Thoughts on Emergency Medicine

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Pinner Doc

Pinner Doc

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Several attendings have told me that "if they were a woman" ("no offense intended"), they would go into ER. Seems to me like it's a good field for docs who want to have time outside of work for family, etc.

Perks:
* shift work
* can leave your job at the door (appeals to some, not others)
* kinda sorta like being a general practitioner/pediatrician, but with more interesting pathology, better compensation
* no extensive rounding! (again, appeals to some and not others)

Cons:
* "glorified triage nurse/consult service" (exact words physicians have used with me when describing the job)
* weird shift hours mess up your circadian rhythms

Thoughts? Anyone else consider ER/peds ER? We don't have an official EM rotation, unfortunately, and I'd like to hear others' experiences. I thought I'd have a clearer picture by this point during third year as to what I want to do, but it seems to have gotten MORE confusing... not less!

I'm really into pediatrics, but I think this angle (peds ER) might mesh well with my other life goals (pursuing outside interests, having a family and having time I want for them, etc).
 
I was going to respond until you put in that "glorified triage nurse/ consult service" garbage... also the whole "good mother/ female" thing kind of put me off, but i'll leave that one alone... if you're interested in EM, do a rotation; it's not like primary care in many, many ways, though peds EM is more primary care-like than the Adult ED. I'm kind of annoyed at your post though, so i'll end my reply here to avoid ranting... maybe others will have some more thoughts.
 
The important thing is to always go to a message board for career validation . . . .
 
Make sure that if you decided to go into EM (not ER), that when asked during your interview "What's a negative about the field?" you respond by saying...
"you're like a glorified triage nurse/consult service." Let me know how well you do in the match following this.
 
BigNavyPedsGuy said:
The important thing is to always go to a message board for career validation . . . .
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what's your problem?!? this person needs some advice... there is NOTHING wrong with posting for some career advice on this forum.. that what its for DUH!!!!🙄 🙄 🙄
 
Wow... I know some of you posters from back in the day (step 1, etc) and I feel bad in that I offended you. I've always appreciated your advice and encouragement along the way. I've gone back and reworded, without changing the intent, because upon second glance, I can see how it might be misconstrued. (Note to self... do not post after imbibing 2 glasses of Sangiovese.)

I posted the "glorified triage/consult" because every time I mention this as a potential field of mine, that is what almost every other physician tells me is the main reason they wouldn't consider the field.

We don't have EM as a rotation, so my only choice is to do a sub-I/elective very early on as a fourth year. Since I don't get much exposure to this specialty, I wanted to hear other's opinions and experences.

I hope folks can look beyond "triage/glorified consult" as an apparent knock on the profession, and see it as an actual topic I'd like to know more about. DO people in this field feel like they are constantly referring patients? How much does this occur vs what is the extent of clinical interaction of an ER doc?

And regarding the mothering comment... there is absolutely nothing wrong with wanting to have more time to spend with family. People have different priorities. It's hard to be both a great doc and a great parent- mother or father.
 
quideam said:
I was going to respond until you put in that "glorified triage nurse/ consult service" garbage... also the whole "good mother/ female" thing kind of put me off, but i'll leave that one alone... if you're interested in EM, do a rotation; it's not like primary care in many, many ways, though peds EM is more primary care-like than the Adult ED. I'm kind of annoyed at your post though, so i'll end my reply here to avoid ranting... maybe others will have some more thoughts.
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1) EM rarely provides definitive care to its patients

2) When EM docs do provide definitive care, it is normally for complaints that would normally be dealt with in a primary care clinic

3) EM doesn't provide followup

4) EM spends a substantial portion of time calling consultants, and coordinating care (much like a Primary Care doc)

5) EM works on a shift schedule, which is of benefit to doctors who also happen to be parents or starting a family

So what are you so worked up over?
 
ocean11 said:
what's your problem?!? this person needs some advice... there is NOTHING wrong with posting for some career advice on this forum.. that what its for DUH!!!!🙄 🙄 🙄
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It's called sarcasm, and there is still now way to convey that via a message board.

EM: Pros-good lifestyle, up-beat work environment, get to be there in true life or death moments, good pay, you don't have to deal (as much) with annoying patients or families that return to the clinic all the time. Less messing with rising creatinines and you don't stand in a hallway and discuss low sodium for hours (see IM). The decreased hours are more conducive to starting a family-and this is a valid and huge issue!!

