Question for ER residents

[Teufelhunden]

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How does ER residency compare, life-style wise, to GS and IM? As an MS-III who's very undecided, I have to admit I'm being affected by the negativity of the posts over on the IM and GS forums. It seems that residents are absolutely miserable 24 hours a day. I'm not sure I wan't to be that miserable (?)

I just got off of an FP rotation, and pretty much hated it. Some of the medical issues were intersting, but the majority of time was devoited to talking and listening. For some reason, a majority of FP patients just want to talk and talk and talk....I simply can't do this. I didn't go into medicine to sit around and talk with old ladies.

So, it seems that the choices presented to me are either "interesting and miserable" or "boring." Of course, there is a third category of fields out there...the one's I don't have a snowball's chance in hell of getting into (i.e. derm, EENT). I'm an osteopathic student w/ slightly above average COMLEX scores (USMLE results not back yet)...so I don't even really entertain these fields.

For some reason, ER just completely slipped my mind as a possibility. I know it's competitive, but not like derm, rads, eent, etc.

It seems that ER would cut down on all the mundane chit-chat that occupies so much of an FP's day. I guess my question is...what's the residency like? How does it compare to GS and IM in terms of misery?

I know....a million people have posted something to the effect of "Residency's don't last forever...don't base your decision on how miserable the residency is." Well...whatever...I'm going to....I just don't have to desire to be a miserable zombie for 4-5 years...call me crazy.

Anyway....just trying to get an idea of how ER residencies compare to others in terms of hours, malignancy, etc.

I'd appreciate any feedback y'all can give me. Thanks.

Terminally undecided in Ohio,

kevin

 

[Apollyon]

I was a paramedic before becoming a doc, and the feature of EMS, and EM, is shift work. Whereas in IM there's a LOT of "hurry up and wait", EM happens now, and is over pretty fast, on to the next patient. It is busy enough that the RRC has limited shifts to 12 hours each (vs. the 24 hours, with 6 for teaching/pt. turnover for IM/FP/Sx). That said, the volume can be heavily towards back pain for months, cough, and abdominal pain, but you put up with those to get the more technically or educationally interesting, or rare cases. For me, also, the patient contact is great, and dynamic - like the best part of clinic, without health maintenance.

I liken EM to a golf course. A lot of cases are putt-putt. Bigger ones, we just have to stay on the fairway, and get to the green. On occasion, we will hole out, but just being on the green is good enough - surgeons and IM docs (or other specialists) will come in to putt, once we've gotten the ball (patient) there.

As a residency, it's still not as malignant in general as many other programs. When you're done with your shift, you're done. There's always continuity, and your coworkers in your local area - always. No paging and waiting, and missing someone, and trying again. This may happen with the consultants, but your team is always there, as you are (even if you go to the can or get lunch, you'll have the phone, or you'll have your patients covered for those 5 minutes).

Of course, every doc spins this question to suit them; one guy who was prelim with me was going to ophtho, and linked EVERYTHING to retina surgery...umm, no. You get the rads nuts, and the ENT guys who are CRAZY about the head and neck. Then, there are the myriad others, and EVERYONE LOVES their own program, and can't believe everyone else in the whole world isn't all fired up about it - that's just the gist...to find a field where you are the same way. Every day of surgery was hell for me, and psych was the copilot of that plane.

But, for EM, residency isn't too bad, even at the worst places, since every day ends, and, as an attending, you work as much as you want ($$$) or as little - 3 8 hour shifts a week lets you see the kids to or from school, and have solid days off with them, and you still make some pretty righteous bucks (if you're not extravagant). And, again, when you're done, you're done. No call.

 

[DrQuinn]

I second what Apolly said...

The residency isn't bad. My internship involves three months of medicine, 1) Ward, 2) MICU, 3) CCU. Obviously on those months I am functioning as a medicine intern, i.e. 90+ hrs a week. Those months definately suck... but it reminds me why I love EM so much... I love coming back down to the ED... its more like home... I see the other EM interns doing their EM months, they are full of energy, having only been in the ED 6 hours, and only have 6 more to go... where as I, as a "functioning" medicine intern, still have 20+ more hours to go!

