Prestige of EM?

[TripleDegree]

I've talked to several physicians and a couple of MS4's, and much to my surprise, they felt unanimously that as far as "prestige" of a specialty was concerned, EM was very average. Why is this the case? Is it because anyone (FP, IM, etc) can moonlight in an ER? Is there any explicit advantage that you get from being a BC EM physician, that say, an FP doctor working in the same ER would not get?

This is important to me, coz there are lots of other things that make going into EM a no-brainer - (1) variety of cases (2) being a clinician (3) decent pay and (4) life away from the hospital.

Oh friendly ER docs/residents - please shed some light on this.

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[kungfufishing]

I've talked to several physicians and a couple of MS4's, and much to my surprise, they felt unanimously that as far as "prestige" of a specialty was concerned, EM was very average. Why is this the case? Is it because anyone (FP, IM, etc) can moonlight in an ER? Is there any explicit advantage that you get from being a BC EM physician, that say, an FP doctor working in the same ER would not get?

This is important to me, coz there are lots of other things that make going into EM a no-brainer - (1) variety of cases (2) being a clinician (3) decent pay and (4) life away from the hospital.

Oh friendly ER docs/residents - please shed some light on this.

When you start talking about prestige, the first thing that comes to mind is "who cares?". I can only speak for myself, but I really have no interest in how prestigous EM is/isnt - in fact I would say the lack of prestige/pretense is part of what I really like about it.

Everyone seems to THINK they could be good at being an ER doc but they ahem choose not to. The explicit advantage of being BCEM, aside from being explicitly trained to do the job you are paid to do, is that it is quickly becoming a prerequisite to work in most metro areas and lots of rural ones, too.

This means that the "FP doctor working in the same ER" scenario probably wont ever happen unless it is in, say, poteau, oklahoma (im from oklahoma, so not a crack on the state).

But back to the point - do you really care about the prestige of your job?

 

[TripleDegree]

When you start talking about prestige, the first thing that comes to mind is "who cares?". I can only speak for myself, but I really have no interest in how prestigous EM is/isnt - in fact I would say the lack of prestige/pretense is part of what I really like about it.

Everyone seems to THINK they could be good at being an ER doc but they ahem choose not to. The explicit advantage of being BCEM, aside from being explicitly trained to do the job you are paid to do, is that it is quickly becoming a prerequisite to work in most metro areas and lots of rural ones, too.

This means that the "FP doctor working in the same ER" scenario probably wont ever happen unless it is in, say, poteau, oklahoma (im from oklahoma, so not a crack on the state).

But back to the point - do you really care about the prestige of your job?

Thanks - that was helpful. To answer your question, no not really a huge factor - however, given the amount of time, dollars, blood, sweat, tears that goes into getting to this point, I would be lying if I were to say that prestige were not a factor.

I think the encouraging trend is limiting ER jobs to BCEM physicians. That would be a huge plus both in terms of quality and selectivity of the specialty. Any idea if Ohio is one of those states? Where could I find that info.

Again, thanks!

 

[waterski232002]

IMHO.... EM is one of the least prestigeous careers within the medical community. It is glamourized by television shows which the lay public see, so it may seem very prestigious to the untrained/non-medical lay person. If you've ever spent time in the ED, it is filled with lots of non-emergent problems, with serious emergencies sprinkled in. You need to be good at everything to work in an ED, but you are an expert at nothing. Thus, there will always be a physician who is an expert (and better than you) at almost everything you do. For this reason, EM physicians have to have tough skin and be able to take crap from other physicians who can be less than understanding. I'm not saying that it's right, but If you can't deal with that, then don't choose EM...

 

[EMApplicant]

My dad's a hard-core medicine doc and when I told him I was doing EM his response was vaguely something like "No really, what are you going into?"

I think the old timers still think of EM docs as being a bit sketchy.... I'm pretty confident that this will change as time passes. But, I think the poster above said it best, who cares? Do what ya love.

 

[typeB-md]

Thanks - that was helpful. To answer your question, no not really a huge factor - however, given the amount of time, dollars, blood, sweat, tears that goes into getting to this point, I would be lying if I were to say that prestige were not a factor.

