Why AMGs don't like neurology?

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Why don't AMGs like much Neurology? Most specialty (according to NRMP data) have about 85-90% occupied with AMGs except neurology in which AMGs are only about 60%.

Why don't AMGs like neurology? 😕

 

[Faebinder]

AMGs go to programs where more AMGs are. It's a fact... if neurology programs have a lot of FMGs, AMGs will avoid them even if the program is good..... It makes sense, if you saw 5 people from your ethnicity, and another group of 5 people from a different ethnicity, whom would you most likely be comfortable joining? Apply the same concept.

 

[McGillGrad]

Didn't mean to haijack...

 

[PeepshowJohnny]

I think they dislike it because of the "Diagnose and Adios" style of the field. Let's say I diagnose someone with ALS. Well, there's only one drug available and it'll extend your life by maybe three months. Good luck with that!

 

[Gfunk6]

A lot of it has to do with the shifting priorities of AMGs. Neurology work hours during residency are not benign. In fact, the PGY-2 year @ many programs is very difficult with a lot of call -- I've heard residents refer to it as the Neurology "intern" year.

Also, while salaries can vary widely the median salary of Neurology is not particularly high compared to other specialities.

Finally, as alluded to above Neuro has a bad reputation (in my mind this is undeserved) of lacking widespread therapeutic interventions. On this last point, people are referring largely to strokes (which can still be @ least partially reversed w/ pharmacotherapy and/or interventional neuro if caught early enough). Of course, people forget other common diseases treated by neurologists including epilepsy, movement disorders, migraines/headaches, and dementias -- many of which have very good (and ever improving) treatments.

 

[Phantom Spike]

I think they dislike it because of the "Diagnose and Adios" style of the field. Let's say I diagnose someone with ALS. Well, there's only one drug available and it'll extend your life by maybe three months. Good luck with that!

There are several neurological diseases where clinicians can make a huge difference. How about epilepsy, where the right medications can render almost two-thirds of patients seizure-free, letting them drive and work again? And where the selection of the right patients for epilepsy surgery can have a significantly positive impact on their lives? The same argument holds for Parkinson's disease, which is eminently treatable in most cases. The diagnosis of multiple sclerosis, and the subsequent management, is hardly easy or trivial. Then there's migraines, where many patients will experience a vast improvement in their quality of life with a well-chosen prophylactic and abortive regimen. Several neuromuscular diseases, like myasthenia gravis, CIDP and vasculitis need careful monitoring, followup, and medication adjustment, but the results can often be very rewarding. True, diseases like ALS, Alzheimer's and vascular dementia are often not amenable to treatment, but you need to be able to rule things out that look like them but turn out to be something else, something that can be treated, not an infrequent occurrence.

I'll admit that not many diseases in neurology are curable, but there are definitely many of them that are treatable. But I this holds true for most medical (as opposed to surgical) fields.

 

[Trifling Jester]

AMGs go to programs where more AMGs are. It's a fact... if neurology programs have a lot of FMGs, AMGs will avoid them even if the program is good..... It makes sense, if you saw 5 people from your ethnicity, and another group of 5 people from a different ethnicity, whom would you most likely be comfortable joining? Apply the same concept.

No. It has nothing to do with xenophobia and everything to do with economic incentive.

When anesthesia was poorly reimbursed plenty of FMGs were in the field. Now that reimbursements have increased it's largely an AMG field. People aren't stupid, they'll follow the money. If neuro suddenly began paying 200-300k per year, you'd see a shift in applicant demographics.

-The Trifling Jester

 

[McGillGrad]

According to salary.com, the average is 193,000 per year.

No. It has nothing to do with xenophobia and everything to do with economic incentive.

When anesthesia was poorly reimbursed plenty of FMGs were in the field. Now that reimbursements have increased it's largely an AMG field. People aren't stupid, they'll follow the money. If neuro suddenly began paying 200-300k per year, you'd see a shift in applicant demographics.

-The Trifling Jester

 

[Doowai]

AMGs go to programs where more AMGs are. It's a fact... if neurology programs have a lot of FMGs, AMGs will avoid them even if the program is good..... It makes sense, if you saw 5 people from your ethnicity, and another group of 5 people from a different ethnicity, whom would you most likely be comfortable joining? Apply the same concept.

The ethnocentric idea you express may have some truth, and you are probably being personally honest. However it is not always the case - people of other ethnicities are often only uncomfortable or "scarey" to be around because they are unfamiliar. Sometimes with some familiarity other ethnicities have many desireable qualities.

