Why is there an EM residency?

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Seems like everyone looks down on them but they seem hardworking and caring to me and their job doesn't allow for them to put in much analytical thinking
 
Could you be more specific? How do they seem dumber?
 
JP2740 said:
It seems like these docs get dumber in residency? Thoughts/comments?
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Meh--they have specific priorities that don't necessarily align with what other specialties think is the best thing to do. It's easy to sit back on medicine, when you have a hundred million hours to think about what the next best step is, and judge what was done down in the ED.
 
Normally I don't feed trolls but... ah, what the hell, I usually feed trolls, actually.

Look, EM knows a little about a lot, and therefore they interact with attendings from every specialty, but those specialists will always know their own specialty a hundred times better than they do. As one of my EM attendings told me, when everyone else goes home, from 7 PM to 7 AM, you know everything, you can handle everything, and you are an absolute genius. 7 AM to 7 PM? You are the dumbest person in the hospital, and you can't do anything right.

If you didn't want to have EM-trained physicians, I suppose you could make sure that every ED in the country had attendings in ID, Ortho, Psych, Cardio, Gen Surg, NeuSu, OB/GYN, Peds, ENT, Opth, Urology, Anesthesia, GI, Radiology and Addiction Medicine, present in the ED at all times. Oh, and maybe an FP doc to handle all the basic stuff that specialists forgot by their second year of residency.

Alternately, you could let us do what we're trained to do, which is handle the first six steps in working up and treating the patient, stabilizing them, and handing them off to you in a nice, neat packet with lab results in hand, so that you can do what you do best. I think I like that one better.
 
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JediZero said:
If you didn't want to have EM-trained physicians, I suppose you could make sure that every ED in the country had attendings in ID, Ortho, Psych, Cardio, Gen Surg, NeuSu, OB/GYN, Peds, ENT, Opth, Urology, Anesthesia, GI, Radiology and Addiction Medicine, present in the ED at all times.
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Your implication being that, because we have the EM physician there, we don't need any of those things? If we had an FP doing the job we would need all of those, because he obviously doesn't have the right training, but because we have an EM trained physician running the ED we don't need any of that?
 
qldman said:
Seems like everyone looks down on them but they seem hardworking and caring to me and their job doesn't allow for them to put in much analytical thinking
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Sorry. Instead of spending countless hours discussing a patients BNP and cholesterol panel, we're too busy treating patients. It's not that we're less analytical, it's just that we're too busy actually seeing patients to discuss why a patient's ProBNP dropped 5 points.
 
J DUB said:
I have always been impressed with the amount of stuff EM docs know. They know a ton about a little.

And can handle almost anything.
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As the joke goes, how do you confuse an emergency physician? Ask what the second dose is.
 
calvnandhobbs68 said:
I think EM would be able to throw a little more analytical thinking in there if there wasn't the looming threat of lawsuits from nonpaying patients around every corner. Yeah they're going to consult neuro everytime some 70yo mentions some tingling in their hand because if they send him home and the guy ends up stroking the next day, guess who gets sued for not working up the TIA?
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don't forget cardiology if it's that left hand.
 
Interesting considering EM has higher board scores than all the services they admit to...(i.e. peds, IM, family, etc)

EM isn't a little about a lot.


EM is a lot about a lot.
 
Seriously?

The OP is either trolling or is a complete tool. A medical student yapping about attending physicians who know what to do when the **** is hitting the fan and all hell is breaking loose. Gimmeaf'nbreak! There's not a 4th year medical student in the country who wouldn't **** their pants dealing with a fraction of what an ED physician is doing on a nightly basis.

Parroting your attendings' political battles just makes you look like a little poodle on a leash yiping at pit bulls.
 
Perrotfish said:
Your implication being that, because we have the EM physician there, we don't need any of those things? If we had an FP doing the job we would need all of those, because he obviously doesn't have the right training, but because we have an EM trained physician running the ED we don't need any of that?
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No. If the EM doc isn't there, then the other specialists should be in house and able to step in immediately. There was no suggestion that other specialists are unnecessary.
 
