There’s no specialty with the knowledge base/skill set that EM has and that kinda sucks

[Maybedoc1]

MS3 here deciding on specialty. Long story short back in 2018 I decided to go to medical school to be an EM physician. Now I’m very aware of all the problems facing EM as much as I can be. I have developed some interest in other specialties like IM, anesthesia, radiology, critical care, which have aspects of medicine that I like, but I don’t feel that any of them have the wide knowledge base, diagnostic skills, and procedural skills that EM has (and that I so desire as a physician) and that’s kind of a bummer.

You’re all comfortable with the “I can’t believe you came to the ED for this” to the “how did you even make it to the ED” and everything in between. Everything from sniffles to minutes from death. Infants, kids, undifferentiated disasters, adults, elderly, ophtho, OB, medical, trauma, neuro, ortho, derm, etc.

Intubations, joint reductions, lac repairs, chest tubes, crics, pericardiocentesis, thoracotamies, peri mortem c sections, etc (I know some of these are extremely rare and its never a good day when you have to do one).

I don’t think there’s another specialty like it.

I know the current landscape and future looks bleak and because of that I’ll probably choose something else, but it’s hard to let go of being the kind of physician that an EM doc is.

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[RustedFox]

It used to not be this way. It used to be way better.

 

[GonnaBeADoc2222]

I was on a flight to SLC once where someone had a syncopal episode.

Flight to SLC in February so naturally tons of doctors.

Family medicine, Ophthalmology, Neurology and Dermatology physicians responded.

I wasn't trying to be pushy, in fact I was trying to avoid the situation,.but as soon as they found out I was EM, they all deferred to me.

I felt like a Chad.

 

[GonnaBeADoc2222]

Personally I wouldn’t get up. In residency when I was on a plane some lady passed out. Was likely just dehydration from Covid. Now I know there’s good samaritan laws to protect you from lawsuits in this situation but as far as I’m aware they’re only valid if you’re not compensated. The airline gave me a free ticket for helping out. Meaning I could get sued if I possibly missed something on an airplane with basically no resources. Since that day I don’t get up for any emergencies in public. Not a chance I’m getting sued off the clock.

Meh. This comes up often.

Stay within scope of practice.

You're fine.

 

[thegenius]

MS3 here deciding on specialty. Long story short back in 2018 I decided to go to medical school to be an EM physician. Now I’m very aware of all the problems facing EM as much as I can be. I have developed some interest in other specialties like IM, anesthesia, radiology, critical care, which have aspects of medicine that I like, but I don’t feel that any of them have the wide knowledge base, diagnostic skills, and procedural skills that EM has (and that I so desire as a physician) and that’s kind of a bummer.

You’re all comfortable with the “I can’t believe you came to the ED for this” to the “how did you even make it to the ED” and everything in between. Everything from sniffles to minutes from death. Infants, kids, undifferentiated disasters, adults, elderly, ophtho, OB, medical, trauma, neuro, ortho, derm, etc.

Intubations, joint reductions, lac repairs, chest tubes, crics, pericardiocentesis, thoracotamies, peri mortem c sections, etc (I know some of these are extremely rare and its never a good day when you have to do one).

I don’t think there’s another specialty like it.

I know the current landscape and future looks bleak and because of that I’ll probably choose something else, but it’s hard to let go of being the kind of physician that an EM doc is.

We are the most useful doctors in our health care system, without question.

The system doesn't value that skillset...and instead values the convenience and ability to send the ER every medical and social problem 24/7/365.

 

[GatorCHOMPions]

MS3 here deciding on specialty. Long story short back in 2018 I decided to go to medical school to be an EM physician. Now I’m very aware of all the problems facing EM as much as I can be. I have developed some interest in other specialties like IM, anesthesia, radiology, critical care, which have aspects of medicine that I like, but I don’t feel that any of them have the wide knowledge base, diagnostic skills, and procedural skills that EM has (and that I so desire as a physician) and that’s kind of a bummer.

You’re all comfortable with the “I can’t believe you came to the ED for this” to the “how did you even make it to the ED” and everything in between. Everything from sniffles to minutes from death. Infants, kids, undifferentiated disasters, adults, elderly, ophtho, OB, medical, trauma, neuro, ortho, derm, etc.

Intubations, joint reductions, lac repairs, chest tubes, crics, pericardiocentesis, thoracotamies, peri mortem c sections, etc (I know some of these are extremely rare and its never a good day when you have to do one).

I don’t think there’s another specialty like it.

I know the current landscape and future looks bleak and because of that I’ll probably choose something else, but it’s hard to let go of being the kind of physician that an EM doc is.

Theory vs Reality

The skill set is good in theory, but 90% of EM is moving the meat through the grinder. The 10% good becomes burdensome when, after finishing that cool procedure or resus, you have to return to 5 new patients waiting for the meat grind.

You might have some cool stories and respect among laypeople in theory, but you'll be recovering too often from constant circadian rhythm disruption to fully enjoy it.

Your pay and job security should be good in theory, but there are mounting pressures to decrease them in the future.

 

[GonnaBeADoc2222]

Theory vs Reality

The skill set is good in theory, but 90% of EM is moving the meat through the grinder. The 10% good becomes burdensome when, after finishing that cool procedure or resus, you have to return to 5 new patients waiting for the meat grind.