I think the encouraging trend is limiting ER jobs to BCEM physicians. That would be a huge plus both in terms of quality and selectivity of the specialty. Any idea if Ohio is one of those states? Where could I find that info.

Again, thanks!

just because you give time and money to something does not mean people should respect you. any intelligent person could've chosen to become a doctor (regardless of specialty). Be a doctor because it allows no one else to know anything more about you than yourself. Especially as an ER doc, i would have to imagine the thought of you being able to acutely treat anyone near death better than any other physician should be reward enough.

every specialty has it's perks... i don't consider prestige to be anywhere near there. maybe it's because i'm hung like john holmes... but i don't know (i keeed, i keeed... maybe not!). but in all reality people could spit on me and the fact that i can pave my own path is more than enough "self-prestige" that i could care less.

do what you do for yourself and not for how others will perceive your actions. i guarantee you will be much happier this way.

 

[Hercules]

My dad's a hard-core medicine doc and when I told him I was doing EM his response was vaguely something like "No really, what are you going into?"

I think the old timers still think of EM docs as being a bit sketchy.... I'm pretty confident that this will change as time passes. But, I think the poster above said it best, who cares? Do what ya love.

I think you're dead on. A lot of the older generations of docs have absolutely no respect for EM. When I talk to my peers though, most of them know EM is becoming one of the more competitive specialties to match in.

 

[dlung]

I think "prestige" is made up of a couple things...

One would be kind of global contributions to academics. Being a very young specialty, EM has a significant disadvantage. There are very few EM academic centers that actually pull in significant amounts of grants/funding (arguably less than 5). The research is relatively fledgling, as well, especially in the basic sciences. However, as with examples of Manny Rivers his goal-directed sepsis study and places like UM/UPenn, this is improving.

I think second is the clinical reputation of EM physicians. I think historically, it's been understood (whether true or not) that many of the early EM docs were guys who either 'couldn't cut it' in medicine or surgery, or were otherwise disgruntled IM/Surg transplants/moonlighters. Then you realize that most of our med/surg attendings are from that era and have that understanding. As has been pointed out in other postings, this is improving as well. I think once our generation gets out and is in practice 10-15 years down the road, there should be a palpable improvement (although not complete) in respect from our peers.

As for your question about Ohio, I've only seen non-EM physicians in EDs running fast tracks or occasionally in rural EDs.

One thing I realized during these past two years of med school, that as irritating it is to put up with some of my attendings s***ing on EM docs all the time, it isn't all personal -- given the chance, a lot of these a**holes would s*** on everyone

 

[12R34Y]

I can't tell you how sick I am of hearing all of my residents in surgery/medicine/peds etc... tell me over and over and over that EM is terrible and they hate the ED etc.... "the good thing about surgery or medicine is that if you want you can work in an ED anyway?"

I hear that quote more than any. Many/most are grossly uninformed and the attendings in general hold poor opinions of EM in my personal experience. As soon as I tell them I'm going to do EM they immediately start saying....."i thought i was going to do EM UNTIL.........insert a million reasons."

I swear I'm about 1 second from saying "I want to do what YOU DO" to every attending/resident from now on. Just so I don't have to hear about how bad EM is.

prestige.......I spit on prestige ( ha ha).

later

 

[WakeMedHeel]

I'm sorry but if you want prestige and great respect from your peers become a cardiothoracic surgeon, or a transplant surgeon, or a world renowned cardiologist. EM ain't where it's at. As others have alluded to, this is changing a bit, but I think one of the things that attracted me to EM is the fact most go into the field because they like what they do, not because they have to become a leader in the field. They aren't looking for prestige. They want to get their hands dirty and treat patients. They don't ask to be called Dr. X, instead they go by their first name.

 

[colforbinMD]

I can't tell you how sick I am of hearing all of my residents in surgery/medicine/peds etc... tell me over and over and over that EM is terrible and they hate the ED etc.... "the good thing about surgery or medicine is that if you want you can work in an ED anyway?"

