Too Smart for EM?

Discussion in 'Emergency Medicine' started by teeayejay, Aug 2, 2018.

  1. teeayejay

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    Finally got it today - I'm on my IM rotation and my attending told me I was too smart to go into EM. In so many words, he went to say that other specialties basically look at EM docs like the dunces of medicine and that my job satisfaction would suffer because of this.

    I've heard it all before and it doesn't sway my interest in EM but I'm curious from you guys, do you interact with other specialties outside of consulting in the ER? How are those interactions? Do you think you get the respect you deserve?
     
  2. BoardingDoc

    BoardingDoc Don't worry. I've got my towel.
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    This sentiment generally comes from people who think they know exactly what our job entails, but are woefully incorrect about it. I still encounter it from other docs from time to time, but the vast majority of the people from other specialties in the community are appreciative of our work, just as I am of theirs. I feel like in academics you see the superiority complex rear its head a lot more often. The benefit of EM is that you learn to let a lot of crap slide. When you run into one of these condescending pricks, it's pretty easy to remember that it isn't so much that you're a dunce as it is that they have a personality disorder.
     
  3. bearstanley

    bearstanley goin' where the climate suits my clothes
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    lol. things i don't think about as i'm walking out the doors of the hospital after an 8 hour shift: a lack of respect from all the other nerds who live in the hospital.

    i'll be at the bar, with real people.
     
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  4. mega_colon

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    Lol, had 270+ on steps, definitely couldnt care less when my duty hours are like 40-50 and I get plenty of spare time chilling with my wife and kids. Everyone elses family has forgotten they exist, who is the smart one again?
     
  5. EMDOC17

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    I think this gets much better in the community. Too many specialists or residents has two problems. Consulting services for things in an ED physicians scope of practice because it’s easy and too many egos.

    In the community I have felt a much greater level of respect and comrodary. I needed help on a shoulder reduction and one of our orthos came right down. I previously had referred their office a follow up hip dislocation and distal radius fracture I reduced with no call and no bother. Just a referral.

    I called one of my hospitalists (they admit to icu overnight) with a soft admit. Grandma can’t walk and can’t go home. X,Y, and Z checked and ok. No push back no whining about why they can’t go home. Patient admitted. I previously had admitted them a septic patient with pneumonia. Intubated, 4 l of fluid, treated with vanco/zosyn, on levophed with a right IJ CVC, and a radial art line.

    My point is be a good ED physician and work in the community and this literally disappears. Granted there are still those that just do not get it and never will. Who cares. Many physicians will understand your role and be appreciative of your hard work. Those that don’t, oh well they still need to show up in my ED at 2 am if I request them.
     
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  6. GonnaBeADoc2222

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    Soooo much better in the community (although personality disorders occur there too). Most of my consultants are awesome. Most push back occurs when a trainee is involved. Speak to their attending or even so much as ask to do so and the problem magically disappears! I also frequently chuckle about this as I walk out the door thinking about the fewer hours I spend at work while making more money. Also, we can compare USMLE scores anyyytimeee they want.
     
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  7. gamerEMdoc

    gamerEMdoc Associate PD; EM Clerkship Director
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    Yeah, nothing better than people who couldn’t even match in EM talking about how dumb EM folks are. Hahahaha. It’s all jealousy of our work hours mixed with them having NO CLUE what juggling our workload is like, and thinking everyone should know everything about their specialty.
     
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  8. GonnaBeADoc2222

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    Funny, cause if we had all their expertise as specialists, we wouldn't need them to consult, and then....they wouldn't have jobs....
     
  9. Tenk

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    He jelly. I’d just be like: can I borrow your pager? I left mine 7 years ago.
     
  10. Perrin

    Perrin sittin in the morning sun
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    There's no such thing as 'too smart' for any specialty. When he/she comes to the ED for any reason, they'll want the smartest EM doc they can get.
     
