Programs with emphasis on social EM

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mango135

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Hey! I’m an applying MS4 this year and am interested in programs that emphasize social EM or public health. Does anybody know of any besides BMC, Stanford, Tenple? This doesn’t have to be an explicit track but I guess just something the institution has an interest in. Thanks!
 
mango135 said:
Hey! I’m an applying MS4 this year and am interested in programs that emphasize social EM or public health. Does anybody know of any besides BMC, Stanford, Tenple? This doesn’t have to be an explicit track but I guess just something the institution has an interest in. Thanks!
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What's "social" EM?

It made me think of performing the Heimlich in a restaurant or delivering a baby on an airplane. Maybe even splinting a kid's colles' fracture after he gets thrown from a camel at the local fair with a splint made out of corndog sticks.

I'm dying to see a social EM curriculum. It sounds fun.
 
Groove said:
What's "social" EM?

It made me think of performing the Heimlich in a restaurant or delivering a baby on an airplane. Maybe even splinting a kid's colles' fracture after he gets thrown from a camel at the local fair with a splint made out of corndog sticks.

I'm dying to see a social EM curriculum. It sounds fun.
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Yeah, like "kicked in the balls" fun. Every damn day is social in the ED. And I'm not a social worker or public health worker, beyond telling people to wear a condom and at least know the name of who you are screwing.
 
I think your programs tied in with large universities with MPH programs and the resources for significant extracurricular outreach is probably the best place to start looking. Of the programs I rotated at as a student I would say maybe LSU-NO had the most prominent "social" focus.

I'm still very new to the whole being a resident thing but I'll say that these kind of extracurricular bells and whistles that some programs advertise can be a distraction. It will be very hard this year with all the COVID restrictions, but generally I'd advise an M4 to make decisions based on whether they think a program's training sites offer sufficient acuity and experience to prepare them extremely well for life after residency followed shortly by how happy are the residents and are they the kind of people you'd enjoy spending the next 3 years with.
 
I disagree with the idea that every county program has "Plenty of Social EM" - every county program has plenty of OPPORTUNITIES for social EM, but only a select few come to mind for true FOCUS on Social EM.

In the IDEALISTIC sense - Social EM is compassion and learning how to be energized by the "challenging" patient rather see them as "hopeless" or "junkies" as described above.

In the very LITERAL sense - Social EM can be seen in residency programs that focus on issues like making Medication Assisted Treatment (with buprenorphine or naltrexone) a part of your skillset. You have to not only care, but you have to have the skillset to appropriately treat addiction, and you have to have a program that FOSTERS the learning space to learn this and not just treat it as "not emergency not my problem." Other literal Social EM programs is seeing what sort of research the EM program does - do they only do ultrasound research? Or, do they have attendings and senior residents who are investigating intimate partner violence, immigration and its affects on healthcare, substance use, and similar topics.

While there are many crispy folks in SDN, I think there are also folks who, like me, want to change healthcare in a broader sense, and believe that we can do that through Emergency Medicine (e.g. Social EM). Whether it be a direct change in your particular department, or whether your residency inspires you to be a public health leader on a national scale, there are MEANINGFUL ways that Social EM impact health that is not just "hopeless junkies."

In terms of programs, I'm sure there are TONS that I am leaving out, but the ones that come to mind readily are USC-LAC, BMC, Stanford, Highland, Temple, to name a few.
 
Your best bet for this info is to reach out to the EMRA Social EM Committee for guidance. Salty SDN people are likely not your crowd.

Programs that come to mind are: LSU, Mount Sinai, USC, BMC, MGH, UCLA, UIC, and Stanford. Basically, the bigger the name and class size, the more opportunities exist.

If you have questions about what social EM is, I also recommend connecting with EMRA or the ACEP committee depending on where you are in your career.

EMRA Social Emergency Medicine Sub-Committee

The Social Emergency Medicine Committee is focused on integrating social determinants of health, social justice, and advocacy for the underserved into the specialty of emergency medicine. Social determinants of health include issues such as homelessness, food insecurity, care for linguistic and...
www.emra.org
 
mango135 said:
Hey! I’m an applying MS4 this year and am interested in programs that emphasize social EM or public health. Does anybody know of any besides BMC, Stanford, Tenple? This doesn’t have to be an explicit track but I guess just something the institution has an interest in. Thanks!
Click to expand...