I hear that quote more than any. Many/most are grossly uninformed and the attendings in general hold poor opinions of EM in my personal experience. As soon as I tell them I'm going to do EM they immediately start saying....."i thought i was going to do EM UNTIL.........insert a million reasons."

I swear I'm about 1 second from saying "I want to do what YOU DO" to every attending/resident from now on. Just so I don't have to hear about how bad EM is.

prestige.......I spit on prestige

YEAH! What he said!!!!!!!!!!! I love it. I am not the only one fight off the urge to hit the next condescending surgeon who trashes EM to me up on the floor and then goes down for a consult and copies everything the EP has just done down for his preop note without even so much glancing at the pt.
God bless you 12R34Y, I thought it was just me!!!!!!!!!!!!!!!!!!

 

[Dr.Evil1]

You need to be good at everything to work in an ED, but you are an expert at nothing. Thus, there will always be a physician who is an expert (and better than you) at almost everything you do.

I disagree that EMs are not experts. They are at least as skilled as anesthesia at airway and probably more skilled if you factor in the non-controlled environment. I would also say that the EM speciality is an expert in diagnosis. No other specialty goes from no history to presumptive diagnosis like EM

 

[DrMom]

I have gotten chewed on by attendings and residents on every service so far except peds. (Today it was the general surgeons' turn, apparently) They all have told me things along the full continuum of complaints from statements about how EMs don't bother to actually work up patients--they just make an assumption & get the patient admitted or that EMs just call specialists for consults on every case...all the way to EMs being gross overusers of medical resources who order way too many tests when they over-workup patients to cover their asses.

I'm not sure yet how these docs can have it both ways, but here's what I've gathered from this:

1. EM docs work in a fishbowl with everyone else seeing the pts later & making assumptions about what the EMs did or didn't do "properly"

2. EM docs often have an adversarial relationships with the specialists because those docs don't want to be bothered with coming down to the ED or deal with a new admit

3. Many specialists really don't understand the role of an ED doc.

 

[kungfufishing]

your post touches on one of the aspects of medicine that surprised me the most, which is the common work aversion attitude. I am currently in the midst of a prelim year, so I would say Im qualified as having seen it from the EM and IM sides of the fence. So many doctors put so much effort into avoiding their job or complain so loudly about it when they are forced to do what they are paid to do (every admit is bad, the ER doc could be replaced by a monkey, etc). Yet another reason Im happy with my chosen career - I actually like to work hard at work, instead of spending half the day trying to get out of working the other half. Makes me wonder how/why some of these people chose their field (maybe back to prestige? who knows.)

 

[Willamette]

I disagree that EMs are not experts. They are at least as skilled as anesthesia at airway and probably more skilled if you factor in the non-controlled environment. I would also say that the EM speciality is an expert in diagnosis. No other specialty goes from no history to presumptive diagnosis like EM

At least as skilled as anesthesia at airway? You're kidding, right?


Willamette

 

[12R34Y]

At least as skilled as anesthesia at airway? You're kidding, right?


Willamette

First of all no one believes that a non-anesthesiologist is better at the airway than an anesthesiologist, but seriously.....EM can handle most airways and their are plenty of studies to support this.

here are a few and i could go on and on and on and on....


A Comparison of Trauma Intubations Managed by Anesthesiologists and Emergency Physicians
Joseph S. Bushra, MD, Bryon McNeil, MD, David A. Wald, DO, Ari Schwell, MD and David J. Karras, MD
From the Department of Emergency Medicine, Temple University Hospital and School of Medicine, Philadelphia, PA. Dr. McNeil is currently in the Department of Emergency Medicine, Sacred Heart Health System, Pensacola, FL.

