Second year medical student asking about the field

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cyanide12345678 said:
Here’s my honest advice to you. And really listen and pay attention.

It actually sounds a little like you want ortho but don’t have the numbers. So EM is kind of like a second choice. It’s very hard to sustain a EM lifestyle especially if it’s your second pick. Yes, i get it, ortho is very very hard to get in.

You say you don’t like kids - 20 percent of ER visits is kids.

You also say you don’t like women’s health. 10 ish percent of ER visits are gynecology/obstetrics related.

So 30 percent of your job as an ER doctors, you already don’t like.

You say ‘no to psych’ - the reality is a lot of the patients we see are some degree of anxiety disorder, running to the ER at the simplest thing. Then obviously there’s all the depressed suicidal people you’ll see. Psych is probably another 5-10 percent of patients we see.

Now throw in the drunks, the drug seekers, the disrespectful, and the belligerent.

I mean you’re basically saying you already dont like 50 percent of what we do.

So i have no idea where your desire to pursue EM is coming from? Let’s be real…. Are you sure you don’t like the idea of making 400k working 36-40 hours a week? I fell for that trap since I’m very financially minded.

You say you like procedures - the reality is when you have a very busy ER, a procedure is the last thing you want to do. Central lines take so long! Sutures take so long!!! When it’s busy, you really really don’t want to do procedures.

I work 10 days a month. I still don’t have perfect work life balance. My wife works 12 days a month, she has better work life balance. She’s off on weekends, i still work quite a few of those. I work nights and don’t sleep in my bed plenty of nights, my body struggles to recover. If your circadian rhythm is flip flopping between days and nights - I’m sorry that’s not work life balance. If you miss a bunch of family events on the weekends, that’s just not work life balance.

Ill tell you what’s work life balance - my wife who goes into work for 4-5 hours a day for 3 days a week - Tuesday through Thursday. Is back from work at 2 pm everyday and still makes 250k as FM -_- that’s work life balance. Even on her work days she has time for life -_-

So….. you think EM is work life balance. It’s better than some, but it’s not derm, psych, allergy/immunology, rheum, pm&r and others. I mean yeah our work life balance is better than surgeons - but thats about all i can say for EM.

Think long and hard. You’re probably better off doing IM and getting a fellowship in something else.
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I'd also add that outside of high acuity tertiary hospitals most EM docs rarely do invasive procedures on shifts.

Besides maybe suturing there really isn't a procedure that's usually done on average more than once when on shifts.

Critical Care procedures for example tubes and lines are extremely rare nowadays and the last study that was performed 10 years ago showed that most docs will do 10 a year on average based on a chart review from USACS sites across the United States. I wouldn't be shocked if it was lower now with more widespread usage of CPAP and BIPAP machines and probably closer to 5 a year for the average EM physician.
 
alpinism said:
I'd also add that outside of high acuity tertiary hospitals most EM docs rarely do invasive procedures on shifts.

Besides maybe suturing there really isn't a procedure that's usually done on average more than once when on shifts.

Critical Care procedures for example tubes and lines are extremely rare nowadays and the last study that was performed 10 years ago showed that most docs will do 10 a year on average based on a chart review from USACS sites across the United States. I wouldn't be shocked if it was lower now with more widespread usage of CPAP and BIPAP machines and probably closer to 5 a year for the average EM physician.
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Probably 3/4 of the tubes and 80% of the lines I put in as a resident wouldn't be performed on the same patient with the same pathology today. BiPap, high flow, and the ability to do CT scans in seconds rather than minutes killed a lot of the indications for emergent intubation. U/S guided PIVs, dedicated PICC teams, the EZ-IO, and relaxed rules around peripheral pressors did the same for CVLs.
 
Arcan57 said:
Probably 3/4 of the tubes and 80% of the lines I put in as a resident wouldn't be performed on the same patient with the same pathology today. BiPap, high flow, and the ability to do CT scans in seconds rather than minutes killed a lot of the indications for emergent intubation. U/S guided PIVs, dedicated PICC teams, the EZ-IO, and relaxed rules around peripheral pressors did the same for CVLs.
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Plus goals of care discussions and POLST forms.
I'd guess most of my "most likely non-survivable" ICH patients go directly to comfort cares.
 