Here’s a thought: to to the place that will teach you to be the best ER Doctor.
 
EM_kindaguy said:
In the IDEALISTIC sense - Social EM is compassion and learning how to be energized by the "challenging" patient rather see them as "hopeless" or "junkies" as described above.
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Do you know what it means to be "tilting at windmills", or, do recall the story of Sisyphus? Why do you think that some of us are "crispy"? What year are you?

Your post implies (or states outright) that the more experienced of us sees these patients as "hopeless" or "junkies", but I read that your insult is that we just stop there. Pro tip - we don't. We continue to treat these pts the best we can, including those like above, who leave AMA after we bend over backwards to help them - again. And again. And again. And, again.

If you are "energized" by socially challenging pts, who would "bite the hand that feeds them", then your partners will lay down the red carpet for you to see them. And, if that doesn't burn you out, you are, possibly, one of the following: a saint, some sort of mentally ill, or (as a subset) a sociopath.

I hope you keep your idealism, but, don't disparage those that are ahead of you, for your fate likely lies in the same vein. It has happened to EM docs, sequentially, for years, after years.
 
Anything not related directly to your emergency department shifts/learning/procedures is a waste of time. All that extra bs programs try to sell is nonsense. You can waste your time as attending with that instead. Wait until you actually see the patients you think you're going to be seeing. 90%+ don't give a damn about you and even if you do a million dollar workup will still be ungrateful.
 
mango135 said:
Hey! I’m an applying MS4 this year and am interested in programs that emphasize social EM or public health. Does anybody know of any besides BMC, Stanford, Tenple? This doesn’t have to be an explicit track but I guess just something the institution has an interest in. Thanks!
Click to expand...

You are a good person. I’ve heard that Dr. Goldfrank at Bellevue would always ask the presenting resident “what is the lesion in the medical system that led to this visit?”

My thinking has never been that evolved. I would’ve been like “I dunno sir, but they have alcoholism now and he’s floridly intoxicated with a head lac. Needs tetanus, wound repair, CT etc”

Don’t be like me. Change the world.
 
It can be so easy to predict what will trigger the SDN EM forum.

Glad you got some real answer, OP. The majority of residencies, particularly ones established enough to have a Social EM resources available for you, are going to provide great clinical training. If this is a passion of yours, having some opportunities to pursue it and being around at least some people with similar personalities and ideally at an institution with similar values will make residency a better experience. Focus on the individual mentors that will be available, what projects they are involved in, and what type of institutional support they get in terms of funding, buy-down, etc. That will give you a good idea of how much that institution really values the work.

Residency is miserable enough without being surrounded by people with a totally different outlook on medicine and life.
 
DeadCactus said:
It can be so easy to predict what will trigger the SDN EM forum.

Glad you got some real answer, OP. The majority of residencies, particularly ones established enough to have a Social EM resources available for you, are going to provide great clinical training. If this is a passion of yours, having some opportunities to pursue it and being around at least some people with similar personalities and ideally at an institution with similar values will make residency a better experience. Focus on the individual mentors that will be available, what projects they are involved in, and what type of institutional support they get in terms of funding, buy-down, etc. That will give you a good idea of how much that institution really values the work.

Residency is miserable enough without being surrounded by people with a totally different outlook on medicine and life.
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I don’t think it’s that anyone is triggered. I think it’s that everyone here realizes the OP is placing things that are secondary (and largely just for the feels) over what should be more important at this point in his or her career.
 
When I saw the OP I hadn’t heard of “the emerging field of ‘social EM.’” So I went to ACEP’s website and read about it. My first impression is it should be renamed, “Social Decay EM.” I’m interested in learning more about it.
 
TimesNewRoman said:
I don’t think it’s that anyone is triggered. I think it’s that everyone here realizes the OP is placing things that are secondary (and largely just for the feels) over what should be more important at this point in his or her career.
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I disagree. Everytime someone asks for recommendations on good programs, this forum breaks out the "all ACGME accredited programs are great, go for fit" party line (granted now there is an asterisk for the CMG programs). If they asked about programs with good skiing, people would trip over themselves with recommendations. But suddenly a student's priorities are wrong because they're looking at programs like Baylor and Stanford for a focus on something they are interested in. I'm sure everyone's just so worried about the quality of clinical training at major academic centers.

