The EM Mentoring Thread

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Are EM residents trained well in Critical Care medicine as anesthesiology and Internal medicine residents?


Wow. that is an incredibly loaded question! :) A better way to ask that is are EM residents trained well in Critical Care.

The answer is yes. Are they trained to go and run and ICU all alone? depends on where they trained but probably not. Are they trained well enough to go and do a critical care fellowship? absolutely. EM residency requires critical care months and in addition, you see and manage alot of critical care patients in the ED.

The training you get in an EM residency is appropriate to what we do: recognize, resuscitate and manage acute ill critical care patients in the ER. As the ED has changed, EMP's have also had to start managing these patients in the first 24-36 hours as shortages in ICU's become more and more problematic. It also sets you up with a solid foundation to go into a critical care fellowship and learn long term CC management to run ICU's.

Members don't see this ad.
 
Hi,
I'm a second year med student who is thinking of doing EM.

My grades so far put me in the top 15% of my class, with Step I, and 3rd year grades still on the horizon.

I have some research, but not in EM, and no publications.

What should I be doing now and in the next few years to make myself competitive for an EM spot?

Thanks,
studyinghard
Find out if there is an EM interest group at your school. If there is get involved. If not reach out to one of the EM docs to be a mentor for you. You might go through your faculty mentor (if you have one) or your advisor. Look into EMRA (Emergency Medicine Resident Assoc.), they have a student section and can clue you into some of the current issues in EM.

http://www.emra.org/index.cfm?FuseAction=Page&PageID=1000000
 
This might be a question more applicable to residencies in general than EM specifically, but how does call and hours/week evolve during your years as a resident?

Basically as a first year, will you work the most and take the most call or is it the other way around? In most programs is there a significant decrease in call and hours in your 3rd and 4th years?

My other question is about the position of "chief resident". What is involved in being the chief, does it usually involve an extra year, or is it within your regular program's length of training, and what are the benefits/drawbacks?

Thanks guys :)
It's actually good to answer this specifically for EM as it's distinct from other specialties.

Call works however it works for whatever off service rotation you're on. If your med service runs q3 call then you will be q3. Often the more malignant off service rotations are earlier in the residency so it seems like it gets easier but you can still pull some uglies later on. For me I had q3 as a senior on the ICU rotation.

Most programs decrease your hours (which translates to shifts) as you move up. For example as a PGY1 I did 20 12s, PGY2 18 12s and PGY3 16 12s.

I'm most familiar with 3 year programs and most of those have an additional chief year. I'm not sure about the 4 years. Most of the chiefs I knew were interested in academics, gunning for a fellowship or needed to kill a year (wife graduates one year behind).

The chief in my program was in charge of scheduling the residents (one of the most thankless jobs in the world), helping with interviews, running the didactics and working clinically.
 
Members don't see this ad :)
So I guess my next question is, what is q3, q4 etc that I have seen people speak of. I am for some reason unfamiliar with this terminology.

Thanks again, because your answers are awesome.
Since EPs aren't "on call" this issue mainly pertains to off service rotations like Internal Medicine and Surgery. Q3 call does indeed mean call every 3rd night and it's pretty tough. When I was doing it it meant 36 hours on, sleep back for 12 hours, sleep, 36 hours on. They've fiddled in down with he 80 hour bit so it's often not as bad anymore.
 
Not to make this thread a conversation between you and I, but I thought I might ask another question about this topic.
When you say "36 hours on" do you mean, you are non-stop working for 36 hours, or for several hours you are sleeping in house, or at least getting lengthy breaks?

When a resident is on call, does that mean he works a 12 hour shift then is on call for 24 hours straight? That is, you aren't sitting at the desk waiting to do work, but if something comes in you have to handle it.

Ok I'll try to stop asking so many call questions hehe, thanks again .


Questions are greatly appreciated and this is the place for them so keep firing away. Some of these topics are well known to the 3rd and 4th year med students from their clinical rotations but for the premeds and the junior med students this may be valuable.

Let me explain “call” in a day by day format. I’ll use Internal Medicine as an example since it’s the prototypical inpatient service. For the sake of illustration well talk about a q3 call schedule.

Day 1 (Call)
Arrive at the hospital early enough to pre round on your patients. Pre rounding is where you see all your patients before rounds so you can knowledgably present them to the team on rounds. I would typically allow about 10-15 minutes per patient for prerounding. So for 10 patients and 7am rounds I get to the hospital at around 4:30 or 5 am. Rounds would last until the end of time (it was medicine). Just kidding. Rounds would last until about 10am (it just seemed like the end of time). Then you do your work. Order tests, get results, call consults, collect consult recommendations, discharge patients and so on. Now, since this is your call cay you are doing all the admissions as well as your work. In the afternoon the other residents start signing out to you. They give you a list of their patients and tell you about them. They go home and you are responsible for those patients. You field all the nursing calls and go see them if they get worse. This is called cross cover. If you’re lucky you might get to sleep a little. With all the admissions and cross cover you may not. Sleep or no it’s soon time to pre round again.

Day 2 (Post call)
Pre round. Round. Work. Today, fortunately, you get to sign out to the on call resident to cross cover for you. Once you sign out go home and sleep. Set your alarm so you can get up early and pre round again.

Day 3 (Good day)
Pre round. Round. Work. Sign out and go home. This is your evening to live your life. Live it well because tomorrow is call again.

