Too Smart for EM?

[RustedFox]

Haters gonna hate.
I'd be pissy if I were them, too.
Too impatient to diagnose anything that's not on a CT scan, too dumb to know that they're not just a blunt instrument.

"If all you have is a hammer, everything looks like a nail."
That includes you, medical student.
I was there, too.
Dr. McDickhead was the best general surgeon that this hospital had ever seen in eleventy years.
I mouthed off at him for some reason or another when I was an MS-3, because that's what I did.
He wrote some awful letter about me, using adjectives that I knew that he didn't know, because they were too long for him to understand.
Words like "brazen" and "impudent" and (whoa!) "unpolished".
His secretary called me in to her office, and showed me the letter before she shredded it in front of me.
"I'm not going to let him ruin a good student, especially one like you who knows what is right and what is wrong."
That letter never made it anywhere.
I was kind to her from day one.
It paid off.
Amazing.
Be kind.
Do you hear me, general surgeons?
Be kind.

---

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[LebronManning]

If I were the surgeon, I'd be wondering why the hospital secretary is getting paid more than me.

I'd argue that most surgeons make more than ER docs. Every subspecialty surgeon makes more than the ER doc. I'd say any general surgeon that wanted to make more than the ER doc, could as well.

 

[GonnaBeADoc2222]

I'd argue that most surgeons make more than ER docs. Every subspecialty surgeon makes more than the ER doc. I'd say any general surgeon that wanted to make more than the ER doc, could as well.

lol k

 

[OneTwoThreeFour]

I'd argue that most surgeons make more than ER docs. Every subspecialty surgeon makes more than the ER doc. I'd say any general surgeon that wanted to make more than the ER doc, could as well.

Cite your sources!
Medscape physician survey shows EM at 350 and gen surg at 332 or so. Subspecialties certainly more but when the average EM doc works 46 hours a week and the average general surgeon works 59 (per AAMC careers in medicine) I'm not sure where they would find the time...

 

[Detective SnowBucket]

Total, probably. On an hourly basis, not even close. If I worked same hours our surgeons work, I’d be making around $700,000 a year or so

Not even close to being a physician (yet...) so this might be common knowledge. I'm kinda interested in EM and I am wondering if you could work as many hours (or just more than you currently do) if you wanted.

 

[LebronManning]

Total, probably. On an hourly basis, not even close. If I worked same hours our surgeons work, I’d be making around $700,000 a year or so

Well working 60 hours a week in EM is a whole hell of a lot worse than working 60 hours as a Gen Surgeon because of how dense the work is in the ED.

Cite your sources!
Medscape physician survey shows EM at 350 and gen surg at 332 or so. Subspecialties certainly more but when the average EM doc works 46 hours a week and the average general surgeon works 59 (per AAMC careers in medicine) I'm not sure where they would find the time...

They wouldn't have to find more time, just would have to alter how they practice (patient base, procedure mix, case turnover). My point is more that surgeons and even proceduralists like Int Cards have the ability to produce whatever income they want. They dont work for an hourly rate. In general, these cases will always have a higher ceiling for money.

So sure on average, EM docs make more than gen surgeons (not any other surgeons or proceduralists tho), but the ceiling for almost any other non EM doc is higher.

 

[LebronManning]

Ultimately I definitely disagree that ER docs are "secretaries." Of course they have an important job and that comment was likely due to an angry doc.

But my point is that unless you're an Orthopod, Int. Cardiologist, or Neurosurgeon..you should probably not try getting into a pissing match about money cause theres someone in the hospital making double your income.

 

[BoardingDoc]

Cite your sources!
Medscape physician survey shows EM at 350 and gen surg at 332 or so. Subspecialties certainly more but when the average EM doc works 46 hours a week and the average general surgeon works 59 (per AAMC careers in medicine) I'm not sure where they would find the time...

The average EM doc works 46 hours a week? Did you mean 36?

 

[gamerEMdoc]

when the average EM doc works 46 hours a week

The average EM doc works 46 hours a week? Did you mean 36?

My PGY1's work less than 46 hours/week clinically on ED months. I can't imagine how that could possibly be accurate as the average hours for an EM doc.