This forum frequently responds negatively to people with goals other than make as much money for as few hours of work as possible and I would refer you not just to this thread but any thread on living in desirable cities, 4 year residencies, or the majority of fellowships if you disagree.
 
southerndoc said:
I think it's learning to take better care of your disorderly intoxicated patients that visit 3 times per week.
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Gourmet turkey sandwiches with fresh ingredients made by the interns. Brought over on a silver platter with some diet coke on ice.
 
DeadCactus said:
I disagree. Everytime someone asks for recommendations on good programs, this forum breaks out the "all ACGME accredited programs are great, go for fit" party line (granted now there is an asterisk for the CMG programs). If they asked about programs with good skiing, people would trip over themselves with recommendations. But suddenly a student's priorities are wrong because they're looking at programs like Baylor and Stanford for a focus on something they are interested in. I'm sure everyone's just so worried about the quality of clinical training at major academic centers.

This forum frequently responds negatively to people with goals other than make as much money for as few hours of work as possible and I would refer you not just to this thread but any thread on living in desirable cities, 4 year residencies, or the majority of fellowships if you disagree.
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You are using poor logic. You are conflating what you do during your working hours and what you do when you’re off. If what you want to do is ski when you’re off, great. But if you want to replace part of a residency curriculum with some nonsense, I have a problem with that. And before you argue that you’re augmenting, not replacing, realize that time is limited and fungible.
 
OP I’m not EM so I don’t have a specific program recommendation, but I just thought I’d respond since you’re getting a lot of negative feedback.

I have several EM friends and colleagues that work in public health in different capacities so seem to fit the "social EM” path you’re looking for. So if that’s what you want to do then don’t feel discouraged and I hope you can find some good mentors.
Best of luck to you!
 
AMEHigh said:
OP I’m not EM so I don’t have a specific program recommendation, but I just thought I’d respond since you’re getting a lot of negative feedback.

I have several EM friends and colleagues that work in public health in different capacities so seem to fit the "social EM” path you’re looking for. So if that’s what you want to do then don’t feel discouraged and I hope you can find some good mentors.
Best of luck to you!
Click to expand...

I’m not trying to discourage him or her; I’m simply saying there is a time and a place for things that are auxiliary - and that time and place is outside of residency. If you want to donate your time by doing a fellowship, go for it, but don’t sacrifice learning to be a great EP to do whatever it is you want to do. If you want to do something as an attending with your free time, you can (and likely without any additional training).

And this is coming from someone who is fellowship trained. I’m boarded in CC. I didn’t waste my precious little time in residency learning CC (beyond that which is directly applicable to EM). In residency, I learned to be an exceptionally good ER doc and very little else.
 
TimesNewRoman said:
You are using poor logic. You are conflating what you do during your working hours and what you do when you’re off. If what you want to do is ski when you’re off, great. But if you want to replace part of a residency curriculum with some nonsense, I have a problem with that. And before you argue that you’re augmenting, not replacing, realize that time is limited and fungible.
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Seems like a non sequitur to me. If we're going with the time is limited and fungible model, then skiing takes as much away from the curriculum as social emergency medicine. No one should do anything during residency then but work shifts, sleep, eat, and work more shifts. There is clearly some amount of time in residency for things other than clinical shifts. Some people spend it drinking and watching sports, some people do research, some people get outdoors, come people get into social medicine. Most people do a combination of things.

The reality is that any of these residencies is providing great clinical training and most (if not every) residency has opportunities to develop skills and knowledge away from the bedside. Research, wilderness medicine, language electives. away rotations internationally, mass gathering events, disaster medicine, etc. Experiences and education in settings other than at the bedside are not new and are well accepted as ways of enhancing a person's education. The idea that some phantom residency is out there starving people of intubations and forcing them to work in some social medicine acid mine is a straw man.
 
DeadCactus said:
Seems like a non sequitur to me. If we're going with the time is limited and fungible model, then skiing takes as much away from the curriculum as social emergency medicine. No one should do anything during residency then but work shifts, sleep, eat, and work more shifts. There is clearly some amount of time in residency for things other than clinical shifts. Some people spend it drinking and watching sports, some people do research, some people get outdoors, come people get into social medicine. Most people do a combination of things.