There are variations to this, some brought about by the work hour restrictions. Often the call resident goes home right after rounds now. There is also frequently a “float” resident who takes the cross cover responsibilities off the call team. That leaves the call team to just do the admits which is more humane. There are also set ups that use a float to guarantee the call resident at least a few hours of uninterrupted sleep. Having call less than q3 is nice too.

When I said “36 hours on” I meant 36 hours straight without sleep and with few brief breaks. This has changed due to the new work hour restrictions. When I was a resident the longest I ever worked straight with out any sleep and with one meal and one vending machine binge was 41 hours. 4am on call day until 9pm post call. I cried at 6:30pm post call when I found out I had to put a central line in someone before I could go home.
 
When I said “36 hours on” I meant 36 hours straight without sleep and with few brief breaks. This has changed due to the new work hour restrictions. When I was a resident the longest I ever worked straight with out any sleep and with one meal and one vending machine binge was 41 hours.

With the new work hours you are not supposed to work more than 30 hours hours straight as described by WorkinEM. So you may go 32 or more hour straight without sleep. I like being on call because I get to do many of the procedures AND work independently (only consulting the senior resident if I'm not sure about anything) during the night when everyone else on the team has gone home. With that being said, you do tend to get a tad bit tired.

In EM you tend to do these marathon hours on off-service rotations (e.g. MICU, CCU, Medicine, etc) NOT during your EM rotation months. Your EM rotation months tend to be scheduled regularly with a set amount of time off between them.



Wook
 
As I was glancing over the EM forums, I saw this thread:

http://forums.studentdoctor.net/showthread.php?t=431621&highlight=em+salaries+down

What caught my attention wasnt about the salaries going down but about the job market going down. Is this predicted in the future? Will there be more too many EM docs?

Thanks

Sox
I apologize for not responding sooner. Greylin and I have been pretty busy and the mentor forum was not getting as much attention as we would have liked.

That's a good question. It alludes to a coming situation in the EM job market that has many of us at the administrative level worried. We expect that we will see a drop in EP compensation soon. It basically comes down to CMS cuts that we have avoided but that will soon catch up with us. At the same time that $$$ is decreasing there will be lots of spots to fill due to the boomer generation EP retiring and the fact that most younger docs do not want to work as much as their predecessors. The answer for those of you in residency is that there will be lots of jobs in EM for the forseeable future. The problem for those that do the hiring is that we will have more spots to fill and less money to dangle as bait. Expect EP compesation to get more creative in the future. Better benefit packages, perks, signing bounses and so on are likley on the way.
 
Hello, I'm new to SDN and just wanted some help in a career in Emergency Medicine.
To begin with...I am 13 (almost 14) and in 8th grade here in big texas. I have always had an interest in Emergency Medicine (wheter it be pre-hospital or not). Lately, I think I have made my decision that I want to be a ED MD when I grow up. I have done ride-alongs with Ambulance Providers, etc. I know that I still have a bunch of time to make that decision BUT I have had an interest in Emergency Medicine since I was a very little boy.

It’s great to have an early interest but keep an open mind. You don’t want to exclude yourself from other opportunities and experiences because they don’t fit with your EM goals. You have a lot of years and experiences to go through and you will likely change your mind (even if you then change it back). Just don’t think of EM as the only thing in life you could ever do. It’s not.
What do I need to do now to help me later in Medical School?
Develop you study habits. Learn to be a self motivator at academics. Learn how to do well at standardized tests. Take an SAT prep course or read some books on it. The MCAT, which you take in your third year of college, has a lot to do with getting into med school. It uses many of the same skills as the SAT. I know it sounds bad saying that the best way to be a doctor is to learn how to fill out a scantron but it’s the truth.
What courses are the best to take in High School to prepare for Medicine?
Your courses in high school don’t matter as much as your overall academic skills. You need to enter college able to make good grades in your early courses. Messing up in an easy, lower level class will come back to haunt you on your med school applications.
What are the advantages of working in Emergency Medicine? Disadvantages?
http://forums.studentdoctor.net/showthread.php?t=470887
If you are a ED MD do you still like your job since you started?
Browse the EM forum. Read through some of the bigger, older threads. That will give you an idea of the attitudes and viewpoints of EPs. You’ll get an idea about the good, bad and just random issues.
What can I do now to help me get into Medical School? (Volunteering?)
Do whatever interests you. Volunteering won’t help as much as grades so if you want the experience then go for it. Don’t do it if it’s just to put on your applications.
Does working as a Paramedic in college help if you are interested in a career in Emergency Medicine?
The consensus of those of us who went from EMS into medicine is that it is helpful BUT that you should not do it if you are already focuses on med school and want it just to pad your application. If you are committed to med school you’d really do better to devote the time you would spend in an EMT class (one semester of 2 full days per week) and especially paramedic (~1200 hours of class and related work after EMT basic) to studying. Again, not glamorous, but true.

That particular question has been discussed on the EM forum and the EMS forum so check those out.
I would really appreciate to have a mentor here in SDN. If you would be willing to help please private message
Greylin and I mentor on the EM Mentor Forum here. The EM forum is actually a surprisingly accurate and helpful source for an internet site.
 
Hi again,
I have this question about the burn-out factor for EM physicians. How often do EM docs get burned out just by the stress and workload they have to handle? I always thought that Hospitalists and Surgeons were the ones to get burned out due to their heavy workload. Is this the same for EM physicians?