For example, I am not Latino, but Latinos are one of my favorite people. I had the chance to coach quite a few in sports 5 years ago and found them great. Right now I live in an area with lots of Hispanics and love it. Every day I see a homeless beggar by the road with a cardboard sign asking for money - everyone I have seen is white. Never have seen a Latino begging that way - but I do see them with work gloves in hand ready to lay tile, or other hard work for money. I have NEVER seen white guys standing around ready to do hard work like that. Unfortunately Lowes and Home Depot now prohibit it - and Latinos standing around Home Depot with work gloves are arrested - but the bums with their cardboard signs are left alone. Go figger.

The Latino's tend to have very tight family structures - you ought to go to a Quincenera and see the extended family and friends that are there. The youth tend to be more well behaved with less drama than some others. Latino men tend to be men. Latina women tend to be women.

I am not Latino, but would seek out a group with Latino's over many others due to the many years of good experiences I have had with them.

So while your expression of ethnocentrism is probably true, and no doubt true for you - its not universal. I admire the hard work Latinos typically are ready to do, their tight family structures, their faith. I am not a big fan of soft fat lazy indulged rude people-especially when you mix that with arrogance - when in all their fatness and laziness they think they are better than others.

 

[lisichka]

.

 

[Miami_med]

At my hospital, this is one of the specialties that actually IS mostly AMGs

 

[Faebinder]

Just to show you that my theory is not just some BS. It's funny how you guys perceived my view as biased when I am saying it straight off an article in JAMA.

http://www.ncbi.nlm.nih.gov/sites/e...med.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus

Here is the abstract for those with weak googlefu powers. Note the part in bold. It might not be very clear how they made that conclusion but they detail it in the article.

Comparison of IMG-dependent and non-IMG-dependent residencies in the National Resident Matching Program.Whitcomb ME, Miller RS.
Division of Medical Education, Association of American Medical Colleges, Washington, DC, USA.

OBJECTIVE: To provide insight into the dynamics that determine the pattern of participation of international medical graduates (IMGs) in graduate medical education (GME). DESIGN: Data on IMG-dependent programs (ie., those having at least 50% of first-year positions filled by IMGs) and non-IMG-dependent programs in 6 core specialties (internal medicine, family practice, obstetrics and gynecology, surgery, pediatrics, and psychiatry) were matched with application data from the 1989 and 1995 National Resident Matching Program (NRMP). MAIN OUTCOME MEASURES: Participation of IMG-dependent and non-IMG-dependent programs in the 1995 NRMP and the pattern of US medical graduate (USMG) and IMG applications to these programs in 1989 and 1995. RESULTS: Of the 1634 programs in the 6 specialties, 93.5% participated in the 1995 NRMP. The 1165 non-IMG-dependent programs were significantly more likely to participate in the NRMP and were slightly more likely to fill their offered positions than were the 469 IMG-dependent programs. Specifically, IMGs constituted 76% of applicants to IMG-dependent programs and only 14% of applicants to non-IMG-dependent programs. Changes in NRMP data between 1989 and 1995 indicated that the number of IMG applications to IMG-dependent programs increased 88.7%, as did the number of applicants ranked. CONCLUSIONS: Persistent differences exist in the mix of USMGs and IMGs applying through the NRMP to IMG-dependent and non-IMG-dependent programs. Over time, programs that enroll large numbers of IMGs are likely to experience an increase in the number and proportion of applications from IMGs and a decrease in the number and proportion of applications from USMGs. If policies are adopted to limit IMG access to GME, IMG-dependent programs may be unable to recruit USMGs unless the total number of GME programs or the quality of existing programs fundamentally changes.

PMID: 8769548 [PubMed - indexed for MEDLINE]

You can conclude from this that pretty much if you fill neurology with AMG, then AMGs will apply there (for whatever reason you like to believe... perceived superiority of AMG (which is another hot debate) or wanting to be around the same ethnicity). If there are plenty of FMGs in a neurology program then expect the FMGs to apply there and expect the AMGs to avoid them.

It's not just money, although there is no denying it to be a significant factor as other articles noted. This article is showing the recruitment differences for the same specialty. So money is somewhat ruled out (I say somewhat because regional perception of income can exist).

 

[McGillGrad]

You are 100% correct. It is a fact that "IMG Friendly" programs are highly sought after and once a program is listed, it will be bombarded with FMGs from foreign countries and from offshore schools.

AMGs mistakenly (and sometimes rightly) assume that IMG-heavy programs are not competitive enough to attract US grads. Residency is hard enough without having to deal with another culture among your peers.

Just to show you that my theory is not just some BS. It's funny how you guys perceived my view as biased when I am saying it straight off an article in JAMA.

http://www.ncbi.nlm.nih.gov/sites/e...med.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus

Here is the abstract for those with weak googlefu powers. Note the part in bold. It might not be very clear how they made that conclusion but they detail it in the article.



You can conclude from this that pretty much if you fill neurology with AMG, then AMGs will apply there (for whatever reason you like to believe... perceived superiority of AMG (which is another hot debate) or wanting to be around the same ethnicity). If there are plenty of FMGs in a neurology program then expect the FMGs to apply there and expect the AMGs to avoid them.