Q, DO

 

[mikecwru]

Originally posted by QuinnNSU
I second what Apolly said...

The residency isn't bad. My internship involves three months of medicine, 1) Ward, 2) MICU, 3) CCU. Obviously on those months I am functioning as a medicine intern, i.e. 90+ hrs a week. Those months definately suck... but it reminds me why I love EM so much... I love coming back down to the ED... its more like home... I see the other EM interns doing their EM months, they are full of energy, having only been in the ED 6 hours, and only have 6 more to go... where as I, as a "functioning" medicine intern, still have 20+ more hours to go!

Q, DO

I have been calling them "career affirmation" months.

mike

 

[jazz]

what's the residency like? How does it compare to GS and IM in terms of misery?

each residency varies depending on the number of shifts per month and length. in terms of hours, the worst er residency does not compare to gen surg in terms of hours. you never have longer than 12 hour shifts (granted you can be standing and busy all 12 hours). for me that also beats having extra time to go to the library to wait around for chart checking. it does take a certain personality to survive the er. if you don't want to deal with needy patients who misuse the emergency services, don't go into er. of course, you'll see you frequent pain medication seeking patients, but hey, depending on you mood you can give then a percocet/vicodin or not. the good thing about er, is you don't really care if they come back (unlike in private practice). also,the little ol' ladies, you don't end up talking to them forever like in FP because you just don';t have enough time and again you're not relying on them to come back.

i know that sounds cynical but it is true.

for residency, i know i that there were many times when i would work a shift, go home, go out for dinner, sleep and then come back for my next shift and the same surgery residnets are still on.

i don't like rounding for immense periods of time. there is less discussion in the er -- your differential includes things likely to kill someone. unlike in medicine, where all the zebras show up on the list.

anyhow, i'm grateful for all those who chose surgery, medicine, psych and every other field b/c i know i couldn't do it and someone needs to.

do a rotation in er and if you love it, than i would go into it.

 

[Med4ever]

How are Em docs paid, salary or per hour. Also are Em doc permitted to work for a few weeks then take off a few, unlike in surgery i can imagine where you must have a standard time you are avalible. Also, I believe I was misinformed I was under the impression that Em doc made only a bit more the Fm/GP is that accurate.

 

[Sessamoid]

As one of the few EM docs here in private practice (I think, there may be more on and off), I'll give you my opinion FWIW.

EM residency is far less unpleasant than either IM or GS residencies, IMO. The hours are clearly much better, and there isn't as much "crap time". I define crap time as waiting around for clinic to start, waiting for surgery to start, waiting for the anesthesia to wear off, rounding, rounding, and more rounding. When you're working, you're moving and always seeing patients and doing stuff. For those of us born with a painfully low attention span, this is the perfect field.

The worst part about EM residency is the off-service rotations. "Career-affirming months" is the best description I've ever heard for them. Practically all the off-service rotations (OB, trauma, IM wards and ICU, peds, anesthesia, surgical ICU, etc) were useful, educational, relevant to my future practice, and UTTERLY PAINFUL AS GETTING STABBED IN THE EYE REPEATEDLY WITH A SHARP STICK. The amount of time it took to get sick of the off-service rotation and long for the ER varied from a few weeks on trauma (at the long end) to halfway through rounds on the first day of medicine wards.

My program did 19 x 12 hour shifts / month in first year, 18 x 12 hour shifts / month in second year, and 17 x 12 hour shifts / month in third year. I think that comes out to be pretty much average for EM residency programs, with some coming in a bit above and some a bit below. There is very little variation in the number of hours worked between EM residency programs, as the RRC for EM is pretty strict about this. This doesn't include some lecture hours which take up about 5 hours per week. If you happened to be scheduled to work that day, you were excused from the ED during the lecture period and you worked 5 hours less.