EM has traditionally had a reputation for a high burnout rate. The traditional answer back is that this reputation was created by non-EM trained docs who had not planned to do EM burning out after they stayed to long in the ED for one reason or another. The idea is that now that docs pick EM and train in it the burnout rate has gone down.

That said it is a problem. It is probably not as big a problem as the reputation would have us believe and it is probably not worse in EM than in other specialties. ACEP addresses the problem frequently with its members and there are many articles in the journals about EM burnout.

The reasons that EPs burnout are multifactorial. EM is a fast paced, high stress field. We deal with difficult patients and difficult doctors. The patients run the gamut from well and whiney to dead, pediatrics, psych, elderly, trauma, etc. The ED is called the “fish bowl” because everything we do gets second guessed by others and we are on display on the front line.

However, EM is in a better position to fight burnout than other specialties. In EM it’s easy to change your hours. You don’t have to cancel clinics or surgeries, you often just have to request the time far enough in advance. There are many environments in EM and you can work where you want. Rural to urban, slow to busy, trauma or not. They all have their ups and downs but you can choose and go where you fit best.

EM is well compensated compared to other specialties given its residency and hours. There’s no call. Often there are no administrative requirements or overhead. Opportunities for working in “extracurricular” positions exist such as EMS director, ACLS/PALS/ATLS instructor to name a few.

Ultimately burnout is more about the person than the specialty. If you choose EM because you like working in EDs and treating ED patients then you are much less likely to burn out.
 
Thanks a lot of the very detailed response! You covered a lot of points. I do have another question and this is off topic from what I asked previously, and this may seem as a ridiculous question. Are EM physicians trained to do certain cases in Emergency Dentistry? What I'm relating to this is to a case about a child I saw who fell and had deep lacerations in the lips and gums. Would cases similar to this be handled by EM physicians or by the oncall dentist?
Thanks
Nev


It depends. Who is on call and who handles different issues. And on the persons experience. I handled most of my major lacerations on the lips, etc unless the ED was just to busy. We have OMFS on call and they will often do these.
 
Originally Posted by nev
Thanks a lot of the very detailed response! You covered a lot of points. I do have another question and this is off topic from what I asked previously, and this may seem as a ridiculous question. Are EM physicians trained to do certain cases in Emergency Dentistry? What I'm relating to this is to a case about a child I saw who fell and had deep lacerations in the lips and gums. Would cases similar to this be handled by EM physicians or by the oncall dentist?
Thanks
Nev


EPs do do some dental procedures. Some of us do the various dental blocks for pain, eg. mandibular blocks. We drain apical abscesses and deal with avulsed teeth.

A good way to get a feel for the various dental procedures that EPs do is to look at Roberts and Hedges (the Bible for EM procedures) and read the chapter on dental procedures. If it's in there, we do it.
 
Thank you so much for answering some of my questions :)

If I can convince LAC+USC to let me shadow an Emergency Physician and observe with their CodeTeam. Hopefully if they let me I will get some good "expierence" there, since they are the buisiest Lvl 1 Trauma Center in the US.

Also, I do ride-alongs here with our local Fire/EMS and just wanted to get some expierence of what EM is like inside a hospital.

What do you think of that? Is that a good idea to shadow and observe?
Sure, shadowing and observing is always a good idea.

One thing to be aware of is that a "Code Team" is usually a group of people in a hospital who respond to cardiac arrests. If you are talking about traumas then the "Trauma Team" is made up of various people and can be different at each institution. The Emergency Physician may not be the primary doc dealing with the most critical traumas. Trauma is often run by surgeons with the EPs managing the airway. It is different at every center.
 
Hey Everyone,

First off thanks for staying here to respond to everyones posts and requests. The thread has been extremely useful and I'll be subscribed for quite a while.

I have a two part question, first, was what rotations third year would best prepare a student for their first year of EM residency? I've got 4-5 non-emergency medicine elective and was looking to see what I should be doing to be ready.

My second question relates to the fact that I am allowed only 2 away rotations in one field, my first in august, second in october. I was thinking of doing a rotation at my number institution in october, and on at my number two institution in august. My question is would the benefit of being a better EM student in october, outweigh the drawbacks of doing the rotation later (and not in august).

Basically, should I do my number one instutition earliest if it means that's my first EM experience?

Thanks again for the advice and information.
-Neil

Good rotations for third year that apply to EM include MICU. ortho, cardiology, radiology, pulmonology. MICU will have sick medical patients, ortho is always an ED issue, ditto cards, ED uses more rads services than anyone so seeing it from the other side is good and pulmo can give you insight into the breathers. Primary care clinic rotations tend to be less valuable, peds seems like it would be good but out patient peds tends to be too primary care oriented to help nless you can find a peds urgent care setting to rotate in.

I would do your #1 in October. October is not late, it's perfect. You'll finish up right at the beginning of interview season. You'll also have the benefit of your other rotation behind you.
 
Members don't see this ad :)
Unfortunately, my med school does not have an EM program. I need some helpful advice. I really enjoyed my interviews at Cinci, Vandy, and Indy. Do any of these carry enough weight to help me in landing an academic job more than the others? I understand Cinci is 4 years but assume the comparison is made with Indy and Vandy + 1 year fellowship for fairness. Thanks for any insight given. Please PM me if you don't want your advice on the public board.
All of those programs would prepare you for an academic career. I think that you should rank based on where you think you would be happiest and where you think you would relate best with the faculty. The faculty will be your research mentors with is extremely important when beginning an academic career. You are in the enviable position of being able to choose between really excellent programs.
 