It's not just money, although there is no denying it to be a significant factor as other articles noted. This article is showing the recruitment differences for the same specialty. So money is somewhat ruled out (I say somewhat because regional perception of income can exist).

 

[lisichka]

.

 

[Faebinder]

well actually, if one takes this statement seriously, that basically means that all the east, west coast US residency programs (incl. Harvard, and JHU) should be avoided. what is left? 😕

I hate to break this to you, but American society is heterogenuous, with many different cultures and traditions. most of my friends are Americans, and they were born here, but each one is different culture-wise, tradition-wise, and individuality-wise. Just because a doctor is cultured and worldly DOES NOT automatically mean he/she is a PROBLEM🙁🙁🙁 (even if, god forbid, that person is a first generation american, or foreign (what a blasphemy))

no offence, but i think u and ur poster-buddies are a bit narrow-minded.

Make that claim after you start applying to residency.. not before you are even in med school. You'll start seeing what people around you are picking as their top choice.

 

[lisichka]

.

 

[McGillGrad]

You should really think before posting. I hardly think you knew that I have lived in 5 countries and speak 3 languages before you posted or you might have saved your pop-psychology PC speech for someone who cares.

Culture is second only to language for creating a cohesive team and people who don't understand that have very little life experience.

well actually, if one takes this statement seriously, that basically means that all the east, west coast US residency programs (incl. Harvard, and JHU) should be avoided. what is left? 😕

I hate to break this to you, but American society is heterogenuous, with many different cultures and traditions. most of my friends are Americans, and they were born here, but each one is different culture-wise, tradition-wise, and individuality-wise. Just because a doctor is cultured and worldly DOES NOT automatically mean he/she is a PROBLEM🙁🙁🙁 (even if, god forbid, that person is a first generation american, or foreign (what a blasphemy))

no offence, but i think u and ur poster-buddies are a bit narrow-minded.

p.s. actually "dealing with another culture" could be helpful, in terms of dealing with diverse patient population.

 

[lisichka]

.

 

[mlw03]

i think another reason AMGs don't flock towards neuro is that many of us have mediocre neurology experiences as med students. also mediocre experiences in psych, which there is admittedly a lot of overlap with neuro.

 

[McGillGrad]

i think another reason AMGs don't flock towards neuro is that many of us have mediocre neurology experiences as med students. also mediocre experiences in psych, which there is admittedly a lot of overlap with neuro.

From what I have seen Neruo is a required clinical rotation in some schools/states but not others. As you mentioned, if we had to rotate through it, then many more people may find it appealing.

 

[mlw03]

From what I have seen Neruo is a required clinical rotation in some schools/states but not others. As you mentioned, if we had to rotate through it, then many more people may find it appealing.

absolutely. at my school it's a 2 week block of our 8 week neuropsychiatry clerkship during MS3. i briefly considered neuro based on a fantastic MS1 neuroscience professor, but after those 8 weeks, no friggin' way. i'm not anonymous on here, so i'll leave it at that.

 

[DREZ Leptin]

No. It has nothing to do with xenophobia and everything to do with economic incentive.

When anesthesia was poorly reimbursed plenty of FMGs were in the field. Now that reimbursements have increased it's largely an AMG field.

-The Trifling Jester

Anesthesia was never poorly reimbursed. When I was a resident in the early 90's I had attendings who were millionaires. During the mid 90's there was a glut of new trainees and starting salaries in groups dropped. Many groups exploited this by not offering partnership slots to new grads like me. The senior guys made even more money during that era by paying juniors less. The supply/demand pendulum has swung the other way now.

Some fields like anesthesiology and pathology don't seem to attract medical students even though they can be very lucrative and lifestyle oriented.

 

[AmoryBlaine]

Anesthesia was never poorly reimbursed. When I was a resident in the early 90's I had attendings who were millionaires. During the mid 90's there was a glut of new trainees and starting salaries in groups dropped. Many groups exploited this by not offering partnership slots to new grads like me. The senior guys made even more money during that era by paying juniors less. The supply/demand pendulum has swung the other way now.

Some fields like anesthesiology and pathology don't seem to attract medical students even though they can be very lucrative and lifestyle oriented.

Since when does anesthesiology fail to attract medical students?

 

[DREZ Leptin]

Since when does anesthesiology fail to attract medical students?

The American Society of Anesthesiologists has a nice website where they have articles on each year's match. Here is the link for 1996:

http://www.asahq.org/Newsletters/1996/05_96/article1.htm

From a high of 945 AMGs matching in 1991 to 169 matching in 1996. Back in 1996 anyone with a pulse could have gone anywhere in anesthesia.