You might have some cool stories and respect among laypeople in theory, but you'll be recovering too often from constant circadian rhythm disruption to fully enjoy it.

Your pay and job security should be good in theory, but there are mounting pressures to decrease them in the future.

Us and the outpatient IM/FM types are the quintessential physicians. It's what the public thinks about when they hear the word "doctor."

That being said think long and hard before embarking on this almost thankless road. There are highs and successes for sure, but doesn't make up for the slavery of CMG or hospital system employment.

 

[Groove]

I think our relevance died when the Manny Rivers early goal directed therapy sepsis data got debunked. Up until then we were envisioned as this resuscitation specialist that was dropping lines in every septic patient and bringing the ICU to the ED bedside. When all that went by the wayside…we have been progressively pigeonholed as triage docs whose sole function is to disposition and “pass the buck” as quickly as possible. The specialty became much less gratifying for me when that happened. I actually enjoyed the specialty back in the Manny Rivers days. I was mortally wounded when that data was proven to be unsound.

 

[lymphocyte]

Personally I wouldn’t get up. In residency when I was on a plane some lady passed out. Was likely just dehydration from Covid. Now I know there’s good samaritan laws to protect you from lawsuits in this situation but as far as I’m aware they’re only valid if you’re not compensated. The airline gave me a free ticket for helping out. Meaning I could get sued if I possibly missed something on an airplane with basically no resources. Since that day I don’t get up for any emergencies in public. Not a chance I’m getting sued off the clock.

I got up once. Told to sit down because there was a doctor there already. Insisted once the lady collapsed. Doctor was a geriatrician and was pretty grateful for the help. All I got was a pile of paperwork as people pushed passed me to get off the plane. Lady did well.

I'd probably do it again, because I'd feel too guilty to do nothing, but I have zero expectations for getting anything in return except for grief.

 

[Tipsy McStagger]

Well let's break it down. No specialty has the knowledge base/skill set that any other specialty has, and that's why there are separate specialties. Don't go down this road man, I went down it myself and got out of EM as soon as I could. In reality, it's not what you think it is, despite the fact that on paper it's an amazing specialty. I wanted to be the doctor I had envisioned - the old school doc that could do it all. I wanted to be able to handle whatever came in the door, sudden delivery, reset fractures, sew up complicated pediatric facial lacs, see normal fevers/aches/pains and send them home with friendly reassurance, resuscitate crashing medical/trauma patients and blah blah blah. It ain't what you think it is.

Do those things exist? Yest they do. Are they the bulk of your day-to-day work? They are not. As was mentioned above, you will be moving meat. Yeah, that crashing septic patient is fine with that 20g in the hand on 2 pressors, ICU can place the line. Yeah it's super busy, trauma will put in that chest tube, hey this airway may be a little complicated let's just 'get anesthesia on board'. And the thing is, the more you do the job, the happier you'll be that these other services are willing to do this because the truth is, aside from trauma on a very busy night, there is nobody in the hospital busier than an EM doc. You'll be so damn grateful that ICU will place that CVC because you know by the time you're done there's gonna be 8 more people ready to be seen. What? Plastics is gonna sew up that peds facial lac? Thank freaking god, because to do the sedation, repair the lac and reassure parents that plastics isn't coming in at 2am to sew up their kids face is going to take so much damn time that there will be 20 new patients to see, all of them angry for waiting. This is the reality that the paper never told you - but seasoned EM docs sure told me. Like you, I was prepared to ignore all of them, and I did.

I'll be honest though, I'm grateful for my EM training. I think it's a great specialty to segue into critical care (which is what I did). And god knows we actually do need EM docs in the pit, getting it done. If you want to join them then by god do it, just know exactly what you're getting into - and don't think you're some superior physician that possesses some kind of skill that nobody else does. Because the truth is, that all those procedures you like, well my friend, there's someone that can do them better. Airway - anesthesia, reductions - ortho, complex lacs - plastics, peds anything - PICU/peds. You're good, but there's better. So don't get trapped into the nonsense that you often find in medical school, residency and acedmia that chasing prestige matters. Nobody gives a ()*% about prestige when you're out there working, you'll just regret chasing someone else's approval. That way lies madness.

You'll see these docs your whole career. They chose based off supposed prestige and are now miserable wrecks - they're just so shocked when the hallways don't part for them. Don't be these guys, follow your heart. Just make sure your heart is actually informed by reality and not dreams. We all have a roll to play. Outpatient docs are by far the most important in my humble opinion, it's also probably the only other job in medicine that might just be harder than EM. Bascially what I'm trying to say to you is this - stay humble, respect the work that other physicians do, and recognize that you really don't have any idea what they actually do on a day-to-day basis anymore than they have an idea what EM does on a day-to-day basis. Be respectful, be humble, and stay the #*% away from EM unless you're cool with the grind, the hours, the nights, the holidays, the CMGs and the patients.

EDIT: yeah and no better doc on an airplane than an EM doc

Good luck!

 

[Apollyon]

I used to be platinum with Northwest, then Delta, for about 4 years. I used to fly A LOT when I lived in HI. Only got asked once for something; I was talking to the flight attendant in the back, when this mother overheard I was a doctor. Somehow, her son had blown air into his canaliculus, from the aperture under the middle turbinate. It was just reassurance.

However, I have a friend who is a radiologist. This story is 100% true. She was flying home to WA from Maui. They called over the air for a doctor. Like a flash, about 30 hands went up. On the flight were cardiologists that had been to the ACC conference on Maui! She didn't volunteer.

