Why choose ER?

[threepeas]

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In EM, is it more like one day you'll do 8 - 5 then the next day 3 - 3 then the next day 9 - 9? Ie schedule varies by day?

Or is it more like, this week I'm doing 8-5, next week night shift, etc?

Also, as you "move up" in seniority, is it more dayshift hours?

Just curious! =)

"usually" you will do a set of certain shift times per week.
there may be "some" places that have seniority when it comes to taking night shifts but the norm is seniority doesnot get you too much. that being said one version of seniority playing a role is an older doc who still does as many nights and weekends as everyone else, but all his other shifts are days (7-4 or 8-6) because that's what he wants.

 

[southerndoc]

As residents, we usually work 4-5 grouped shifts in a row, have a day or two off, then move to the next shift schedule.

Some of the schedules I've seen attendings have:

3 8-hour shifts per week (academic center), all sporadic

7 12-hour day shifts, 7 days off, then 7 12-hour night shifts, 7 days off, repeat

16 shifts per month, usually grouped, with varying shifts; only 2 overnight shifts per month; all shifts 8-10 hours long

5 12-hour shifts, 1 week off, 5 12-hour night shifts, 10 days off

 

[nvshelat]

"usually" you will do a set of certain shift times per week.
there may be "some" places that have seniority when it comes to taking night shifts but the norm is seniority doesnot get you too much. that being said one version of seniority playing a role is an older doc who still does as many nights and weekends as everyone else, but all his other shifts are days (7-4 or 8-6) because that's what he wants.

Hmm.. do you find it difficult to go from, say day shifts one week to night shifts the next, then back to day?

 

[threepeas]

Hmm.. do you find it difficult to go from, say day shifts one week to night shifts the next, then back to day?

my last job had double coverage at night, usually one doc and one PA, and sometimes 2 docs. they worked 4 night shifts per 4 week block (10hr/shift). that means one week of nights and the other 3 weeks either day or evenings. evenings could be 1-11 or 4-2am days were 7-4 and 8-6p. now they dont use PAs in the main ER so they are doing 6 nights per 4 week block which appears a little rougher on them. every place does it different. hope that helps.

 

[fantasty]

I'm a md/phd student. I've always been inclined toward IM (probably rheum or ID) or preventive med. I *never* thought I'd be interested in EM, but I started to think of a few things. Obviously, I still can get some advice from school and I could do the ER rotation. But, would anyone be willing to give me some advice on this?

I'll start with the negatives. I don't not get excited about procedures, and don't consider myself to be a very "hands-on" person. And, although I'm usually pretty level-headed, I tend to be very deliberate (read as: slow, thinker not a doer) and I hate to be rushed. And, I like the theory of having long-term relationships with patients.

The things I really like about EM, though, is the variety of patients and the schedule. Plus, I think the interpersonal & team skills may be interesting. I have career priorities (med education & clinical research) that would fit well into this schedule. Plus, I've always wanted to work with underserved populations, so being part of the national "safety net" would facilitate that. One of the academic physicians I know what always going on about how a background in public health and epidemiology would be beneficial in this field, too.

My questions are:
1) I know there are supposed to be a lot of opportunities for clinical research. But, is there much chance for epidemiologic or preventive med research?
2) Is the love of procedures and aptitude at them something that may grow on you?

 

[ERMudPhud]

I guess you can tell from my screen name that you're not alone. I've been done with residency for 5 years now and still do basic research plus clinical work.

If you want to do clinical research EM is great. Almost everything comes through the ER so anything you are interested in can be made relevant. Epidmiology is probably the best. There are some clinical trial type stuff done through the ED but those tend to be very expensive and you have all the difficulties associated with our patient population in terms of recruitment. i.e. you never know when the patients you are interested in will come in, cant get consent if they are incapicitated, followup may be aproblem... It can be done though. Look at Manny Rivers recent NEJM study on goal directed therapy in sepsis.

Epidemiology/Public Health is easier. You can find examples in Annals or Academic EM or just by talking to people at most residency programs. Lots of people have made a career of this.


You are right that the schedule ( as few or as many shifts per month as you can negotiate) is great for a career in academics/research

As for procedures I think the only way you can know is to do an EM elective and do it somewhere that lets students do a decent number of procedures. I totally love the short, instant gratification, type of procedures we do in the ED. Spending an hour in the OR though would be like water torture for me. I am very hands on in the lab and I think that carries over to the ED for me. I think at the very least you have to enjoy procedures a bit, otherwise as the novelty wears off you will begin to hate or avoid them. I think that can be a disservice to the patients as I have seen ED docs like this rationalize why the patient doesn't really need the procedure or leave it for the admitting team. If the admitting doc is IM they are probably less skilled at these procedures and have less resources (ultrasound, fluoro, etc...) so you are actually hurting the patient by avoiding the procedure.

As for the intellectual side of clinical work. You certainly can't be as contemplative as say neurology. You have to make quick assessments and multitask or you will drown. On the other hand, I find the intellectual challenge of starting from scratch with a patient with an unusual complaint and no previous work and eventually but fairly rapidly arriving at a diagnosis to be great fun plus nearly instant gratification. The gratification is certainly more rapid and serves as a nice contrast to research where the payoff(publication, completed study, etc...) might take months or years.

Your description of yourself as a thinker rather than a doer who hates to be rushed and wants long term patient contact would probably sound like the antithesis of an ED doc to most of us but I probably would have described myself in similar terms before I tried it.

Do one or even better two elective months too see what EM is really like while also doing a few IM subspecialty months. You can even do like I did and apply in both and then make up your mind by the time you are done interviewing. As an MD/Phd you will probably be competitive anywhere in IM and EM so don't worry about using your electives to get great letters or great contacts. Use them to really test out the fields you are interested in so go places where you will get to do what an EM doc, or rheumatologist or ID doc does.

 

[adamdowannabe]

I have an odd anecdotal type comment about the choice of emergency medicine...

I have been told (by two people) one a cardio and the other a 15 year veteran of the ED (both now in academia) that I am destined for EM. Good thing I have always had an interest in the treat em and street em mentality, but I asked them why??!!?? I have a backround in orthopedics and a true interest in surg and orthosurg, The cardio said........ Nah, you're gonna end up in the ED. She said it's black and white written all over my personality. Mind you, I am a PA student, so I will have the option of lateral mobility (one of the great aspects of PA'dom) But we shall see, I hit rotations in a 10 weeks.

Maybe emergency medicine chooses the provider??

 

[EctopicFetus]

See the light my friend... See the light.

 

[nosugrefneb]

As a general followup to Dante's and ERMudPhud's discussion a few months ago, how much does having an MD and PhD help in getting a residency spot? Do different programs emphasize basic research more than others, or are certain programs at least amenable to taking the time to do it? I just started the graduate portion of an MD/PhD but my Step I was really low, so I'm wondering if perhaps I should start to focus my attention on a slightly less competitive field.

 

[DocYuki]

Hey guys, just relaying some information relevant to the thread:

From (http://www.ucihs.uci.edu/emergmed/clerkships_em630d_choosing_em.htm)

"Emergency Medicine has also drawn people because of its lifestyle. Because a physician does not have his/her own patients, the job allows for a much greater level of flexibility. For instance, a physician may work on a cruise ship during the summer and then in Vail, Colorado during the winter. The lack of need in sustaining a patient base allows one the personal freedom to work as little or as much as desirable and to take vacations at any time. Part time work is also available, something which is difficult in other specialties, especially when first starting out. This flexibility in working hours allows a person to take time out to raise a family or to explore other interests."