Chunkle

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Aug 14, 2010
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I am a MS 2 thinking about career choices and looking for some discussion.

After shadowing, talking to friends in different specialties, and browsing SDN, I've got a question regarding professional development in EM.

I came into medicine looking for a career ( a little bit more than a "gig"), a profession in which I can improve over the course of my life. For EM physicians out there who are 20+ years out, do you feel as if you are a better physician now than you were 5 years out? My number one priority is my family. I don't need a pat on the shoulder for a job well done, but what I do need is meaningful professional development. Please forgive my ignorance and generalization, but EM seems a bit superficial and mercenary as a career. 20 years into practice, will I know more and have professionally grown compared to the fresh attendings?

I also do realize practice setting influences the aforementioned concern: i.e. community vs academic. I tried searching for this topic, but can't seem to find too much information regarding it. If there are previous discussions, I would appreciate being pointed in the correct direction.
 
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deleted109597

20 years out, you're likely to be less well trained than a new attending. You'll probably have much better people/admin skills though.
Unless you plan on going into administration, politics, or building your own CMG or empire of FSEDs, there's little to no difference in a junior attending and senior attending. You're not part of a law firm, you're not going to make extra money for time in. If anything, on straight RVUs, you might earn less because you can't go as quick, or you might earn more because you know more about how the system works and you use it to your advantage.
If you want to get into organized medicine, ie ACEP, AAEM, AMA, etc, you will have ample opportunity. I would reckon less than 1% of practicing physicians actually participate in the machinations of these organizations. Sure, they go to the meeting, get the free CMG parties, etc, but they aren't part of the council, or house of delegates, or board.

Beyond that, I'm not sure what professional development means. Emergency medicine is by no means unique in this. Any generalist or specialist can go out and hang up a shingle, practice for 20 years, and never change.
 

Chunkle

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Aug 14, 2010
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Thanks for your reply. When I say professional development, the terms growth and improvement are emphasized.

For example, in general, the established surgical attendings here are better operators and possess further knowledge compared to an assistant professor. Being more efficient in the OR and widely published in their field makes them "further developed" than when they just finished residency. By no means do I have a strong urge to be a surgeon however...
 
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Angry Birds

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Dec 4, 2011
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20 years out, you're likely to be less well trained than a new attending.
I would say it depends on if you work in the community or in an academic center. I'm fresh out of residency and working at a small community shop, and I can say that I will often think to myself about my colleagues, "these guys don't know what they are doing" when I see their work-ups. This is due to them being so many years out of EM residency or being family medicine trained.

This may seem like a knock against community doc's... But, it's more of a warning to myself, since (1) I am one myself now, and (2) I'm sure there are community doc's who spend the time to stay on top of their game, reading journal articles, etc. They are the exception and should be commended for their effort. I'm sure a lot of community doc's on SDN fall into this category.

The truth is that people tend to practice exactly as they learned in residency. I know I do this. The meds I used in residency I still use as an attending even though here other meds may be more common, and I might get a quizzical look from a nurse when I ask for "Ketamine" for instance. Even with antibiotics, I'm using Levaquin, Zosyn, Vanco, etc. for instance, and never Invanz. In fact, when my colleague used Invanz and I took over care of the patient, I had to look up WTF Invanz is. Then, I realized everyone is using it here. It's probably not wrong and just a different antibiotic choice, but since I don't have practice with it, I don't use it.

Anyways, I'm on top of my game now, but I fear that in 20+ years I'll still be using meds and treatment patterns that I learned in residency, thereby dating myself.

On the other hand, I recall my attendings in residency, most of them were on top of the latest and best... And the ones who had 20+ years experience as academic doc's are definitely better doctors than me. I know this since if I had a tough case I'd trust their opinion on what to do if I called them (which I don't though).
 
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BoardingDoc

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Even with antibiotics, I'm using Levaquin, Zosyn, Vanco, etc. for instance, and never Invanz. In fact, when my colleague used Invanz and I took over care of the patient, I had to look up WTF Invanz is. Then, I realized everyone is using it here.
If your hospital is consistently using carbapenems for infections which can be treated with levaquin, those doctors are doing a horrific job when it comes to antibiotic stewardship.
 

Angry Birds

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^ BoardingDoc, that's what I thought when I looked it up and fount out it was a carbapenem!

I even asked the doc why he used such a heavy duty antibiotic, and he didn't give me any good reply. But, I've seen at least a couple docs here using it, so I shrugged it off...But, your comment makes me think my initial reaction was justified.

I'm half the age of the other doc's here, so I don't really "correct" anyone. I just do my thing. My fear though is that in twenty years I'll turn into a dinosaur like them.
 

Hair Police

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The way to guard against this is to be in academics, develop a niche, and use those around you - experienced clinicians with their own areas of expertise - to help you stay as current as possible.

That's the point of academics - to create and disseminate knowledge and research to the community.
 
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Birdstrike

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Dec 19, 2010
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I am a MS 2 thinking about career choices and looking for some discussion.

After shadowing, talking to friends in different specialties, and browsing SDN, I've got a question regarding professional development in EM.

I came into medicine looking for a career ( a little bit more than a "gig"), a profession in which I can improve over the course of my life. For EM physicians out there who are 20+ years out, do you feel as if you are a better physician now than you were 5 years out? My number one priority is my family. I don't need a pat on the shoulder for a job well done, but what I do need is meaningful professional development. Please forgive my ignorance and generalization, but EM seems a bit superficial and mercenary as a career. 20 years into practice, will I know more and have professionally grown compared to the fresh attendings?

I also do realize practice setting influences the aforementioned concern: i.e. community vs academic. I tried searching for this topic, but can't seem to find too much information regarding it. If there are previous discussions, I would appreciate being pointed in the correct direction.
There is no specialty in Medicine where you cannot keep learning if you want to. There are enough journals and scientific papers coming out on a regular basis, you can, and now are expected to as a part of board certification, continue learning throughout your career.

There is no specialty where intellectual stagnation is the fault of the specialty. That can only be the fault of the person. There is such a vast amount to know, beyond what one could ever know in Medicine, especially Emergency Medicine since it covers all areas, to ever come even remotely close to knowing it all. I'm 15 years post-medical school graduation, board certified in a specialty and subspecialty and the amount I could attempt to learn still, if I wanted to, is mind blowing. That being said, 15-20 years in, you definitely can get to a place where you know enough to just phone it in and see it as a job if you want to. But again, that's person dependent, not specialty dependent.
 
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Arcan57

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I'll go against the grain a little bit on this one.

I think there is definitely a difference in my skills and abilities as a doc compared to when I left residency. Now if you compare my knowledge base with that of someone that had the benefit of 8 more years of medical advances, they're going to be more up then I am on recent advances in the high acuity/low incidence diseases. Off the top of my head, I've never had to give push dose pressors due to concerns for hemodynamic collapse during intubation, never had a calcium channel blocker OD severe enough to break out HIE tx, or given Intralipid for lipophilic med ODs.

Compared to when I finished residency, I'm significantly better at picking up who to work up for the more common life-threatening diseases. This tends to be subtle from a clinical standpoint because it's much easier to identify the false negatives (ie your M&M cases) than to demonstrate improvement in your true negatives. Of course we as a specialty devalue clinical gestalt (a topic I've touched on previously and probably deserving of its own thread), so I'm not surprised people make the assertion that there isn't much difference between a junior and senior attending. But if you (individually) are not better 5 years into the game compared to the day you came out then something has gone horribly wrong.
 
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