But the main point of my post was to respond to Trifling Jester who suggested that reimbursement was the main determinant in whether AMGs or IMGs dominated a specialty. The reimbursement in anesthesia is better than other fields that are much tougher to match into. Most of the data that I have seen indicate anesthesia income as equal to or slightly higher than urology and ENT.

 

[Faebinder]

Kent pointed out a study about 6 months ago posted on the AAFP website showing that 4th year med students going into a field is heavily influenced by the way their peers and other specialty residents perceive that specialty. If I can find the darn article I'd post a link. Basically, if everyone thinks pathology sucks, then AMGs will not want to go to pathology even if it makes half a million.

If neurology wants to increase the number of AMGs attracted to it, it needs to make itself look better amongst the other specialty. The other specialties need to start having better opinion of it and not talk crap about it. How do you do that? Well that is something the neuro societies and boards should address.

 

[RockfordWF]

Why don't AMGs like much Neurology? Most specialty (according to NRMP data) have about 85-90% occupied with AMGs except neurology in which AMGs are only about 60%.

Why don't AMGs like neurology? 😕

It's boring. You just do neuro exams all day.

 

[Blade28]

I think part of the reason is that Neuro isn't a requirement at many med schools. Conversely, outside of the true cores, things like ER, Rads, Path, Anesthesia, etc. usually are.

There may be a shred of truth to the notion that AMGs are scared away from fields heavily dominated by IMGs - but I've found this to be more true of specific residency PROGRAMS, not fields. For example, on my interview trail I found that many applicants shied away from applying to, or interviewing at, certain programs known to be dominated by IMGs.

 

[Pir8DeacDoc]

Most of the data that I have seen indicate anesthesia income as equal to or slightly higher than urology and ENT.

Which is absurd, but I'll save that for another day and another thread.

 

[DREZ Leptin]

Which is absurd, but I'll save that for another day and another thread.

http://www.merritthawkins.com/pdf/2005_Modern_Healthcare_Physician_Compensation_Review.pdf

http://www.studentdoc.com/salaries.html

Check for yourself.

 

[Pir8DeacDoc]

http://www.merritthawkins.com/pdf/2005_Modern_Healthcare_Physician_Compensation_Review.pdf

http://www.studentdoc.com/salaries.html

Check for yourself.

I don't disagree that the compensation is simliar. My point is that it shouldn't be.


**Disclaimer: This in no way should be considered a neutral or unbiased opinion. **

 

[oudoc08]

The ethnocentric idea you express may have some truth, and you are probably being personally honest. However it is not always the case - people of other ethnicities are often only uncomfortable or "scarey" to be around because they are unfamiliar. Sometimes with some familiarity other ethnicities have many desireable qualities.

For example, I am not Latino, but Latinos are one of my favorite people. I had the chance to coach quite a few in sports 5 years ago and found them great. Right now I live in an area with lots of Hispanics and love it. Every day I see a homeless beggar by the road with a cardboard sign asking for money - everyone I have seen is white. Never have seen a Latino begging that way - but I do see them with work gloves in hand ready to lay tile, or other hard work for money. I have NEVER seen white guys standing around ready to do hard work like that. Unfortunately Lowes and Home Depot now prohibit it - and Latinos standing around Home Depot with work gloves are arrested - but the bums with their cardboard signs are left alone. Go figger.

The Latino's tend to have very tight family structures - you ought to go to a Quincenera and see the extended family and friends that are there. The youth tend to be more well behaved with less drama than some others. Latino men tend to be men. Latina women tend to be women.

I am not Latino, but would seek out a group with Latino's over many others due to the many years of good experiences I have had with them.

So while your expression of ethnocentrism is probably true, and no doubt true for you - its not universal. I admire the hard work Latinos typically are ready to do, their tight family structures, their faith. I am not a big fan of soft fat lazy indulged rude people-especially when you mix that with arrogance - when in all their fatness and laziness they think they are better than others.

Wow dude. I've been on SDN for over three years, and this is the most RACIST post I've ever READ! Do you have even the slightest inkling how offensive this is??? Seriously. You just broadly stereotyped two specific groups of people and I'm still like, WTF??? How come you didn't say, "I've never seen BLACK guys standing around ready to do hard work like that"? Hmmm.
Oh yeah... it's fine to stereotype the white guy, huh. Let's just see what this would sound like if I change a couple of words in your post, and see what you think?


QUOTE:

For example, I am not White, but Whites are one of my favorite people. I had the chance to coach quite a few in sports 5 years ago and found them great. Right now I live in an area with lots of Whites and love it. Every day I see a homeless beggar by the road with a cardboard sign asking for money - everyone I have seen is black. Never have seen a white begging that way - but I do see them with work gloves in hand ready to lay tile, or other hard work for money. I have NEVER seen black guys standing around ready to do hard work like that. Unfortunately Lowes and Home Depot now prohibit it - and Whites standing around Home Depot with work gloves are arrested - but the bums with their cardboard signs are left alone. Go figger.

