Why so much hate on EM?

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jcorpsmanMD

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Incoming M1 that has clinical experience / battlefield medicine experience as I was previously a medic in the U.S. Navy with interest in Emergency Medicine. No I am not opposed to other fields, obviously I'm just an incoming M1 at an MD school. Just clarifying all this so my thread doesn't turn into something else.

The question:
Why do other people / physicians hate on EM so much? There seems to be a dislike for EM doctors. At least in regards to my experiences when I tell other physicians what I'm interested in. I just don't get it? I know the ER can be a mess but dang.

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Because EM didn't order the exact labs to make the IM's day easier. Patients who make it through the ER get added to everyone else's list. Yes, there are many questionable admissions.

EM deals with a lot on a very short time scale. Most of the diagnostics are going on in the ER, not some long drawn out, is it lupus? House MD situation. To the IM's I say, sorry we all don't have 4 hours to pontificate about patients.

There are arguments on each side. We all need some chill.
 
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Because EM didn't order the exact labs to make the IM's day easier. Patients who make it through the ER get added to everyone else's list. Yes, there are many questionable admissions.

EM deals with a lot on a very short time scale. Most of the diagnostics are going on in the ER, not some long drawn out, is it lupus? House MD situation. To the IM's I say, sorry we all don't have 4 hours to pontificate about patients.

There are arguments on each side. We all need some chill.
Yeah, I still vividly remember all the animosity the IM department had for the ER doctors when I shadowed at a hospital for a while. They'd constantly be "annoyed" by them. Just crazy how everyone I talk to other then EM doctors tells me to stay away from EM. But I suppose people are going to have a little disdain towards the physicians that increase their workload? Even though it's something completely out of their control. Oh well, I'm sure I'll get a better of perspective things in school. We'll see.
 
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The ED is the messenger for all other services, and in academics, you want to shoot the messenger. In PP it seems to be different.
 
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It's like what was said above, as an ER doc, you're potentially increasing the workload for somebody else which I get. But EM docs aren't trained on the nuances of every specialty yet they see issues from each and must be able to respond. Sure some admissions may not necessarily be warranted but that's the nature of the beast. If you feel so strongly Dr. Cardio/Dr. IM then come sit down in the ED for the day and see every chest pain or potential CHF exacerbation that comes in and you decide.
 
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Honestly EM sounds like the perfect career for me. No call, about 15 shifts per month, wide array of patients and problems, still a lot of clinical medicine used from med school, and chances to do procedures. I'm ok with other physicians hating EM but I feel like I'd be happy. But we'll see how this changes in med school haha
 
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1. Hospitals make money in the OR. They lose it in the ER.
2. Most practicing physicians are aware that pretty much anyone could work in an ER prior to the recent introduction of a residency in EM. The quality of these earlier referrals may have left a bitter taste for the field.
3. Referral bias makes us more aware of wrong thinking/doing. Good decision-making often doesn't surface again and goes unnoticed.
 
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EM distributes work to you for the most part, when you see their extension....admit is coming. I never started to hate on EM as an intern and didnt really deal with them in residency, but many of my colleagues constantly hated on them. They have a tough job. Plus you get to monday morning qb all their orders/decisions.
 
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Disposition is king in EM, but lower on the priority list elsewhere, which can easily put it at odds with other specialties.
 
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I think any service that regularly consults other specialties will get some flak, at least in academics. That's not entirely limited to EM, as it also describes IM and peds, but EM also refers patients to those services.

When you're a consult service, you want all the work cut out for you - the history, labs, exam, and xrays should all be wrapped up and presented with a bow, preferably with a diagnosis at hand. You provide your all important insight to the problem and the ED carries out your plan. When any part of that goes wrong, it's easy to blame the ED. If a patient doesn't have the perfect set of labs or XRs, it's the ED's incompetence or lack of diligence. It doesn't matter that the ED is high throughput by design or that their scope of practice is wider than everyone else's. As a consult service, all I see is that the ED did not know how to properly workup, diagnose, and treat that distal radius fracture that I clearly did not need to go into the hospital for.

