Pro/Cons of EM

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Go to the sticky: FAQ... there's a wonderful post there.
 
I hate the search function. It sucks. So here are my pros/cons:

Pros:
1. Variety
2. Not having to worry about buying a practice
3. Occasional trauma
4. Procedures
5. Not worrying about insurance status when treating patients
6. Hours
7. Money (c'mon, you're all thinking it)
8. Time for other interests

Cons:
1. Overnights (may not be a con for some)
2. Not being an expert in a specific subject (other than resuscitation)
3. Will have to work holidays occasionally (but so do most other specialties)
4. Relative salary cap (hourly pay instead of pay by procedure)
5. Drug seekers
6. Having to put up with people coming to the ER for ridiculous reasons
 
breaker1919 said:
I hate the search function. It sucks. So here are my pros/cons:

Pros:
1. Variety
2. Not having to worry about buying a practice
3. Occasional trauma
4. Procedures
5. Not worrying about insurance status when treating patients
6. Hours
7. Money (c'mon, you're all thinking it)
8. Time for other interests

Cons:
1. Overnights (may not be a con for some)
2. Not being an expert in a specific subject (other than resuscitation)
3. Will have to work holidays occasionally (but so do most other specialties)
4. Relative salary cap (hourly pay instead of pay by procedure)
5. Drug seekers
6. Having to put up with people coming to the ER for ridiculous reasons
Click to expand...

Interesting list (and the search function on vB is better than most forums!)
 
I think I'm quoting myself from a previous thread on the topic:

Pros: pros

Cons: cons
 
Pros: get to treat everybody, for everything
Cons: have to treat everybody, for everything
 
Pros: The physician everyone would chose if there was only going to be one on their deserted island.
Cons: Pts who try to bite you.
 
southerndoc said:
You mean have to treat everybody, for nothing. We're the only specialty that is forced to treat the uninsured's primary care problems.
Click to expand...
No, I mean for everything, or maybe a more accurate way to put it would be anything... including nothing.

And I'm not talking about compensation; I'm talking about 'everything' meaning 'every medical condition that happens to come through the door.'
 
breaker1919 said:
I hate the search function. It sucks. So here are my pros/cons:


Cons:
1. Overnights (may not be a con for some)
2. Not being an expert in a specific subject (other than resuscitation)
3. Will have to work holidays occasionally (but so do most other specialties)
4. Relative salary cap (hourly pay instead of pay by procedure)
5. Drug seekers
6. Having to put up with people coming to the ER for ridiculous reasons
Click to expand...

How much experience in the field do you have?? As a medical student, It is obvioulsy very limited.

2. Not being an expert in a specific subject (other than resuscitation) ??? WTF?? - Not at all. Many ED attendings are experts in a variety of subjects, EMS, emergent airway, toxicology, procedural sedation, wilderness medicine just to name a few

4. Relative salary cap (hourly pay instead of pay by procedure) - you have no clue. Many groups are fee for service, you are paid based on your billings.

5. Drug seekers - Again, as a medical student you may find these annoying or challenging, but once you have experience , these are the easiest pts to handle. You just say NO and discharge them


Whats next ?- Premeds offering advice on passing ABEM boards?:meanie:
 
Calm down, and don't be such a jerk. I'm entitled to my opinion. The only thing you are guaranteed to be is an expert at resuscitation. You can do a fellowship in whatever you want. And I'm well aware that drug seekers are easy to handle, but if it doesn't frustrate you that they're abusing the system, then you're jaded. And fee for service is capped when you can only work a certain amount of hours. So before you start attacking people, try to have a civilized conversation.
 
breaker1919 said:
Calm down, and don't be such a jerk. I'm entitled to my opinion. The only thing you are guaranteed to be is an expert at resuscitation. You can do a fellowship in whatever you want. And I'm well aware that drug seekers are easy to handle, but if it doesn't frustrate you that they're abusing the system, then you're jaded. And fee for service is capped when you can only work a certain amount of hours. So before you start attacking people, try to have a civilized conversation.
Click to expand...

Just an FYI, when pointing out something to someone, try to preface it as 'I am a medical student with interest in EM and have spent lots of time in the ED...' Or something to that affect.