Is it harder to find a job if you do a D.O. EM residency vs. an M.D. one?
Happy Holidays.
No.

The job market for Board Certified and Board Eligible EPs is really the same regardless of the degree.
 
All of those programs would prepare you for an academic career. I think that you should rank based on where you think you would be happiest and where you think you would relate best with the faculty. The faculty will be your research mentors with is extremely important when beginning an academic career. You are in the enviable position of being able to choose between really excellent programs.



Ditto what WorkinEM said. remember, there are only a teensy tiny percentage of 4 year programs and they are the only ones with a bias for hiring 4 year grads, and that only when you are a recent grad from a 3 year program. I know several people who graduated from a 3 year and ended up at a 4 year program without a fellowship.

all 3 of those programs will prepare you well. most important is that you pick a place where you will be happy. you will get better training that way and do more with your residency
 
I am a 3rd year medical student (DO) and have a keen interest in EM. I have worked as a RN in EM for over 5 years and feel I have a good grasp of the job and requirements.

I took the USMLE and COMLEX and will look at ACGME 3 year programs mostly because I am an older student. I have not done any research and I continue to work in the ER as an RN.

My question is should I look into research to strengthen my application? I have a family and REALLY need the money so work is kinda important. I want to be competitive and have had some great rotation so far. I will do 2 away rotations at programs I am interested in and should not have any issues since I have some decent ER experience (this has been the case so far).

Thanks


OldMan


You should not do research to 'strengthen' an application. You don't do great research and it will show when you interview. If you have good step scores, good grades, and good evals and LOR's, then you will be fine. Lots and lots of people match without research. Without a doubt, do NOT do research unless it is something you want to do.
 
Originally Posted by oldManDO2009
I am a 3rd year medical student (DO) and have a keen interest in EM. I have worked as a RN in EM for over 5 years and feel I have a good grasp of the job and requirements.

I took the USMLE and COMLEX and will look at ACGME 3 year programs mostly because I am an older student. I have not done any research and I continue to work in the ER as an RN.

My question is should I look into research to strengthen my application? I have a family and REALLY need the money so work is kinda important. I want to be competitive and have had some great rotation so far. I will do 2 away rotations at programs I am interested in and should not have any issues since I have some decent ER experience (this has been the case so far).

Thanks


OldMan

I agree with Greylin. Applicants often feel compelled to do extra stuff to pad their apps. This usually winds up resulting in poorly executed stuff that's obviously padding. Sometimes it's good to have something extra to point to on a application to set you apart if it is something done well and for the right reasons. Your work as an RN should cover that for you.
 
woah, is it safe to guess that if you ranked 13 places (w/15 interviews) there is more to the story if you didn't even match? why would this guy even get interviews if people didn't want to rank him highly?


Probably so. there are so many variables and it is difficult to speculate.
 
Hi,

In earlier posts, I read that EPs work about 35-40 hours per week. What about Emergency Surgeons- how much do they work and what usually is their net salary?


there is no such thing as "emergency surgeons." There are trauma surgeons, who do a 5 year general surgery residency and then a 2 year fellowship in trauma and critical care, who act both as general surgeons and trauma surgeons. There are also general surgeons who take call who will handle other 'emergencies' (such as acute appenditis, etc). It depends on the place where they are. You might want to ask this in the general surgery forum. The few trauma surgeons I know work 70-90 hours a week.
 
So i am a first year allo med student, and ER is one of the specialties that interest me. My questions/concerns are:

1- As an ER doc, how hard is it to get a job in a busy hosptial with many real emergencies (one with a trauma center, for example), as opposed to running an ER that is like an urgent care center? Will this require sacraficing location preference? Would you say most ER's have enough serious emergencies to keep the attendings excited? I say this because I volunteered at two ER's in the same city, and there was a huge difference (from what I observed, granted I knew very little) in the type of patients/work at each.
It's quite easy for board certified EPs to find work. If you want to work in a busy ED with lots of "real emergencies" it's easy to get. Most EDs are plenty busy to keep everyone interested.
2- Are there any EM fellowships? maybe like a peds? anything kind of surgical? Anything intensive care related? As you might notice, I am bringing in other specialties that inerest me in the mix.
Yes, there are fellowships. Yes there's peds. Here's the list:
http://www.saem.org/saemdnn/Home/Communities/Fellows/Fellowship/tabid/78/Default.aspx
3- In an academic setting, do ER doctors teach med students/residents? Is it ever class room setting or just in the hospital?
90% clinical and 10% didactic
4- Is there much room for research as an ER doc (this isn't very high on my list, just thought to ask since I have already started :)

:thumbup:Thanks in advance!! :thumbup:
Yes, most academic EP do research. An academic EP is one who holds a professorship in an academic center, usually associated with a residency.
 
Hi Guys,
I have a question about exposure to EM during the 3rd year of medical school. I was perusing through the saem website and came across rotation information for medical students. Most of these require you to have completed your 3rd, and be enrolled into 4th year. With the application season about to start early 4th year, how would a student with an interest in EM go about gaining exposure to the field earlier, in order to make a definitive decision to apply? I will be starting at PCOM in philadelphia in the fall and only saw one place that allows 3rd years to rotate. I'm not sure if I'm missing something?