Cons: A lot of the time what you see isn't actually emergencies: it's frequently people who don't have insurance, or just don't know what an ER is for. You have no continuity of care. The return customers you do get are usually non-compliant, on drugs, or fall into that annoying don't-know-what-an-ER-is-for category. In most academic centers, a great portion of the ER resident's day is managing consults.


If you go to the stickies list on the EM forum, you'll find a link to "things I wish my patients knew" It's hilarious! you should read it, and it does kind of give an accurate picture of the tone of a lot of EM physicians
 
Pro: Predictable schedule and lighter hours
Fast paced, some procedures, broad range, generally aplicable knowledge base. good compensation and generally cool people. No billing hassels for you.

cons: Dont get to follow the patient, rarely get a full diagnosis, some very ungratefull patients depending on area.

In addition I think ER (sorry EM ) docs are in a vulnerable position to be moved in upon by NPs and PAs. er work IS glorified triage for most cases. For an er to run all you really would need is 1 attending and some PAs that are good at running an algorithm. The one (maybe 2 in some areas) attending would be enough to identify the outlier cases and trauma services could take the banged up folks like they pretty much do at most places now.
 
dynx said:
.

In addition I think ER (sorry EM ) docs are in a vulnerable position to be moved in upon by NPs and PAs. er work IS glorified triage for most cases. For an er to run all you really would need is 1 attending and some PAs that are good at running an algorithm. The one (maybe 2 in some areas) attending would be enough to identify the outlier cases and trauma services could take the banged up folks like they pretty much do at most places now.
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You've obviously never set foot in LA county's or Cook County's ED have you?
 
dynx said:
In addition I think ER (sorry EM ) docs are in a vulnerable position to be moved in upon by NPs and PAs. er work IS glorified triage for most cases. For an er to run all you really would need is 1 attending and some PAs that are good at running an algorithm. The one (maybe 2 in some areas) attending would be enough to identify the outlier cases and trauma services could take the banged up folks like they pretty much do at most places now.
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Versus who? IM... No, lots of PAs already, some even work like hospitalists. OB... Nope, nurse midwives. Anesthesia? I'm not even going to comment on that one. I could go on and on. There are PAs in EM like almost every other field. 99% of them usually just see low acuity patients. I think they are generally good to have as long as you understand their role. Emergency medicine frequently deals with a lot of sick patients with multiple comorbidities. That is definitely NOT a job for a PA. For a variety of reasons, people are getting sicker and more complicated. This demands the expertise of a residency trained physician.

As to the triage nurse thing, who isn't a "triage nurse?" Don't most internists consult cardiology for chest pain, GI for GI problems, renal for kidney disease? Nobody does it all anymore. If they do, they won't for long because the litigious state of the country will not allow it. Maybe it's just me, but at every hospital I've seen doctors consult specialists ALL THE TIME! The nature of modern medicine is such that physicians are 1) specializing and subspecializing so much they only handle a few disorders 2) live in constant concern over litigation. I think I've made my point.

Also, I actually like seeing some colds and sore throats. Seeing a URI followed by an MI then a trauma is what attracted me to emergency medicine.
 
One more thing. I actually was a triage nurse for several years (although not very glorified). I can assure you that this analogy is false better than probably anyone here.

I can also assure you the docs that say stuff like this would not last a few hours in any fairly busy emergency department. I've actually seen other physicians try to work in the ED back in my nursing days (IM, general surgery, PM&R and even ortho). One word... Painful.
 
polygonal said:
One more thing. I actually was a triage nurse for several years (although not very glorified). I can assure you that this analogy is false better than probably anyone here.

I can also assure you the docs that say stuff like this would not last a few hours in any fairly busy emergency department. I've actually seen other physicians try to work in the ED back in my nursing days (IM, general surgery, PM&R and even ortho). One word... Painful.
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I've lasted.
 
I didn't make it through the rest of the posts yet, so maybe this is a bit of a repeat, but here it goes...

I considered emerg in my 2nd year of med school and did an elective in it (we have a half day a week to do a clinical elective in both med 1 and med 2 at my school). I changed my mind fairly quickly... here's why:

1. I felt like a consult service.

This would be completely different in a non-urban/non-academic center, I think. But, as soon as we had an idea of what it was, it was consult consult consult. Plus, it took a lot of convincing to "sell" patients when making consults. I didn't like not knowing what happened to the patients, either.

2. No one was ever happy.

Patients were angry, nurses were angry, consultants were angry. Maybe it's just where I was, but I didn't like it. The patients were waiting hours to be seen and were never happy. I couldn't thrive in an environment like that.