 

[dozitgetchahi]

Well let's break it down. No specialty has the knowledge base/skill set that any other specialty has, and that's why there are separate specialties. Don't go down this road man, I went down it myself and got out of EM as soon as I could. In reality, it's not what you think it is, despite the fact that on paper it's an amazing specialty. I wanted to be the doctor I had envisioned - the old school doc that could do it all. I wanted to be able to handle whatever came in the door, sudden delivery, reset fractures, sew up complicated pediatric facial lacs, see normal fevers/aches/pains and send them home with friendly reassurance, resuscitate crashing medical/trauma patients and blah blah blah. It ain't what you think it is.

Do those things exist? Yest they do. Are they the bulk of your day-to-day work? They are not. As was mentioned above, you will be moving meat. Yeah, that crashing septic patient is fine with that 20g in the hand on 2 pressors, ICU can place the line. Yeah it's super busy, trauma will put in that chest tube, hey this airway may be a little complicated let's just 'get anesthesia on board'. And the thing is, the more you do the job, the happier you'll be that these other services are willing to do this because the truth is, aside from trauma on a very busy night, there is nobody in the hospital busier than an EM doc. You'll be so damn grateful that ICU will place that CVC because you know by the time you're done there's gonna be 8 more people ready to be seen. What? Plastics is gonna sew up that peds facial lac? Thank freaking god, because to do the sedation, repair the lac and reassure parents that plastics isn't coming in at 2am to sew up their kids face is going to take so much damn time that there will be 20 new patients to see, all of them angry for waiting. This is the reality that the paper never told you - but seasoned EM docs sure told me. Like you, I was prepared to ignore all of them, and I did.

I'll be honest though, I'm grateful for my EM training. I think it's a great specialty to segue into critical care (which is what I did). And god knows we actually do need EM docs in the pit, getting it done. If you want to join them then by god do it, just know exactly what you're getting into - and don't think you're some superior physician that possesses some kind of skill that nobody else does. Because the truth is, that all those procedures you like, well my friend, there's someone that can do them better. Airway - anesthesia, reductions - ortho, complex lacs - plastics, peds anything - PICU/peds. You're good, but there's better. So don't get trapped into the nonsense that you often find in medical school, residency and acedmia that chasing prestige matters. Nobody gives a ()*% about prestige when you're out there working, you'll just regret chasing someone else's approval. That way lies madness.

You'll see these docs your whole career. They chose based off supposed prestige and are now miserable wrecks - they're just so shocked when the hallways don't part for them. Don't be these guys, follow your heart. Just make sure your heart is actually informed by reality and not dreams. We all have a roll to play. Outpatient docs are by far the most important in my humble opinion, it's also probably the only other job in medicine that might just be harder than EM. Bascially what I'm trying to say to you is this - stay humble, respect the work that other physicians do, and recognize that you really don't have any idea what they actually do on a day-to-day basis anymore than that have an idea what EM does on a day-to-day basis. Be respectful, be humble, and stay the #*% away from EM unless you're cool with the grind, the hours, the nights, the holidays, the CMGs and the patients.

EDIT: yeah and no better doc on an airplane than an EM doc

Good luck!

Right? For me in medical school, the question wasn’t “what specialty gives me the widest skill set” or something, it was “what specialty looks like it’s something I would enjoy doing for 30-40 years, AND isn’t going to subject me to unreasonable and unsustainable demands in terms of work hours and living the rest of my life”?

This is how I ended up with rheumatology. I realized pretty early on in medical school that call, night float, etc was for the birds. I can remember a resident asking me early on in 3rd year what I wanted to do more than anything else at 3am - because that’s how you pick a specialty - and I said “sleep”. Working back from there, I found what I liked that lined up with that lifestyle. I realized I liked outpatient medicine much more than inpatient, and that I liked “thinking medicine” more than procedures. And I liked that nobody else really does what we do in rheumatology (at least at its core). We usually don’t get some other specialty pompously riding in on their stallion, telling us how to manage RA or SLE etc (in fact, the reaction is usually more like “oh god, go ask your rheumatologist about that, we don’t know anything about those dark arts (lol)”

At the end of the day, OP, it’s not about what you could theoretically do in your specialty and which procedures you can do and yadda yadda. This all sounds jazzy in medical school, but much like in marriage, you need to pick what harmonizes with you and your personality and well being, and what is going to be sustainable for decades down the road. And a neverending circadian rhythm rotation isn’t going to be sustainable for the vast majority of humans.

 

[Clean7795]

MS3 here deciding on specialty. Long story short back in 2018 I decided to go to medical school to be an EM physician. Now I’m very aware of all the problems facing EM as much as I can be. I have developed some interest in other specialties like IM, anesthesia, radiology, critical care, which have aspects of medicine that I like, but I don’t feel that any of them have the wide knowledge base, diagnostic skills, and procedural skills that EM has (and that I so desire as a physician) and that’s kind of a bummer.

You’re all comfortable with the “I can’t believe you came to the ED for this” to the “how did you even make it to the ED” and everything in between. Everything from sniffles to minutes from death. Infants, kids, undifferentiated disasters, adults, elderly, ophtho, OB, medical, trauma, neuro, ortho, derm, etc.