Oh and any other advise for someone interested in EM, with a few months left before school?
EM usually demands 4th years because it's felt the you need exposure to IM, Surg, OB/Gyn, Peds and so on to get anything out of EM. We see it all. Although you won't be working in the ED you will spend time there as a third year when you are admitting patients and doing consults. To get more exposure you should get into your school's EM interest group and try to spend some time shadowing some EPs. I don't know anyone at PCOM but you can ask on the EM forum if anyone knows how a PCOM student can start getting some time in. Someone there will know. If not there then I'd try the Osteo forum.
 
Hi,
I am fortunate enough to get on board EM research, except for only 6 months because my schedule won't allow it after. Do you think its worth it even if publishing is not going to happen? I've heard mixed things so wanted to hear your thoughts. Thanks

Research is good for experience if you like research. So, if you have an interest in research and want to learn about it, you should go for it. If you are looking only to publish for the checking of boxes, I would spend your time doing something you like.
 
I am going to be a M1 this Fall. I have a strong interest in EM due mainly to time spent volunteering at a Level 1 trauma center. It's funny because I didn't think I would like EM going in, but I found that I enjoyed the pace and the variety.

My question is how does a student prepare himself to be a strong applicant for a particular field, while at the same time gaining enough exposure with other specialties to determine what field to choose. I plan on joining the EM interest group at my school, but I don't want to shut myself out from other possibilities. I'd like to get some additional exposure then just the clinical rotations. I feel it's difficult to base a career decision on just a few weeks experience no matter how good or bad.

I know my main focus for the first two years will be grades and Step 1. Just looking for some general advice on how to further investigate my career options.

BTW - I'm a non-trad in mid 30's. Being able to have a life outside of medicine is important to me. Besides all the obvious things that are interesting in EM, it seems that is also provides an opportunity to have a balanced life.


Believe it or not, with your attitude, it is very simple to prepare yourself: keep an open mind (you never know what will appeal to you).
Get good grades (never hurts to have good scores)
JOin the EM interest group.
Have a life.

If you like research, consider that. If you don't, just get some experience. Keep an open mind and realize that all fields touch EM.
 
Hello-

I am not sure if this is the most appropriate place to post this question, but I will give it a try. I am MS3 interested in emergency medicine as well as global health with an emphasis on refugee health. I have been reading up on the international emergency medicine fellowship and I am curious to know how if differs from doing a preventive medicine residency. They both seem to be two years in length with one component being obtaining a MPH. Both require that you complete some type of project (clinical field work). The only main difference I see is that at the end of the international EM fellowship you can not become board certified, but with the preventive medicine residency you are board certified. Can anyone provide some more clarification for me?
I have to admit that I'm not well versed on either of these fellowships. Rather than guess at an answer I suggest you post this same question to the Em forum and see if anyone there has some better info. Sorry.
 
Do either of you have thoughts about which type of residency program may be more beneficial in finding a job afterwards: a big name in EM (i.e. Harbor, Denver, Cincinatti, Carolinas, etc.) or a big name overall (Harvard, Penn, Hopkins, etc.)?

It seems that coming from a well known program in EM should matter more, but we'd love to hear your thoughts on this, since you are in the community and see who gets "recruited" and hired.

Thanks!
Your program doesn't matter as much as you'd think in landing a job. It matters more in academics. If you're looking at academic EM then a big name EM program matters more than a big name in general, ie. Cinci > Harvard.

In private practice we're looking for fit and speed and experience more than program name.
 
hello,
I'm a 2nd year, and I will be attending the ACOEP spring seminar at Scottdale, AZ in March. from what I understand, many representatives from different schools will be there to present their residency programs as well for Q&As. Is there any way I can obtain a list of the schools that will be there? I have searched the web and read the brochure for the conference and turned out nothing.
Also, anyone from this forum will also be there? :)

thank you, and have a good day.
I'm not sure. I would suggest contacting the ACOEP directly.

http://www.acoep.org/main.asp?main=con
 
I'm thinking along these same lines with EM and Gas as my "other" considerations, reversed from yourself. If I may ask, I know this is an EM thread, why would you do Gas in a do over?
I wouldn't do gas in a do over. But it'd be a close second. It has the same mix of medicine and procedures as EM and it deals with critical patients. It has less of the frantic hyper overload crisis time that EM has which is no fun. The bad things about it are that it can get boring and you are on call. You also have to be really available to your surgeons or they'll quit using you.
Also, do you still enjoy your work?
No. But that's just me and there are good patients you run into. You also can get into other things in addition to working the pit (not instead of because makeing a good income on these is very difficult) like administration, sports medicine, consulting, EMS, etc.
Is it as lucrative as you would like?
Yes. The money's good enough. I would probably be happier in an EM setting with better conditions (in my case lower volume and better specialty coverage) even if it meant less pay but it's hard to leave a place where you're established for an unknown.
Do you ever find yourself wishing you could follow a patient to the OR?
No.
 
I have to admit that I'm not well versed on either of these fellowships. Rather than guess at an answer I suggest you post this same question to the Em forum and see if anyone there has some better info. Sorry.


I am fairly well versed in the international fellowships, not so much the other. What you will need to do is look specifically at the programs and what experiences they offer. MPH's are also exceptionally flexible in your focus.