  11. fahimaz7

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    I used to get that crap. 257 step 1. 272 Step 2, 3.95 GPA, etc. I'm glad I went ED.
     
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  12. Birdstrike

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    I definitely think you're "too smart." But you're not too smart for EM. You're too smart to work with arrogant ---holes who think Emergency Physicians are a bunch of dunces.
     
    #12 Birdstrike, Aug 3, 2018
    Last edited: Aug 3, 2018
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  13. VA Hopeful Dr

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    I think it helps outside of academics because you're more likely to know the various other doctors in the hospital. Its hard to be a jackass when you actually know the person you're talking to/about.

    For instance, if I know that you normally do great work and don't consult me without good reason then if I get an occasional consult that I think is unneeded I'm more likely to say something like "Must be really busy down there" or "Maybe GonnaBe is having a rough night". If you're just a faceless voice on the phone, I think its human nature to be a little more of a jerk. Doesn't make it right, but its there.

    Of course the caveat to this is you actually have to be a good doctor, but that's not exactly an insurmountable task.
     
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  14. RoyBasch

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    So dumb I make just as much as a specialist surgeon in 1/3rd the working hours...real stupid.
     
  15. The White Coat Investor

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    Ha ha. Did you ask him "If you're so smart, how come you make half of what those idiots in the ED make?" or "Why is it so much easier to match into IM?" or "How come you demand the emergency doc diagnose everything before admitting it to you?" or "Why is the average boards score and GPA so much higher for emergency docs than for internists?"

    Should I go on? Because I could.

    If your goal is to "get respect" then become a super-hyper-specialist where you know the most about some tiny little niche in medicine. That way nobody can ever judge you for not knowing something. But if your goal is to help people on one of the worst days of their life, have a reasonable shift-work lifestyle, make good money, and have a satisfying practice touching many fields of medicine, then come on in, the water's fine and attendings don't spend any time whatsoever thinking about what you're worried about.
     
  16. Apollyon

    Apollyon Screw the GST
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    "Ortho - taking the smartest students, and making them into the dumbest doctors" - and, do they care? Nope, no way, all the way to the bank. "Talk is is talk, but the biscuit speaks for the cook" (A.T. Still, ~150 years ago) - go to ACEP, and hear approx 4000 people says, "hey, I'm just a dumb ER doc!".

    Jealousy, personality disorder, just being an dingus, being misinformed, having an agenda - all possibilities.

    And, a final quote, by me -"some animals HAVE to live in the zoo, because they can't live in the wild". That's academic medicine.
     
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  17. Brorthopedic

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    Our lord and savior, AT Still. RIP.
     
  18. Apollyon

    Apollyon Screw the GST
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    I'm not a bone wizard, just a money-grubbing MD, but, I heard that once, and liked it.
     
  19. BAM!

    BAM! Senior Member
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    Haha, I haven't thought about something like this in years! This is definitely NOT a factor out in the real, nonacademic, working world.

    Perhaps it was meant, if you get really good scores you could match a position that pays more? Like neurosurgery or dermatology? (look a the can of worms i'm opening!)
     
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  20. Moose A Moose

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    I disagree with your attending. You’re a perfect candidate for EM. I mean just look at you; who asks a question like that? Smh
     
  21. Brorthopedic

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    It's not too late to accept him into your life, friend
     
  22. Psai

    Psai Snitches get zero vicryl
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    What school did you go to
     
  23. Mr. Hat

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    Maybe I'm different than most of my colleagues on here, but every time I hear something like this it really gets under my skin and affects my sense of self wor....

    Wait.... sorry.... hold on a minute. The truck with my bi-weekly pile of cash is backing up to my house, and by the time I get all of the stacks of Benjamins inside it'll be time to go catch my flight for my 8th vacation this year.

    Ok anyway what was I saying? Ah I forget now. Maybe it'll come back to me when I'm sipping my fourth scotch in the first class cabin.
     
  24. southerndoc

    southerndoc life is good
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    I had a few non-EM attendings tell me that during medical school. I just smiled and said "it's what makes me happy."
     