Graduated residency in last 10 years.

I did over 100 central lines; just one in past year

I did about 20 chest tubes; zero in past year

I still intubate frequently.

Lacerations, abscesses and reductions are time sucks, although I love shoulders and hips.

We are simply living too long with chronic irreversible disease. We sustain "life", however the patient are bedridden without any quality, then show up in the ED for whatever unfixable thing they have. We admit, they get discharged, cycle begins anew. Population is increasingly medically and psychiatrically needy. Families are not stepping up. It's way easier to dump on the ED. More patient demands, more patient violence, more CMS and regulatory demands, less pay. Avoid.
 
WhatJobDoIPick said:
Graduated residency in last 10 years.

I did over 100 central lines; just one in past year

I did about 20 chest tubes; zero in past year

I still intubate frequently.

Lacerations, abscesses and reductions are time sucks, although I love shoulders and hips.

We are simply living too long with chronic irreversible disease. We sustain "life", however the patient are bedridden without any quality, then show up in the ED for whatever unfixable thing they have. We admit, they get discharged, cycle begins anew. Population is increasingly medically and psychiatrically needy. Families are not stepping up. It's way easier to dump on the ED. More patient demands, more patient violence, more CMS and regulatory demands, less pay. Avoid.
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Jesus.
The truth in this statement .
 
WhatJobDoIPick said:
Graduated residency in last 10 years.

I did over 100 central lines; just one in past year

I did about 20 chest tubes; zero in past year

I still intubate frequently.

Lacerations, abscesses and reductions are time sucks, although I love shoulders and hips.

We are simply living too long with chronic irreversible disease. We sustain "life", however the patient are bedridden without any quality, then show up in the ED for whatever unfixable thing they have. We admit, they get discharged, cycle begins anew. Population is increasingly medically and psychiatrically needy. Families are not stepping up. It's way easier to dump on the ED. More patient demands, more patient violence, more CMS and regulatory demands, less pay. Avoid.
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One gotta ask why is EM a specialty?

One pulmonologist where I work said the order day that they should put a CT scan machine at the entrance of every ED so everyone can get a full body CT scan before seeing a clinician. We all at the lounge LOL.
 
Splenda88 said:
One pulmonologist where I work said the order day that they should put a CT scan machine at the entrance of every ED so everyone can get a full body CT scan before seeing a clinician. We all at the lounge LOL.
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A pulmonologist I admit to CT's every single patient that I don't. Doesn't matter what they are going to the ICU for. If I haven't scanned some body part he will. Whatever parts of head, neck, chest, abd, pelvis that I felt didn't need a scan he scans. My stupid story is just as useful as yours. The my specialty is better than yours pissing contest is old news. You couldn't do what I do and I sure as s*!t couldn't or wouldn't do whatever it is you do.
 
ERMudPhud said:
A pulmonologist I admit to CT's every single patient that I don't. Doesn't matter what they are going to the ICU for. If I haven't scanned some body part he will. Whatever parts of head, neck, chest, abd, pelvis that I felt didn't need a scan he scans. My stupid story is just as useful as yours. The my specialty is better than yours pissing contest is old news. You couldn't do what I do and I sure as s*!t couldn't or wouldn't do whatever it is you do.
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Well, none of us can be compared to surgeons.
 
thegenius said:
Seems pretty obvious to me. Are you EM?

We are by far, far and away, immeasurably, and undoubtely the most useful doctors on this planet.
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The only person who would agree with this statement are the most delusional of ER docs

Said as an ER doc myself

Not a single physician outside of EM would agree with the above statement

Yet another damning aspect of this godforsaken "specialty"
 
HemorrhagicShock said:
The only person who would agree with this statement are the most delusional of ER docs

Said as an ER doc myself

Not a single physician outside of EM would agree with the above statement

Yet another damning aspect of this godforsaken "specialty"
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Well I think you are 100% wrong, and I'm certainly not delusional.
 
Splenda88 said:
One gotta ask why is EM a specialty?

