Good salary, better then average lifestyle, procedures, excellent job market, exciting work (relative to rads or gas), prestige - why isn't EM more competitive?
Why isn't EM more competitive?
- Thread starter spectrin
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Part of it is a matter of fit. Quite a number of my class mates just plain hate being in the ED. They don't like the confusion, the undifferentiated patients, the noise, taking care of more than one patient at a time. Some of them really want to be the expert and final say in something, like being a nephrologist.
I'm also starting to believe that there are hospital doctors and office doctors. Yes, I know a lot of specialists do both, but some of my friends grew up with the idea of being the family doctor, having the office and their own nurse. Seeing patients one on one after they had made an appointment. I never had any interest in that, just wanted to be in the hospital.
So for those of us who love EM, we're like "why doesn't everyone want to do this?" But people are wired differently and some just hate being in the ED.
I'm also starting to believe that there are hospital doctors and office doctors. Yes, I know a lot of specialists do both, but some of my friends grew up with the idea of being the family doctor, having the office and their own nurse. Seeing patients one on one after they had made an appointment. I never had any interest in that, just wanted to be in the hospital.
So for those of us who love EM, we're like "why doesn't everyone want to do this?" But people are wired differently and some just hate being in the ED.
i think it has gotten pretty competitive, on avg 800 or so applicants for 8-10 pgy1 spots/program this year for most of the programs i have applied to this year. and it seems that next yr it may be even more competitive as EM has gotten very popular
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deleted65604
Because a lot of specialties make more money than us.
GAS and rads don't have to interact with patients very much. For example, when a pre-op patient is really annoying, the anesthesiologist can just tune them out for a few minutes and then they can just think in their mind, "Blah, blah, blah", "Hey! breath deep!", by the time the patient can wake up and beg for 8 mg IV dilaudid push, "The only thing that ever touches my pain", the anesthesiologist can say, "My work here is done."
Most other specialties have Easy Buttons...
FP- Oh doctor, I have chest pain... "I'm going to call 911, this could be serious".
Rads- "Could be consistent with infection versus malignancy, or scarring, versus normal variant... clinical correlation warranted, CT recommended for further evaluation, (CT report reads the same, but change CT, with triple-phase contrast in F/U, then CT with contrast reads the same, but with MRI to further evaluated, and hopefully, the case goes to a different radiologist, who may actually have an idea what they are looking at.)
But, the main reason that ER isn't more competitive is that it is rather boring usually
GAS and rads don't have to interact with patients very much. For example, when a pre-op patient is really annoying, the anesthesiologist can just tune them out for a few minutes and then they can just think in their mind, "Blah, blah, blah", "Hey! breath deep!", by the time the patient can wake up and beg for 8 mg IV dilaudid push, "The only thing that ever touches my pain", the anesthesiologist can say, "My work here is done."
Most other specialties have Easy Buttons...
FP- Oh doctor, I have chest pain... "I'm going to call 911, this could be serious".
Rads- "Could be consistent with infection versus malignancy, or scarring, versus normal variant... clinical correlation warranted, CT recommended for further evaluation, (CT report reads the same, but change CT, with triple-phase contrast in F/U, then CT with contrast reads the same, but with MRI to further evaluated, and hopefully, the case goes to a different radiologist, who may actually have an idea what they are looking at.)
But, the main reason that ER isn't more competitive is that it is rather boring usually
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Actually EM is quite competitive, although not entirely in the traditional sense of scores and GPA. EM residencies place a much heavier emphasis on personality and clinical aptitude, thus good letters of rec and dean's letter could easily outweigh numbers, although numbers are still very important. I think it's much easier to have good numbers than to fake personality and clinical aptitude if you don't have it.
Medical students that feel the need to be in a "competitive" specialty with high numbers probably aren't a good fit for EM anyways.
Medical students that feel the need to be in a "competitive" specialty with high numbers probably aren't a good fit for EM anyways.
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The way the question is asked, it sounds like you want it to be more competitive. Why would you want that?
Just pick something that interests you. Who cares what anyone else is doing?
Just pick something that interests you. Who cares what anyone else is doing?
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EM docs have an easy button too: "I'll just admit you."
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deleted6669
nights/weekends/holidays. how many rheumatologists work on christmas day?
most folks can spontaneously go to a show on saturday night while many em folks have to schedule it off a month in advance.....not that I would do anything else...but it's an issue....
most folks can spontaneously go to a show on saturday night while many em folks have to schedule it off a month in advance.....not that I would do anything else...but it's an issue....