Rendar5 said:
for when it's not an emergency (DKA, HHS, HyperK, BB Overdose).
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I probably should have put a smiley to indicate that the rhetorical question was rhetorical. 😀
 
Perrotfish said:
Your implication being that, because we have the EM physician there, we don't need any of those things? If we had an FP doing the job we would need all of those, because he obviously doesn't have the right training, but because we have an EM trained physician running the ED we don't need any of that?
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I meant having someone from each of those specialities physically sitting in the ED, ready to take any case that walks in the door that goes beyond FM's scope. EM is capable of literally handling any of those roles for the first few steps of management. Otherwise, you've got to have Anesthesia there every time you need an airway, ortho for simple fractures, etc. until you've got a dozen specialists sitting around. Or, one EM doc that has all off the above.
 
link2swim06 said:
Interesting considering EM has higher board scores than all the services they admit to...(i.e. peds, IM, family, etc)...
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not unexpected -- total weekly hours are great -- you are selling a lifestyle. But boards become meaningless once you start your specialty so unless you are saying its fine to rest on your laurels and peak on Step 1, I don't think your argument holds water.

I'm not going to bash ED because there are quite a few good ones. but I think there's a bigger range in quality across this specialty than most, and with the supposed goal of triage there are absolutely hospitals out there where imaging is ordered and consults are requested by nurses even before a patient is actually even seen and examined, which tends to create embarrassing situations and make the EM doctor look bad.
 
Law2Doc said:
not unexpected -- total weekly hours are great -- you are selling a lifestyle. But boards become meaningless once you start your specialty so unless you are saying its fine to rest on your laurels and peak on Step 1, I don't think your argument holds water.

I'm not going to bash ED because there are quite a few good ones. but I think there's a bigger range in quality across this specialty than most, and with the supposed goal of triage there are absolutely hospitals out there where imaging is ordered and consults are requested by nurses even before a patient is actually even seen and examined, which tends to create embarrassing situations and make the EM doctor look bad.
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I've noticed this as well. Now granted, my sample size isn't huge, but the trend I've noticed is that if the hospital has no or few residents, the ED folks tend to do better work as opposed to when they have legions of residents to take over care. At my old residency hospital, the ED docs were great. Good work ups, great patient stabilization. We were the only residents there. At my wife's large teaching hospital, this is not usually true.
 
link2swim06 said:
Interesting considering EM has higher board scores than all the services they admit to...(i.e. peds, IM, family, etc)

EM isn't a little about a lot.


EM is a lot about a lot.
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That's actually irrelevant and a specious argument. It may say something about the people in EM, but at most its meaning is fixed to a specific point in time -- in this case, that point in time is during second year of medical school, or thereabouts. So you could argue that at that point in time EM physicians were "smarter on average" than their peers, but that's about it. In case that offends you, a similar comparative statement could be made about Dermatologists, who are among the "smartest" (by that poor measure) physicians in the entire country, although I highly doubt that anyone considers them to be so, say, fifteen years after they graduate.

Your statement that EM is a "lot about a lot" is just silly and not really worth addressing. The only thing it demonstrates is the shallowness that you view other specialties with. In other words, you seemingly think that the entirety of knowledge of Cardiology or Surgery or Ob-Gyn is held by an EM physician, which is amazingly ignorant. Making grandiose statements like that only reflects on your own wisdom.
 
Law2Doc said:
not unexpected -- total weekly hours are great -- you are selling a lifestyle. But boards become meaningless once you start your specialty so unless you are saying its fine to rest on your laurels and peak on Step 1, I don't think your argument holds water.

I'm not going to bash ED because there are quite a few good ones. but I think there's a bigger range in quality across this specialty than most, and with the supposed goal of triage there are absolutely hospitals out there where imaging is ordered and consults are requested by nurses even before a patient is actually even seen and examined, which tends to create embarrassing situations and make the EM doctor look bad.
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Good post and accurate points.

ruralsurg4now said:
That's actually irrelevant and a specious argument. It may say something about the people in EM, but at most its meaning is fixed to a specific point in time -- in this case, that point in time is during second year of medical school, or thereabouts. So you could argue that at that point in time EM physicians were "smarter on average" than their peers, but that's about it. In case that offends you, a similar comparative statement could be made about Dermatologists, who are among the "smartest" (by that poor measure) physicians in the entire country, although I highly doubt that anyone considers them to be so, say, fifteen years after they graduate.