Although airway management by emergency physicians has become standard for general emergency department (ED) patients, many believe that anesthesiologists should manage the airways of trauma victims. Objectives: To compare the success and failure rates of trauma intubations performed under the supervision of anesthesiologists and emergency physicians. Methods: This was a prospective, observational study of consecutive endotracheal intubations (ETIs) of adult trauma patients in a single ED over a 46-month period. All ETIs before November 26, 2000, were supervised by anesthesiologists (34 months), and all ETIs from November 26, 2000, onward were supervised by emergency physicians (12 months). Data regarding clinical presentation, personnel involved, medications used, number of attempts required, and need for cricothyrotomy were collected. Study outcomes were: 1) successful intubation within two attempts, and 2) failure of intubation. Failure was defined as inability to intubate, resulting in successful intubation by another specialist, or cricothyrotomy. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were used to compare results between groups. Results: There were 673 intubations during the study period. Intubation within two attempts was accomplished in 442 of 467 patients (94.6%) managed by anesthesiologists, and in 196 of 206 of patients (95.2%) managed by emergency physicians (OR = 1.109, 95% CI = 0.498 to 2.522). Failure of intubation occurred in 16 of 467 (3.4%) patients managed by anesthesiologists, and in four of 206 (1.9%) patients managed by emergency physicians (OR = 0.558, 95% CI = 0.156 to 1.806).

Conclusions: Emergency physicians can safely manage the airways of trauma patients. Success and failure rates are similar to those of anesthesiologists


The who, where, and what of rapid sequence intubation: prospective observational study of emergency RSI outside the operating theatre.

Reid C, Chan L, Tweeddale M.

Department of Critical Care Medicine, Intensive Care Unit, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK. [email protected] <[email protected]>

BACKGROUND: Emergency rapid sequence intubation (RSI) performed outside the operating room on emergency patients is the cornerstone of emergency airway management. Complication rates are unknown for this procedure in the United Kingdom and the factors contributing to immediate complications have not been identified. AIMS: To quantify the immediate complications of RSI and to assess the contribution made by environmental, patient, and physician factors to overall complication rates. METHODS: Prospective observational study of 208 consecutive adult and paediatric patients undergoing RSI over a six month period. RESULTS: Patients were successfully intubated by RSI in all cases. There were no deaths during the procedure and no patient required a surgical airway. Patient diagnostic groups requiring RSI are described. Immediate complications were hypoxaemia 19.2%, hypotension 17.8%, and arrhythmia 3.4%. Hypoxaemia was more common in patients with pre-existing respiratory or cardiovascular conditions than in patients with other diagnoses (p<0.01). Emergency department intubations were associated with a significantly lower complication rate than other locations (16.9%; p = 0.004). This can be explained by the difference in diagnostic case mix. Intubating teams comprised anaesthetists, non-anaesthetists, or both. There were no significant differences in complication rates between these groups.

CONCLUSIONS: RSI has a significant immediate complication rate, although the clinical significance of transient events is unknown. The likelihood of immediate complications depends on the patient's underlying condition, and relevant diagnoses should be emphasised in airway management training. Complication rates are comparable between anaesthetists and non-anaesthetists. The significantly lower complication rates in emergency department RSI can be explained by a larger proportion of patients with comparatively stable cardiorespiratory function.

Role of the emergency medicine physician in airway management of the trauma patient.

Omert L, Yeaney W, Mizikowski S, Protetch J.

Department of Surgery, Allegheny General Hospital, South Tower, Pittsburgh, Pennsylvania 15212, USA.

BACKGROUND: A Level I trauma center recently underwent a policy change wherein airway management of the trauma patient is under the auspices of Emergency Medicine (EM) rather than Anesthesiology. METHODS: We prospectively collected data on 11 months of EM intubations (EMI) since this policy change and compared them to the last year of Anesthesia-managed intubations (ANI) to answer the following questions: (1) Is intubation of trauma patients being accomplished effectively by EM? (2) Has there been a change in complication rates since the policy change? (3) How does the complication rate at our trauma center compare with other institutions? RESULTS: EM residents successfully intubated trauma patients on their first attempt 73.7% of the time compared with 77.2% ANI. The overall success rates, i.e., securing the airway within three attempts, were 97.0% (EMI) and 98.0% (ANI). The airway was successfully secured by EMI 100% of the time while a surgical airway was performed in two ANIs.