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deleted65604
True, we have easy buttons too.
Ours whine a lot about being pushed.
The other day, I called to admit a patient. I started the conversation, with, "This is a 37 year old female complaining on chest tightness on presentation to the ER." The admitting doc started laughing uproariously. I was quite annoyed, and said, "Hey, I haven't even presented the patient... what are you laughing at? She is in new onset atrial fibrillation, maxed out on diltiazem drip, with a heart rate of 180 despite after 2 liters of fluids. WHen she first got to the ER, her heart rate was 210."
If you've worked in an ER for long, you can't help get a little annoyed at whiny patients. On my last shift, I had 5 patients check in in one hour with the presenting complaint of abdominal pain. None ended up having any discernible pathology. (2 were females with menstrual cramps, one was an 18 year old kid who had normal labs, US, and CT the day before, and hadn't filled any of his presciptions from the day before).
Ours whine a lot about being pushed.
The other day, I called to admit a patient. I started the conversation, with, "This is a 37 year old female complaining on chest tightness on presentation to the ER." The admitting doc started laughing uproariously. I was quite annoyed, and said, "Hey, I haven't even presented the patient... what are you laughing at? She is in new onset atrial fibrillation, maxed out on diltiazem drip, with a heart rate of 180 despite after 2 liters of fluids. WHen she first got to the ER, her heart rate was 210."
If you've worked in an ER for long, you can't help get a little annoyed at whiny patients. On my last shift, I had 5 patients check in in one hour with the presenting complaint of abdominal pain. None ended up having any discernible pathology. (2 were females with menstrual cramps, one was an 18 year old kid who had normal labs, US, and CT the day before, and hadn't filled any of his presciptions from the day before).
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EM appeals to a specific group of people. The abilities needed to thrive in EM don't necessarily spring from the the same talent pool that gives rise to AOA/ultra-gunners. I am not saying that there aren't brilliant people in EM (clearly there are), but I am saying that there are a lot of geniuses that want nothing to do with/ would suck at working in the ED. Also, the ED is smelly.
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Just FYI, EM is extremely competitive this year. In my program (small community hosp. even though it's a city hospital) nearly all the applicants are 99/99 Step scores. Yes, it's competitive.
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Competitive is a relative term. In relation to dermatology, neurosurgery, or radiation-oncology, we are not competitive. In terms of many other specialties, we are competitive.
Personally, I don't care if we're competitive or not. I'd prefer we not be competitive. I would prefer people who want to join the specialty are able to do so, and I don't get any higher salary or any more perks from my job because emergency medicine is more competitive than another specialty. I can do without the notch on my shoulder.
Personally, I don't care if we're competitive or not. I'd prefer we not be competitive. I would prefer people who want to join the specialty are able to do so, and I don't get any higher salary or any more perks from my job because emergency medicine is more competitive than another specialty. I can do without the notch on my shoulder.
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AHHAHAHAH Arcan57
- i don't know you but i think i love you
Yep the ER is smelly. I cuddle babies and exam their bowel movements same as for old people. I check out decubs and look under fat folds because no one else will. we do what we do because we are the kids who wanted to answer all of the above on the chose your own adventure books.
and we did and we are good at it. i am an advocate and a counselor and a primary care doctor and a friend. and if you are drunk obnoxious and screaming because someone hit you in the hit with a shovel and i can't figure out if you have a closed head/injury/open fracture/are a drunk *******. i will haldol your ass and scan your head and call your mom in the morning.
- i don't know you but i think i love you
Yep the ER is smelly. I cuddle babies and exam their bowel movements same as for old people. I check out decubs and look under fat folds because no one else will. we do what we do because we are the kids who wanted to answer all of the above on the chose your own adventure books.
and we did and we are good at it. i am an advocate and a counselor and a primary care doctor and a friend. and if you are drunk obnoxious and screaming because someone hit you in the hit with a shovel and i can't figure out if you have a closed head/injury/open fracture/are a drunk *******. i will haldol your ass and scan your head and call your mom in the morning.
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I'd a laughed, too. Electricity is your friend, mate.
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I'd like it just fine if EM was like pathology - path is noncompetitive, but the people that do it are whip smart and get paid really well. Path just selects a certain type, as does EM.