 

[LebronManning]

Excuse this completely random weird question. But do neurosurgeons ever actually come down to the ED to see a patient? Or is it always filtered through other people before a neurosurgical patient ever sees the eyes of an attending neurosurgeon in the OR or SICU

 

[TheComebacKid]

Excuse this completely random weird question. But do neurosurgeons ever actually come down to the ED to see a patient? Or is it always filtered through other people before a neurosurgical patient ever sees the eyes of an attending neurosurgeon in the OR or SICU

As a resident, I have never seen a neurosurgery attending once in the ED. Neurosurgery residents, however, manage consults in the ED routinely.

There are multiple critically ill neurosurgical patients that go directly to the OR from the ED depending on what's going on.

 

[hundreddaysoff]

Not even close to being a physician (yet...) so this might be common knowledge. I'm kinda interested in EM and I am wondering if you could work as many hours (or just more than you currently do) if you wanted.

You can work as many shifts as you can stand in EM. It's not that hard if you're young and healthy and at a shop with reasonable volumes and good support. Working more than 12h in a row at a shop with any amount of volume is pretty hard though.

My boss has been working roughly 20 shifts (180h/mo) in the ER for the last 10y. Still not sure why he isn't able to retire yet.

I worked 210h my first month out. Could probably have sustained that for a while if I hadn't then gone and married a normal person with normal emotions who, like, starts missing me and stuff when I'm away from home too much. Tradeoffs.

 

[Apollyon]

Excuse this completely random weird question. But do neurosurgeons ever actually come down to the ED to see a patient? Or is it always filtered through other people before a neurosurgical patient ever sees the eyes of an attending neurosurgeon in the OR or SICU

My first job out of residency, university hospital with ortho and GSx residents, but no other surgical training programs, NSx attendings all the time. Then again, they're a good bunch of guys.

To recall, more than once, in residency, I saw the NSx attending in the ED with the resident.

 

[Brigade4Radiant]

Keep in mind that a specialty surgeon has at least a 2-3 year delay from an ER physician and there loans are accumulating interest. That is a 1 million dollar advantage you have over IM and surgical specialties if you live like a resident.

 

[LebronManning]

How do y'all feel generally about your Neurosurgery colleagues when you consult them in comparison to the other specialties?

I know this is a weird question in an ED post, but y'all have the best view of the consultants since you deal with so many, so you're the best to ask.

 

[deleted859535]

How do y'all feel generally about your Neurosurgery colleagues when you consult them in comparison to the other specialties?

I know this is a weird question in an ED post, but y'all have the best view of the consultants since you deal with so many, so you're the best to ask.

Are you thinking about maybe wanting to pursue neurosurgery?

 

[LebronManning]

Are you thinking about maybe wanting to pursue neurosurgery?

Haha not really, EM is my number 1 followed by ortho. But my cousin is applying Neurosurgery this cycle and I just wanted to get an idea of what other's think of them and their practice/consultancy.

 

[theseeker4]

How do y'all feel generally about your Neurosurgery colleagues when you consult them in comparison to the other specialties?

I know this is a weird question in an ED post, but y'all have the best view of the consultants since you deal with so many, so you're the best to ask.

Depends entirely on the neurosurgeon. There are surgeons who are more than willing to take that non traumatic brain bleed with shift to the OR for a craniotomy at 1:30 PM on a tuesday, but suddenly when they are called for an identical presentation at 2AM on a sunday, the case is futile and they will evaluate in the morning. There are others who are more than willing to come in to the ED personally at any time of the day or night for a potentially surgical patient when they are the ones on call. I would say this is pretty typical across the board of specialties. There are some who are always willing to work, always willing to help out, and others you can barely get a hold of even when they are getting paid to take call.

 

[Apollyon]

Depends entirely on the neurosurgeon. There are surgeons who are more than willing to take that non traumatic brain bleed with shift to the OR for a craniotomy at 1:30 PM on a tuesday, but suddenly when they are called for an identical presentation at 2AM on a sunday, the case is futile and they will evaluate in the morning. There are others who are more than willing to come in to the ED personally at any time of the day or night for a potentially surgical patient when they are the ones on call. I would say this is pretty typical across the board of specialties. There are some who are always willing to work, always willing to help out, and others you can barely get a hold of even when they are getting paid to take call.