  25. Perrin

    Perrin sittin in the morning sun
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    While in 4th year, I sat down with the chief of medicine, who was my attending, for my end of rotation review. He said, 'Perrin, I hope you go into emergency medicine. When you get a new patient, you do a stellar work up and evaluation, your ddx is good, and you proposed treatments are appropriate. But...., I can tell by day 3 or 4, that you're bored with the daily course of the patient. You'll perk up if anyone on our service needs an LP, thora/parecentesis, or intubation. I think you'll make a good EM physician.'

    I told him that I was applying to EM, because I enjoy it.
     
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  26. LebronManning

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    My dad is a hospitalist for the last 20 years in the community and I’ve been working in the ED as a scribe for the last year prior to starting med school. I frequently ask him what he thinks about the ED.

    He tells me the ED is where everything happens. He says his job is much easier because 80% of the time the ER doc has made the dx and directed treatment. Whenever I shadow him or other docs in the community, I also see no disrespect for ER docs. He says the ER docs are much better now than 20 years ago since they’re all board certified in EM now vs. having the occasional fm in the ED when he first started practicing. He says good ER docs are one of the most valuable assets to a hospital.

    In the setting I work in though (academic), I have seen quite a bit of flak against the ER residents I scribe for but it’s always from other residents. I think it just takes time to appreciate what the ED does.
     
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  27. Jlaw

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    Anything you give to a resident is just more work for them, hence the push back. For an attending a consult is money in the bank, hence the acceptance.
     
  28. MechEDoc

    MechEDoc maybe minor rocket surgery...
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    Ignore him. Sentiment doesn't exist in the community. You'll make better money (at this point in time).
     
  29. gro2001

    gro2001 SOCMOB
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    Ask him how often he saves a life.
     
  30. miacomet

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    Unless you go into research, clinical medicine doesn't really value intelligence. It's people skills, common sense, and a bit of brain power. The smartest people I know in clinical medicine are among the most frustrated. But research doesn't pay, and people have families. Part of our culture's general anti-intellectualism, I guess.
     
  31. TheComebacKid

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    I agree with pretty much everything else that others have said on here. I'll just reiterate some important points.

    This IM doc doesn't have the slightest clue what an EM physician does. He has never intubated someone with massive hemoptysis (but he has deliberated on the usefulness of a protonix infusion vs BID dosing ad nauseum). He has never pulled a lifeless infant out of his mother's arms and resuscitated this child. He has never placed a subclavian cordis in a peri-code trauma patient.

    He has also never looked at an x-ray and reduced a fracture. He's never talked to a woman who is actively miscarrying. He's never I&D's a simple abscess.

    He can't do the majority of things we do everyday. You don't know what you don't know.

    The fact of the matter remains though that his mentality is pervasive in medicine. But it's not just towards EM. You should hear IM docs talk about an orthopedists ability to manage hypertension. You should here urologists talk about an IM docs ability to place a foley. You should hear surgeons talk about an orthopedists ability to identify "an acute abdomen". You should hear a radiologist talk about a pediatrician's ability to read an x-ray.

    A lot of this mentality is rooted in an idea that "I am the expert" and the EM doc is the "generalist". I'm OK with being able to do virtually everything. That being said, I am an expert. I don't care what anyone says, we are hands down the experts in resuscitation. Don't let anyone convince you otherwise. If you don't believe me, I highly recommend just witnessing a code on the floor to see how this "expert IM doc" does things vs how we do it in the ED.

    Go forth into EM young paladin. Go forth.
     
  32. mega_colon

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    Quoted for truth, and to be honest this extends to your MICU rotation. You will soon realize that even compared to your fellows who trained IM that no one is better at resuscitating a patient than us, they can figure out all the weird ARDS ddx afterwards and do Q fever workup and what not. But when the patient crumps they slump to the back of the room and let us do our thing.
     