3. Shift work just didn't agree with me. It sounds crazy, but I liked the 6-6 surgery schedule better than the randomness I had in the ER.

But, one of the great things about medicine is that there is something for everyone. There are a lot of pluses for emerg.

-- no office, no overhead, etc

-- no call. When you're done, you're done

-- lots of variety

-- trauma

-- no clinics (a plus for some people)

I can't think of any more, but you get the idea. Do you have any vacation time when you might be able to do a couple shifts and see if you like it enough to do a sub-I in emerg?

Good luck!

Edit: I just saw you're interested in peds emerg. Although I don't want to do peds, my peds emerg rotation was one of the most enjoyable I had (much better experience than adult emerg)

Pinner Doc said:
Several attendings have told me that "if they were a woman" ("no offense intended"), they would go into ER. Seems to me like it's a good field for docs who want to have time outside of work for family, etc.

Perks:
* shift work
* can leave your job at the door (appeals to some, not others)
* kinda sorta like being a general practitioner/pediatrician, but with more interesting pathology, better compensation
* no extensive rounding! (again, appeals to some and not others)

Cons:
* "glorified triage nurse/consult service" (exact words physicians have used with me when describing the job)
* weird shift hours mess up your circadian rhythms

Thoughts? Anyone else consider ER/peds ER? We don't have an official EM rotation, unfortunately, and I'd like to hear others' experiences. I thought I'd have a clearer picture by this point during third year as to what I want to do, but it seems to have gotten MORE confusing... not less!

I'm really into pediatrics, but I think this angle (peds ER) might mesh well with my other life goals (pursuing outside interests, having a family and having time I want for them, etc).
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Alright, so here are my (non-aggrivated) 2 cents:

I think there are many pros to EM, as well as some cons, and a lot of those have already been discussed above. What I wanted to mention is that the practice of EM, perhaps more than most fields, is extremely variable based on where you work - what part of the country, county hosp vs. university/ community vs. academics, etc. Doing residency at Cook County or USC/LAC (both 'hard-core' county places w/ lots of trauma, extremely busy and extremely well-respected emergency departements) is an extremely different experience from doing residency at smaller, newer 'ivy' programs or at smaller, more community-based programs (I won't specify names, check out the EM forum for details). Depending on the kind of experience you want and the sorts of things about medicine that really interest you, you have an opportunity to find programs that fit what you like.

Furthermore, EM has many incredible opportunities that are not available (or not usually available) to other specialties, including (but certainly not limited to!): EMS (training paramedics, scene responses, working on helicopter flight crews!), disaster medicine, diving medicine/ hyperbaric, international medicine (everything from disaster response to development of EMS systems and EM programs abroad), flight/space medicine, wilderness med, toxicology, ultrasound training, etc.... you get the idea. Additionally, EM can be used as a stepping stone to doing policy work (get an MPH, etc), critical care, research, academics....

You really should check out the EM forums and read the "FAQs" sticky - it has a lot of information. I think you'll find that EM is an extremely vaired, interesting field, but that it's also not for everyone. Some people love being specialists with relatively narrow scopes of practice, others like clinics, and stil others don't mind the insane hours required of surgery and go into that. For those that like things to be a little hectic and unpredictable, like seeing variety including a mixture of every specialty, like traveling or have other interests they can tie in with medicine... I think those people may find EM very rewarding.

But in any case, the best way to really find out is to do an EM rotation yourself. I do, however, recommend doing two: one at an urban/ county- type place, and one either at a very academic/ university ED or at a community ED, just to get an idea of how varied your options are. Good luck and don't worry, i'm over being offended 😀

Q
 
I love emergency medicine, and this is what attracted me towards it:

1. Variety- you see everything. seriously. the days of direct admitting are gone in many parts of the country. And I really liked every rotation I did (thought I was going to be an ob-gyn, surgeon, orthopod, critical care doc). When I did my EM rotation, I knew that was it! It combines everything!

2. You get to work up the patient- when I did my internal medicine rotation, I would get so mad that the ED ordered all of the tests and essentially made the diagnosis in many cases. I would be mad that I didn't get to stabilize the patient, and by the time I saw them, they looked fine (I would read in the note about how horrible they looked when they walked in the door, and after their ED course, looked fine)

3. Take care of sick patients- yeah you see uninsured pts with a URI, but you also are running codes and in some places trauma, seeing patients with strokes, heart attacks, sepsis, etc.