One pulmonologist where I work said the order day that they should put a CT scan machine at the entrance of every ED so everyone can get a full body CT scan before seeing a clinician. We all at the lounge LOL.
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And yet when I admit people without CT scans someone (hospitalist or consultant) invariably asks why I didn't get a CT of some body part.
Undifferentiated sepsis? Might as well do a quick stop for the C/A/P CT on the way upstairs.
 
WhatJobDoIPick said:
Both OB and Hospitalist needed my help the other night.

Our usefulness to appreciation ratio is certainly very high.
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I feel like there's a reason why I'm always hearing about these small rural hospitals where the only doctor who is always in house overnight is the EP.
 
In a system where financial incentives skew towards ordering every possible test and admitting patients who do not require time critical interventions to a hospital with every possible consultant, we are very much not needed. The farther away you skew from the above scenario, the more useful we become.
 
Arcan57 said:
In a system where financial incentives skew towards ordering every possible test and admitting patients who do not require time critical interventions to a hospital with every possible consultant, we are very much not needed. The farther away you skew from the above scenario, the more useful we become.
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My most cynical take on this is that y'all can do enough of most other fields' areas to prevent needing to have every other specialty in house 24/7. Ortho doesn't need to come in for every dislocation or non-operative fracture. OB doesn't need to be there for vaginal bleeding or pelvic pain. Cardiology doesn't need to be there for every chest pain rule out. Endocrine doesn't have to get called in for blood sugars of 1200. You get the idea.
 
VA Hopeful Dr said:
My most cynical take on this is that y'all can do enough of most other fields' areas to prevent needing to have every other specialty in house 24/7. Ortho doesn't need to come in for every dislocation or non-operative fracture. OB doesn't need to be there for vaginal bleeding or pelvic pain. Cardiology doesn't need to be there for every chest pain rule out. Endocrine doesn't have to get called in for blood sugars of 1200. You get the idea.
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This means that if you live in or want to live in any desirable area (where a plethora of other specialists want to live and would kill their colleagues for volume and referrals) being an ER doc is completely useless as a value-add to any system. There are plenty of left-hand-only and right-hand-only orthopods is just about every highly desirable metro in the US.

DO NOT GO INTO EM!
 
HemorrhagicShock said:
This means that if you live in or want to live in any desirable area (where a plethora of other specialists want to live and would kill their colleagues for volume and referrals) being an ER doc is completely useless as a value-add to any system. There are plenty of left-hand-only and right-hand-only orthopods is just about every highly desirable metro in the US.

DO NOT GO INTO EM!
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Does it? Not only do those left hand only and right hand only orthopedic surgeons not want to have to come into the hospital every time someone injures their right or left hand, the hospital sure as heck does not want to have to pay them to be there.

My field is the same but on the chronic side. No endocrinologist wants to see every single patient with diabetes or thyroid disease. The cardiologist does not want to have to fill their day with routine blood pressure and cholesterol patients.
 
WhatJobDoIPick said:
Both OB and Hospitalist needed my help the other night.

Our usefulness to appreciation ratio is certainly very high.
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Agreed.

Regardless of the overall crappiness of the job these days, I'm still quite proud to say that I'm part of one of the only specialties that can manage a vent, reduce a dislocation and deliver a baby and resus both mother AND child.
 
HemorrhagicShock said:
This means that if you live in or want to live in any desirable area (where a plethora of other specialists want to live and would kill their colleagues for volume and referrals) being an ER doc is completely useless as a value-add to any system. There are plenty of left-hand-only and right-hand-only orthopods is just about every highly desirable metro in the US.

DO NOT GO INTO EM!
Click to expand...

If this were true, you would see basically zero BCEM physicians in any major cities and yet that's not the case.
 
VA Hopeful Dr said:
Does it? Not only do those left hand only and right hand only orthopedic surgeons not want to have to come into the hospital every time someone injures their right or left hand, the hospital sure as heck does not want to have to pay them to be there.

My field is the same but on the chronic side. No endocrinologist wants to see every single patient with diabetes or thyroid disease. The cardiologist does not want to have to fill their day with routine blood pressure and cholesterol patients.
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I've valued your input over the years you've been here, and when I was a pre-med and med student, your advice and posts burned bright in my memory.