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  33. petegriffin

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    it's alright...all of medicine is work...not sure anyone's really satisfied with what they do...just be smart enough to realize EM pays double whatever gets XYZ specialty + no follow ups for you which is really the icing on top! : )
     
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  34. hundreddaysoff

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    OT, but sometimes it's actually turtles all the way down. I was a scientist for about 10 years before becoming an emergentologist. AFAICT, basic and clinical research most value towing the party line, doing whatever your bosses want you to do, faster, and faking it till you make it. You need some amount of intelligence to do these things well, but the smartest people I knew in research were also the most frustrated and often the most underemployed.

    Of course, when those people are persistent and lucky enough, they're also the ones who make the actual discoveries that matter.

    </axegrinding>
     
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  35. theseeker4

    theseeker4 PGY 3
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    The point about IM not being able to resuscitate a patient really hit home for me my intern year. I remember being at MULTIPLE floor codes, with multiple different IM senior residents, and when the pulse check time comes, they hit the "analyze" button on the defibrillator and wait for it to tell them what to do, instead of simply LOOKING AT THE RHYTHM! This happened more than once, with multiple different IM senior residents. Add this little detail to the fact that every IM resident who responds to a code is staring at their tablet looking up the patient's chart hoping it will magically tell them why this patient is coding, rather than actually evaluating the patient, and it is very clear we are MUCH better at handling acutely ill, decompensating, or trying-to-die patients than they are.

    No hate toward IM in general, or any other specialty of course, but it is laughable when they talk down to us when some of them are so bad at doing what we do every day.
     
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  36. The White Coat Investor

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    That's a really observant doc. I hope you paid a lot of attention on that rotation. I bet there were a lot of pearls being dropped there.
     
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  37. Dr.McNinja

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    And people wonder why we bristle about other specialties trying to do EM. It's this. Many of the old guard out there don't see the value of EM. They think only dumb people can do it. That's why they can become facile without doing a residency, or perhaps doing a year fellowship afterwards.
     
  38. Birdstrike

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    I think a lot of the "ER docs are dumb" stuff from other specialties is due to personal feelings of inadequacy. They know EM is highly respected and admired in the lay population and has a huge "sizzle factor" in pop culture. They're well aware there are countless shows on TV about trauma, "ER" and the like. And it makes some people feel inadequate. They know there's not going to be any shows with the titles, "Chronicles From ID Rounds," "Real Lives of Endocrine Fellows," "Gripping Tales from Geriatrics IM Clinic," or "The Long Slog Through Nursing Home Urinalysis & Code Status Rounds" shooting up the Netflix ratings charts anytime soon. A lot of it is "tease the cute girl you like but don't have the confidence to ask out" stuff.

    Since I've left the day to day practice of general EM to practice Pain Medicine, I almost never hear this "EM docs are idiots" stuff anymore, from other docs. When other docs, in other specialties, find out I used to do EM, I almost routinely hear comments more like, "Oh man. ER? Wow. I could never do that. Toughest job in all of medicine." It's amazing how much the message changes when the roles change and the defense mechanisms are no longer needed. I'm telling you, a lot of this stuff is jealousy and envy.
     
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  39. VA Hopeful Dr

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    I really don't think that's it.

    Y'all uniformly make work for other doctors. Often uncompensated work. People don't like that. Its why you have EPs here who work in areas with hospitalists/specialists who get paid for productivity and those doctors don't talk crap about y'all. Its why the worst of it comes from academics where most everyone is salaried. So each new admission isn't more money, its just more work for the same money. Its why those of us who don't interact with y'all regularly don't talk crap about EM. I'm outpatient FP, you guys affect my life not at all. So I don't say bad things about EM.
     
  40. Simba699

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    This is a joke right? Based off TV shows...specialists and inpatient docs are like "Damn should've done EM so I could tell people Im just like Dr. Doug Ross?" Lol that really made me laugh out loud.. I can guarantee you that NO ONE upstairs is jealous or envious of EM.