Your statement that EM is a "lot about a lot" is just silly and not really worth addressing. The only thing it demonstrates is the shallowness that you view other specialties with. In other words, you seemingly think that the entirety of knowledge of Cardiology or Surgery or Ob-Gyn is held by an EM physician, which is amazingly ignorant. Making grandiose statements like that only reflects on your own wisdom.
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Exactly. When you take Step 1 you know very little about the actual practice of medicine. Your knowledge and skills will be determined by what you do everyday as an attending.

Anyway, in the end this is all ego oriented - my specialty knows more than your specialty!

Who cares. Each specialty serves a particular service that is of value to the system. EMs value isn't to know a lot - it's to be present at all times and not let anyone die. Just like every military needs different types of soldiers and a football team needs different players - the healthcare system does too. Do you need a patient cerebral middle line backer? Or a patient cerebral quarterback? EM serves its purpose - and that purpose doesn't involve knowing as much as an internal medicine doc.
 
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happygilmore said:
EMs value isn't to know a lot - it's to be present at all times and not let anyone die.
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Correct. The problem is, those are pretty low goals (particularly because the second one involves getting someone else involved, and not necessarily completing that goal by yourself). It's like saying "you're a warm body." I can understand how someone would not want that to be their mission statement, but it's unfortunately the case in almost all instances. The reason EM gets so little respect or credit is because it doesn't matter if they get it right or wrong -- if they pick up something, that's great, but if they miss something or get it completely wrong, that's also fine as long as someone else picks it up. That's not a great way to establish a lot of respect, which EM fails to understand. Their value is to the hospital administration, not necessarily to other physicians.
 
ruralsurg4now said:
Correct. The problem is, those are pretty low goals (particularly because the second one involves getting someone else involved, and not necessarily completing that goal by yourself). It's like saying "you're a warm body." I can understand how someone would not want that to be their mission statement, but it's unfortunately the case in almost all instances. The reason EM gets so little respect or credit is because it doesn't matter if they get it right or wrong -- if they pick up something, that's great, but if they miss something or get it completely wrong, that's also fine as long as someone else picks it up. That's not a great way to establish a lot of respect, which EM fails to understand. Their value is to the hospital administration, not necessarily to other physicians.
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Fair enough. You are right, in reality - it doesn't matter if they are right or wrong. And also, agree that the value is to the hospital admin / system.

This is a business. Some docs/med students embrace that - I've found most to ignore or despise that. EM serves the purpose to get lots of people through the doors, admit those that can profit the hospital and discharge those that can't. That's why so many EDs use customer service surveys. They want people coming in those doors.

You're probably right that EM physicians won't establish respect. Their purpose is to be there 24/7 and not let anything terrible happen. That's a very valuable service in the American healthcare system - which is why many of those guys can earn $200/hr.

Earning respect from your peers is a fickle pursuit. Certainly not something that would affect my decision making.
 
happygilmore said:
This is a business. Some docs/med students embrace that - I've found most to ignore or despise that. EM serves the purpose to get lots of people through the doors, admit those that can profit the hospital and discharge those that can't.
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Sure, but people only "embrace" the business aspect of medicine that they want to embrace. Many dermatologists went to medical school to treat acne and wrinkles, they take cash only, and they work very little while generating large salaries. When that is pointed out, people say "it's a business, deal with it." But if a Cardiologist refused to treat your father who was in florid CHF because he was uninsured, you wouldn't say "this is a business." You'd demand that someone force him to treat your father, then sue him merely out of spite even if he did. We have a very dichotomous medical care system where the most important people get paid the least and are expected to treat everyone while the least important people get paid the most and are allowed to treat selectively. That's why I don't buy the "this is a business, learn it" argument.

happygilmore said:
Earning respect from your peers is a fickle pursuit. Certainly not something that would affect my decision making.
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That may be, but I would say that being respected by your peers is quite important to most people, including EM. That's often what bothers them the most, I find, is the lack of respect they are given by other physicians.
 