Also, the ED for the most part does not see the long term consequences of their interventions, so when other services see complications, it's fairly easy to point the blame at the ED who isn't even there to defend itself.
 
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Honestly EM sounds like the perfect career for me. No call, about 15 shifts per month, wide array of patients and problems, still a lot of clinical medicine used from med school, and chances to do procedures. I'm ok with other physicians hating EM but I feel like I'd be happy. But we'll see how this changes in med school haha
There is the "always on" and constant turn of patients that may contribute to some burn out. I was under the impression EM had one of the highest rates of burn out. There is a lot of pressure for productivity to turn around rooms, and high liability for decisions on sending someone home and the person ends up dead with an aortic dissection that you didnt do a full work up for.Plus rotating shifts messes with some people. Its not all roses.
 
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I think any service that regularly consults other specialties will get some flak, at least in academics. That's not entirely limited to EM, as it also describes IM and peds, but EM also refers patients to those services.

When you're a consult service, you want all the work cut out for you - the history, labs, exam, and xrays should all be wrapped up and presented with a bow, preferably with a diagnosis at hand. You provide your all important insight to the problem and the ED carries out your plan. When any part of that goes wrong, it's easy to blame the ED. If a patient doesn't have the perfect set of labs or XRs, it's the ED's incompetence or lack of diligence. It doesn't matter that the ED is high throughput by design or that their scope of practice is wider than everyone else's. As a consult service, all I see is that the ED did not know how to properly workup, diagnose, and treat that distal radius fracture that I clearly did not need to go into the hospital for.

Also, the ED for the most part does not see the long term consequences of their interventions, so when other services see complications, it's fairly easy to point the blame at the ED who isn't even there to defend itself.
I think what everything is saying completely spot on. Just a shame but at the same time I understand it. Just have to ignore the hate and have an open mind to it once I get to that point in school. I was starting to have second doubts about my interest I suppose because of all the negative flack EM gets and that's whu I thought I'd ask the sdn community to see their thoughts on it!
 
There is the "always on" and constant turn of patients that may contribute to some burn out. I was under the impression EM had one of the highest rates of burn out. There is a lot of pressure for productivity to turn around rooms, and high liability for decisions on sending someone home and the person ends up dead with an aortic dissection that you didnt do a full work up for.Plus rotating shifts messes with some people. Its not all roses.
Oh definitely. Having to balance ~12 patients at a time sounds pretty stressful. I've also seen a lot of doctors that are pretty jaded since you see a huge population of alcoholics, smokers, drug addicts, and narcotic seekers. But I still think I'd enjoy it from my limited experiences so far
 
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EM is also relatively new as a specialty. "Back in the day" emergency departments were staffed by anyone with a pulse (peds guy, IM guy, FP guy, whoever). So some of the older docs especially still feel like because anybody can work in an ED, it shouldn't even be a specialty, much less one that makes more money than they do.

Unrelated but worth mentioning that latest data from ACEP shows EM physicians have highest rate of burnout across all specialties...
 
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There is the "always on" and constant turn of patients that may contribute to some burn out. I was under the impression EM had one of the highest rates of burn out. There is a lot of pressure for productivity to turn around rooms, and high liability for decisions on sending someone home and the person ends up dead with an aortic dissection that you didnt do a full work up for.Plus rotating shifts messes with some people. Its not all roses.

THE highest..
 
It's kinda shocking how EM burns out more than the other "intense" fields like gen surg, every surgical specialty, and critical care. I've seen people argue that it's a life style field because it's shiftwork only, low median hours per week, and well compensated, but the stress must be ridiculous.
 