CONCLUSION: EM residents and staff can safely manage the airway of trauma patients. There is no statistically significant difference in peri-intubation complications. The complication rate for EDI (33%) and ANI (38%) is higher than reported in the literature, although the populations are not entirely comparable.

 

[typeB-md]

At least as skilled as anesthesia at airway? You're kidding, right?


Willamette

explain

 

[bartleby]

Lots of good insight up above in this thread...

I think that one big reason for the gradual changes in other specialties' attitudes towards EM is the fact that today's residents are training in hospitals with academic EM departments. It isn't just "some dude" anymore. The IM residents used to rotate at an outside ED with mostly grandfathered IM & surgery people, but now that they rotate in our ED with our residents, they're a lot less apt to complain about us now that they've walked a mile...or at least a month in our shoes.

One of the other posters is right in that you DO need thick skin, and you need to remember that your job is to advocate for the patient in front of you. And the _right_ thing to do is seldom also the _popular_ thing to do, with sending them home without followup being the most favored choice.

As far as prestige goes, just remember that when someone stands up in a movie theater and asks, "Is there a doctor in the house?" they don't want a transplant surgeon or a pediatric nephrologist... they want an EM doc.

 

[Homunculus]

the ER doc could be replaced by a monkey

c'mon, now you're just being silly. we all know it would take TWO monkeys to replace the ER doc. or one smarter than average baboon.

either way i imagine the ****-throwing would eliminate a lot of the unnecessary visits.

--your friendly neighborhood ED monkey trademarking caveman

 

[EMApplicant]

At least as skilled as anesthesia at airway? You're kidding, right?


Willamette

If I recall correctly, it's at Cincy where the EM docs back-up anesthesia on difficult airways. Pretty much the reverse of most other places.

 

[NinerNiner999]

I chose EM because prestige means nothing to me - I mean what can be more prestigious than actually saving a life when it needs it most.

I chose EM because I don't like to argue about where a patient needs to go. They are in my ED and I'm telling you to take them, or never recieve another referral for your care again - ever. No prestige in that.

I chose EM because I like to think that some of the things I do make a difference right then and there, not months after labwork has been been exhausted.

I chose EM because I enjoy to work hard and play hard, something that I think evey field of medicine should try to do instead of dodging admits and pontificating - I'll trade prestige for efficiency any day.

I chose EM because I'm a blue collar guy in a white coat, trapped with the title "professional" - and I'm a specialist at that.

Prestige is what you make of it, and there is very little left in medicine to begin with. I could care less about the CT surgeon, the transplant surgeon, or the world famous cardiologist who walks into my ED to take a consult. I could care less because I know my patient doesn't give a rats ass how many pieces of paper are on the wall, or how many articles have been published when his AAA is ready to burst.

I guess I chose EM because I believe it is the only field where we can still be doctors today, without letting prestige get in the way.

 

[emeddoc2001]

Ok. We have all heard other services trash Emergency Physicians from time to time. I have even seen some students interested in EM be swayed away from it by the periodic barages of condescending remarks. By and large these students didn't have a strong idea of what they wanted, or had weak enough egos that they cared enough of about what a few other well positioned people thought that they bought into the hype. As has been said above, this is mostly from old school doctors not enlighted, educated forward looking practioners. It also comes from interns, residents and attendings that just do not want people admitted to their service.

Outside of the medical community it is a whole different story. Thank, if you want, the broad if less than accurate exposure EM has received on television through shows like ER or reality/documentary shows for an ever improving view by the general public of Emergency Physicians. I have found that most people outside of medicine find the fact that I am going into Emergency Medicine very exciting and interesting, and are impressed that I would "throw myself" into an enviroment as fast paced as it sometimes seems on televison. They are impressed with the fact that lives are on the line in acute settings. Obviously their opinion is warped by what they see on TV, but what is pretige other than being highly regarded by others because of effective marketing, or a long history of exposure.

I would rather be on the frontline than sitting back in headquarters typing. Most people that criticize couldn't possibly be effective EPs without further training, they just know how to be monday morning critics.

Just my two cents.

 

[emeddoc2001]

Ditto

I chose EM because prestige means nothing to me - I mean what can be more prestigious than actually saving a life when it needs it most.