TooMuchResearch said:
Since there is emerging data that treating asymptomatic hyperglycemia in the ED serves little purpose other than increasing LOS, I think the answer is no insulin and f/u w/ pcp.
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that is a correct answer, but I was being rhetorical on how to confuse an ED attending is to ask them how insulin is dosed, since we don't normally dose it.
 
ruralsurg4now said:
That's often what bothers them the most, I find, is the lack of respect they are given by other physicians.
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As a 4th year currently interviewing in EM, I find this thread hilarious. Its always interesting to hear people pontificate about "other" specialties.

And please dont let me stop you guys, but I must take issue with the above quoted post. I dont know one EM physician who is "bothered" by what other physicians think of them. You may assume we care about your perceived lack of respect but in reality we just care about taking care of our patients. Another glaring difference (that most physicians fail to understand) about EM guys, we just dont care what you think about us. 😀

As a non-trad, prior career student who basically liquidated his life to return to school to enter emergency medicine ... I'll just keep honing my skills, staying on the cutting edge of resuscitation and saving people's lives. You guys keep chatty Kathy about how I'm bothered by your thoughts about me though. Its entertaining for sure. 😛
 
I think the reason why the ED team gets so much guff is because they are the source of work for the hospital. The main intake of really sick patients. So you're always getting paged by them to work more.

Only a shallow twit would take this above grumbling and pointing out the occasional egregiousness to the bashing of an entire specialty.

All of these complaints about EM are based on the tenets of your own specialty. You're completely ignoring that EM's uniqueness is that it is a phase of care. Where undifferentiated patients are sorted.

If you haven't worked the swing shift on a busy Friday night while being responsible for the outcomes of it then you don't wtf you're talking about.

Why do we always bash each other in such mundane and repetitive ways. Like we're reading a bad script. It's ridiculous.
 
Mr. Hat said:
Well I've heard this more than once about myself and my colleagues. So then riddle me this: Why does just about every generalist and specialist seem to send anything harder than a hangnail to the ER, especially at night?
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Simple. For triage.

Physicians make fun of EM as being "triage monkeys" and while there could be a more polite way of saying it, that's the case. They are being paid so that other physicians don't have to come into the hospital. That's literally the long and short of it, so you shouldn't overthink it.

What happens is a patient calls someone, you can't diagnose it over the phone, physicians can't be bothered with driving in for every phone call, so an ER physician sees the patient, then calls the physicians and lets them know if they need to come in. That's the real world. It's a lot like being an eternal intern in many cases, since what happens is that the physician on the other end of the line asks you questions, you answer them, they tell you what they want ordered, and then you usually call them back with the results. The pluses are that EM doesn't take call and they get more time off than other people.
 
ruralsurg4now said:
That's actually irrelevant and a specious argument. It may say something about the people in EM, but at most its meaning is fixed to a specific point in time -- in this case, that point in time is during second year of medical school, or thereabouts. So you could argue that at that point in time EM physicians were "smarter on average" than their peers, but that's about it. In case that offends you, a similar comparative statement could be made about Dermatologists, who are among the "smartest" (by that poor measure) physicians in the entire country, although I highly doubt that anyone considers them to be so, say, fifteen years after they graduate.

Your statement that EM is a "lot about a lot" is just silly and not really worth addressing. The only thing it demonstrates is the shallowness that you view other specialties with. In other words, you seemingly think that the entirety of knowledge of Cardiology or Surgery or Ob-Gyn is held by an EM physician, which is amazingly ignorant. Making grandiose statements like that only reflects on your own wisdom.
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The OP makes a post implying EM docs are idiots. In my experience that is far from the case. Most people fail to realize that ERs are staffed by EM, IM, and FM docs. Unless you know for certain who staffs your ED it is invalid to make conclusions based on this fact alone. Conversely it is not invalid to assume that people who have performed well throughout medical school (as measured by step 1/2 and clinical grades) will perform well throughout residency and as an attending.