EM is also relatively new as a specialty. "Back in the day" emergency departments were staffed by anyone with a pulse (peds guy, IM guy, FP guy, whoever). So some of the older docs especially still feel like because anybody can work in an ED, it shouldn't even be a specialty, much less one that makes more money than they do.

Unrelated but worth mentioning that latest data from ACEP shows EM physicians have highest rate of burnout across all specialties...
can you post the link?
 
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Going into surgery, I have mad respect for EM docs. I would not be able to deal with a career where so many non-issues (medical especially) walked through my door.

Here's a list of common complaints surgeons have about EM docs.

Surgery:
"Those dang ER docs consulted me for something they could have done themselves"
"Why did this patient NOT get a surgery consult sooner?"
"Why did you call me in the middle of the night about X, this could have waited until morning when I get here"
"Why didn't this patient have a GI consult first?"
"Why is everyone getting a CT scan?"
"Why did THIS patient get a non-constrast CT?

So as you can see, when you are in a specialty that is often deemed "the jack of all trades, master of none," doctors who perceive themselves as the "masters" are going to give you a hard time no matter what you do.
 
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As a civilian paramedic, probably 50% of the 911 calls I responded to were more like social work than true medical emergencies. This might be pretty different from your experience in the military where all the patients are young and generally healthy. I think anesthesia might actually be a more natural transition than EM - one patient at a time, high acuity, mix of procedures and medicine, etc.
 
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Here's my $.02 as a chief scribe with 4,000 hours working with EM docs.

On the one hand I understand why EM docs admit and consult the way the do. My hospital is a small community hospital that is not academic and we have tons politics to go with it. For example our cardiology department used to admit pt all the time back when they were a private practice. Then they got bought out and are not on RVU's (compensation per pt load) and literally never admit anyone who is not a STEMI and going to the cath lab. They also say "admit to IM and we will consult" which has made IM bitter about having pt's in their lineup overnight only for a stress test in the morning. Pretty much every other specialty we consult has gone the same way except for OB/GYN and very special cases. I have seen countless times when the EM doc is literally holding the IM service and the necessary consult away from each other's throats as one may demand one thing that the other doesn't want to do.

Craziest case was a guy coming in septic, hypotensive, and hypoxic after having a colon resection for his colon cancer. He ended up having a perforated colon and the surgeon did not want to admit the pt back as they felt it was a "medical issue" because the pt had colon cancer. He wanted the pt admitted to IM and he would consult. IM was not having it (rightfully so, plus this surgeon was already under administrations eye for similar cases and was a dingus) and felt he needed to be taken back into the surgeon's care as it was his post op pt. The gray area was that neither really knew it he had a perforated colon due to a post op complication of his surgery or because of his cancer (he had only been in the ED for a few hours). Mind you in all this the EM doc is calling them both back and forth who are refusing to admit, while trying to save the pt's life with fluid bolus, intubation, and he eventually coded. Eventually, 8 hours later the house administrator came down and got into a shouting match with both of them and forced the surgeon to admit the pt.

EM is getting caught in the cross hairs of private practices being bought out and the result of physicians not caring about snatching up patients, because why would they if they are now hospital employees and can simply consult. But IM gets the brunt when they have to "watch" these pt's that are taking up a bed for procedures and workups that they aren't even performing.
 
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1-10 how dumb is it to be interested in EM for the excitement of juggling multiple patients, the variety, and the awesome time off/no call?
 
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Here's my $.02 as a chief scribe with 4,000 hours working with EM docs.

On the one hand I understand why EM docs admit and consult the way the do. My hospital is a small community hospital that is not academic and we have tons politics to go with it. For example our cardiology department used to admit pt all the time back when they were a private practice. Then they got bought out and are not on RVU's (compensation per pt load) and literally never admit anyone who is not a STEMI and going to the cath lab. They also say "admit to IM and we will consult" which has made IM bitter about having pt's in their lineup overnight only for a stress test in the morning. Pretty much every other specialty we consult has gone the same way except for OB/GYN and very special cases. I have seen countless times when the EM doc is literally holding the IM service and the necessary consult away from each other's throats as one may demand one thing that the other doesn't want to do.