The good guy you mention makes me think of one of the NSx that was also our medical board member. I see him at 4am one morning when I called him, and he is just stylin'. Dude is natty. I asked him about this. He said, "You never know who you are going to meet", and I said, "I think YOU are the person that someone is going to meet!"

 

[TheComebacKid]

The majority of neurosurgery residents and attendings I have interacted with are amazing at their job. Some are friendlier than others, some are very grumpy. But overall, I cut these guys an immense amount of slack. True, they signed up for it and knew what they were getting into, but they have arguably the most brutal residency of all and for they do some pretty amazing stuff. I try to make their jobs easier when I can.

 

[thegenius]

Depends entirely on the neurosurgeon. There are surgeons who are more than willing to take that non traumatic brain bleed with shift to the OR for a craniotomy at 1:30 PM on a tuesday, but suddenly when they are called for an identical presentation at 2AM on a sunday, the case is futile and they will evaluate in the morning. There are others who are more than willing to come in to the ED personally at any time of the day or night for a potentially surgical patient when they are the ones on call. I would say this is pretty typical across the board of specialties. There are some who are always willing to work, always willing to help out, and others you can barely get a hold of even when they are getting paid to take call.

I don't even care if they take (or don't take) the patient to the OR. It's all about being nice, and seeing the patient in the ED (or soon after in the hospital).

In the case above, it is the Neurosurgeon who has to explain to the jury why he took the 1:30 PM case to the OR and not the 2:00 AM case to the OR. At this point in my life I don't really care if they take or don't take. But they have to come in and see the patient and write a note.

That's my general belief for most consults. We ER docs know if the advice we are receiving makes sense or not. Most of the time I'm not gonna argue with them. If the ortho guy says I'll see the stable pelvic fracture tomorrow in the hospital (as opposed to now), I'm ok with that. The guy in acute renal failure, I get the recs from Nephrology. They don't need to come in. I only call Cardiology now if I want them to DO something, not to hear "start on heparin, nitro gtt, do some cartwheels, surf Ebay, and I'll see in the morning."

 

[OneTwoThreeFour]

My PGY1's work less than 46 hours/week clinically on ED months. I can't imagine how that could possibly be accurate as the average hours for an EM doc.

I just parroted what the AAMC site said. Maybe 46 hours including other responsibilities + charting + admin etc. But the sample size for the survey is pretty large I think.

 

[Hamhock]

Haters gonna hate.
I'd be pissy if I were them, too.
Too impatient to diagnose anything that's not on a CT scan, too dumb to know that they're not just a blunt instrument.

"If all you have is a hammer, everything looks like a nail."
That includes you, medical student.
I was there, too.
Dr. McDickhead was the best general surgeon that this hospital had ever seen in eleventy years.
I mouthed off at him for some reason or another when I was an MS-3, because that's what I did.
He wrote some awful letter about me, using adjectives that I knew that he didn't know, because they were too long for him to understand.
Words like "brazen" and "impudent" and (whoa!) "unpolished".
His secretary called me in to her office, and showed me the letter before she shredded it in front of me.
"I'm not going to let him ruin a good student, especially one like you who knows what is right and what is wrong."
That letter never made it anywhere.
I was kind to her from day one.
It paid off.
Amazing.
Be kind.
Do you hear me, general surgeons?
Be kind.

Greatest story I have heard this month.
(and not in the wonderfully sarcastic way NewTimesRoman replies to the flippant anesthesiologists and surgeons -- I truly mean it; that said, I also laugh at NTR's responses in those forums)

HH

 

[ZigZag]

It's funny to see this whole conversation to get so much traction.

This whole thing has more to do with hospital politics than the intelligence of people in question.
My hospital has a strong ED with better parking spots, more money ets, stronger positions on the board.
I don't ever remember seeing an internal medicine attending questioning my decisions.
IM is more cerebral, sure... I don't have time to care about urine electrolytes between 2 intubations and a trauma guy... nor do I care to quite honestly.
To each its own.