I chose EM because I don't like to argue about where a patient needs to go. They are in my ED and I'm telling you to take them, or never recieve another referral for your care again - ever. No prestige in that.

I chose EM because I like to think that some of the things I do make a difference right then and there, not months after labwork has been been exhausted.

I chose EM because I enjoy to work hard and play hard, something that I think evey field of medicine should try to do instead of dodging admits and pontificating - I'll trade prestige for efficiency any day.

I chose EM because I'm a blue collar guy in a white coat, trapped with the title "professional" - and I'm a specialist at that.

Prestige is what you make of it, and there is very little left in medicine to begin with. I could care less about the CT surgeon, the transplant surgeon, or the world famous cardiologist who walks into my ED to take a consult. I could care less because I know my patient doesn't give a rats ass how many pieces of paper are on the wall, or how many articles have been published when his AAA is ready to burst.

I guess I chose EM because I believe it is the only field where we can still be doctors today, without letting prestige get in the way.

 

[ERMudPhud]

To answer the OP: If you are sitting in a bar full of sorority girls the presitge of EM is quite high-just ask Quinn. If you are sitting in the hospital cafeteria its not so high. I agree with the other posters though-who cares

your post touches on one of the aspects of medicine that surprised me the most, which is the common work aversion attitude.

It is amazing how much this changes when you hit private practice (unless you go to an HMO or other salaried setting) for what I think are three reasons.

1. The consultants and hospitalist are getting paid per patient so they have lots of incentive to work. Some specialties like plastics could be an exception to that but even still the degree of collegiality goes up quite a bit when you are all attendings and nobody feels like a put-upon resident.

2. My colleagues and I try to do as much as possible ourselves in terms of work up and procedures which makes it easier on the consultants. This includes things you've never actually done before. I've had Gyn talk me through suturing up a big vaginal lac over the phone and ENT has done the same with cauterizing a post-op tonsillar bleed. Every time you learn something new like that it gives you one more thing you can do on your own without calling the specialist in the middle of the night. Good communications skills and a willingness to try things are essential.

3. I don't call my consultants with the attitude, "I've decided they are coming in and they are coming in to you and their is nothing you can say about it" I believe in discussing things and working things out if possible. Sometimes the consultants have had much better plans than what I've called for which don't necessarily require admission. Sometimes they already know the patient very well and can reassure you that something you thought was new and acute is actually old, chronic, and BS. That being said the final decision is mine and if I'm not comfortable sending someone home I have multiple competing hospitalist groups who will jump at the chance to admit anything and then consult the needed specialist. It's getting to the point where we only admit to Peds, OB, Gen-Surg, or the hospitalist. Everything else gets handled on a consulting basis by the subspecialists.

 

[BMW19]

Why can't you all just get along like good boys and girls? I am just a measly med-student to be, but have been an EMT for 7 years and see what goes on. Correct me if i'm wrong, but if i'm the patient coming in with an MI I want the EM doc stabilizing me. If if it is then discovered that my heart prob. is something that requires a consult I damn well then want to see the cardiologist asap. It seems to me that everyone has there role, and you know that one day either the specialist or the EM doc is going to save your ass someday/somehow so there should be mutual respect. Just a thought from a measly almost MS-1 who wants to go into EM

BMW-

 

[WilcoWorld]

...except saving lives, that is.

The OP's username is Triple Degree, so I assume he/she values prestige a lot more than I do.

HOWEVER, at many of the places I interviewed I was told that the EM residents were very well respected on their off service rotations, though I s'pose this could be a lie.

Moreover, if someone respects me simply because of the letters that follow my name, or because of which service's pager I'm carrying, than that person's respect doesn't mean much to me. I think that the only respect worth being concerned about is that which you earn from interacting with whoever is doing the respecting. If you're a great doctor, be it Neuro Surgeon to the Rocket Scientists, Family Practicioner, Pediatrician, or Emergentologist than thoughtful people will respect you. If they are not thoughtful, that I don't care about their respect.

But, to get to the heart of the matter for the OP, if prestige is what you seek, you'd best look outside of the ED.