Craziest case was a guy coming in septic, hypotensive, and hypoxic after having a colon resection for his colon cancer. He ended up having a perforated colon and the surgeon did not want to admit the pt back as they felt it was a "medical issue" because the pt had colon cancer. He wanted the pt admitted to IM and he would consult. IM was not having it (rightfully so, plus this surgeon was already under administrations eye for similar cases and was a dingus) and felt he needed to be taken back into the surgeon's care as it was his post op pt. The gray area was that neither really knew it he had a perforated colon due to a post op complication of his surgery or because of his cancer (he had only been in the ED for a few hours). Mind you in all this the EM doc is calling them both back and forth who are refusing to admit, while trying to save the pt's life with fluid bolus, intubation, and he eventually coded. Eventually, 8 hours later the house administrator came down and got into a shouting match with both of them and forced the surgeon to admit the pt.

EM is getting caught in the cross hairs of private practices being bought out and the result of physicians not caring about snatching up patients, because why would they if they are now hospital employees and can simply consult. But IM gets the brunt when they have to "watch" these pt's that are taking up a bed for procedures and workups that they aren't even performing.

This post is SOOO triggering for me lmao same amount of hours/same position except with IM physicians. Most of them absolutely despise working swing/admitting in ED because IM service gets dumped on.

The IM docs get annoyed when EM does an incomplete workup but says things like "i know this patient will be coming to you guys." OR when they lead with "this is kind of a social admit" OR when IM asks something simple/relevant to the case and EM is like "I don't know, I don't remember, etc." OR when IM has been chilling for 5 hours without a single admission then EM comes in with "hey guys I have 8 new admissions for you." It's def a love hate between the two groups at my hospital.
 
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I thought it said, "why so much hate on EDM?" I was like I know, right?
 
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As a civilian paramedic, probably 50% of the 911 calls I responded to were more like social work than true medical emergencies. This might be pretty different from your experience in the military where all the patients are young and generally healthy. I think anesthesia might actually be a more natural transition than EM - one patient at a time, high acuity, mix of procedures and medicine, etc.

As someone on blue side, the vast majority of my patients are viral URIs, rhinosinusitis, VGE, and malingerers. Out of 10 patients during an average sick call, maybe 1-2 will have something actually worth going to medical for. The rest are just there to get out of work for 5-10 mins and get some free pills. They come with an upset tummy or sinus congestion and then say the corpsmen are stupid because they never get anything other than ondansetron, ibu/Tylenol, or mucinex.

I actually started to consider EM too, because despite the BS, the cellulitis and clot I caught, the occasional trauma we get, and taking care of the few people who come in with pneumonia, etc. is cool and rewarding.

Were you FMF, @jcorpsmanMD?
 
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This post is SOOO triggering for me lmao same amount of hours/same position except with IM physicians. Most of them absolutely despise working swing/admitting in ED because IM service gets dumped on.

The IM docs get annoyed when EM does an incomplete workup but says things like "i know this patient will be coming to you guys." OR when they lead with "this is kind of a social admit" OR when IM asks something simple/relevant to the case and EM is like "I don't know, I don't remember, etc." OR when IM has been chilling for 5 hours without a single admission then EM comes in with "hey guys I have 8 new admissions for you." It's def a love hate between the two groups at my hospital.

Lmao why have I heard every single one of those phrases . I can't even lie sometimes they know they have to hurry up and admit a bunch of patients at once at the end of the shift cause they know the new doctor hates admitting and won't answer the phone


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Lmao why have I heard every single one of those phrases . I can't even lie sometimes they know they have to hurry up and admit a bunch of patients at once at the end of the shift cause they know the new doctor hates admitting and won't answer the phone


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Incoming M1 that has clinical experience / battlefield medicine experience as I was previously a medic in the U.S. Navy with interest in Emergency Medicine. No I am not opposed to other fields, obviously I'm just an incoming M1 at an MD school. Just clarifying all this so my thread doesn't turn into something else.