Our class (and pretty much all of those I worked with) were pretty cheerful folks. We were generally happy to be working where we were and doing what we were doing.

EM work schedules in the private world are about as variable as you could imagine. You can probably find a work schedule to fit almost anything. I know docs that work seven on, then seven off. Some prefer only nights. Some take a few months off a year. Most of us work rotating shifts, generally 8-12 hour shifts, though longer shifts are seen in rural EDs in which you can usually get some sleep in the night shifts, generally no more than 4 or 5 days in a row.

As far as salary goes, I don't really know how much FPs get paid for sure, but I've always had the impression that EM makes a good deal more than FPs and general internists. I have two relatives that are FPs, and I'm pretty sure I make a good deal more than they do. I'm also pretty sure I'm not making as much as my cousins who are plastics/oral and ophtho surgeons. There are exceptions on both counts of course, but I think we generally fall between medicine and surgery in pay. In pay per hour worked, we're probably comparable to gen. surgery and some of the surgical subspecialties. I imagine I could make as much as some of the surgeons if I kept surgeons' hours. I'll never make as much as the derm, plastics, ortho, or OMFS guys though. I don't really care. I like my lifestyle as it is, thanks.

 

[Med4ever]

Thanks that was a great insight. I think the hardest thing to research on when considering a specialty is life style and what it is really like. Having said that, I know every doc thinks that there specialty is the best and things are great, but I would like to hear some reasons why one may NOT choose EM. Dont hold back, tell me the worst I can expect.

Thanks 🙂

 

[Scrubbs]

Agree with all that was said above... as an FYI: not all programs work 12 hr shifts. My program does 10 hr shifts 1st year, 12 hr shifts 2nd year, and 8 hr shifts 3rd year. We also don't do the traditional switching from day shifts to overnights... we work a circadian rotating schedule, which is a little easier sleep-wise. Regardless, it'll never be as malignant as some of the other call-taking specialties. Even my friends who are now in night-float surgery/med systems are working way more hours than I am.

As for the downsides to EM... the most common off-service rotater complaints I've heard are:

1. They don't like the lack of downtime. People who like rounding hate EM. We may work less time, but when we work, we work.

2. They can't sort out the bull$hit. EM is fast paced and you can't focus on all of the minutia... you need to be able to filter out what's going to kill people, and what VERY INTERESTING things can be worked up by their primary doctors.

3. We work 24 hours a day, 7 days a week... meaning weekends and overnight shifts are no different from any other shift... we work holidays like its going out of style and that's the price we pay for our lifestyle specialty. That being said, what other job lets you take a few weeks/months off if you feel like you can afford $$$ it?

Any way you slice it though, I love what I do and I can't imagine doing anything else!

 

[docB]

Originally posted by Teufelhunden
I just got off of an FP rotation, and pretty much hated it. Some of the medical issues were intersting, but the majority of time was devoited to talking and listening. For some reason, a majority of FP patients just want to talk and talk and talk....I simply can't do this. I didn't go into medicine to sit around and talk with old ladies.

Terminally undecided in Ohio,

kevin

I'd say surgery is the one for you.

 

[deleted6669]

.....or anesthesiology,diagnostic radiology, or pathology
(the non-talking specialties).

 

[DrQuinn]

I second what Scrubbs says...

What some people don't like about EM:

No continuity of care (although we do see some of the same patients in the ED... CHFers, homeless, alcoholics), etc. There are always bounce backs that you may remember from being there for their first admission.

Some people dont' like the fast pace. It is "scary" to them.

Some people don't like the clientele. If talkign to an alcoholic who continues to drink no matter what you say bothers you, or you absolutely abhor IVDUers, EM may not be for you. Although you get people from all walks of life, you also see a lot more of the lower SES than say private IM attendings.

Lots of procedures. I love 'em but not everyone does.

You have to learn your peds. Although you may focus on adults, you still have to know your pedi ed.

Man i love EM.
Q< DO