 

[aliraja]

If I recall correctly, it's at Cincy where the EM docs back-up anesthesia on difficult airways. Pretty much the reverse of most other places.

Oh ye of little faith...

Not true - at all. Airways are broken down by location, ED and inpatient. ALL ED airways go to us, no matter what. If our resident, r4, or attending can't get an airway, it can't be gotten - and we need to cut. If we want to have ENT come down as backup in case a crich doesn't work and they need to do a slash they will. But anesthesia is not involved.

Upstairs, as is the case everywhere, they call anesthesia for non-emergent intubations. For emergent stuff, the code team responds. If it's a difficult airway, the airway pager gets activated - which goes out to both anesthesia and us. Our R4 has a spiffy little airway backpack loaded with toys. They sprint off from the ED and whoever gets there first takes the airway. This is pretty unique since, at most places, difficult airways on the floor go to the gas guys, not us. It actually says a lot that anesthesia ASKED us to carry the airway pager because they had so much faith in our R4s' ability to get the tube.

<getting off of soapbox>

Whew - sorry about that... but that was a little below the belt.

and, yeah, EM is not prestigious in most places. But it's hella fun.

 

[Apollyon]

hella

Hey, Texas - you're not allowed to use that word.

Dude!

 

[doc05]

prestige in EM? no. but it's a great field if it fits your personality.

stop all these questions about prestige, and just do what you like.

 

[BMW19]

Forget about prestige, i'm more worried about malpractice. That is what would keep me from a lot of fields unfortunately. Seems like all the Docs are leaving their profession because they are getting sued by everyone or the premiums are just insane

prestige in EM? no. but it's a great field if it fits your personality.

stop all these questions about prestige, and just do what you like.

 

[Eme-RG-ency]

I chose EM because I'm a blue collar guy in a white coat, trapped with the title "professional" - and I'm a specialist at that.

Haha... I am stealing that one Niner!

 

[DocM]

I chose EM because prestige means nothing to me - I mean what can be more prestigious than actually saving a life when it needs it most.

I chose EM because I don't like to argue about where a patient needs to go. They are in my ED and I'm telling you to take them, or never recieve another referral for your care again - ever. No prestige in that.

I chose EM because I like to think that some of the things I do make a difference right then and there, not months after labwork has been been exhausted.

I chose EM because I enjoy to work hard and play hard, something that I think evey field of medicine should try to do instead of dodging admits and pontificating - I'll trade prestige for efficiency any day.

I chose EM because I'm a blue collar guy in a white coat, trapped with the title "professional" - and I'm a specialist at that.

Prestige is what you make of it, and there is very little left in medicine to begin with. I could care less about the CT surgeon, the transplant surgeon, or the world famous cardiologist who walks into my ED to take a consult. I could care less because I know my patient doesn't give a rats ass how many pieces of paper are on the wall, or how many articles have been published when his AAA is ready to burst.

I guess I chose EM because I believe it is the only field where we can still be doctors today, without letting prestige get in the way.

Hot Damm! Good Post.

 

[Homunculus]

They are in my ED and I'm telling you to take them, or never recieve another referral for your care again - ever.

lol. that's mature.

I could care less

i think you mean "couldn't care less". this is a pet peeve of mine. "could care less" implies you actually have the capacity to care less, and in fact still care somewhat about the subject.

and by the way-- thinking that EM is the only field that lets someone be a doctor without letting prestige get in the way is a little narrow minded. look at peds and FP. one of the reasons i went into peds is because people do it for the right reasons-- no one is there for the money or prestige or egos.

--your friendly neighborhood nitpicky caveman

 

[Seaglass]

i think you mean "couldn't care less". this is a pet peeve of mine.

Man, this one gets me all the time too. Drives me nuts.

 

[roja]

irregardless.

 

[WilcoWorld]

i think you mean "couldn't care less". this is a pet peeve of mine. "could care less" implies you actually have the capacity to care less, and in fact still care somewhat about the subject...