You do have a right to your own opinon and I am glad to see that you take what you know and develop one....but for the sake of the integrity of the board, I think its also good to preface with a disclaimer. I try to do that as well (I am just a PGY 1, but.....)
 
southerndoc said:
You mean have to treat everybody, for nothing. We're the only specialty that is forced to treat the uninsured's primary care problems.
Click to expand...

You don't like being forced to treat the underserved... did you put that in your personal statement for your residency application?
 
Truth!

I think having a front-row seat to the most messed-up aspects of our health care system has some serious drawbacks, but at least in the ED we get to be a part of the solution.

If you want to focus on how inefficient and inappropriate the solution is, that's completely valid and I agree with that as well. Personally, though, I choose to think of it as a situation where we will be among the first to see things improve, once the country decides what it's going to do about the mess.

There will always be those that abuse the ED when they should be seeing a PMD... but when I was at the County, even there this was a reasonably slim minority of patients.
 
FISKUS said:
How much experience in the field do you have?? As a medical student, It is obvioulsy very limited.

2. Not being an expert in a specific subject (other than resuscitation) ??? WTF?? - Not at all. Many ED attendings are experts in a variety of subjects, EMS, emergent airway, toxicology, procedural sedation, wilderness medicine just to name a few

4. Relative salary cap (hourly pay instead of pay by procedure) - you have no clue. Many groups are fee for service, you are paid based on your billings.

5. Drug seekers - Again, as a medical student you may find these annoying or challenging, but once you have experience , these are the easiest pts to handle. You just say NO and discharge them


Whats next ?- Premeds offering advice on passing ABEM boards?:meanie:
Click to expand...

Preface: Im a med student with an interest in EM, and a medic

Isnt that one of the reasons EM has such high lability insurance? Almost every person in the ED looks like they shouldnt be there.

I saw an extremely "careful" attending do a head CT on an EtOH that stumbled in every single night for a warm bed. Biggest bleed you ever saw.

What about the violent ones? I'd like not to get stabbed in the chest because I said no to a drug seeker.
 
howelljolly said:
Preface: Im a med student with an interest in EM, and a medic

Isnt that one of the reasons EM has such high lability insurance? Almost every person in the ED looks like they shouldnt be there.

I saw an extremely "careful" attending do a head CT on an EtOH that stumbled in every single night for a warm bed. Biggest bleed you ever saw.

What about the violent ones? I'd like not to get stabbed in the chest because I said no to a drug seeker.
Click to expand...

Actually the liability insurance for EM varies greatly from state to state - but it as not "high" compared to many specialities

RE Drug seekers - Sure, give them anything they want because you are afraid of being assaulted. If that is truly a concern of yours, you are looking at the wrong profession
 
howelljolly said:
Isnt that one of the reasons EM has such high lability insurance? Almost every person in the ED looks like they shouldnt be there.
Click to expand...

"Looks" can be deceiving. Making the effort to figure out what is wrong with someone is more challenging.


howelljolly said:
What about the violent ones? I'd like not to get stabbed in the chest because I said no to a drug seeker.
Click to expand...

If you just give everybody what they want because you're afraid of getting stabbed, you aren't going to be much of a physician regardless of your specialty. Part of the reason that there are drug seekers in the first place is that too many physicians fail to appreciate the risks of prescribing narcotics with impunity. If you don't feel safe in your working environment, you need to find another job, not a another specialty.
 
docB said:
Go ahead and ride that there high horse off into the sunset thataway pardner. You're in the EM forum now. Giddyup.
Click to expand...

I'd quote that in my sig if I wouldn't feel like such a goddamn poser for it since I'm not even in med school yet.

Remind me you said that in a few years, mmkay?
 
Now that I've actually done 2 months of EM I'd like to share the two biggest cons that I was "unprepared" for. When you hear med students talking about EM they always say that they are attracted to the hours of EM and that they want to "work their butt off" and then go home.

1. Sleep problems - It is way easier to SAY you like the crazy schedule than to actually live it. Not being able to go to sleep at 2am sucks. The amount of free time you have is extensive but I think sometimes we students focus on the total # of hours free while not considering how bad you feel during some of them.