(I've been around SDN for over 15 years now with various handles)

But you're just dead wrong about this.

Here's where you're right: the right-hand-ortho doesn't want to come in and isn't going to come in. But taking call at the hospital is required for him to have privileges (since OR time is precious and urban metro hospitals know they can leverage that to get fancy specialties to take call). He also needs MULTIPLE continuous referral streams.

Ultimately, that right-hand-ortho is also in competition with the OTHER right-hand-ortho across the street, so he'll also break his back much longer to take call at 4 different hospitals since he's hungry for volume too.

Remember, that right-hand-ortho is also hustling to outpace his peers in a keep-up-with-the-Joneses-and-Chans-and-Patels in that same VHCOL city, and thus wants to make more than what a depressed W2 average wage for his subspecialty (given the desirable geography).

He also doesn't even have to go to the hospital when consulted from the ED, because his group's PA will do the initial consult, discuss over text via pictures and x-rays. By the way, that PA-C used to work in the ED for a meager $110k per year, until she wisened up and realized she could go make $185k/year working in a subspecialty. Why would she waste her time in the ED when she can switch specialties on a dime and almost double her income.

This leads to what is actually needed in the ED for any of that. Does any of that need an ER doc? No, a reasonably trained EM PA-C can quickly identify "Oh this hand is injured, must call right-hand-ortho." If A, then B. Simple. You don't need medical school to know that the hand is injured. Doesn't matter how it's injured, what's injured, or any of that. In a zero-miss environment, you're just a consult monkey for the specialist.

And of course those volume-based specialists love the easy punts. Easy consult, easy money, send the PA to get it started.

EM is dead in any desirable urban metro.

But yes, we have plenty of use in the most rural of rural BFE hospitals. Our skill is truly cherished there. I will agree full on this point.

But who wants to spend an entire career traveling 2-3 hours to get to your rural site, away from your family, your home, your whatever in order to leverage that skill. Because I (and many others) don't want to live or raise a family in those areas.

Better to just start some woo-woo lifestyle medicine BS clinic in the metro and start doing reasonable HRT, weight loss, aesthetics and other easier and more desirable cash-pay services.
 
Lexdiamondz said:
If this were true, you would see basically zero BCEM physicians in any major cities and yet that's not the case.
Click to expand...

Of course you still see EM docs in those major cities, but those jobs aren't sustainable. And if they are, they're completely locked up (not hiring), their rates are abysmal for the work required ($150 range per hour, to see 2.5 PPH, see Denver Colorado USACS if you don't believe me), and or it's some SDG that's completely predatory that's even worse than a CMG gig.

And ALL of these groups are heavily looking to hire more midlevels, not physicians.
 
VA Hopeful Dr said:
My most cynical take on this is that y'all can do enough of most other fields' areas to prevent needing to have every other specialty in house 24/7. Ortho doesn't need to come in for every dislocation or non-operative fracture. OB doesn't need to be there for vaginal bleeding or pelvic pain. Cardiology doesn't need to be there for every chest pain rule out. Endocrine doesn't have to get called in for blood sugars of 1200. You get the idea.
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This is correct. One of our roles is that we do just enough of everyone else's job. That's not the entire job, but it's certainly a big part.
 
VA Hopeful Dr said:
Does it? Not only do those left hand only and right hand only orthopedic surgeons not want to have to come into the hospital every time someone injures their right or left hand, the hospital sure as heck does not want to have to pay them to be there.

My field is the same but on the chronic side. No endocrinologist wants to see every single patient with diabetes or thyroid disease. The cardiologist does not want to have to fill their day with routine blood pressure and cholesterol patients.
Click to expand...
Our cardiologists are fine with this...
 
HemorrhagicShock said:
Of course you still see EM docs in those major cities, but those jobs aren't sustainable. And if they are, they're completely locked up (not hiring), their rates are abysmal for the work required ($150 range per hour, to see 2.5 PPH, see Denver Colorado USACS if you don't believe me), and or it's some SDG that's completely predatory that's even worse than a CMG gig.

And ALL of these groups are heavily looking to hire more midlevels, not physicians.
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We struggle with staffing more PAs at the urban sites. Primarily because it makes the job harder for the physicians working those shifts and PA turnover is too high.