Since your interest is primarily international with a focus on refugee, I would suggest an international fellowship. Preventive medicine is very different from the world of international medicine. Although there are definately overlaps, an international fellowship will focus more on the issues surrounding international medicine: NGO's, refugees, etc.
 
So WORKINEM,
You said that you do not enjoy your job anymore...what about your colleagues? I'm a radiology resident who had a tough time in medschool deciding between EM and radiology but ultimately chose radiology. I'm actually thinking about switching to EM b/c i miss the action and patient care but almost every er doc i talk to tells me to stay put and that i'd be insane to switch:confused:. I actually talked to several that said they would never have chosen EM if they knew what it was "really" like. What do you think? It just seems like all the EM residents i meet love their jobs but all the attendings i meet hate it...strange
 
Hi again Mentors,
Based on your experience and by looking at the current trend, would the demand for urgent care medicine physicians go up in the future (EM or FM trained)? Will it be comparable to the demand for emergency room physicians?
Thanks
Drox



Not sure what you mean by urgent care. The demand for primary care and EM will continue to rise.
 
MS3 here, very interested in EM residency. I was wondering what type of letters of rec (i.e. certain specialties/fields) EM residencies favor?? I'd like to assume critical care, EM directors, etc. The problem for me is that I rank slightly under par on paper....but I stand out on the wards, completely opposite of board scores and average-ish grades (I have a 3.0). Will my LOR even have any weight on my app, or will programs see my bland-average stats on paper and disregard me from the beginning? I just want to have realistic expectations. Any input would be appreciated :)


LOR's have VERY high weight. You will want to have two letters from EM physician's. Preferably from different institutions. The other LOR doesn't really matter but you should have one from something else. When you ask for a letter of rec, even though its uncomfortable, be sure to ask "Are you willing to write me an outstandign LOR." Some people will agree and write mediocre letters. You might be disregarded from a few places because of numbers, but most will look at your entire application.
 
So WORKINEM,
You said that you do not enjoy your job anymore...what about your colleagues? I'm a radiology resident who had a tough time in medschool deciding between EM and radiology but ultimately chose radiology. I'm actually thinking about switching to EM b/c i miss the action and patient care but almost every er doc i talk to tells me to stay put and that i'd be insane to switch:confused:. I actually talked to several that said they would never have chosen EM if they knew what it was "really" like. What do you think? It just seems like all the EM residents i meet love their jobs but all the attendings i meet hate it...strange


I love my job. However, I knew exactly what I was getting into when I chose my field. EM is a young specialty and some people picked for what were percieved perks: no call, no setting up an office, shift work. However, EM is a unique field. You must like to multitask. You must like diversity. You must be willing to deal with a significant amount of stress easily.

I, and many I know, still love the field. I love having undifferentiated patients. I love the diversity. There are definately annoyances. No field is perfect. But for me, the benefits outweight the negatives over and over again. There are several threads in the EM forum if you want to check them out.
 
Hi I am a little new to this forum and I hope that I am doing this right. I am currently pursuing a degree in psychology and I am planning to attend Oklahoma's Medical School. I have been recently thinking about EM as a field that I would like to go into. How would I go about doing that? Could You please help me out?


You have a very long way to go, but there are many things you can do, to see if EM is right for you.

1. Find an EM doctor to shadow.
2. Join the EM interest group in your undergrad school/medical school
3. Join EMRA (www.emra.org) once you are a medical student
4. Approach EM faculty to find a mentor to help you along.
5. Keep an open mind. EM touches all fields so learn as much as you can.
6. Study hard but don't spend your entire life in medical school.
 
So WORKINEM,
You said that you do not enjoy your job anymore...what about your colleagues? I'm a radiology resident who had a tough time in medschool deciding between EM and radiology but ultimately chose radiology. I'm actually thinking about switching to EM b/c i miss the action and patient care but almost every er doc i talk to tells me to stay put and that i'd be insane to switch . I actually talked to several that said they would never have chosen EM if they knew what it was "really" like. What do you think? It just seems like all the EM residents i meet love their jobs but all the attendings i meet hate it...strange
Some of my colleagues still like it. Many are like me, they like parts and hate other parts. One thing about EM is that practice situations vary dramatically. In my particular situation it is high volume, high acuity, poor specialty coverage and a high volume of inner city issues (ie. addiction). One thing I deal with that particularly irks me is a totally dysfunctional psych system. In my area there are no services or beds available for in patient psychs so they just board in the ED for weeks on end. Being responsible for these patients long term is not within my training and causes me a great deal of stress and wasted time.

Now I could change jobs, and getting another EM job is pretty easy, but I'd take a big pay cut and have to move my family and we like where we are geographically. So I'm sticking it out and trying to find other medicine related interests to keep things fresh. Fortunately there's lots of opportunity for this in EM. So even though I don't whistle zippity-doo-dah on my way into work every day I still think EM is one of the better places to be in medicine.

Here's a thread that talks about the problems with trying to change your workload by changing jobs:
http://forums.studentdoctor.net/showthread.php?t=471900
 
How important would you say it is for someone who wants to go into EM to complete a residency at a level I trauma hospital?


You must have level 1 trauma experience. Wether this is accomplished at your primary institution, or at an outside mandatory rotation (what many places do that aren't level 1), you must have it.