Intubations, joint reductions, lac repairs, chest tubes, crics, pericardiocentesis, thoracotamies, peri mortem c sections, etc (I know some of these are extremely rare and its never a good day when you have to do one).

I don’t think there’s another specialty like it.

I know the current landscape and future looks bleak and because of that I’ll probably choose something else, but it’s hard to let go of being the kind of physician that an EM doc is.

If you want to do EM there's only one choice there.

That said, your thought process does not sound like a mature one. Medical students commonly invest into a certain identity e.g. "I will be a pediatric cardiothoracic surgeon" or "I'm going to be the one who volunteers on an airplane" and have trouble divesting from that when something comes up. You're over-valuing the ability to do intubations, joint reductions, lac repairs, chest tubes, etc. without any really good reason, other than that's what an EM doc does. Why not prefer doing organ lac repairs/resections and managing the SICU/TICU as a trauma surgeon? Or doing acute bleed embolizations and reading images as an interventional rad? Or taking care of sick ICU patients as an intensivist?

Picking a specialty because you're in love with the idea of being a "X" doctor is a very common reason to become disillusioned as you progress through training/career, because the foundation of why you liked a specialty wasn't rooted in the actual day-to-day.

 

[lymphocyte]

You’re nicer than me. If someone told me to sit down after initially volunteering, I’d feel so insulted that I wouldn’t get up again. And then having to do paperwork and get off the plane late and no compensation while on a vacation and possibly getting served with a suit later? Forget it.

In Australia, there's an obligation to help. There have never been any lawsuits. Plus while I stew there'd be a lady dying. I have no beef with her. On the other hand, **** you United.

 

[BoardingDoc]

In Australia, there's an obligation to help. There have never been any lawsuits. Plus while I stew there'd be a lady dying. I have no beef with her. On the other hand, **** you United.

There's no duty to act in the US. The good sam laws protect you (in theory, and to my knowledge there haven't been any lawsuits related to someone jumping in to help for an in-flight emergency) but do not require you to act. I've always wondered what would happen if you volunteered to help with an emergency if you had a drink or two on a flight. Does that constitute gross negligence / willful and wanton or whatever the legal term is that ejects you from the Good Sam protections?

I'm always "Mr." on my boarding pass when I fly and not "Dr."

This is deliberate.

 

[dozitgetchahi]

In Australia, there's an obligation to help. There have never been any lawsuits. Plus while I stew there'd be a lady dying. I have no beef with her. On the other hand, **** you United.

America has a sue-happy culture, laws that benefit lawyers and support that lawsuit focused culture, and a metric ton of lawyers who will try as hard as they can to skirt any law if they think they can get to your money doing it.

Not worth it. At the end of the day, my ability to feed myself and my family matters more to me (or, at the very least, not having to deal with fighting off a stupid lawsuit that won’t get dismissed for years). Off duty, I do whatever I can to avoid these situations. Your malpractice insurance isn’t going to help you for anything that happens outside of work.

 

[cyanide12345678]

Picking a specialty because you're in love with the idea of being a "X" doctor is a very common reason to become disillusioned as you progress through training/career, because the foundation of why you liked a specialty wasn't rooted in the actual day-to-day.

Problem is, very few med students will get true exposure to the day to day. If they get to do a lac repair that they think is cool, they don’t have to worry about the multiple people that will show up while you’re doing a repair.

Med students are sheltered. And they really don’t understand the day to day after 2 months in the ER or any other specialty for that matter. 2 months is the honey moon phase.

 

[RustedFox]

Problem is, very few med students will get true exposure to the day to day. If they get to do a lac repair that they think is cool, they don’t have to worry about the multiple people that will show up while you’re doing a repair.

Med students are sheltered. And they really don’t understand the day to day after 2 months in the ER or any other specialty for that matter. 2 months is the honey moon phase.

This is why I say they rotating student/resident is a "tourist".

 

[nVictus]

Please listen to these posters and pick something else.

 

[ShockIndex]

I started fellowship thinking that EM uniquely prepared me. It certainly prepared me but it absolutely wasn’t unique.

Well let's break it down. No specialty has the knowledge base/skill set that any other specialty has, and that's why there are separate specialties. Don't go down this road man, I went down it myself and got out of EM as soon as I could. In reality, it's not what you think it is, despite the fact that on paper it's an amazing specialty. I wanted to be the doctor I had envisioned - the old school doc that could do it all. I wanted to be able to handle whatever came in the door, sudden delivery, reset fractures, sew up complicated pediatric facial lacs, see normal fevers/aches/pains and send them home with friendly reassurance, resuscitate crashing medical/trauma patients and blah blah blah. It ain't what you think it is.

Do those things exist? Yest they do. Are they the bulk of your day-to-day work? They are not. As was mentioned above, you will be moving meat. Yeah, that crashing septic patient is fine with that 20g in the hand on 2 pressors, ICU can place the line. Yeah it's super busy, trauma will put in that chest tube, hey this airway may be a little complicated let's just 'get anesthesia on board'. And the thing is, the more you do the job, the happier you'll be that these other services are willing to do this because the truth is, aside from trauma on a very busy night, there is nobody in the hospital busier than an EM doc. You'll be so damn grateful that ICU will place that CVC because you know by the time you're done there's gonna be 8 more people ready to be seen. What? Plastics is gonna sew up that peds facial lac? Thank freaking god, because to do the sedation, repair the lac and reassure parents that plastics isn't coming in at 2am to sew up their kids face is going to take so much damn time that there will be 20 new patients to see, all of them angry for waiting. This is the reality that the paper never told you - but seasoned EM docs sure told me. Like you, I was prepared to ignore all of them, and I did.