We could probably make a higher hourly somewhat if we staffed more PA heavy, but we're a physician group and can staff however we prefer.
 
HemorrhagicShock said:
Remember, that right-hand-ortho is also hustling to outpace his peers in a keep-up-with-the-Joneses-and-Chans-and-Patels in that same VHCOL city, and thus wants to make more than what a depressed W2 average wage for his subspecialty (given the desirable geography).

He also doesn't even have to go to the hospital when consulted from the ED, because his group's PA will do the initial consult, discuss over text via pictures and x-rays. By the way, that PA-C used to work in the ED for a meager $110k per year, until she wisened up and realized she could go make $185k/year working in a subspecialty. Why would she waste her time in the ED when she can switch specialties on a dime and almost double her income.

This leads to what is actually needed in the ED for any of that. Does any of that need an ER doc? No, a reasonably trained EM PA-C can quickly identify "Oh this hand is injured, must call right-hand-ortho." If A, then B. Simple. You don't need medical school to know that the hand is injured. Doesn't matter how it's injured, what's injured, or any of that. In a zero-miss environment, you're just a consult monkey for the specialist.

And of course those volume-based specialists love the easy punts. Easy consult, easy money, send the PA to get it started.

EM is dead in any desirable urban metro.

But yes, we have plenty of use in the most rural of rural BFE hospitals. Our skill is truly cherished there. I will agree full on this point.

But who wants to spend an entire career traveling 2-3 hours to get to your rural site, away from your family, your home, your whatever in order to leverage that skill. Because I (and many others) don't want to live or raise a family in those areas.

Better to just start some woo-woo lifestyle medicine BS clinic in the metro and start doing reasonable HRT, weight loss, aesthetics and other easier and more desirable cash-pay services.
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Had a good laugh.
 
I was trained at big trauma center where ED docs would do therapeutic para, thora, and even pericardiocentesis etc... When I started working at my smaller hospital, I was called to admit a patient with ascites (cirrhosis). My dumb self asked the ED doc what do you mean you want me to admit someone so he can get a therapeutic para?

Now we have a new nocturnist right out of school that when they call him for these admits, he just goes to the ED, do the procedure and discharge the patient after a couple of hours.

I must say that the coolest docs at my place are these ED docs.
 
HemorrhagicShock said:
When you add Asian and Indian values/culture/drive to American capitalism, you get pretty impressive results!
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Hard to argue

When we bought our house my dad pointed out a lot of the neighborhood was east Asian/Indian (we are plain ol white bread).

I told him that's not nearly the bad thing he thought it might be. Indeed, I think I'm a minority in my own neighborhood and probably one of the poorer households.
 
AlmostAnMD said:
Hard to argue

When we bought our house my dad pointed out a lot of the neighborhood was east Asian/Indian (we are plain ol white bread).

I told him that's not nearly the bad thing he thought it might be. Indeed, I think I'm a minority in my own neighborhood and probably one of the poorer households.
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The average household income for Indian Americans is ridiculously higher than the average. Pakistani culture is the same - literally given two life choices by parents - doctor or engineer. Everything else is considered disappointing and a failure 😂

Had to even start as a chemical engineer undergrad to satisfy parents as a backup in case i don’t get into med school -_-

Educational excellence is expected.
 
HemorrhagicShock said:
I've valued your input over the years you've been here, and when I was a pre-med and med student, your advice and posts burned bright in my memory.

(I've been around SDN for over 15 years now with various handles)

But you're just dead wrong about this.

Here's where you're right: the right-hand-ortho doesn't want to come in and isn't going to come in. But taking call at the hospital is required for him to have privileges (since OR time is precious and urban metro hospitals know they can leverage that to get fancy specialties to take call). He also needs MULTIPLE continuous referral streams.

Ultimately, that right-hand-ortho is also in competition with the OTHER right-hand-ortho across the street, so he'll also break his back much longer to take call at 4 different hospitals since he's hungry for volume too.

Remember, that right-hand-ortho is also hustling to outpace his peers in a keep-up-with-the-Joneses-and-Chans-and-Patels in that same VHCOL city, and thus wants to make more than what a depressed W2 average wage for his subspecialty (given the desirable geography).