Trauma is a crucial (albeit not total) element of being an Emergency Physician. You must learn how to manage trauma patients.
 
How important would you say it is for someone who wants to go into EM to complete a residency at a level I trauma hospital?
I would argue that the Level of the institution you train at is not as important as the volume of trauma it receives. The vaunted title of "Level I" really refers to the research and training functions of that institution. There is not very much capability difference between Level 1 and Level 2. Level 3 means that the OR staff is on call rather than in house and Level 4 just means you have an ED and filed with the ACS. I've seen great training and high volumes at suburban Level 3 centers and poor training at Level 1 centers. The program and the volume mean much more than the level designation.
 
is this really an issue? even if a program isn't based in a level 1 trauma center, you would usually have some rotations/experience in one or two level 1 centers anyway. I'd agree with the above...it's the volume and clinical exposure that you get that would probably be more beneficial.
 
This is my third posting. SDN doesn't like the level 1 discussion.

Level 1 is not an important designation in and of itself. However, it is an indirect proxy of exposure and experience. Many EMS systems do not take traumas to level 2's unless they are unstable or there is not one close by. (for further understanding of the designation, go here: http://www.ilga.gov/commission/jcar/admincode/077/077005150H20300R.html).

While I would not advise dismissing programs without level 1 status, or a level1 rotation, I would simply take a few extra moments to explore that programs level of exposure.

Even with level 1 status, there are trends that experience is declining.

Incompatibility Between RRC Requirements and Actual Number of Emergent Procedures in Trauma Patients
G. Garraa, A. Wacketta, J.E. McCormacka, A.J. Singera, M. Shapiroa, H.C. Thode Jr.a and M.C. Henrya

aStony Brook University, Stony Brook, NY

Available online 21 August 2007.



Article Outline

Study Objectives Methods Results Conclusion



Study Objectives


The RRC requires EM and surgical residents to have sufficient opportunities to perform invasive procedures. Each resident is required to perform 20 central lines, 10 chest tubes, 3 cricothyrotomies, 35 intubations, 3 pericardiocenteses, and 3 peritoneal lavages, during residency. We determined the number of procedures needed by trauma patients at a regional trauma center to see whether there were enough procedures to credential all our residents. Methods


Study Design-Secondary analysis of regional trauma registry. Setting-Suburban, academic, level 1 trauma center with affiliated residencies in EM (10 residents/year) and surgery (6 residents/year). Measures-Demographic and clinical data extracted from computerized trauma registry between 1996-2005. Outcomes-Mean number of procedures per resident over residency. Data Analysis-Descriptive statistics. Results


There were 15,606 trauma patients admitted to our trauma service. Over 11 years there were 622 chest tubes, 143 peritoneal lavages, 50 emergent thoracotomies, 6 surgical airways, 1,002 intubations, 14 pericaridiocenteses, and 666 central lines placed on trauma patients. The mean annual number of procedures were chest tubes 56, pericardiocentesis 1.3, thoracotomies 4.5; surgical airways 0.5, intubations 91.5, and central lines 60.5. Over the study period the number of peritoneal lavages and thoracotomies has declined while the number of central lines has increased. With 60 emergency and surgical residents at our center, on average each resident would perform 3 chest tubes, 9 trauma intubations, 6 central lines, and very few if any surgical airways, emergent thoracotomies and peritoneal lavages in the ED during residency, assuming they are evenly distributed. Conclusion

In order to maximize procedural experience, surgical and EM residents must collaborate. Alternative venues (simulation lab, animal lab, operating room) are necessary for mastering the skill of trauma procedures.
 
Hello everyone,
I am a med student interested in entering an EM residency program. I am looking for an academic program, with a busy load of patients and the possibility of doing research. I would appreciate if someone could mention some examples of such kind of programs.

thanks a lot


There is a ton of EM residency reviews, stickied, in the EM forums. There you will see many peoples reviews of exactly the same thing. Best of luck!
 
I know that the EM workschedule normally involves doing shiftwork, which would probably also involve doing the 'graveyard shifts' - i.e. hours when most people are sleeping. How has your experience been going through these types of shifts? How did you adapt to disruptions in your circadian rhythm and normal sleep patterns? Was it difficult to adjust? Is it usually the people who are starting out who get stuck with these shifts?


This depends on where you go. Almost everyone has to work some nights but it depends. Some places have 'night people'. Those people who work only night shifts. They usually get a differential: either more money or the same money but less shifts. Some places you work anywhere from 1-4 overnights a month.

I don't mind nights. Everyone figures out their own recovery system. If I am doing a random, isolated night, I tend to stay up later the night before (till 1 or 2 am) and then don't sleep the next day. Or if I am completely wiped, I only let myself take a short nap so I don't mess up my schedule.
 
As a New osteopathic medical student what do you recommend for me to do if I really want to get into a allopathic EM residency program besides do well on the USMLE's?
Since your profile says you're a med student I assume you will be starting DO school in the fall.

I would get involved with the EM interest group at your school. Seek out a mentor in EM who can steer you toward research projects and advise you on rotations when those come up. There are some posts in this thread on finding and cultivating mentors as well as in the EM forum.

Clearly the above is basic info that applies to everyone. For your situation of being a DO looking for an allo EM residency I suggest trying to find a mentor who has ties into an allo residency. There may be some MDs on staff at your program, some of the DOs may have gone allo and the PD will know PDs at other places. You can also plan to do away rotations at your target program. You can start calling them the year before to figure out how to arrange such a rotation.