 

[SXMMD]

Commenting as an fm resident-

Lots of arm chair doctoring goes on in residency. Personally I appreciate EM, you bring a perspective and skillset I don't have to the table. If I could do what you do, I'd be you

Just one complaint- for the love of god not everything is sepsis! (Jokes!)

 

[Fox800]

Commenting as an fm resident-

Lots of arm chair doctoring goes on in residency. Personally I appreciate EM, you bring a perspective and skillset I don't have to the table. If I could do what you do, I'd be you

Just one complaint- for the love of god not everything is sepsis! (Jokes!)

Update your status, it still says you're a student.

And you can thank CMS and hospital administration for the current sepsis goat rodeo situation. We have a spinning toy that makes noise that I like to use whenever we call something sepsis (our "sepsis alarm"), always good for a laugh.

 

[SXMMD]

Update your status, it still says you're a student.

And you can thank CMS and hospital administration for the current sepsis goat rodeo situation. We have a spinning toy that makes noise that I like to use whenever we call something sepsis (our "sepsis alarm"), always good for a laugh.

I know i am constantly hearing it from faculty for not drowning my "septic" chf exacerbation patients in fluids, apparently im not good at "quality measures." Will have to adopt that sepsis alarm

 

[leviathan]

So as an internist and intensivist, this is what I tell residents or students rotating with me about EM. The bashing is simply out of having no idea what you guys do on a regular basis and also a number of cognitive biases.

First off, people only ever see the patients you consult to us, not the hundreds of patients you successfully managed without needing to call, so there is a bias from that.

Second, often there are the less-than-stellar emerg physicians who consult all too often for things they should be able to manage, but then everyone else gets painted with the same brush. There are definitely people in the ED who you know you're going to have a busy night when you find out they're working. Conversely, you know there are some docs who you rarely hear from, and when you do, you know it's legit. That's not to also say that good people have their off days or simply are getting swamped and need some help.

Lastly, some people forget that the bread-and-butter things they spent their entire residency learning how to manage and have become easy to them, are not necessarily easy to the guy/gal who has to know how to manage everything from every specialty. So people should take pride in the fact that someone is consulting for their advice / expertise, rather than give attitude. Note: That attitude often melts away quickly once you're an attending and are getting paid for that consult, vs. the trainee whose only incentive to see is for more experience/learning.

Overall I think it's ridiculous to say someone is "too smart for EM" or "too smart for FM" etc. The more generalist-based specialties NEED the smartest applicants, because there's just so much to know, and only the brightest people are able to do the job well. Those are the ones who end up being the ones you enjoy working with and trust when you they consult you.

 

[VA Hopeful Dr]

So as an internist and intensivist, this is what I tell residents or students rotating with me about EM. The bashing is simply out of having no idea what you guys do on a regular basis and also a number of cognitive biases.

First off, people only ever see the patients you consult to us, not the hundreds of patients you successfully managed without needing to call, so there is a bias from that.

Second, often there are the less-than-stellar emerg physicians who consult all too often for things they should be able to manage, but then everyone else gets painted with the same brush. There are definitely people in the ED who you know you're going to have a busy night when you find out they're working. Conversely, you know there are some docs who you rarely hear from, and when you do, you know it's legit. That's not to also say that good people have their off days or simply are getting swamped and need some help.

Lastly, some people forget that the bread-and-butter things they spent their entire residency learning how to manage and have become easy to them, are not necessarily easy to the guy/gal who has to know how to manage everything from every specialty. So people should take pride in the fact that someone is consulting for their advice / expertise, rather than give attitude. Note: That attitude often melts away quickly once you're an attending and are getting paid for that consult, vs. the trainee whose only incentive to see is for more experience/learning.

Overall I think it's ridiculous to say someone is "too smart for EM" or "too smart for FM" etc. The more generalist-based specialties NEED the smartest applicants, because there's just so much to know, and only the brightest people are able to do the job well. Those are the ones who end up being the ones you enjoy working with and trust when you they consult you.

Rational discourse has no place on SDN. Begone!