The question:
Why do other people / physicians hate on EM so much? There seems to be a dislike for EM doctors. At least in regards to my experiences when I tell other physicians what I'm interested in. I just don't get it? I know the ER can be a mess but dang.
In academia, pretty much everyone is salaried. That is, if I see 10 patients in clinic I get paid X... and if I see 20 patients I still get paid X. Some attendings might have a productivity bonus, but certainly none of the residents do. This, plus the fatigue from your job juggling a million things, leads to you having an incentive to do as little work as possible. You also have incentives to do more work of course, but those are typically more nebulous (as in, you have an incentive to get the best education you can, but that is a lot harder to quantify today relative to an extra hour of sleep).

This leads to a dislike of anyone that gives you "extra" work. And the ED seems to do nothing EXCEPT give work to all of the other services. If a patient comes with chest pain, the ED takes a careful history, does a physical, EKG, and a set or two of enzymes and sends them home? Well, you never hear about that patient. So the only interaction you get with the ED is when they want to give you more work. This leads to some resentment.

You can complex that with the fact you know your field better than they know your field. That is, Emergency Medicine physicians are the experts in their own domain: The evaluation and stabilization of the undifferentiated patient. But they aren't the experts in the management of just about any condition once it's stabilized. Their job is to get the patient to the actual experts... and often while accomplishing their task, they don't do things in the same order or in the same exhaustive detail that the new primary service would do them in. Most of the time, it doesn't make a huge difference, but you can certainly look down on them for not knowing the nuances of your specific field if you aren't careful. Of course, you can only do that after they figure out the problem falls in your wheelhouse, in between seeing the other half dozen fields worth of patients in that few hour period they were seeing your patient.

The "ED just gives me work" problem tends to get better if you ever end up in a non-salaried (private) environment, but persists if you're in a salaried environment (whether in academia or directly hospital employed without a production component). The "ED doesn't know all 40+ specialties worth of medicine" problem never goes away.
 
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This post is SOOO triggering for me lmao same amount of hours/same position except with IM physicians. Most of them absolutely despise working swing/admitting in ED because IM service gets dumped on.

The IM docs get annoyed when EM does an incomplete workup but says things like "i know this patient will be coming to you guys." OR when they lead with "this is kind of a social admit" OR when IM asks something simple/relevant to the case and EM is like "I don't know, I don't remember, etc." OR when IM has been chilling for 5 hours without a single admission then EM comes in with "hey guys I have 8 new admissions for you." It's def a love hate between the two groups at my hospital.

For some reason this this tends to always happen at 5pm...on a Friday.
 
lol I love zdogg but man. If I hear one more video about healthcare 3.0, oh boy....

Yeah I actually had to stop watching him for a bit. He's just so annoyingly gregarious and pleased by himself sometimes. I dig the healthcare is teamwork and preventive medicine is awesome stuff, but sometimes he's a tad over the top.
 
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As someone on blue side, the vast majority of my patients are viral URIs, rhinosinusitis, VGE, and malingerers. Out of 10 patients during an average sick call, maybe 1-2 will have something actually worth going to medical for. The rest are just there to get out of work for 5-10 mins and get some free pills. They come with an upset tummy or sinus congestion and then say the corpsmen are stupid because they never get anything other than ondansetron, ibu/Tylenol, or mucinex.

I actually started to consider EM too, because despite the BS, the cellulitis and clot I caught, the occasional trauma we get, and taking care of the few people who come in with pneumonia, etc. is cool and rewarding.

Were you FMF, @jcorpsmanMD?
Blue side as well.
 
Blue side as well.

EM gonna do what EM gonna do: not let people die.