4. Get to do lots of procedures- intubations, lines, lacs, fracture reductions, procedural sedations to name a few. Plus ultrasound is really developing in EM, and honestly, there is no part of the body you can't ultrasound.

5. You make a lot of decisions- you are the one who decides who is sick, who is not sick. Many people make that triage comment in ignorance, not realizing how many patients the consult services don't see or how many patients are not being admitted, and they don't see the patients you don't CT or order labs on. You have the chance to make very important decisions in people's lives at their most vulnerable times, and it is humbling how many people will trust you on this.

6. Research opportunities are awesome- if you are a budding researcher, there is virtually no field you can't do research in and carve out your own niche.

7. Shift work- when you're done, you're done. Generally EM docs work around 40 hrs/week or less, and the pay isn't bad. It is nice to have a Tuesday off. You do have time to have a life. Schedule is somewhat flexible- some people will work a certain number of weeks on, then have a certain number off, for example.

8. No set routine- I like organized chaos. I hate clinic. I like going to work and being busy from the time I walk in the door until I leave.

Cons
1. Lack of continuity- most people cite this as a con, (when honestly, I don't really care about it.) This is not important to some people and of the utmost importance to others.

2. You take care of "the shallow end of the gene pool," as one paramedic so eloquently described to me. This includes people high or drunk on whatever, screaming at you, peeing on you, throwing up on you.

3. You are in a glass fishbowl- there is always someone who loves to criticize or tells you how to do things, or assumes you are a "triage nurse." You have to be able to let that roll off of your back.

4. Working nights, holidays, weekends- sometimes you aren't going to make your kid's games, or the Xmas celebration.

If you are really serious about this, you should spend some time in a big, busy department, preferably one that has a residency program, to show you EM at its best. Many people love or hate it after one shift!
 
hah hah. i just noticed that. yay for bowel.
 
Seriously, EM isn't a complete consult service.
The consults are called either after a decision to admit the patient is made, or the patient needs specialized followup (ortho, plastics, hand). The call isn't made for every patient. I bet for every cardio consult, 10 more are ruled out in the ED (or the obs unit) without cardio ever knowing it.
Yeah, so we don't get to follow up patients (except the trolls), but that doesn't bother me. As long as I make an attempt for the patient to get followup, that is on them whether or not they go.
The whole fishbowl thing annoys me, because I love it on IM when all the 37 fleas on their 12th hour of rounding make comments like, "we started him on steroids, I bet they didn't even think of that in the ED." Big whoop. I don't live my life worrying about what people think of me, I try to help people. They don't like it, tough, there are other EDs in the world.
 
I think alot of younger students are attracted to EM w/o knowing all the dirty secrets. I don't care how much you want to call it a lifestyle field, working as hard as the average EM doc does for 12 hours on Christmas Eve does not constitute a "great lifestyle." Shift work has been proven to decrease lifespan.

Probably the biggest thing I struggled with is this: you have to do this for the rest of your life. Does EM sound awesome when you are 25, single, in perfect health, and full of energy? Heck yeah. Is that night shift going to be getting pretty old when you are 45? You'd better believe it.

If you want to have a great family life, I think a primary care field would be much better. If you get into a big group your call is minimal and the predictable hours would be much more condusive to parenthood.

If you still think you want to do it, spend some time with it. The last time I was down there I was admitting a 300 pounder with a COPD exaccerbation who smelled like something from another world and refused to answer any of my questions. I was quite literally gagging as I examined her. In the next bed was a drunk dude with a femur fracture who was screaming the F-word over and over at the top of his lungs. It was not fun. Anyone who tells you they "thrive on that sort of thing" b/c they are "so EM" is full of ****. It's a stressful place. That said, I still want to do it.
 
AmoryBlaine said:
I think alot of younger students are attracted to EM w/o knowing all the dirty secrets. I don't care how much you want to call it a lifestyle field, working as hard as the average EM doc does for 12 hours on Christmas Eve does not constitute a "great lifestyle." Shift work has been proven to decrease lifespan.

Probably the biggest thing I struggled with is this: you have to do this for the rest of your life. Does EM sound awesome when you are 25, single, in perfect health, and full of energy? Heck yeah. Is that night shift going to be getting pretty old when you are 45? You'd better believe it.

If you want to have a great family life, I think a primary care field would be much better. If you get into a big group your call is minimal and the predictable hours would be much more condusive to parenthood.

