The biggest determinant on whether or not I do a bedside ultrasound is if it will change management or outcomes.
I don't ultrasound the optic sheath (which probably isn't the optic sheath, anyway). I frequently ECHO sick paitents, regardless of how many are waiting to be seen.
Then, again, I don't listen to the heart sounds, unless pericarditis is in my differential (and even then I only do it sometimes -- and I will always have done an ECHO).
This is not intended to be flippant. Rather, the post is intended to point out another reason for obtaining a measure of "competence" and 800 scans. I would much rather have an ED doc who has done 1000 ECHOs than an ED doc who has listened to the heart sounds of 10,000 patients.
We all have to choose how we want to spend our "extra time" learning during residency.
OTOH: I am not sure there is much use to the actual letters 'RDMS'.
HH