The reality is that any of these residencies is providing great clinical training and most (if not every) residency has opportunities to develop skills and knowledge away from the bedside. Research, wilderness medicine, language electives. away rotations internationally, mass gathering events, disaster medicine, etc. Experiences and education in settings other than at the bedside are not new and are well accepted as ways of enhancing a person's education. The idea that some phantom residency is out there starving people of intubations and forcing them to work in some social medicine acid mine is a straw man.
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Now I remember why I logged off SDN for the past month.
 
People trash me for having done a Pain fellowship. But it’s been great for me. I’d do it over again 100 times and I’m 10 times happier and it’s reduced my stress and burnout to a negligible 2% of what it used to be. If a “Social EM” residency or fellowship floats your boat, go for it. I’m of the opinion that any skill you can add to your talent stack increases your enjoyment, marketability and longevity in EM. And yes, often on this forum many of us are unnecessarily harsh at times. But don’t be discarded. For every 100 garbage post you have to throw out, you’ll come across one that’s also free, but worth gold. Stick with it, @mango135.
 
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Apollyon said:
Who? Who has trashed you? If anything, it's sheer jealousy. Any of us that can get out of the pit, good on ya!
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It’s rarely overt trashing of me personally, to my face. It’s usually in the form of, “Pain? Uhaghh. I’d rather stab needles into my eyes and eat fish guts than do that!”

It’s sort of like, “Yeah, your new girlfriend? She’s great. Yeah. For you, I mean. She’s great for you. But man, I couldn’t...No, just no. I couldn’t. I’d rather drink gasoline than...oh, forget it. Did I say how great she was? Good for you, man.” 😆

But, I don’t take it personally. I find it kinda funny. It’s all good. What works for me, works for me. I don’t care what anyone else says.

Cuz I’m chillin at a rockin’ lake house in the NC mountains right now, for the next week. Life is good.😎
 
Birdstrike said:
It’s rarely overt trashing of me personally, to my face. It’s usually in the form of, “Pain? Uhaghh. I’d rather stab needles into my eyes and eat fish guts than do that!”

It’s sort of like, “Yeah, your new girlfriend? She’s great. Yeah. For you, I mean. She’s great for you. But man, I couldn’t...No, just no. I couldn’t. I’d rather drink gasoline than...oh, forget it. Did I say how great she was? Good for you, man.” 😆

But, I don’t take it personally. I find it kinda funny. It’s all good. What works for me, works for me. I don’t care what anyone else says.

Cuz I’m chillin at a rockin’ lake house in the NC mountains right now, for the next week. Life is good.😎
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Hot chicken Italian sausage with onions and homegrown peppers (from our yard) today! Hell YEAH!
 
"Social EM"?

Are you kidding me?

The worst part of my job was the "social services" factor.
Here's a nursing home transfer: make four phone calls to get them out of your department.

STFU.
 
EtomidateAndSux said:
Hey, don't knock on sociopaths! Sociopaths make some of the best EM physicians by their inherent ability to stay emotionally detached and project charm and charisma on-the-fly. The lack of empathy/compassion/ability to form attachment (as long as it is well-masked by superficial charm) is, in the long run, advantageous to medical-decision making as it ensure that all patients with a given complaint will be treated more or less the same. Their ability to manipulate and exploit in order to accomplish a goal/task is a strategic asset for dealing with bull**** psych cases/patients who come to the ED only for a social visit, and in general translates well to the move-the-meat mantra of the ED.
Click to expand...

You've done a great job of describing David Newman.
 
TimesNewRoman said:
I don’t think it’s that anyone is triggered. I think it’s that everyone here realizes the OP is placing things that are secondary (and largely just for the feels) over what should be more important at this point in his or her career.
Click to expand...
But maybe, just maybe we should prioritize "just for the feels"?
 
I trained at UCSF/SFGH and feel that it's a very social mission-driven training program along with providing excellent training generally. Highland, LA County/USC and Harbor felt similarly mission-driven when I interviewed at their programs, and NYU/Bellevue is where Goldfrank arguably originated the concept. I did not interview there though I know several attendings who trained there and would say it's a great place to be exposed to that sort of environment and to train.