2. Endless work - once again, it is very easy to SAY that you want to "work your butt off for 10 hours and then go home." If you are in clinic, when you see all of your patients you are done, in the ED if you work fast and efficiently they just keep filling up the rooms. And when one of those exciting traumas/codes comes in you just have rooms full of people getting angrier and angrier.

Dont get me wrong, it's still awesome, but ya gotta take the bad w/ the good.
 
I am comming from the same amount of experience as my fellow fourth year Amory....and I have to admit the schedule was the most unexpected adjustment I had to deal with. Even though those in the business will tell you about adjusting to sleep and circadian rhythms its another thing to experience them yourself.....while I love many other parts this is what will take the most getting used to...however, I do think (at least for my medical school rotations) they were so busy trying to give the students the entire experience of EM with shifts, lectuers, procedure labs that the schedule is probably a little rougher ,than our 15-18 shifts a month would suggest, to keep any sort of regularity. Now I do agree you have even as an attending there will be other obligations that will mess with your natural cycle , but I think these are more controllable than the required sessions we do as students.
 
As another MS4, I might as well chime in since we decided to answer the question (since pros and cons can be personal, the more the merrier, right?)

Some Pros:
1. The schedule is a plus for me in one sense, in that I like being able to do mid-day errands when I have a day off or am working nights.
2. Variety! Procedures! All that jazz
3. I like working with the underserved (I think this is part of the appeal for minorities, to be honest)
4. The research opportunities rock
5. No friggin' billing or social dispo to do :barf"
6. I think we underestimate the beauty of being a "jack of all trades" when everyone else is subspecializing in "multiple sclerosis", "heart failure", or "glaucoma"
7. No rounding!!!!!!!!!!!!!!!!
8. I love the constant work. I get soooooooooooooo bored when there is nothing to do
9. The field is new and rapidly evolving, providing great opportunities for leadership and positive change
10. tons more 🙂


Some Cons:
1. Yeah, the sleep schedule can be a bit rough, especially when transitioning between nights and weekends. I actually found not sleeping at the same time as my husband to be worse (ie, if he had the same schedule as I did, it wouldn't bother me as much).
2. The fishbowl/whipping boy. No one likes to hear from you, you mean more work to everyone you call. Everyone has experience with the ED and likes to rag on EPs for being "masters of none". They also like to dump their middle-of-the-night pts on EPs (even tho they know nothing)
3. The hard part of being primary care for the underserved to me is that it is painful is that the primary care they get is crappy. We can't (and don't wanna) follow up and tweak HTN meds, etc. A study recently found the #1 cause of death in the homeless to be chronic illness. Very frustrating (and %#$! you very much, Mr. Bush)!
4. Always being behind. With overcrowding the way it is, people are waiting for hours, and they often blame you. It also isn't very safe, of course.
5. It is a new field, still finding its place in academia. Though I am pretty confident EM will eventually become a powerful, research-rich department, its standing as an academic specialty is fledging compared with the need for its clinical contributions.

Note that many cons are just the flip side of pros. No field is perfect, but most should be able to find a pretty good approximation that makes them happy.
 
trisomy55 said:
You don't like being forced to treat the underserved... did you put that in your personal statement for your residency application?
Click to expand...

Try on the hat of an indentured servant under the nation's largest unfunded mandate, be forced to play PCP (something you're not trained for) because you're the only one who HAS to care for a pt that no one else WILL care for and see how your witty comeback feels.

EMTALA is our nation's way of easing our collective consciousness about piss poor access to health care and it is done on our (EPs) back. Look at Bush's face when he says everyone has access to health care...just go to an ER.

Being forced, by law, to give your services away for free while paying off massive education debt and paying large sums for malpractice protection against those you are caring for for free sucks. No need to get all high and mighty about it.

Take care,
Jeff
 
Hard24Get said:
5. No friggin' billing or social dispo to do :barf"
Click to expand...

Man, I truly wish that were the case. Every time I get a note telling my one of my charts was 'downcoded' because I didn't include enough systems in my ROS (a business reality we should all just accept and move on) I am reminded of how much we're involved in billing. I guess if we truly don't care about how much we make, we can ignore billing but I'd like to pay off some loans.