I like semantics too, so let's discuss some:

Clearly the origin of the phrase was "couldn't care less", but it is highly unlikely that that is actually the case. There is alsomst certainly some concievable thing that one could care less about. So, semantically speaking, "could care less" is more accurate.

no one is there for the money or prestige or egos.

"no one" is in Peds for money or prestige? I highly doubt that is the case, just as I highly doubt that not a single EMP in existence is in medicine for $$$/prestige.

I actually agree with the gist of your post, but if you wanna call someone out on semantics, you ought to make yours un****wittable.

 

[Rudy Guliani]

That's ******ed wilcoworld, couldn't care less is correct, because you are saying you hold something in such low esteem that you could not care less about it. Which is the point of saying that phrase to begin with. It's a derogatory phrase. How derogatory is it to say, "I care at some level about this." For example: I couldn't care less if you reply to this post.

 

[Argentus]

Why would anyone care what another physician thinks of them? From what I have seen, the great majority of doctors are people who were nerds and got picked on their whole lives and use medicine as a crutch for serious personality defects. Personal satisfaction in your work and happiness is much more important than "prestige".

 

[kungfufishing]

this thread has such a bright future.

 

[Eme-RG-ency]

From what I have seen, the great majority of doctors are people who were nerds and got picked on their whole lives and use medicine as a crutch for serious personality defects.

Hey now, speak for yourself buddy! hehe

Actually, I do sort of understand the prestige question on some levels. For example if I decided to do Hair Replacement Therapy for the rest of my career, I think that would be a little less than prestigous than a doc treating sick patients. I think i would feel like I went through all of my schooling for nothing. But then again, its more of an internal struggle than an external "do people respect me?" question.

Sometimes the less prestigious positions are the more noble (peds is a good example, so is Mother Theresa), but then again, this isnt always the case (example, Telemarketing Sales... nothing noble or prestigious about that). Anyway, enough rambling... bottom line, do what you enjoy, do what is fullfilling for you, and do what pays off them damn student loans!

Me, I could care f***ing less about prestige. (To all you semantic experts: if I put an explicitive in there, can I say 'could' instead of 'couldn't'? haha, just wondering).

 

[USAF MD '05]

WHAAT??? Are you telling me EM isn't glamorous?? I only signed up for this deal because it would make me look cool!! I didn't know there was crusty yeasty folds,poop and vomit! I'm outta here. Do you think the USAF will let me take my toys and go home?
Probably not.
I guess I'll just have to get used to having time for golf AND my family.
Sweet.
Screw glam and prestige. I only work to play. It's not like I would be doing ANYTHING but kickin' it if I was one of those independently wealthy types. No offense to the trust fund babies on the board!
Peace. Steve

 

[Trajan]

From what I have seen, the great majority of doctors are people who were nerds and got picked on their whole lives and use medicine as a crutch for serious personality defects.

I don't think one can understate how often this is true.

 

[aphistis]

From what I have seen, the great majority of doctors are people who were nerds and got picked on their whole lives and use medicine as a crutch for serious personality defects.

I don't think one can understate how often this is true.

Er...do you mean "overstate"? Kinda changes the whole meaning of what you're saying, y'dig?

 

[NinerNiner999]

I hate sementics...

 

[Febrifuge]

sementics

Isn't that the study of DNA from those special stains on clothing and surfaces?

 

[placebo_B12]

sementics

Isn't that the study of DNA from those special stains on clothing and surfaces?

Do you have experience in this field? I can prepare a sample

 

[roja]

WHAAT??? Are you telling me EM isn't glamorous??

Oh, its glam baby.

 

[BMW19]

How the heck did you end up in the Emer. Med. thread? Are you lost?

From what I have seen, the great majority of doctors are people who were nerds and got picked on their whole lives and use medicine as a crutch for serious personality defects.
Er...do you mean "overstate"? Kinda changes the whole meaning of what you're saying, y'dig?

 

[DrMom]

aphistis roams

 

[Febrifuge]

Do you have experience in this field? I can prepare a sample

I remember Monica Lewinsky. I saw Monica Lewinsky on TV a lot. And I, sir, am no Monica Lewinsky.