Reminds me of whenever someone rags on a HM for successfully medevac'ing a traumatic
amputation off a hot X, but didn't package him pretty enough for the shock trauma platoon.

c3069329090bcd2069ac707b46cd807338336796b70cfc910303ce93c02f37f3.jpg
 
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EM gonna do what EM gonna do: not let people die.

Reminds me of whenever someone rags on a HM for successfully medevac'ing a traumatic
amputation off a hot X, but didn't package him pretty enough for the shock trauma platoon.

c3069329090bcd2069ac707b46cd807338336796b70cfc910303ce93c02f37f3.jpg
I like the way you think @BKNbkn
 
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Most of the hate is seen in academics. Academics reminds me of rival gangs (i.e. Medicine, surgery, etc) who always come by the ED and try to stir up a fight. Community is a lot better. More team work and less bickering.
 
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Here's my $.02 as a chief scribe with 4,000 hours working with EM docs.

On the one hand I understand why EM docs admit and consult the way the do. My hospital is a small community hospital that is not academic and we have tons politics to go with it. For example our cardiology department used to admit pt all the time back when they were a private practice. Then they got bought out and are not on RVU's (compensation per pt load) and literally never admit anyone who is not a STEMI and going to the cath lab. They also say "admit to IM and we will consult" which has made IM bitter about having pt's in their lineup overnight only for a stress test in the morning. Pretty much every other specialty we consult has gone the same way except for OB/GYN and very special cases. I have seen countless times when the EM doc is literally holding the IM service and the necessary consult away from each other's throats as one may demand one thing that the other doesn't want to do.

Craziest case was a guy coming in septic, hypotensive, and hypoxic after having a colon resection for his colon cancer. He ended up having a perforated colon and the surgeon did not want to admit the pt back as they felt it was a "medical issue" because the pt had colon cancer. He wanted the pt admitted to IM and he would consult. IM was not having it (rightfully so, plus this surgeon was already under administrations eye for similar cases and was a dingus) and felt he needed to be taken back into the surgeon's care as it was his post op pt. The gray area was that neither really knew it he had a perforated colon due to a post op complication of his surgery or because of his cancer (he had only been in the ED for a few hours). Mind you in all this the EM doc is calling them both back and forth who are refusing to admit, while trying to save the pt's life with fluid bolus, intubation, and he eventually coded. Eventually, 8 hours later the house administrator came down and got into a shouting match with both of them and forced the surgeon to admit the pt.

EM is getting caught in the cross hairs of private practices being bought out and the result of physicians not caring about snatching up patients, because why would they if they are now hospital employees and can simply consult. But IM gets the brunt when they have to "watch" these pt's that are taking up a bed for procedures and workups that they aren't even performing.

I've seen that too many times to count. It's like being caught in a fight between mommy and daddy. Like somebody please come take this pt so we can make room for the other 30-40 some odd people in the waiting room.

Lmao why have I heard every single one of those phrases . I can't even lie sometimes they know they have to hurry up and admit a bunch of patients at once at the end of the shift cause they know the new doctor hates admitting and won't answer the phone


Sent from my iPhone using SDN mobile

Hahaha, or they do it the opposite way knowing that IM doc is about to leave.

EP: Who's on for IM?
Secretary: Dr. So&So
EP: meh, I'll wait...
 
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1-10 how dumb is it to be interested in EM for the excitement of juggling multiple patients, the variety, and the awesome time off/no call?


1 - NOT dumb.

That is the main appeal of EM.

We also get paid a TON of money.
 
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In academia, pretty much everyone is salaried. That is, if I see 10 patients in clinic I get paid X... and if I see 20 patients I still get paid X. Some attendings might have a productivity bonus, but certainly none of the residents do. This, plus the fatigue from your job juggling a million things, leads to you having an incentive to do as little work as possible. You also have incentives to do more work of course, but those are typically more nebulous (as in, you have an incentive to get the best education you can, but that is a lot harder to quantify today relative to an extra hour of sleep).