I'll be honest though, I'm grateful for my EM training. I think it's a great specialty to segue into critical care (which is what I did). And god knows we actually do need EM docs in the pit, getting it done. If you want to join them then by god do it, just know exactly what you're getting into - and don't think you're some superior physician that possesses some kind of skill that nobody else does. Because the truth is, that all those procedures you like, well my friend, there's someone that can do them better. Airway - anesthesia, reductions - ortho, complex lacs - plastics, peds anything - PICU/peds. You're good, but there's better. So don't get trapped into the nonsense that you often find in medical school, residency and acedmia that chasing prestige matters. Nobody gives a ()*% about prestige when you're out there working, you'll just regret chasing someone else's approval. That way lies madness.

You'll see these docs your whole career. They chose based off supposed prestige and are now miserable wrecks - they're just so shocked when the hallways don't part for them. Don't be these guys, follow your heart. Just make sure your heart is actually informed by reality and not dreams. We all have a roll to play. Outpatient docs are by far the most important in my humble opinion, it's also probably the only other job in medicine that might just be harder than EM. Bascially what I'm trying to say to you is this - stay humble, respect the work that other physicians do, and recognize that you really don't have any idea what they actually do on a day-to-day basis anymore than they have an idea what EM does on a day-to-day basis. Be respectful, be humble, and stay the #*% away from EM unless you're cool with the grind, the hours, the nights, the holidays, the CMGs and the patients.

EDIT: yeah and no better doc on an airplane than an EM doc

Good luck!

Truth. A great way to get humbled in a hospital is to think that you’re hot stuff because you spent 3-4 years scratching the surface of what your colleagues spent 5-10 years learning.

 

[cyanide12345678]

I know the current landscape and future looks bleak and because of that I’ll probably choose something else, but it’s hard to let go of being the kind of physician that an EM doc is.

Lol the TV shows make us look pretty cool eh?

So it’s that hard to not be an EM physician eh? 😂😂😂😂😂😂

So you want a 60 percent chance of being burned out? You want to be a physician with the highest burn out rate? You want to age faster due to circadian rhythms disruptions? You want to not be there for your family or your future kids on Christmas or thanksgiving? You want your spouse going alone to family events and friends because you are working on a weekend? You want an increased risk of htn, obesity, hld due to circadian rhythm disruptions and shift work disorder? You want to be the guy who has no respect from other doctors in the house of medicine?

So that’s the kind of physician you want to be huh? Lol…. Everyone gets attracted by the flashy lights, then reality hits and 60 percent of us (the highest of any specialty) realizes the dream isn’t reality.

What you should want is a regular 9-5, no call, no weekends, no overnights, a specialty where you own your own patients.

 

[cyanide12345678]

the ER is a very humbling place. I don’t think we are the most skilled. Specialty surgeons take years and years to truly master their skill set and do impressive and incredible things.

 

[Birdstrike]

MS3 here deciding on specialty.

You have to decide what you were put here to do. If that is Emergency Medicine, so be it. If not, be happy, for there are many smoother roads to travel.

If you decide you were put here to play this role, you will face the weight of human suffering and stupidity, alike.

You will face the incessant demands of the urgency of non-urgency.

Your resilience, compassion, and mental well-being will be tested.

You’ll occasionally save a life, but with no guarantee of fulfillment.

If you don’t already have the wisdom to recognize your own limits, you’ll earn it.

At the end of your journey, you won’t be the same person who started it.

It is a noble road, but one with a heavy toll to pay.

 

[Siggy]

Personally I wouldn’t get up. In residency when I was on a plane some lady passed out. Was likely just dehydration from Covid. Now I know there’s good samaritan laws to protect you from lawsuits in this situation but as far as I’m aware they’re only valid if you’re not compensated. The airline gave me a free ticket for helping out. Meaning I could get sued if I possibly missed something on an airplane with basically no resources. Since that day I don’t get up for any emergencies in public. Not a chance I’m getting sued off the clock.

For in-flight emergencies, the protection is via federal law except in gross negligence or willful misconduct. Getting a voucher doesn't change that coverage. So enjoy your ticket stress free.

https://www.congress.gov/bill/105th-congress/house-bill/2843

 

[Birdstrike]

To lawyers, any bad outcome equals “gross negligence, willful and wonton neglect.”

 

[Splenda88]

Theory vs Reality

The skill set is good in theory, but 90% of EM is moving the meat through the grinder. The 10% good becomes burdensome when, after finishing that cool procedure or resus, you have to return to 5 new patients waiting for the meat grind.

You might have some cool stories and respect among laypeople in theory, but you'll be recovering too often from constant circadian rhythm disruption to fully enjoy it.

Your pay and job security should be good in theory, but there are mounting pressures to decrease them in the future.

You said the quiet part out loud.

 

[dozitgetchahi]

Lawyers can spin “gross negligence” in ridiculous ways. Just look at that snake bite case in the other thread. And between screaming kids with completely ignorant parents, people with horrible BO, people silently ripping ass every 5 minutes, and overweight folks that spill into my seat and elbow me every 2 minutes I have considerable contempt towards most passengers on planes to the point that I have no desire to interact with them.