If you still think you want to do it, spend some time with it. The last time I was down there I was admitting a 300 pounder with a COPD exaccerbation who smelled like something from another world and refused to answer any of my questions. I was quite literally gagging as I examined her. In the next bed was a drunk dude with a femur fracture who was screaming the F-word over and over at the top of his lungs. It was not fun. Anyone who tells you they "thrive on that sort of thing" b/c they are "so EM" is full of ****. It's a stressful place. That said, I still want to do it.
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You're just not looking at it in the right way. It's like the concept of a "weekend." A lot of people get irate if they have to work on the weekend even if they get, say, Monday and Tuesday off. To me, a weekend is just two days and I'd as soon have them in the middle of the week as on Saturday and Sunday. It's just not that big a deal to do a shift on a Saturday if I know that I will get three days off in row when I'm done.

Same with Christmas. We can open presents on Christmas eve or mornng or afternoon. It doesn't matter. It's just a day. Except for Easter, there are no specific days that I absolutely need to get off or feel like I am being opressed.

Shifts are highly variable in Emergency Medicine once you get into private practice. Some work eight hour shifts. Some work twelve. There are even people who prefer to work two 24-hour shifts a week and have five days off. Some people work back-to-back 12-hour shifts for two weeks and then take two weeks off. It's pretty flexible once you accept the fact that you will be working wierd hours.
 
AmoryBlaine said:
Does EM sound awesome when you are 25, single, in perfect health, and full of energy? Heck yeah. Is that night shift going to be getting pretty old when you are 45? You'd better believe it.

If you want to have a great family life, I think a primary care field would be much better.
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Absolutely. I went to med school because of my EMS experiences, and it wasn't until midway through that I recognized that I didn't want to spend my career in the emergency department. It wasn't just the shift work, or the frenetic pace, or the drunks, or the malpractice, or the hospital bulls--t...it was all of it combined. If you enjoy it, more power to you...somebody's gotta do it, and better you than me. However, calling EM a "lifestyle specialty" is a stretch, IMO.

I've been telling people for years that primary care is the ultimate "lifestyle specialty," but nobody believes me. 😉
 
KentW said:
Absolutely. I went to med school because of my EMS experiences, and it wasn't until midway through that I recognized that I didn't want to spend my career in the emergency department. It wasn't just the shift work, or the frenetic pace, or the drunks, or the malpractice, or the hospital bulls--t...it was all of it combined. If you enjoy it, more power to you...somebody's gotta do it, and better you than me. However, calling EM a "lifestyle specialty" is a stretch, IMO.

I've been telling people for years that primary care is the ultimate "lifestyle specialty," but nobody believes me. 😉
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I agree with you 100%, today was my last shift (12am-8am) and boy was it painful. I have decided over the last 2 days or so that i'm probably NOT going into ER. I don't like the shift schedule. Night calls just kill you! I also can't stand all these chronic patients coming in every week trying to get Tylenol #3 (who ever said ER dosn't have continuity LOL). There are some patients that smell so rancid its just disgusting, I almost feel that we shouldn't have to treat them until they bathe themselves (ofcourse there are exeptions to this: ie: people who are disabled or chronicly sick etc). Today I saw this homeless crack head scream at my attending, I couldn't believe my attending put up with it! I would have thrown her out, but my attending kept 'trying to help her', finally the patient discharged herself AMA?!?!? Anyhow.... ER is definetly not as glamorous as I thought. Although I love suturing and seeing those bizarre cases, ultimately I don't think its for me.... oh well at least I narrowed down my list further...
 
Panda Bear said:
You're just not looking at it in the right way. It's like the concept of a "weekend." A lot of people get irate if they have to work on the weekend even if they get, say, Monday and Tuesday off. To me, a weekend is just two days and I'd as soon have them in the middle of the week as on Saturday and Sunday. It's just not that big a deal to do a shift on a Saturday if I know that I will get three days off in row when I'm done.

Same with Christmas. We can open presents on Christmas eve or mornng or afternoon. It doesn't matter. It's just a day. Except for Easter, there are no specific days that I absolutely need to get off or feel like I am being opressed.

Shifts are highly variable in Emergency Medicine once you get into private practice. Some work eight hour shifts. Some work twelve. There are even people who prefer to work two 24-hour shifts a week and have five days off. Some people work back-to-back 12-hour shifts for two weeks and then take two weeks off. It's pretty flexible once you accept the fact that you will be working wierd hours.
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Dude, you're preaching to the choir. I just think there is a tendency on SDN to portray EM in much the same way your sig portrays derm. I like to keep it real. For alot of people, working nights and weekends for their whole career is a big minus. It seems like every week there is another post about how EM is The Perfect Medical Specialty but people don't ever seem to comment on some of the negative aspects of the field.
 