He also doesn't even have to go to the hospital when consulted from the ED, because his group's PA will do the initial consult, discuss over text via pictures and x-rays. By the way, that PA-C used to work in the ED for a meager $110k per year, until she wisened up and realized she could go make $185k/year working in a subspecialty. Why would she waste her time in the ED when she can switch specialties on a dime and almost double her income.

This leads to what is actually needed in the ED for any of that. Does any of that need an ER doc? No, a reasonably trained EM PA-C can quickly identify "Oh this hand is injured, must call right-hand-ortho." If A, then B. Simple. You don't need medical school to know that the hand is injured. Doesn't matter how it's injured, what's injured, or any of that. In a zero-miss environment, you're just a consult monkey for the specialist.

And of course those volume-based specialists love the easy punts. Easy consult, easy money, send the PA to get it started.

EM is dead in any desirable urban metro.

But yes, we have plenty of use in the most rural of rural BFE hospitals. Our skill is truly cherished there. I will agree full on this point.

But who wants to spend an entire career traveling 2-3 hours to get to your rural site, away from your family, your home, your whatever in order to leverage that skill. Because I (and many others) don't want to live or raise a family in those areas.

Better to just start some woo-woo lifestyle medicine BS clinic in the metro and start doing reasonable HRT, weight loss, aesthetics and other easier and more desirable cash-pay services.
Click to expand...
Its possible that I haven't worked in a large enough area to see this sort of thing, but I've yet to meet a busy specialist who doesn't get irritated about easy cases that don't result in procedures (since that's where the money is). From what my wife says from her hospitalist days, this is doubly true outside of business hours.

But, we've never worked outside of SC and not in Charleston.
 
WhatJobDoIPick said:
Graduated residency in last 10 years.

I did over 100 central lines; just one in past year

I did about 20 chest tubes; zero in past year

I still intubate frequently.

Lacerations, abscesses and reductions are time sucks, although I love shoulders and hips.

We are simply living too long with chronic irreversible disease. We sustain "life", however the patient are bedridden without any quality, then show up in the ED for whatever unfixable thing they have. We admit, they get discharged, cycle begins anew. Population is increasingly medically and psychiatrically needy. Families are not stepping up. It's way easier to dump on the ED. More patient demands, more patient violence, more CMS and regulatory demands, less pay. Avoid.
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Yep been working at rural hospitals in the rockies and have done a total of 2 intubations and central lines over the last 6 months.

The crazy thing is that I'm currently working in africa this month and did the same number the very first day in the emergency department.

Personally its one of the main reasons I'm disappointed with EM since to be honest I've always loved procedures and it was a huge part of the reason that I chose it rather than surgery since I was told I could still regularly do procedures without all the downsides of surgery.

Definitely not looking to be in the OR for hours every day but still enjoy a quick bedside nerve block and reduction but overall those cases are such a small percentage of the countless people that we see that demand imaging for mild injuries on shifts.
 
VA Hopeful Dr said:
Its possible that I haven't worked in a large enough area to see this sort of thing, but I've yet to meet a busy specialist who doesn't get irritated about easy cases that don't result in procedures (since that's where the money is). From what my wife says from her hospitalist days, this is doubly true outside of business hours.

But, we've never worked outside of SC and not in Charleston.
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They have the PAs see those patients...
 
Splenda88 said:
I was trained at big trauma center where ED docs would do therapeutic para, thora, and even pericardiocentesis etc... When I started working at my smaller hospital, I was called to admit a patient with ascites (cirrhosis). My dumb self asked the ED doc what do you mean you want me to admit someone so he can get a therapeutic para?

Now we have a new nocturnist right out of school that when they call him for these admits, he just goes to the ED, do the procedure and discharge the patient after a couple of hours.

I must say that the coolest docs at my place are these ED docs.
Click to expand...
I still do them. A few years ago I had a patient flown fixed wing to my tertiary hospital for a therapeutic para because no one was "available" to do it at his hospital. I took off about 8 liters, watched him for an hour, and then asked him how he was going to get home...
 
