I have a pretty limited understanding, but I'm under the impression that both of these specialties are considered a jack of all trades. Both residencies expose you to all areas of medicine. So what problems can pts present with in the ED that would be better handled by EM docs?
What can EM docs do that FM docs can't?
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EM- airway management. more procedural experience, resuscitation, and critical care. The mindset and knowledge bases are also quite different. Emergency doctors limit their scope of practice to emergency care. While family physicians occasionally see emergencies, their focus is long-term health maintenance, working up and managing things over a longer period of time.
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EM doc = acute generalist, FM doc = chronic generalist.
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deleted109597
Um, emergencies?
I'm sure all physicians can handle emergencies in their respective field. Since EM and FM are both exposed to various areas of medicine I was curious as to what EM docs are specifically better trained in. "Emergencies" is kind of a broad term that doesn't give me much information. I could see how you, as a doctor, would find this obvious and a stupid question though.
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That's because EM is inherently a broad field.
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Not all doctors can handle emergencies. It requires being able to diagnose and treat in parallel, often times with no information except for what you can immediately gather from the patient in front of you who is actively dying.
Many specialists, when confronted with an emergency involving the organ system in which they specialize, will want "more data" before starting treatment. It's a lofty approach, and the better one in stable patients. However, undifferentiated respiratory distress, hypotension or altered mental status require the approach and skills that differentiate EM trained docs from the rest.
(Of course an FP who has been working in an ER for 20+ years may have these skills, but he or she picked them up on the job, not in residency).
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"The rapid recognition of sickness and health, and the resuscitation of the critically ill and injured."
That is "emergencies", and EM, in one line. The first part - most patients are not emergent. The second - that's why we're there.
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Disturbingly, an old friend of mine wanted to make a career switch from Family Medicine to EM. I strongly encouraged him to consider residency (or at the very least, one of those FM-->EM fellowships). Unfortunately, last I heard he had "taken a course" over a couple of days and was going to start working in some more rural locations.
*sigh*
*sigh*
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When you or someone you care about has an undifferentiated condition that is life threatening today-->ER
When you or someone you care about has an undifferentiated condition that is life threatening over the next 40 years-->FP clinic (even though we'll also probably see it in the ED .....)
When you or someone you care about has an undifferentiated condition that is life threatening over the next 40 years-->FP clinic (even though we'll also probably see it in the ED .....)
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Agreed,
IOW, Help you in the short run: EM
Help you in the long run: FM
IOW, Help you in the short run: EM
Help you in the long run: FM
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Funny thing is that our ED offers a procedural course for rural ED docs. We travel around to their hospital and host a 3 day event where we teach things like RSI, chest tubes, needle decompression, LP's, arthrocentesis, etc....
One of the docs there said, "I haven't intubated a patient in 20 years" followed by "if we have a patient that's having trouble breathing we just call respiratory to come down to the ED." Kinda shocking that rural ED's are being housed by doctors that can't intubate. This physician knew nothing about the different drugs, protocol, etc.
She was a family doc doing ER
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If you are a premedical student, spend some time shadowing each and you will see that the two fields are vastly different in patient encounters, philosophical approach to the patient and in training.
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If you are unfortunate enough to suffer a medical emergency, may you be fortunate enough to receive care from physicians who have the knowledge and skills to take care of you.
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10 years ago, I started a job. One place was a rural hospital. ED coverage provided by a PA. At night. Alone.
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I moonlit at a rural ED. The docs there were nothing short of scary. One was an OB/gyn who was also a veterinarian. Looking through her old notes and taking sign out from her were scary. It was one of the times in my life where I really appreciated what I had learned.
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I really quite honestly, don't think you want to play the "EMS is smarter" game (and this comes from someone that was a paramedic for 9 years).
Do you know why people become paramedics? Because EMT is too hard to spell.
haha not playing that card at all. there is no comparison (obviously) between a BC EM physician and medic. What I was getting at was the lack of procedural skills in some non-EM specialty docs trying to work in the ED.
I would never try to insult the docs in the specialty I hope to one day enter (or any specialty for that matter), I am just one who believes physicians should work in the specialty they were trained in.
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deleted6669
that's why they become FIRE medics....house hot, I run in, pour on water until not hot....
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Was something I said so wrong it was funny? I stated I have a very limited understanding... that's why I'm asking.
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Take for example one of the most serious but frequent "emergencies" --> cardiac arrest. This is something that EM's do on a daily basis but FM's don't. There's no way an FM can run a code the same way we can. An FM would have the advantage of "maybe" knowing the patient's medical history to help them figure out the underlying cause of a code (but many have no clue off hand what their patients' histories are). But when it becomes difficult - ie. multifactorial - there's no one who can think about a code in a multifactorial way better than an EM doc. An FM doesn't train that way, and doesn't approach disease that way. EP's approach many presenting complaints by thinking of the top different "things that can kill you" first, and so we practice with that in mind.
EM is thought of as being general and broad medicine, but our actual specialty is the practice of treating acute critically ill patients with rapidity, accuracy and without hesitation. No other specialty can do this except for some surgical specialties (ie. trauma) and intensive care specialties.
EM is thought of as being general and broad medicine, but our actual specialty is the practice of treating acute critically ill patients with rapidity, accuracy and without hesitation. No other specialty can do this except for some surgical specialties (ie. trauma) and intensive care specialties.
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Trying to explain medical specialty differences to a pre-med is really difficulty I think unless they are diametrically opposed. i.e. (psychiatry....neurosurgery) I see very little "real" overlap with family medicine as an emergency physician in an emergency department setting. A lot of people like to talk about lots of overlap and similarities, but I honestly don't see any real similarity at all in the two fields. Management styles, patient populations, practice settings, mindset, lifestyles, schedules, skillsets, are all fundamentally different.
I'd encourage you to keep researching but don't pressure yourself to understand everything enough to make a decision about "what do I want to do when I grow up (graduate medical school)". You've got plenty of time to figure it out and get a feel for the individual specialties and honestly... that's what your 3rd and 4th year of medical school is all about.
I'd echo what someone else encouraged you earlier about shadowing... that's probably the best thing you could do to give you an idea at this point.