No joke, ever since the pandemic happened I’ve gone back to driving to most any destination within reasonable distance in the US. At this point, the average American isn’t really someone you want to have packed in two inches away from you in coach.

 

[allantois]

You’re nicer than me. If someone told me to sit down after initially volunteering, I’d feel so insulted that I wouldn’t get up again. And then having to do paperwork and get off the plane late and no compensation while on a vacation and possibly getting served with a suit later? Forget it.

How absurd is our medicolegal system, that ER physicians don't feel safe helping out in an emergency

 

[gro2001]

You’re nicer than me. If someone told me to sit down after initially volunteering, I’d feel so insulted that I wouldn’t get up again. And then having to do paperwork and get off the plane late and no compensation while on a vacation and possibly getting served with a suit later? Forget it.

I think you can relax a bit in terms of your concerns about getting sued in this situation. So far there has never been a lawsuit against a doctor assisting on an inflight emergency. Considering that the denominator must be huge (just about every doctor has some sort of story), those are pretty good odds. Don't be drunk, don't do anything insane, and you'll be fine.

 

[thegenius]

I think you can relax a bit in terms of your concerns about getting sued in this situation. So far there has never been a lawsuit against a doctor assisting on an inflight emergency. Considering that the denominator must be huge (just about every doctor has some sort of story), those are pretty good odds. Don't be drunk, don't do anything insane, and you'll be fine.

I can't get tipsy on a plane en route to my vacation?

 

[gutonc]

I can't get tipsy on a plane en route to my vacation?

Of course you can. Just don't stand up when someone asks if there's a doctor on board.

 

[emergentmd]

It is a pain being an ER doc. When someone gets sick at wedding, sporting events, large gatherings - I get the look from wife to help. We are probably the bets to deal with acute stuff so there is somewhat of an obligation to jump in. Went to my kids soccer game, another kid got hurt. Surgeon friend got their first, and when I got there essentially said I was best to deal with it.

I don't mind helping but kind of ruins the experience of just being a parent watching their kids play.

To all Med students. Heed this. Pick a Field where you are content doing the 90%. Don't pick a field where you are fascinated with the 10% if you can't deal with the 90% because that 90% will be 100% of your life. Even if you can't see yourself outside of the operating room, well guess what. 90% of your life will be outside of the operating room and the 10% actually in surgery will get boring.

Those who pick the 10% and ignore the 90% become miserable b/c the 90% is your job.

When I was deciding on a specialty, I did not pick EM b/c I was fascinated with acute care or was an adrenaline junkie. My criteria was essentially
1. Hate clinic, time was like molasses no matter what clinic I was in be it OB, surg, Ortho
2. Hate being on call. When Im working, I want to work. When I am home, I don't want the constant weight of someone calling me any moment.
3. Hate carrying a pager.
4. Hate dressing up in business attire

That left me with Radiology vs EM vs anesthesiology. I chose EM and although not perfect is way better for me than anything not named Rad/EM/Anesth.

If I had to be in clinic even 25% of my life, I would have been miserable.

Look around at the other specialist, they are just as miserable or more than you. There are 5 docs who I know well from my kids schools. 2 surgeons are miserable and tell their kid not to go into medicine. The kid told me he never would go into medicine because his parents are never home. 1 anesthesiologist who always complains about work, call, etc. His wife always miserable/complaining that he is at work/call/tired. Cardiologist couple is never home, the daughter is essentially a latchkey kid.

Guess who is the most involved in their kids school activities, yup me.

 

[Apollyon]

Cardiologist couple is never home, the daughter is essentially a latchkey kid.

Honest question: they don't have a maid/housekeeper? Radiologist friend of mine (one doctor household) kept their nanny after their kid got older, and she minds him until my friend and her husband get home.

 

[Dr Mantis Toboggan]

Honest question: they don't have a maid/housekeeper? Radiologist friend of mine (one doctor household) kept their nanny after their kid got older, and she minds him until my friend and her husband get home.

my buddy is an interventional cardiologist and his wife does gyn/onc. When he had to come in for a STEMI while his wife was operating late during her fellowship he’d just bring their baby with him. He said he could always find a nurse or intern to watch the kid lol.

 

[RoyBasch]

You have to decide what you were put here to do. If that is Emergency Medicine, so be it. If not, be happy, for there are many smoother roads to travel.

If you decide you were put here to play this role, you will face the weight of human suffering and stupidity, alike.

You will face the incessant demands of the urgency of non-urgency.

Your resilience, compassion, and mental well-being will be tested.

You’ll occasionally save a life, but with no guarantee of fulfillment.

If you don’t already have the wisdom to recognize your own limits, you’ll earn it.

At the end of your journey, you won’t be the same person who started it.

It is a noble road, but one with a heavy toll to pay.

This is some legit poetry.

 

[emergentmd]

Honest question: they don't have a maid/housekeeper? Radiologist friend of mine (one doctor household) kept their nanny after their kid got older, and she minds him until my friend and her husband get home.

Maid/Housekeeper? I am sure most docs have them.

Most don't have nannies. I didn't have kids so I can hire someone to watch over and be a parent. It sure would have been easier but I actually enjoy being around them and the bond it forms.

That is the beauty of EM medicine, I am available for almost all occasions.