Can anyone comment on the wilderness medicine aspect of EM? Stanford U is offering a fellowship in this field, and I'm wondering if other programs will follow suit until this subspecialty is officially accredited (along the lines of Underwater and Hyperbaric EM, Sports EM, etc).

I ask because I am interested in pursuing an EM career in a site near a wilderness area (Colorado, Utah, pacific NW, etc), or a career affiliated with NOLS, the National Ski Patrol, etc.

I was lucky enough to be accepted to do a rotation at the Big Sky Clinic in Big Sky, MT (www.docsky.us) for next January... anyone else have experience at this site? Anyone else going next year?
 
When people here talk about shift work, is it some variant of the sort of constantly rotating schedule that has you working three 12-hour days on, two days off, two 12-hour nights on, two days off...repeated endelessly? I.e. are you always forced to change from a night schedule to a day schedule every couple of days without ever being able to establish a sleep pattern? Or do you simply mean that you don't get the same days off from one week to the next?
 
Pinner Doc said:
Can anyone comment on the wilderness medicine aspect of EM? Stanford U is offering a fellowship in this field, and I'm wondering if other programs will follow suit until this subspecialty is officially accredited (along the lines of Underwater and Hyperbaric EM, Sports EM, etc).

I ask because I am interested in pursuing an EM career in a site near a wilderness area (Colorado, Utah, pacific NW, etc), or a career affiliated with NOLS, the National Ski Patrol, etc.

I was lucky enough to be accepted to do a rotation at the Big Sky Clinic in Big Sky, MT (www.docsky.us) for next January... anyone else have experience at this site? Anyone else going next year?
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I cannot for the life of me imagine that there is a living to be made in "wilderness medicine."

I also think EM is a poor choice for someone who wants to a be a sports doc. That is why we have ortho and PM&R.
 
ocean11 said:
I agree with you 100%, today was my last shift (12am-8am) and boy was it painful. I have decided over the last 2 days or so that i'm probably NOT going into ER. I don't like the shift schedule. Night calls just kill you! I also can't stand all these chronic patients coming in every week trying to get Tylenol #3 (who ever said ER dosn't have continuity LOL). There are some patients that smell so rancid its just disgusting, I almost feel that we shouldn't have to treat them until they bathe themselves (ofcourse there are exeptions to this: ie: people who are disabled or chronicly sick etc). Today I saw this homeless crack head scream at my attending, I couldn't believe my attending put up with it! I would have thrown her out, but my attending kept 'trying to help her', finally the patient discharged herself AMA?!?!? Anyhow.... ER is definetly not as glamorous as I thought. Although I love suturing and seeing those bizarre cases, ultimately I don't think its for me.... oh well at least I narrowed down my list further...
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:laugh: Good post. I still love EM, however - there is a smug satisfaction and excitement in being at work in the middle of the night. And I like the LACK of glamour in EM - I don't want to dress up or call people or myself Dr. so and so all the time. I'd readily trade the prestige of medicine for an I&D of a big fat abscess or suturing a rasty-looking lac (so satisfying!).

I always chew peppermint gum to ward off nausea; the bad smells keep it interesting, and remind me to clean my stethoscope! Besides, crack addicts are fun (not more so than the psych cases, but close....). And there's nothing like conducting a medical interview on someone in handcuffs while the cops lurk outside. 😀

A perfect example of why every profession is not for everyone. 😉


P.S. How about surgery or critical care for you?
 
ocean11 said:
ER is definetly not as glamorous as I thought. Although I love suturing and seeing those bizarre cases, ultimately I don't think its for me.... oh well at least I narrowed down my list further...
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Well, nothing is as glamorous once you get to the seedy underbelly, except for maybe Derm.

However, it is good that you have changed your mind early, but since you are hot, may I ask that you reconsider? :laugh:
 
quideam said:
AmoryBlaine said:
I cannot for the life of me imagine that there is a living to be made in "wilderness medicine."
QUOTE]

Wow, that's so... uninformed...

Check these out:

http://www.wms.org/

http://www.basecampmd.com/

Q
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Good links, Q.