The Whites tend to have very tight family structures - you ought to go to a rodeo and see the extended family and friends that are there. The youth tend to be more well behaved with less drama than some others. White men tend to be men. White women tend to be women.

I am not white, but would seek out a group with Whites over many others due to the many years of good experiences I have had with them.

So while your expression of ethnocentrism is probably true, and no doubt true for you - its not universal. I admire the hard work Whites typically are ready to do, their tight family structures, their faith. I am not a big fan of soft fat lazy indulged rude people-especially when you mix that with arrogance - when in all their fatness and laziness they think they are better than others


It's also incredibly disrespectful to lump all Latino's into a group, even a "good" group with "good" intentions. It's like watching Hillary talk about how we need them to wash our dishes, clean our houses, etc. There's Latino doctors, bricklayers, accountants, and gangbangers. But you make them all sound like they're all hanging around the hardware store ready to hop on the back of a lawn truck to go trim your hedges. It's exactly these stereotypes that are creating a new underclass in America.

 

[Blade28]

OK everyone, let's try to remain civil here. This is a charged issue because anytime you're talking about "AMGs vs. IMGs" there's a strong possibility that the thread will degenerate into one of purely racial issues - thus losing the original intent of the OP (in this case, why Neurology isn't attractive to US med student seniors).

Let's all try to avoid making broad, blanket statements about race.

 

[oudoc08]

OK everyone, let's try to remain civil here. This is a charged issue because anytime you're talking about "AMGs vs. IMGs" there's a strong possibility that the thread will degenerate into one of purely racial issues - thus losing the original intent of the OP (in this case, why Neurology isn't attractive to US med student seniors).

Let's all try to avoid making broad, blanket statements about race.

If anyone came in here and made blanket statements like that denigrating any other race, they'd have been banned in a heartbeat. I'm sick of it, I don't think it gets to get swept under the rug just because it the poster didn't happen to target gays, blacks, women, muslims or hispanics and I'm calling him on it. There's a pervasive double standard which is prevalent in our society, and frankly it's absolute BS, and has no place in a professional forum such as this one.

This doesn't have anything to do with the original intent of the thread, I agree. But that's beside the point. If I were to waltz into the allopathic thread for the Harvard Class of 2010 and make an inflammatory statement like that, you don't think there would be outrage, regardless of the original thread?

And while I agree that AMG vs IMG threads can have potential to be inflammatory, a "Latino vs. white" analogy made by the above poster is hardly relevant. One could've made a point that nearly all of the FMG's who pursue neurology happen to be of middle eastern origin. True? Yes, and that argument would be one that I most certainly could have understood being controversial, however, the above was purely defamatory without provocation. There's a big difference.

 

[lisichka]

If anyone came in here and made blanket statements like that denigrating any other race, they'd have been banned in a heartbeat. I'm sick of it, I don't think it gets to get swept under the rug just because it the poster didn't happen to target gays, blacks, women, muslims or hispanics and I'm calling him on it. There's a pervasive double standard which is prevalent in our society, and frankly it's absolute BS, and has no place in a professional forum such as this one.

This doesn't have anything to do with the original intent of the thread, I agree. But that's beside the point. If I were to waltz into the allopathic thread for the Harvard Class of 2010 and make an inflammatory statement like that, you don't think there would be outrage, regardless of the original thread?

And while I agree that AMG vs IMG threads can have potential to be inflammatory, a "Latino vs. white" analogy made by the above poster is hardly relevant. One could've made a point that nearly all of the FMG's who pursue neurology happen to be of middle eastern origin. True? Yes, and that argument would be one that I most certainly could have understood being controversial, however, the above was purely defamatory without provocation. There's a big difference.

please calm down. i completely agree with you, but i don;t think that u will change those people's minds. they will keep their primitive views regardless. i am a pre-med, and was already "sent" back home by some of them.
i don;t think those people are worth ur time and energy. ok ok going back home to pre-allo. sorry again for posting here.😳😳😳 please don;t ban me😀

 

[Blade28]

Echoing previous sentiments, everyone should please refrain from making stereotypical statements about race. Please keep this thread on-topic as it relates to the unpopularity of Neurology among US med school seniors. I agree that not any one race should be singled out.

It's a difficult task because the original issue at hand inherently addresses many inflammatory issues, one of which is that of AMGs' perceptions of IMGs.

But let's all try to get back to the original discussion.

 

[buckley]

This thread scared me... but I think a quick look into a nearby thread (see Neurology) will show that actually there are a lot of AMGs going into Neuro. And just like any specialty, they rightfully have priority. I think Neuro in general isn't as popular as the other subspecs even in other countries. There are many "stereotypes" associated with it such as frustrating, depressing, diagnose-without-treating, poor income, intellectual nerds...

and hey, I'm going for neuro!