Obviously my experience is very west-coast focused. As other posters have said, if you are interested in taking care of the destitute and marginalized you will see that in every program and any program that prepares you to be a good emergency physician will prepare you to work with these populations. Some will expose to more extreme varieties or quantities of marginalized populations (e.g. SFGH), and some will be actively doing a lot of research focused on these populations and allow you to get involved in such research, but they'll all provide adequate training to go and help take care of these folks.

For those who are asking "What is social emergency medicine?" One of my more thoughtful attendings and Lewis Goldfrank wrote a nice piece last year in Annals that you can read for free here that tries to answer this question.
 
The big problem with "social EM" compared to lets say "international or wilderness medicine" is that its not actually a subspecialty of EM.

If you're interested in the social aspects of EM patients that's great but social work is a completely different field with its own degree program.

Now if you really just want to help care for homeless substance abuse patients you'll get this experience at any county hospital and you can certainly help with creating outreach programs for these types of patients but just realize that your job as an emergency physician involves providing emergency medical care not drug rehab counseling for 30 minutes while there are still 30 patients in the waiting room.
 
Reading this thread doesn’t leave me with the impression that the forum actually understands social emergency medicine anymore than it understands being a pain specialist. All the more reason to look for a program with mentors that can actually provide meaningful guidance on whatever your career interests might be.
 
DeadCactus said:
Reading this thread doesn’t leave me with the impression that the forum actually understands social emergency medicine anymore than it understands being a pain specialist. All the more reason to look for a program with mentors that can actually provide meaningful guidance on whatever your career interests might be.
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I believe you are correct, but, where does one find a substantial description of it? I shall be first to admit that I am not Potter Stewart, and I don't "know it when I see it". When I had a legitimate question of what "defund the police" means, someone responded with an editorial cartoon. That clarified it somewhat, as redistribution of government money. However, as I say, what does "Social EM" even mean? Who can, again, substantially, define it?
 
Apollyon said:
I believe you are correct, but, where does one find a substantial description of it? I shall be first to admit that I am not Potter Stewart, and I don't "know it when I see it". When I had a legitimate question of what "defund the police" means, someone responded with an editorial cartoon. That clarified it somewhat, as redistribution of government money. However, as I say, what does "Social EM" even mean? Who can, again, substantially, define it?
Click to expand...

I think (I surely don't know) that those pursuing Social EM broadly want to be mentored on how to use their medical expertise (or simply their gravitas) to take effective action (usually legislative) to address the systemic societal problems that lead to many of the terrible situations that end up in the ED on the regular. As such, it's nebulous out of necessity.

If I'm right, then it's nicely at home with a number of other fellowships (like the one I did) in that your extra effort and expertise will be rewarded with a pay cut. I suspect that won't be a strong deterrent to most who are interested in its pursuit.
 
WilcoWorld said:
I think (I surely don't know) that those pursuing Social EM broadly want to be mentored on how to use their medical expertise (or simply their gravitas) to take effective action (usually legislative) to address the systemic societal problems that lead to many of the terrible situations that end up in the ED on the regular. As such, it's nebulous out of necessity.

If I'm right, then it's nicely at home with a number of other fellowships (like the one I did) in that your extra effort and expertise will be rewarded with a pay cut. I suspect that won't be a strong deterrent to most who are interested in its pursuit.
Click to expand...
Thank you for the clarity. I think, though, that those ideas that you crystallized a bit are, by nature, antithetical to EM, because EM training and practice is one patient at a time - it is necessarily micro. Systemic problems, are, by definition, macro problems. When the "family plan" comes in, we have to examine every single patient, even if they will all have the same dx of "URI", even though, to be very frank, we are trained and experienced enough to know the diagnosis without examining all of them. But, that's where the "devil is in the details". Someone who wants to be in "Social EM" would be better served with an MPH or MSW. It's like being the arsonist and the firefighter (stole that from last night's rerun of "Blue Bloods"). You can't, with fidelity, sell bullets and bulletproof vests. "Social EM" is trends, and "trends" are not individual patients, which is for what we specialize for 3-4 years, and practice after that.
 