    And I think you misinterpret the "Oh I could never do that, toughest job in medicine" to mean they couldn't handle the intellectual rigors when they actually mean they can't handle the patient population and triage work in general.
     
  41. Simba699

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    "You don't know what you don't know" Oh the irony
     
  42. GonnaBeADoc2222

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    Ho hum...another MS3 telling us attendings how it is. Let us know the next time you have an airway or vascular access emergency and there's no anesthesia in house. Also, enjoy your 2000+ hour work year. I'll be next to a pool or on a mountain someplace drinking a beer.
     
  43. Simba699

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    The funniest part of this thread is all the ER guys talking about how the only people that talk **** about other specialties are ones that are insecure about their own.....and then go on to talk **** about other specialties.
     
  44. Veil

    Veil EM Attending
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    You don't know what you're talking about.
     
  45. GonnaBeADoc2222

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    Nah brah. You don't get it. I have immense respect for other specialties. Def can't do what they do. I'm very secure in my career choice too btw. Great pay, great work life balance, get to do really cool stuff.
     
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  46. Brorthopedic

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    Someone get the nerve block, I think we hit a nerve
     
  47. Birdstrike

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    I haven't worked in an ED in 6 years.

    This definitely is a part of it. But that's also a very misguided resentment. In the days before full time EPs (not that long ago, 1960's, 1970's) those docs that now b**tch about getting called for an admission, not only still had to do those admissions, they had to pull shifts in the ED at night, regardless of specialty. Many of you millenials have forgotten this, or are not aware, but prior to when board certified EPs were the norm and common, every doc on staff, whether surgeon, dermatologist, GP or psychiatrist, had to cover the ED shifts at night.

    So, in reality, the existence of full time, residency-trained, board certified EPs, which didn't exist prior to 1970 (Univ Cincinnati, 1st EM residency, 1970) greatly, greatly, reduce the workload of those physicians who now resent the false impression that Emergency Physicians increase their workload. So, in reality, doctors who resent "emergency physicians increasing their workload" are actually ignorant of (or have forgotten) the fact that those full time, board certified ER docs, greatly reduce their workload. In fact, prior to this era, the norm, regardless of what specialty, was to work a busy clinic at least 40 hrs per week (+/- OR time), and share group and ER call after hours, AND rotate through the ER to cover actual ED night shifts, regardless of specialty and regardless of having any competence to do so. Peds, psych, derm, path, it didn't matter. If you were on staff, you had to share in the coverage, because "ER doctors" as we know them today, didn't exist. Imagine how much it would suck, to have to go back to that. I'm thankful everyday, for those dedicated enough to cover any and all ED shifts, so that I don't have to, on nights weekends or holidays. It wasn't long ago, prior to the EM speciality, that all of you non-emergency physicians would have had to.
     
    #47 Birdstrike, Aug 6, 2018
    Last edited: Aug 6, 2018
  48. VA Hopeful Dr

    VA Hopeful Dr Senior Member
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    I'm aware you haven't, but you completed an EM residency so to my mind you're still an EP - you're just also a pain management specialist as well.

    I'm very well aware of how medicine used to work. Doesn't change anything about my statement though. Its like saying that I can't complain when I get sick because hey, at least its not polio which is what people used to get sick with.
     
    gutonc likes this.
  49. Birdstrike

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    Hospitalists are group that's greatly underappreciated, in that they're relatively new to the world of Medicine (becoming more commonplace in the '90s) and have greatly improved the work lives of other specialties. Hospitalists have saved countless doctors, not only primary care, from having to deal with the full weight of after hours work, admissions, consults, phone calls and care coordination. All specialites should be appreciated, but EP and hospitalists are a God-send, in how much they reduces the burden upon other specialties, whether they're appreciated for it or not.
     
  50. Birdstrike

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    Oh, I know. Human nature will never change. People will still b**ch when call to do work, especially if already feeling they're working "hard enough."
     
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