 

[pathnerd]

Which is absurd, but I'll save that for another day and another thread.

Why is this absurd? Aside from performing an emergency trach, what skills does an ENT or a urologist possess that can save a life? Are they comfortable using inotropic or vasoactive drugs in a hemodynamically unstable patient like an anesthesiologist? Do they have the vascular access skills of an anesthesiologist when a patient requires aggressive volume resuscitation? When someone codes in any hospital in America, is it ENT that responds because of their outstanding mask airway and intubation skills? When your 80 year old granny goes into sustained V-tach on the OR table, or at the mall for that matter, do you want an ENT or a urologist taking care of her? What’s truly absurd is your idea that anesthesiologists are overpaid for the resuscitation knowledge and skills they possess.

 

[RockfordWF]

Why is this absurd? Aside from performing an emergency trach, what skills does an ENT or a urologist possess that can save a life? Are they comfortable using inotropic or vasoactive drugs in a hemodynamically unstable patient like an anesthesiologist? Do they have the vascular access skills of an anesthesiologist when a patient requires aggressive volume resuscitation? When someone codes in any hospital in America, is it ENT that responds because of their outstanding mask airway and intubation skills? When your 80 year old granny goes into sustained V-tach on the OR table, or at the mall for that matter, do you want an ENT or a urologist taking care of her? What’s truly absurd is your idea that anesthesiologists are overpaid for the resuscitation knowledge and skills they possess.

No, isn't the ENT. It's also not the Anesthesiologist.

It's the emergency physician that will respond and is most capable in the above listed scenarios.

 

[Blade28]

It's the emergency physician that will respond and is most capable in the above listed scenarios.

The ER physicians don't tend to come up to the floors/ICUs to respond to codes/intubate people. 😕

 

[RockfordWF]

The ER physicians don't tend to come up to the floors/ICUs to respond to codes/intubate people. 😕

Weird. They do it in every hospital I've worked at. I don't see why it would be anesthesia, since they normally aren't around at night.

 

[pathnerd]

Weird. They do it in every hospital I've worked at. I don't see why it would be anesthesia, since they normally aren't around at night.

You obviously haven't worked in many hospitals. As an anesthesiologist, I have been called to bail out ER docs for numerous intubations. I have never seen an anesthesiologist call an ER doc to bail them out of a difficult intubation. Watching most of them even try to intubate a patient is pretty damn funny. I have NEVER seen an ER doc at a code on the floor, but I have seen them botch inductions in the ER due to incomplete knowledge of drugs and doses which they use infrequently. I have personally been stuck far too many times by an ER doc with a 22 gauge IV for a vein that could easily accomodate an 18 gauge. The idea that ER docs are the resuscitation experts is truly laughable. They are rarely more than glorified triage nurses. The true experts are critical care physicians, trauma surgeons, and anesthesiologists.

 

[Faebinder]

You obviously haven't worked in many hospitals. As an anesthesiologist, I have been called to bail out ER docs for numerous intubations. Watching most of them even try to intubate a patient is pretty damn funny. I have NEVER seen an ER doc at a code, but I have seen them botch inductions in the ER due to incomplete knowledge of drugs and doses which they use infrequently. I have personally been stuck far too many times by an ER doc with a 22 gauge IV for a vein that could easily accomodate an 18 gauge. The idea that ER docs are the resuscitation experts is truly laughable. They are rarely more than glorified triage nurses. The true experts are critical care physicians, trauma surgeons, and anesthesiologists.

I have seen the anesthiologists bail out the ER docs many times it aint even funny (and I am not in anesthesia). My by-far favorite was when two anesthiology attendings responded to "Anesthiology Attending STAT Emergency Room" overhead. The respiratory therapist and the EM attendings failed to intubate this guy several times (I think he was some asthma exacerbation, I was doing my ER rotation in fourth year). The two anesthesia attendings were standing there with their arms folded, until finally one of them look at the other and was like "So you wanna do this one or should I just end their misery." The other one shrugs and walks away. The first attending sighs, puts down his arms, walks over, snatches a pair of gloves, pushes the EM doc out of the way and just eyes the damn patient's mouth and slips the tube in place first time. I was blinking all along. I never looked at an anesthia attending the same after that.

 

[RockfordWF]

You obviously haven't worked in many hospitals. As an anesthesiologist, I have been called to bail out ER docs for numerous intubations. I have never seen an anesthesiologist call an ER doc to bail them out of a difficult intubation. Watching most of them even try to intubate a patient is pretty damn funny. I have NEVER seen an ER doc at a code on the floor, but I have seen them botch inductions in the ER due to incomplete knowledge of drugs and doses which they use infrequently. I have personally been stuck far too many times by an ER doc with a 22 gauge IV for a vein that could easily accomodate an 18 gauge. The idea that ER docs are the resuscitation experts is truly laughable. They are rarely more than glorified triage nurses. The true experts are critical care physicians, trauma surgeons, and anesthesiologists.