It's funny that the poster used the word "living," presumably referring to financial reward. To use the word "living" another way, I can hardly think of a profession that would allow me to live quite so much. I've been a little down and stir-crazy lately... perhaps too many windowless ORs and the stifling atmosphere of NYC in the winter.
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Chulito said:
When people here talk about shift work, is it some variant of the sort of constantly rotating schedule that has you working three 12-hour days on, two days off, two 12-hour nights on, two days off...repeated endelessly? I.e. are you always forced to change from a night schedule to a day schedule every couple of days without ever being able to establish a sleep pattern? Or do you simply mean that you don't get the same days off from one week to the next?
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I'm an attending in EM, and generally the schedule kind of flows and "undulates" like a sine wave. As a "new" attending, i.e. one year out, I work more than my colleagues, but it gets better after year 3. Currently I work about 1680 hours a year with six weeks paid vacation. My typical schedule is about 3-4 days a week (I work 5 this week, but in the month of November I only worked 10 days, and no, I didnt' use vacation time!). Generally I will work about 3-4 night shifts a month, but htey are in a circadian rhythm, and are usually in a row. For example, I will work 1-2 "evening shifts" that start in the afternoon and get out around midnight. Then I will work 2-3 "night shifts" that are around midnight to 7 AM. Which si nice, because I just sleep 4-5 hours during the day, spend the evening with my wife, kiss her goodnight at 10pm, then go to work. 8 AM my head hits the pillow, I sleep for about 4-5 hours, tehn rinse, spin repeat for 1-2 more days.

Trust me, I get to see all the other "specialty" docs in the ED when they come down to admit patients (and no, I am not a consulting service. Out of 20 patients I see in a shift, I might consult 0-2 times, unless they are MICU players, most of the stuff I can handle, but I am far more liberal than most of my colleagues), they all work probably 1.5 - 2.5 x more than I do. And I make more than they do. Except the CT surgeons and ortho.

Q
 
Thanks, Dr. Quinn. That's helpful.
 
Panda Bear said:
quideam said:
Well, how do you make money in Wilderness Medicine? Does medicaid reimburse more for a patient treated in a high altitude base camp? I don't doubt it's a cool job but where's the money coming from?
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I would like to know as well. My impression is that many of these people maintain a career in standard emergency departments, but act as a liason to wilderness programs.
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I know that the physician who runs the Everest Base Camp only does this about three months out of the year - the rest of the time she's the medical director for a national park in the US (Yellowstone? don't quote me on that, but it's one of the large ones...) so, still in essence wilderness medicine.

Of the physicians i've talked to, the best way to 'make a living' doing wilderness EM is to incorporate it into your normal practice. For instance, if you're in academia and interested in altitude research (AMS, etc.) then you could put together projects and do research on it in the mountains - of course this isn't a full-time thing, but if you can get out there a few months out the year, that's not too shabby. Check this out: http://www.xtreme-everest.co.uk/

Other options are to do expedition medicine (be the doc on a climbing team), work in a diving clinic, run ski patrol... I think the options are about as varied as your imagination. I'm not saying that these kinds of opportunities are easy to find (but who said anything worth doing is going to be easy?) - but EM certainly gives you the flexibility and opportunity to pursue these interests, and definetely more so than any other specialty. Can you make a living spending your entire year on Mt. Everest? Doubtful. But can you spend at least a couple months of the year doing some pretty cool stuff? Absolutely...

Btw, this isn't even mentioning the hundreds of opportunities available in international EM that involve travel to some pretty cool places (and some pretty crazy ones too)...

Q
 
Pinner Doc said:
quideam said:
It's funny that the poster used the word "living," presumably referring to financial reward. To use the word "living" another way, I can hardly think of a profession that would allow me to live quite so much. I've been a little down and stir-crazy lately... perhaps too many windowless ORs and the stifling atmosphere of NYC in the winter.
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Aww, Pinner Doc, I know the feeling! I'm stuck in NYC too! What medical school are you at? PM me - we should chat 🙂.

Q
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DrQuinn said:
I'm an attending in EM, and generally the schedule kind of flows and "undulates" like a sine wave. As a "new" attending, i.e. one year out, I work more than my colleagues, but it gets better after year 3. Currently I work about 1680 hours a year with six weeks paid vacation. My typical schedule is about 3-4 days a week (I work 5 this week, but in the month of November I only worked 10 days, and no, I didnt' use vacation time!). Generally I will work about 3-4 night shifts a month, but htey are in a circadian rhythm, and are usually in a row. For example, I will work 1-2 "evening shifts" that start in the afternoon and get out around midnight. Then I will work 2-3 "night shifts" that are around midnight to 7 AM. Which si nice, because I just sleep 4-5 hours during the day, spend the evening with my wife, kiss her goodnight at 10pm, then go to work. 8 AM my head hits the pillow, I sleep for about 4-5 hours, tehn rinse, spin repeat for 1-2 more days.

