wrong, I like Madigan's program and they are very high on my list but the Harborview situation is a political nightmare even though you do get good training there (all this info is from the residents I talked with and I talked with 5 or 6 about this situation). Now, for the VA Hospital. That patient population has a large proportion of non-acute patients who have chronic complaints and come in all the time as well as a large proportion of drunks. The pathology you would get at the VA doesn't at all compare to the pathology the residents get with the combined training at where they rotate now. If they substitute a bunch of resident rotations at the VA for the ones at Harborview and UW, that will significantly weaken their program.

See you, Kickbackdude
 

blackcat

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i don't mean that they are going to rotate at the va. they are goign to be the VA er. the patients will go to madigan instead of going to the VA. it will be a similar situation to what he have here in hi. my hospital is also the va er for the island. some good pathology.
 

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