At every hospital I've worked at, there was a "code team" which included several members of the emergency department. Let's keep in mind that these were at hospitals were emergency medicine was the only residency OR there were no residencies of any kind in the hospital.

You clearly are working at hospitals that don't have good ER docs. The places I have worked, the ER are docs are the best docs in the hospital. ER docs do resuscitations on a daily basis. Obviously, you are working somewhere where they do not. Perhaps these are family physicians in the department or just poorly trained EM docs, which is sad.

Anesthesiologists are rarely involved in resuscitations, compared to EM docs overall, however. I remember several times running from the ER to the ICU or the floor to intubate or work a code. I have been in hospitals in the midwest, southwest, and south central United States and have seen it happen time after time.

At 3am ER docs are often the only physicians in the hospital at a non-teaching hospital and they are your only resource anyways.

I'm not sure where you live and work, but please tell us---they clearly need new EM residency trained physicians!

 

[RockfordWF]

I have seen the anesthiologists bail out the ER docs many times it aint even funny (and I am not in anesthesia). My by-far favorite was when two anesthiology attendings responded to "Anesthiology Attending STAT Emergency Room" overhead. The respiratory therapist and the EM attendings failed to intubate this guy several times (I think he was some asthma exacerbation, I was doing my ER rotation in fourth year). The two anesthesia attendings were standing there with their arms folded, until finally one of them look at the other and was like "So you wanna do this one or should I just end their misery." The other one shrugs and walks away. The first attending sighs, puts down his arms, walks over, snatches a pair of gloves, pushes the EM doc out of the way and just eyes the damn patient's mouth and slips the tube in place first time. I was blinking all along. I never looked at an anesthia attending the same after that.

In my home school hospital, there is an anesthesiology residency. Even there does ER residents respond to difficult intubations and codes on the floor. If for some reason an ER attending cannot get an intubation, they have all of the difficult intubation equipment available.

 

[Winged Scapula]

It obviously depends on the hospital.

In my residency and fellowship, the code team was anesthesia and medicine; no EM attendings or residents were involved in any codes outside of the ED. Surgery was often called to codes (although we did not wear code pagers and did not receive the code pages unless we were specifically called) to place central lines if the code team was unable.

At the community hospital I moonlighted at (no residents), the code/emergency intubation calls went to the ED until about 2 months ago when they changed the policy and had the codes go to the in-house hospitalists. Talk about a disaster...those guys suck. They can't place lines and I've seen the patients struggle while they are trying to intubate. Thank God I never had to call a code while there...I think I would prefer the in-house CRNA come to the code over the hospitalists.

 

[f_w]

Oh the world of dogmatic proclamations, life saving competitions and broad sweeping condemmnations of entire speicalties. SDN at it's best.

If you want to get an idea why many people are not so fond of neurology, check out this thread:

http://forums.studentdoctor.net/showthread.php?t=455276

A prime example of the mental masturbation some neuros can get into.

I think this poster summed up the issue the best way:

so if the lesion is located, does that offer any different treatment options? or is it just prognostic? or this is just curiousity?

 

[Doowai]

No, isn't the ENT. It's also not the Anesthesiologist.

It's the emergency physician that will respond and is most capable in the above listed scenarios.

Out here there is an ENT group that often does emergency Crikes on pedes.

 

[Doowai]

Wow dude. I've been on SDN for over three years, and this is the most RACIST post I've ever READ! Do you have even the slightest inkling how offensive this is??? Seriously. You just broadly stereotyped two specific groups of people and I'm still like, WTF??? How come you didn't say, "I've never seen BLACK guys standing around ready to do hard work like that"? Hmmm.
Oh yeah... it's fine to stereotype the white guy, huh. Let's just see what this would sound like if I change a couple of words in your post, and see what you think?


QUOTE:

For example, I am not White, but Whites are one of my favorite people. I had the chance to coach quite a few in sports 5 years ago and found them great. Right now I live in an area with lots of Whites and love it. Every day I see a homeless beggar by the road with a cardboard sign asking for money - everyone I have seen is black. Never have seen a white begging that way - but I do see them with work gloves in hand ready to lay tile, or other hard work for money. I have NEVER seen black guys standing around ready to do hard work like that. Unfortunately Lowes and Home Depot now prohibit it - and Whites standing around Home Depot with work gloves are arrested - but the bums with their cardboard signs are left alone. Go figger.

The Whites tend to have very tight family structures - you ought to go to a rodeo and see the extended family and friends that are there. The youth tend to be more well behaved with less drama than some others. White men tend to be men. White women tend to be women.

I am not white, but would seek out a group with Whites over many others due to the many years of good experiences I have had with them.