Trust me, I get to see all the other "specialty" docs in the ED when they come down to admit patients (and no, I am not a consulting service. Out of 20 patients I see in a shift, I might consult 0-2 times, unless they are MICU players, most of the stuff I can handle, but I am far more liberal than most of my colleagues), they all work probably 1.5 - 2.5 x more than I do. And I make more than they do. Except the CT surgeons and ortho.

Q
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Its kind of refreshing to hear your schedule seems to be working out well, one of the ppl I work with scared me with stories about never knowing his schedule until the week before, working random day and night shifts, being the only doctor on the hospital and not being able to call anyone including consults, never seeing his family, his group losing contracts all the time, etc, etc...
 
LanceArmstrong said:
Its kind of refreshing to hear your schedule seems to be working out well, one of the ppl I work with scared me with stories about never knowing his schedule until the week before, working random day and night shifts, being the only doctor on the hospital and not being able to call anyone including consults, never seeing his family, his group losing contracts all the time, etc, etc...
Click to expand...

My job is awesome. And just going to get better. More raises in the future (I can expect about a 20% increase in my salary over the next few years, but it will top out after that), and also about a 15-20% decrease in the # of hours over the same period of time. I know my schedule 3 months in advance, ALWAYS get the time off I request off, have > 6 weeks paid vacation. I love being there late at night, that's sometimes my favorite time to be there, and I see my family a lot more than nearly every consultant or FP I call on the phone. Oh, and I never get woken up at 3 AM to answer a page.

Q
 
To the EM Docs and residents,
Do you any of you have kids yet? If so, how much do you get to see them? How does the rotating schedule of nights to days etc. work with a family who is on a regular Mon-Friday schedule? Does it ever feel like you are out of sync with them? I can understand Panda Bear's point about a day off being a day off but with a family that is in school M-F all days off are not created equal. Thanks!
 
I have one cooking in the oven right now, the timer will ding in about 7 weeks (although her belly button has popped out already).

Its not going to be an issue, really. My wife plans on taking off, perhaps indefinately, but might go to work strictly part-time. I make enough where she doesn't have to go to work, so she can stay home. And I work ~ 32 hours a week. 16 shifts a month. Let's say 1/3 of those are 7a-3p shifts, so my wife takes them to work. 1/3 of those are 3p-11p shifts, so I would see my kids in teh AM. And the other 1/3 are 11p-7a, so I can see my kids all evening, kiss them goodbye to school, and go to sleep when they leave.

Really, its not going to be an issue.

Q
 
What if mom is the ER doc? how does this work for daycare?
 
A lot of my fellow attendings are new mothers, most of them come back full time, the others come back part time (i.e. work 1-2 shifts a week, and still make six figures).

Q
 
Dr. Quinn, are you serious? I could totally see doing this if I get to be a mom as well. Wow!
 
In the next bed was a drunk dude with a femur fracture who was screaming the F-word over and over at the top of his lungs. It was not fun. Anyone who tells you they "thrive on that sort of thing" b/c they are "so EM" is full of ****. It's a stressful place. That said, I still want to do it.[/QUOTE]

i agree that the ER is a stressful place at times but not always... once, i was draining a perianal abscess and had a stuffy nose.... my senior resident was supervising me and gagging from the smell. i thought it was really funny. :meanie: most of the time, i find the above situations pretty funny as well. the stuff i don't find funny and very stressful (but i still like EM too) is when a beaten wife comes in with some serious head injury🙁
 
Hey Quinn what program are you in currently and from which school did you graduate? Thabks!

DrQuinn said:
My job is awesome. And just going to get better. More raises in the future (I can expect about a 20% increase in my salary over the next few years, but it will top out after that), and also about a 15-20% decrease in the # of hours over the same period of time. I know my schedule 3 months in advance, ALWAYS get the time off I request off, have > 6 weeks paid vacation. I love being there late at night, that's sometimes my favorite time to be there, and I see my family a lot more than nearly every consultant or FP I call on the phone. Oh, and I never get woken up at 3 AM to answer a page.

Q
Click to expand...
 
ClubberLang said:
Hey Quinn what program are you in currently and from which school did you graduate? Thabks!
Click to expand...

it says it right under his posts:

__________________
Author of the PIMP Protector
Alumnus:
Nova Southeastern University College of Osteopathic Medicine 1999-2003
USF EM Residency Program 2003-2006
 
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