Second point nice job putting words in my mouth. Easy to win a debate when you get to pick what I say, huh? Of course specialists know a ton more than the EM doc. However, implying that EM docs only know 'a little' about what they are treating is the NOT the case where I have rotated. Especially anything that is life threatening or involves resuscitation.

Finally other services confuse practicing defensive medicine (for malpractice reasons) with bad medicine. This does not make the EM doc an idiot.

This entire thread should be closed. It serves no valid discussion.
 
EsTxDr said:
Another glaring difference (that most physicians fail to understand) about EM guys, we just dont care what you think about us. 😀
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Then why are you on a thread trying to project a positive viewpoint about yourself?
 
ruralsurg4now said:
Simple. For triage.

Physicians make fun of EM as being "triage monkeys" and while there could be a more polite way of saying it, that's the case. They are being paid so that other physicians don't have to come into the hospital. That's literally the long and short of it, so you shouldn't overthink it.

What happens is a patient calls someone, you can't diagnose it over the phone, physicians can't be bothered with driving in for every phone call, so an ER physician sees the patient, then calls the physicians and lets them know if they need to come in. That's the real world. It's a lot like being an eternal intern in many cases, since what happens is that the physician on the other end of the line asks you questions, you answer them, they tell you what they want ordered, and then you usually call them back with the results. The pluses are that EM doesn't take call and they get more time off than other people.
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You have a remarkable ability to see things in one dimension strictly from your own narrow perspective. These traits are probably useful as a surgeon. As an ED doc that would kill people.
 
link2swim06 said:
it is not invalid to assume that people who have performed well throughout medical school (as measured by step 1/2 and clinical grades) will perform well throughout residency and as an attending
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Yeah, it actually is. Sorry to break it to you.
 
Nasrudin said:
You have a remarkable ability to see things in one dimension strictly from your own narrow perspective. These traits are probably useful as a surgeon. As an ED doc that would kill people.
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Not really. What happens as a surgeon when we send people into the ER is that when they arrive, they get basic labs, usually a random CT scan, and then we get called back with the results. If it's the daytime and we send someone in from the office, we send them with instructions on what we want done. If we don't, then as soon as they arrive, our office gets a call about "the guy you just sent in" and we are asked what we want done.

I'd love it if the ER was a place for me to randomly send people for accurate and quick workups without my direction or supervision, but even EM guys in their own forum will protest that they "aren't here to diagnose." What you are demonstrating is that you don't want the responsibility but you want the credit. That doesn't usually occur.
 
ruralsurg4now said:
Not really. What happens as a surgeon when we send people into the ER is that when they arrive, they get basic labs, usually a random CT scan, and then we get called back with the results. If it's the daytime and we send someone in from the office, we send them with instructions on what we want done. If we don't, then as soon as they arrive, our office gets a call about "the guy you just sent in" and we are asked what we want done.

I'd love it if the ER was a place for me to randomly send people for accurate and quick workups without my direction or supervision, but even EM guys in their own forum will protest that they "aren't here to diagnose." What you are demonstrating is that you don't want the responsibility but you want the credit. That doesn't usually occur.
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So the only patients they get are yours and they just can't seem to get it right.

You know what I would love. A surgeon with some humility and healthy amount of doubt outside of the OR. Because guess what....we aren't in your OR right now. This is something we call...the world.
 
ruralsurg4now said:
Not really. What happens as a surgeon when we send people into the ER is that when they arrive, they get basic labs, usually a random CT scan, and then we get called back with the results. If it's the daytime and we send someone in from the office, we send them with instructions on what we want done. If we don't, then as soon as they arrive, our office gets a call about "the guy you just sent in" and we are asked what we want done.

I'd love it if the ER was a place for me to randomly send people for accurate and quick workups without my direction or supervision, but even EM guys in their own forum will protest that they "aren't here to diagnose." What you are demonstrating is that you don't want the responsibility but you want the credit. That doesn't usually occur.
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We get it. You hate EM.

Obviously no amount of reasonable debate is going to change that.
 
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