Apollyon said:
Thank you for the clarity. I think, though, that those ideas that you crystallized a bit are, by nature, antithetical to EM, because EM training and practice is one patient at a time - it is necessarily micro. Systemic problems, are, by definition, macro problems. When the "family plan" comes in, we have to examine every single patient, even if they will all have the same dx of "URI", even though, to be very frank, we are trained and experienced enough to know the diagnosis without examining all of them. But, that's where the "devil is in the details". Someone who wants to be in "Social EM" would be better served with an MPH or MSW. It's like being the arsonist and the firefighter (stole that from last night's rerun of "Blue Bloods"). You can't, with fidelity, sell bullets and bulletproof vests. "Social EM" is trends, and "trends" are not individual patients, which is for what we specialize for 3-4 years, and practice after that.
Click to expand...

I'd like to again flag that I may not know what I'm talking about here.

With that out of the way...it's really hard for me to see how a Social Medicine fellowship would be superior to going to a good law school.
 
Apollyon said:
I believe you are correct, but, where does one find a substantial description of it? I shall be first to admit that I am not Potter Stewart, and I don't "know it when I see it". When I had a legitimate question of what "defund the police" means, someone responded with an editorial cartoon. That clarified it somewhat, as redistribution of government money. However, as I say, what does "Social EM" even mean? Who can, again, substantially, define it?
Click to expand...

I can only give you my take on it, speaking form no more authority than any other emergency physician. Let's draw a parallel to EMS. Providing occasional online medical direction and providing on-the-spot feedback and education to EMS crews is a small but inherent part of being an emergency physician. Some physicians invest in being above average at these skills. Some invest in going beyond and being medical directors of small agencies or hospital liaisons. Some people even decide to devote large portions of their career to it. They seek formal training, take leadership roles in major organizations, conduct research, and train others to perform their roles in the EMS system better. We recognize that physicians are not paramedics or EMTs and that the practice of prehospital care is different from the practice of medicine in the emergency department. We recognize that staffing ambulances with physicians is generally inefficient. But we also recognize that by combining their medical knowledge, experience in the emergency department, and complementary experience in the EMS setting, emergency physicians bring valuable insights that improve the way our patients get to us. When trainees show an interest in this area, we foster their career development with opportunities to get involved as a resident.

Taking a social history is part of every patient encounter and frequently guides treatment and disposition decisions to avoid needless bounce backs or treatment failures. Some people work to be above average at collecting and utilizing this information. Some people start programs in the emergency department to tackle a particular shortfall or become particular advocates for things like addiction medicine, domestic abuse, and human trafficking interventions in the emergency department. Some people really focus their career on social medicine. They gain an education and exposure to the world of social workers, policymakers, and social programs. EMS combined expertise in emergency medicine with exposure to prehospital systems to improve the way patients get to us and the overall performance of the emergency healthcare system. Social emergency medicine combines emergency medicine expertise with exposure to the world of social work to identify patients who never should have had to come to the emergency department and the close the holes in the safety net that got them there. It's no more being an overtrained social work than being an EMS physician is being an overtrained EMT. No, it shouldn't make up the majority of a residency curriculum any more than EMS should but there is certainly time in residency to foster a trainees interest and give them a starting place.

We can't have it both ways. We can't complain about safety net patients using ED resources and then hassle people who want to keep them out of the ED. We can't wine about physician leadership of the healthcare team and then act like systems and society level issues are outside of what we should be doing. Ultimately, Social EM is the yin to EMS's yang. EMS brings patients in. Social EM keeps patients out. Abdicating our role as the ultimate experts on who should have been able to be kept out of the emergency department and how to do it is just another slide down the slippery slope of lost authority our profession has been fighting against.
 
Mistake one here was clearly OP posting this on the SDN EM forum. May as well be asking about liberal politics at the GOP convention. A fairly simple question turning into a discussion, among other things, about how social EM should not exist. In case no one has said it, Highland is big on social EM and I was super impressed with their emphasis when I interviewed there a few years ago. And agree 100% with looking for/researching programs with potential mentors or active research in this field. Don't be fooled into thinking every county place will have this for you, and even if they do have these things, make sure you like the rest of the program. Good luck!
 
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