This leads to a dislike of anyone that gives you "extra" work. And the ED seems to do nothing EXCEPT give work to all of the other services. If a patient comes with chest pain, the ED takes a careful history, does a physical, EKG, and a set or two of enzymes and sends them home? Well, you never hear about that patient. So the only interaction you get with the ED is when they want to give you more work. This leads to some resentment.

You can complex that with the fact you know your field better than they know your field. That is, Emergency Medicine physicians are the experts in their own domain: The evaluation and stabilization of the undifferentiated patient. But they aren't the experts in the management of just about any condition once it's stabilized. Their job is to get the patient to the actual experts... and often while accomplishing their task, they don't do things in the same order or in the same exhaustive detail that the new primary service would do them in. Most of the time, it doesn't make a huge difference, but you can certainly look down on them for not knowing the nuances of your specific field if you aren't careful. Of course, you can only do that after they figure out the problem falls in your wheelhouse, in between seeing the other half dozen fields worth of patients in that few hour period they were seeing your patient.

The "ED just gives me work" problem tends to get better if you ever end up in a non-salaried (private) environment, but persists if you're in a salaried environment (whether in academia or directly hospital employed without a production component). The "ED doesn't know all 40+ specialties worth of medicine" problem never goes away.


It is all about developing a relationship with your staff and consultants.

ER medicine is 100% better in the community, especially when you get more rural. There I may be the only physician readily available for 30 miles....patients are happy to see me because I can help them. In the smaller community hospitals you develop a relationship with the other docs and get to a point where I know how they like things done, or if they want to be called, etc. You also get to a point where my opinion carries real weight. When I say "hey Doc X, you really need to come in and see this guy.....", that means this guy is sick.

You are right about the salary thing, but the real bugger in academic medicine is that it is rarely attending to attending communication. Every service you admit to or consult has a resident, and residents are tired and don't want to do any extra work. They are also underexperienced, so they tend to think only in black and white instead of shades of gray.

I personally find that when I communicate directly with an attending, the process if faster, more cordial, and far better for the patient. If I am having a problem with a difficult resident, I go completely around them to the attending, and the problem magically disappears when I say , "Hey doc X, I can't get your resident to take me seriously, and I am worried about this patient". The key is that I don't consult for stupid stuff. If I am calling you, it means I need you to do something right now, or I need your expert opinion on management right now. Most of the time, it can wait to get to the floor.
 
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For some reason this this tends to always happen at 5pm...on a Friday.

This happens ALL THE TIME
I get that your shift is ending but this patient has been sitting in the ed for 10 hours, were you really unable to call me earlier so I can start doing the H&P on one of them instead of having 3 to do right before I was about to sign out like damn
 
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This happens ALL THE TIME
I get that your shift is ending but this patient has been sitting in the ed for 10 hours, were you really unable to call me earlier so I can start doing the H&P on one of them instead of having 3 to do right before I was about to sign out like damn
as an EP, i call on admissions as soon as possible and dont batch. but when i come in and see 4 pts in the first 30 minutes that all need to be admitted... labs imaging come back and whoops 4 admissions all at once. its quite common unfortunately.

Most ERs are also very profitable, OR, ICU, ED are the profit centers for the hospital if done right... it covers the losses from the inpatient side.

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I personally find that when I communicate directly with an attending, the process if faster, more cordial, and far better for the patient. If I am having a problem with a difficult resident, I go completely around them to the attending, and the problem magically disappears when I say , "Hey doc X, I can't get your resident to take me seriously, and I am worried about this patient". The key is that I don't consult for stupid stuff. If I am calling you, it means I need you to do something right now, or I need your expert opinion on management right now. Most of the time, it can wait to get to the floor.

What happens if the attending was the same way and not giving you the consult you needed? Or refusing to admit?

I've only seen that ever happen once and the ER doc got the IM's boss to force him to act.
 
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