Point is, other specialists have issues too and are just as if not more miserable than EM docs. From my experience, EM docs are one of the happier groups of docs. SDN just tilts it the other way as some just constantly jump on with negative views at a drop of a hat.

Don't believe me? Do a shift and look at the zombie hospitalists, or pissed off surgeon doing call after a long clinic day.

 

[VA Hopeful Dr]

Maid/Housekeeper? I am sure most docs have them.

Most don't have nannies. I didn't have kids so I can hire someone to watch over and be a parent. It sure would have been easier but I actually enjoy being around them and the bond it forms.

That is the beauty of EM medicine, I am available for almost all occasions.

Point is, other specialists have issues too and are just as if not more miserable than EM docs. From my experience, EM docs are one of the happier groups of docs. SDN just tilts it the other way as some just constantly jump on with negative views at a drop of a hat.

Don't believe me? Do a shift and look at the zombie hospitalists, or pissed off surgeon doing call after a long clinic day.

I would wager a pretty good number of dual physician couples do.

 

[sloh]

I would wager a pretty good number of dual physician couples do.

Yup, WCI actually ran a poll on this. 49% utilize nannies to some extent.

 

[cyanide12345678]

Point is, other specialists have issues too and are just as if not more miserable than EM docs. From my experience, EM docs are one of the happier groups of docs. SDN just tilts it the other way as some just constantly jump on with negative views at a drop of a hat.

Don't believe me? Do a shift and look at the zombie hospitalists, or pissed off surgeon doing call after a long clinic day.

why do you think all surveys year after year show Em as the highest burn out rate with some fairly low job satisfaction numbers?

While consistently, the cushy outpatient specialties like derm and psych are consistently some of the lowest burn out specialties?

There has to be some truth to surveys based on thousands of responses.

i know so many burned out ER docs (and hospitalists) that all legitly want to get out. You just don’t see that kind of sentiment in cardiologists, ICU docs, anesthesiologists, pain specialists, pm&r, peds, psych etc.

 

[cyanide12345678]

I would wager a pretty good number of dual physician couples do.

We thought about it especially after baby no 2. Cost of two kids at daycare is more or less the same as a nanny. Would be really nice having someone kinda assist with chores as well.

Just struggle with the idea of finding someone so reliable that they show up at 7 am consistently and reliably.

Society work ethic is so unreliable i swear. I know our daycare opens at 7 am reliably every day. Plus you truly can’t beat the social interaction kids get in that setting.

 

[VA Hopeful Dr]

We thought about it especially after baby no 2. Cost of two kids at daycare is more or less the same as a nanny. Would be really nice having someone kinda assist with chores as well.

Just struggle with the idea of finding someone so reliable that they show up at 7 am consistently and reliably.

Society work ethic is so unreliable i swear. I know our daycare opens at 7 am reliably every day. Plus you truly can’t beat the social interaction kids get in that setting.

Our kids were in daycare for 4 months.

They were sick literally the entire time.

 

[GonnaBeADoc2222]

why do you think all surveys year after year show Em as the highest burn out rate with some fairly low job satisfaction numbers?

While consistently, the cushy outpatient specialties like derm and psych are consistently some of the lowest burn out specialties?

There has to be some truth to surveys based on thousands of responses.

i know so many burned out ER docs (and hospitalists) that all legitly want to get out. You just don’t see that kind of sentiment in cardiologists, ICU docs, anesthesiologists, pain specialists, pm&r, peds, psych etc.

Peds self selects for delusion

ICU is just as burnt out

So is anesthesia, it's just that the money is still there.

Psych sucks unless private practice

 

[Nocturnist]

There's no duty to act in the US. The good sam laws protect you (in theory, and to my knowledge there haven't been any lawsuits related to someone jumping in to help for an in-flight emergency) but do not require you to act. I've always wondered what would happen if you volunteered to help with an emergency if you had a drink or two on a flight. Does that constitute gross negligence / willful and wanton or whatever the legal term is that ejects you from the Good Sam protections?

I'm always "Mr." on my boarding pass when I fly and not "Dr."

This is deliberate.

This guy wasn't looking to find out..

Why doctor refused to help in mid-air emergency on long-haul flight backed

A travel-agency owner and Medicare insurance adviser told Newsweek why they also side with the man's decision.

www.newsweek.com

 

[emergentmd]

Can some

why do you think all surveys year after year show Em as the highest burn out rate with some fairly low job satisfaction numbers?

While consistently, the cushy outpatient specialties like derm and psych are consistently some of the lowest burn out specialties?

There has to be some truth to surveys based on thousands of responses.

i know so many burned out ER docs (and hospitalists) that all legitly want to get out. You just don’t see that kind of sentiment in cardiologists, ICU docs, anesthesiologists, pain specialists, pm&r, peds, psych etc.

I am not talking about outpt specialties. Being a doctor all day every day is just so mind numbing to me.

But the hospital specialists were all unhappy. GS, OB, Anesth, cards.

I know what the survey says and if Er docs would do less shifts there would be much greater satisfaction IMO. All I know is many hospital based specialists always complained once you get to know them.

 

[RustedFox]

Can some

I am not talking about outpt specialties. Being a doctor all day every day is just so mind numbing to me.

But the hospital specialists were all unhappy. GS, OB, Anesth, cards.

I know what the survey says and if Er docs would do less shifts there would be much greater satisfaction IMO. All I know is many hospital based specialists always complained once you get to know them.