So while your expression of ethnocentrism is probably true, and no doubt true for you - its not universal. I admire the hard work Whites typically are ready to do, their tight family structures, their faith. I am not a big fan of soft fat lazy indulged rude people-especially when you mix that with arrogance - when in all their fatness and laziness they think they are better than others


It's also incredibly disrespectful to lump all Latino's into a group, even a "good" group with "good" intentions. It's like watching Hillary talk about how we need them to wash our dishes, clean our houses, etc. There's Latino doctors, bricklayers, accountants, and gangbangers. But you make them all sound like they're all hanging around the hardware store ready to hop on the back of a lawn truck to go trim your hedges. It's exactly these stereotypes that are creating a new underclass in America.

I point out the strong work ethic I see in them - obviously everyone knows Latinos have jobs in all levels of our society -as a teenager might say "Duh" - you must think people are extremely stupid not to know that. If I say something about a white medical doctor do I have to post an asterisk leading to a disclaimer saying : the above statements do not presuppose that white people only work as doctors, many white people are also capable of building houses.

People like you who over react to every perceived and imagined insult, looking for reason to be offended, with your attempts to remove any degrees of gray through forced political correctness which never in fact makes anything better, are the sort of societal clutter that clog our legal systems and make daily interaction cumbersome and costly, and are of no value at all to humanity.

It must suck to go through life constantly in an over-emotional uproar about something or another.

 

[Doowai]

. But you make them all sound like they're all hanging around the hardware store ready to hop on the back of a lawn truck to go trim your hedges. It's exactly these stereotypes that are creating a new underclass in America.

Not anymore than I make it sound like all white people are standing around begging. But I have seen hundreds of guys begging on the corner over the past 10 years and all that I have seen have been white. I guess you want me to lie? Of course we all know that white people can also have jobs, and that all of them aren't begging.

My boss and several of my superiors right now are Hispanic. They are great guys (and when I say "guys" this is not to presuppose that women cannot be considered "great" also - nor that hermephrodites or transgenders cannot also be considered "great" - its just that my boss is Hispanic and a guy and I think he is great. I do not mean to create a whole underclass of hermephrodites who are not considered "great" - they can be "great" too - and could be a boss too. The same is true for women, and cross dressers - they can be bosses.....and "great". Did I leave anyone out? Did I make it clear that anyone can be anything? And everyone is great?)

 

[Doowai]

. It's like watching Hillary talk about how we need them to wash our dishes, clean our houses, etc. There's Latino doctors, bricklayers, accountants, and gangbangers. But you make them all sound like they're all hanging around the hardware store ready to hop on the back of a lawn truck to go trim your hedges. It's exactly these stereotypes that are creating a new underclass in America.

First of all Hispanics are not a "new" underclass - you obviously have no knowledge, sympathy, empathy or understanding of the history of Latinos in the USA. They have been discriminated against, predominantly by whites, for an extremely long time (since Kit Carson helped steal Arizona from Mexico, actually probably earlier in California)- it is not new. You can drop your supposed superior moral stance, - what have you ever done to improve the status of Latinos (or even racism in general) 6 of my clinical rotation preceptors were Hispanic, 3 of whome I have stayed in touch with. I currently work under the supervision of a Hispanic boss. I have employed quite a few for many years- not to trim my bushes or lay tile - but in white collar positions in businesses I owned before I went back to medical school - I know better than you that Hispanics work at all levels of society.

Second, twisting the meaning of my comments around to support your obviously anti-democratic political aspirations is a transparent attempt to spin the illusion that somehow the right wing has Hispanic best interests at heart - when the Bush administration has probably done more to set Latinos back, except for perhaps President James Polk's administration.

With your comment about Hillary Clinton, are you suggesting the right is somehow more in touch with the Latino community? George Bush suggests Latinos are merely "chicken pluckers". Here are some enjoyable comments from the right (George Bush quotes) demonstrating George Bush's [lack of] knowledge about Latinos and Latino culture:

"If you've got a chicken factory, a chicken-plucking factory, or whatever you call them, you know what I'm talking about."—discussing the sorts of jobs many illegal immigrant workers perform, Tipp City, Ohio, April 19, 2007


"A lot of times in the rhetoric, people forget the facts. And the facts are that thousands of small businesses—Hispanically owned or otherwise—pay taxes at the highest marginal rate."—to the Hispanic Chamber of Commerce; Washington, D.C., March 19, 2001

"Neither in French nor in English nor in Mexican."—Declining to answer reporters' questions at the Summit of the Americas, Quebec City, Canada, April 21, 2001

Bush: "First of all, Cinco de Mayo is not the independence day. That's dieciséis de Septiembre, and ..."
Matthews: "What's that in English?"
Bush: "Fifteenth of September." (Dieciséis de Septiembre = Sept. 16)