Your reason for wanting to go allo may get questioned at some point. I find that the majority of DOs who want to go allo (I work in an ED that has DO students) have some geographical need. If your desire to go allo is other than geography or a desire to go to a particular program for some reason you're closing off a lot of options early in the game.
 
I went on the EMRA site and asked for a mentor. I have done research at a hospital that my school rotates at and I know some of the assistant PD and the Chief resident. I will be integrated into their study once they publish their research results, I hope that is good in the long run for residency. I wanted to ask if I should continue to do research with them or at least keep in contact with them so that I may have a better chance at landing a residency their because I would love to be a resident at that program.


Its never a bad idea to maintain contact. It can definitely make it easier for you. Plus research is always good.
 
Is the 4th year requirement a hard and fast rule or is there wiggle room for a program with 1.5 yrs preclinical (so I'd be done with core rotations by midway through 3rd year)?

Thanks!


There are no absolutes. Some programs have an EM rotation during surgery. Other schools don't allow EM until your fourth year.

the point is, to do well in an EM sub-I, you need to have done most of your third year clerkships. EM touches all fields and you really want a solid foundation in all the areas. And you also want to be performing at your best. If you are dying to do EM during your third year, you could always try shadowing in the ED on your 'lighter' rotations.
 
What are the main differences between EM and Intensivist? How come there aren't that many combined EM/Intensivist programs (i don't even know of one)?
It seems like the most common route to becoming an intensivist is via Surgery or IM. Will this change in the future?

thank you
MS III

There are lots of differences (and some overlaps). Most intensivists also do something on the 'side': anesthesia, surgery, pulmonary, a few renal, or Emergency.

Intensivists work in the intensive care units. Which ones depend on the path to training.

Most go IM and then do pulmonary/critical care fellowship.

A growing number do EM and then do a critical care fellowship. Currently, EM trained MD's can't sit for the american boards, but sit for the european critical care boards. This seems to matter very little in terms of getting a job.

If you go to the residency forum, there is a section for critical care where this is discussed as well.

Hope that helps!
 
Hi,

Being a semi-competitive field, how good are my chances for matching into a osteopathic EM residency with an average perfromance on the COMLEX I and average grades in year I and II. I have lots of extra-curriculars and have held leadership positions while in school. I am currently doing third year rotations and am trying to excel in them.

I have not worked as an EMT or anything similar to it but I feel like EM suits my personality best.

your input would be appreciated.

I think allopathic residencies would be out of the question with my average scores...but I do not know. I havent taken the USMLE 1 but I dont know if I want to study for Step I again...when I think of it I should have taken them both at the same time....oh well.

Help!:(


As I am trained in allopathic, I can't speak for DO programs. However, applying to residency is similar across both areas. It sounds like you are fairly competitive. You really need to touch base with an EM advisor. You should also consider posting in the EM forum as there are several EM trained DO's there. I would say if you want to go allopathic, you need to take the USMLE.
 
Hi Graylin. I'm in my second year and am currently leaning towards EM (although I know that could change next year when I start rotations). I've been searching around SDN for private practice opportunities in EM and I've found a few mentions of groups of EM physicians that get together and contract to hospitals. I was wondering if you could tell me more about this and if there are other ways to go into private practice as an EM doc. Also, does doing a fellowship change these opportunities?

Thanks.
The vast majority of EPs work for groups contracted to hospitals. Even many academic groups function this way. Being an employee of the hospital is very much the exception to the rule. The term "private practice" when applied to EM has more to do with working in a community or non-academic setting than the differentiation between being an employee or a contractor with a contracting group.

Doing a fellowship can allow you to be a more attractive candidate for many groups dependeing on which fellowship and what they need. For example my group is looking for EPs with peds training right now. The main reason EPs do fellowships though is that it can make you more attractive to academic institutions. Some people feel that to be competitive for academic spots you must do a fellowship. That's not true bot a fellowship will probably help.
 
What make a student competitive for EM residencies? Do you need to have research on your CV, or having good grades, good board scores and tons of extracurricular activities will be enough? Btw what do you think is a good COMLEX or USMLE score for someone interested in EM?

Sorry for the delay in answering you. Sometimes we get a little sidetracked.

You don't have to have research or really anything other than decent grades and boards for EM but everything helps. The more extras you have such as better grades or boards, research, relevent experience, letters, letters from recognized people and so on the more likley you'll be to get ranked at a program you want.

I don't know what numbers would correlate to good boards or COMLEX as I took the boards so long ago I have forgotten and I never took the COMLEX. I'd say that anything better than the 50th%ile is decent.

Extracirriculars help if they're relevent. EM programs will like EMRA and the EM interest group and the like but they won't care about stuff that's totally unrelated.
 
This question might have been asked before, but I have heard around that residency programs for EM are easier for DO's to get into than other residencies because EM likes to see the "whole package" that an applicant has to bring. Is this true? Secondly, is it possible for a DO student to do an away rotation at an MD school? Thanks!

-LPB

EM may be a little less stodgy than some other speciaties but I don't think that it's easier for DOs. Like most specialties EM has some programs that don't accept DOs and others that do. As for doing away rotations I think it's possible but planning as far in advance as possible is always a good idea.
 
Top