 

[HemorrhagicShock]

Once again we need to put a disclaimer on all of Emergentmd's posts

None of the newer posters or posters from outside the EM forum know that he didn't make his "F*ck You" money by being an employed ER doc, he made it by being a BUSINESS ENTREPRENEUR via opening up Free-standing EDs when those were on the up and up.

His perspectives on the day-to-day practice of EM should be heavily colored through that lens. He makes more money on facility fees seeing 3 patients a day than the average ER doc makes working 2 weeks' worth of shifts.

Kudos to him, and it's a great inspiring story to show what's possible with hard work, ingenuity, and a lot of risk tolerance.

But by no means should anybody consider his advice routine and/or achievable by most.

 

[coachB]

Once again we need to put a disclaimer on all of Emergentmd's posts

None of the newer posters or posters from outside the EM forum know that he didn't make his "F*ck You" money by being an employed ER doc, he made it by being a BUSINESS ENTREPRENEUR via opening up Free-standing EDs when those were on the up and up.

His perspectives on the day-to-day practice of EM should be heavily colored through that lens. He makes more money on facility fees seeing 3 patients a day than the average ER doc makes working 2 weeks' worth of shifts.

Kudos to him, and it's a great inspiring story to show what's possible with hard work, ingenuity, and a lot of risk tolerance.

But by no means should anybody consider his advice routine and/or achievable by most.

Not to mention billing the federal government for large sums of money for administering a worthless medication. Go back and review his posts on remdesivir if you don't know what I'm talking about. There's a clear theme through is posts over the years that would suggest practicing high quality, patient-centered emergency medicine hasn't really been a priority.

Oh, and Austin area real estate..... You mean you all didn't get in on that and that's why you're still slaving away?

 

[W22.0]

Responding to initial question comment two major points in this thread I'll briefly comment on separately: 1) EM clinical competence/work and 2) Good Samaritan scenarios/ pre-syncope in-flight shenanigans

1) Yea, sadly it's true there really is no other specialty with the breadth or ability of emergency medicine. I don't say this with arrogance, it's a function of the healthcare system and societal stressors combined with the pressures towards super specialized care. As other have mentioned here, there shear volume of pathologies and procedures far exceeds anything elsewhere presently in the house of medicine or other specialties Rivers Sepsis and EAST Thoracotomy abandonment considered. I completed additional fellowship training with a majority of non-emergency physicians- literally anytime there was a "medical" or "diagnostic" question they would call me. This was true for patients as much as it was attending's personal medical problems or those of their families. So yea, we're real doctors and some of the few that are good at "medicine" broadly. The problem is while the "work" is good, the "job" sucks. I've been telling residents for some time now that the actual diagnosis, flow management, therapeutic interventions, patient conversations, min by min labor can be satisfying and constitutes the work of emergency medicine, we're not paid for that- we're paid to work a job the job sucks. The job, put simply, is to accept liability and maximize revenue. Some dip**** highway patrol me wants to drop off a patient with get of jail free chest pain because they don't want the hassle of taking them to jail so puts them on a psych hold? Some midlevel wants to discharge the waiting room while I'm intubating a patient and list me as the attending of record? My boss wants everything to be a level 6 chart because they need to justify their own position and bonus working me as an independent contractor as part of a corporate owned medical group fleecing patients and hospitals while billing for my labor as an out of network provider? The reality is the emergency department has become society's dumping ground and we're spending hours emailing, staying late after shift, recertifying online hazardous waste modules, attending forced meetings generally all unpaid after hours, exhausted, and increasingly defeated. It's some of the best work in medicine and increasingly one of the worst jobs. I sadly can't recommend it as a career to medical students any longer in good faith. Good work- bad job.

2) Regarding getting called on planes/ public emergencies. I've had this happen to me four of five times now. In respect to liability especially if the patient doesn't want to follow your advice (go t the ED), ask for an email, and write the world's strongest AMA note and ask for their email address- send it to them and then block them forever, I've done this several times and imagine if I ever got tagged by my local friendly malpractice attorney I would just forward them the email and that would be the end of it. What I do hate about these scenarios is the population that pops up. There's almost always some FP or GI doc who the moment they find out I'm an ED doc just leaves. There's also always some nurse who taps me on the shoulder for or five times separately just to remind me they're a nurse in case I forgot while taking a pulse of running through a GCS. My favorite most recently was a guy who told me he was off duty EMS and offer help and when I asked him to help me pick up and move a face plant head trauma lady into a wheelchair quickly told me he was retired and wasn't moving jack- as if his announcement of assistance was to inform me of how lucky I was to have him present to consult his illustrious wealth of medical knowledge if needed. I was then tapped on the shoulder a sixth time to be reminded that the nurse was still present is needed while moving bleeding face plant into wheelchair.

 

[Nocturnist]

if the patient doesn't want to follow your advice (go t the ED), ask for an email, and write the world's strongest AMA note and ask for their email address- send it to them and then block them forever

I'm confused.

Patient face plants on the plane.
You recommend they go to the ED? You ask for said face planters email, send them a nastigram and block them? I always imagined the only thing you have to do is to stabilize them in the air and instruct air crew on whether to continue or divert, then ems on the ground takes over.

 

[W22.0]

My error- face plant was in public setting (museum opening) not air. And yea, all plane pre-syncope I send an email.