VA Hopeful Dr said:
My most cynical take on this is that y'all can do enough of most other fields' areas to prevent needing to have every other specialty in house 24/7. Ortho doesn't need to come in for every dislocation or non-operative fracture. OB doesn't need to be there for vaginal bleeding or pelvic pain. Cardiology doesn't need to be there for every chest pain rule out. Endocrine doesn't have to get called in for blood sugars of 1200. You get the idea.
Click to expand...
Did something new along those lines the other day. Provided ketamine sedation for a crash csection when anesthesia couldn't get to the hospital quick enough. FP got the baby out in seconds. Mom and baby fine. My underwear, not so much.
 
alpinism said:
I'd also add that outside of high acuity tertiary hospitals most EM docs rarely do invasive procedures on shifts.

Besides maybe suturing there really isn't a procedure that's usually done on average more than once when on shifts.

Critical Care procedures for example tubes and lines are extremely rare nowadays and the last study that was performed 10 years ago showed that most docs will do 10 a year on average based on a chart review from USACS sites across the United States. I wouldn't be shocked if it was lower now with more widespread usage of CPAP and BIPAP machines and probably closer to 5 a year for the average EM physician.
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Lol if you are rural you will be doing everything, and will be called to the floor for central lines, intubations etc. High acuity tertiary hospitals are the LEAST likely place to do procedures, as there are subspecialists, PICC nurses, IR, radiology, and even residents.

In a small hospital EM does EVERYTHING- paracentesis, pleuros, chest tubes, intubations, central lines, reductions.
 
ERMudPhud said:
I still do them. A few years ago I had a patient flown fixed wing to my tertiary hospital for a therapeutic para because no one was "available" to do it at his hospital. I took off about 8 liters, watched him for an hour, and then asked him how he was going to get home...
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How does this even happen?

Like
where was the patient where no-one could do the procedure?
 
TrailRun said:
How would you defend it if there were a complication? “Dr. Apollyon, how many of these have you done before? - zero. Is there a specialty in Medicine that specializes in sedating people for surgery - yes. Are you board certified in that specialty? - no. Did you consider what affects the ketamine might have on the fetus/neonate” ad infinitum.

I’m glad there are docs willing to step up as our colleague did, but the anesthesiologist “not being available” (too far from hospital, weather, lack of coverage, or who knows) put them in a tight spot
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Crash c-section, if anesthesia isn't within 15-20 minutes then its not quick enough and we're talking serious baby complications or an unmedicated c-section which can be done but isn't ideal at all.
 
TrailRun said:
How would you defend it if there were a complication? “Dr. Apollyon, how many of these have you done before? - zero. Is there a specialty in Medicine that specializes in sedating people for surgery - yes. Are you board certified in that specialty? - no. Did you consider what affects the ketamine might have on the fetus/neonate” ad infinitum.

I’m glad there are docs willing to step up as our colleague did, but the anesthesiologist “not being available” (too far from hospital, weather, lack of coverage, or who knows) put them in a tight spot
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I'm assuming this was done in the ED?
 
TrailRun said:
How would you defend it if there were a complication? “Dr. Apollyon, how many of these have you done before? - zero. Is there a specialty in Medicine that specializes in sedating people for surgery - yes. Are you board certified in that specialty? - no. Did you consider what affects the ketamine might have on the fetus/neonate” ad infinitum.

I’m glad there are docs willing to step up as our colleague did, but the anesthesiologist “not being available” (too far from hospital, weather, lack of coverage, or who knows) put them in a tight spot
Click to expand...
The same way I'd defend a bad outcome for a delivery complication at the rural hospital I cover that has OB but they don't always make it in on time. Delivering babies in L&D is my least favorite part of working there. "Your majesty, I was the only physician in the hospital. Case dismissed."

Still better than delivering babies at one of our hospitals that doesn't have OB.
 
thegenius said:
How does this even happen?

Like
where was the patient where no-one could do the procedure?
Click to expand...
Rural hospital in lower 48. But I know for a fact there were at least two providers in town who do them. On a Friday night though with no one available until Monday the decision was to fly 300 miles fixed wing to see me at a tertiary center. My job there is to pretty much say yes to any transfer request. Figure the rest out after they get here.
 
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