Social dispo... man, I wish. That's how I spent a pretty good chunk of last night...just me and my new favorite person, our social worker.

Take care,
Jeff
 
Jeff698 said:
Man, I truly wish that were the case. Every time I get a note telling my one of my charts was 'downcoded' because I didn't include enough systems in my ROS (a business reality we should all just accept and move on) I am reminded of how much we're involved in billing. I guess if we truly don't care about how much we make, we can ignore billing but I'd like to pay off some loans.

Social dispo... man, I wish. That's how I spent a pretty good chunk of last night...just me and my new favorite person, our social worker.

Take care,
Jeff
Click to expand...

fair enough, I guess I meant running a clinical office type stuff by "billing". I too have been schooled in the 10 ROS system. But I don't think the horrors of social dispo in the ED compares with rounding on the same patient on the IM floors for a month, meeting daily with SW, simply because they can't afford to go to a nursing home! :scared:
 
Hard24Get said:
But I don't think the horrors of social dispo in the ED compares with rounding on the same patient on the IM floors for a month, meeting daily with SW, simply because they can't afford to go to a nursing home! :scared:
Click to expand...

True, although I have certainly had to deal with the social issues of placement for a patient we couldn't get admitted and could kick out for more than one shift. Very rare at my place (thank God) but I suspect not all that rare in others.

As you point out, though, medicine certainly feels this pain more than we do. Yet another reason for choosing EM. 🙂

Take care,
Jeff
 
I am a med student considering EM. It is very interesting, and I can see myself doing this in my future.

The thing is, I don't know if I can see myself doing this when I am 50. How do most EP's feel after having practiced in these conditions for >25 years? What kind of a toll does the shift work take on you?
 
perilou said:
I am a med student considering EM. It is very interesting, and I can see myself doing this in my future.

The thing is, I don't know if I can see myself doing this when I am 50. How do most EP's feel after having practiced in these conditions for >25 years? What kind of a toll does the shift work take on you?
Click to expand...



I personally think call a few times a month as a 50 something year old would be MUCH worse. An internist or surgery person could barely pay the office electric bill if they work only 4-5 days each month at that time.

My take on my career is to be financially wise early, and kick it back as I age. I figure anyone can work 4-5 shifts per month when they are 50...and I would think you could just works days by then if you wanted to. Sure, you wont be getting rich working that few shifts, but hopefully you already have a very nice bank account and you are working not so much for money, but to keep your skills up and have something to look forward to doing....


I am just a PGY1, so I might be completely wrong...I'll get back to you in 20-30 years (gasp that seems like a LONG time from now).
 
EM_Rebuilder said:
My take on my career is to be financially wise early, and kick it back as I age. I figure anyone can work 4-5 shifts per month when they are 50...and I would think you could just works days by then if you wanted to.
Click to expand...
Great points. Saving as early as possible is important. Everyone should remember that money saved at 35 becomes way more valuable than money saved at 55.

I will offer one point of caution. The 60 yo EP who wants to slow down and only work a few shifts a months is fine but the ED is unpredictable. Even if you're only working one shift you can get crushed that shift, particularly if you're single coverage. I've seen some old guys who just can't pick up the pace when it really hits the fan.
 
One of the older docs at my hospital just left for another ED, where he was hired to do just fasttrack. He openly admits to not being able to handle very complicated patients anymore, but still wants to work.
 
bartleby said:
"Looks" can be deceiving. Making the effort to figure out what is wrong with someone is more challenging.




If you just give everybody what they want because you're afraid of getting stabbed, you aren't going to be much of a physician regardless of your specialty. Part of the reason that there are drug seekers in the first place is that too many physicians fail to appreciate the risks of prescribing narcotics with impunity. If you don't feel safe in your working environment, you need to find another job, not a another specialty.
Click to expand...


I know that looks can be deceiving, that was the reason I asked the question. Maybe I should have written that the patient "looks" like they shouldnt be there, but they really should.... Thats why I gave the example of the head bleed. In response to another poster saying that drug seekers are the easiest patients to manage, My intended question was, what if the "drug seeker" actually does have a legit problem?

As for the "getting shot" comment. I believe the term is hyperbole.
 
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