Wilderness medicine...

[link2swim06]

I see from old threads that wilderness medicine seems to be a fellowship after EM residency. So what sort of "jobs" does this unlock and how hard these to obtain?

I am also confused...if you are far from a clinic and have no labs, no imaging, very few medications...wouldnt your abilities be limited to that of an EMT or paramedic? Is this the purpose of the fellowship, or what I am missing?

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[DeadCactus]

Almost all if not most wilderness medicine physicians still spend most of their time working in an ED. They may get a small wilderness medicine job on the side ranging from working at a ski resort to being a physician at Everest base camp to teaching wilderness medicine courses. It's more of a true fellowship where you're spending time studying a topic of interest to you and building some credibility than the medicine kind of fellowship where you drastically change the nature of your practice and career.

Your second question will evoke some strong opinions on the whole concept of wilderness medicine physician. I think it's fair to say that there are a variety of possible implementations with a wide range of efficiency in the use of a physician's training and knowledge...

 

[BushDoc20]

ok so i mainly work in the Outback of the northern territory in australia...visting missions, education on diabetes and hypertension, and riding in my chopper to do field medicine in areas that are 500kms + from any sort of hospital. yes i also do birthing classes for those on missions and i do check ups.

i have a landrover fully kitted out so i can do basic lab tests and anything else ....i'm the dr.Hank lawson of australia (for those that have seen royal pains) and yes i carry a silver tray with me so i can do blood typing in emergencies.

i spend about 3 days a week in an ER and 4 days doing wilderness work. this is how i like it and i'm up for attending next year

 

[sylvanthus]

Now that is truly awesome.

 

[winkleweizen]

ok so i mainly work in the Outback of the northern territory in australia...visting missions, education on diabetes and hypertension, and riding in my chopper to do field medicine in areas that are 500kms + from any sort of hospital. yes i also do birthing classes for those on missions and i do check ups.

i have a landrover fully kitted out so i can do basic lab tests and anything else ....i'm the dr.Hank lawson of australia (for those that have seen royal pains) and yes i carry a silver tray with me so i can do blood typing in emergencies.

i spend about 3 days a week in an ER and 4 days doing wilderness work. this is how i like it and i'm up for attending next year

 

[BushDoc20]

thanks, its very rewarding work.

 

[link2swim06]

ok so i mainly work in the Outback of the northern territory in australia...visting missions, education on diabetes and hypertension, and riding in my chopper to do field medicine in areas that are 500kms + from any sort of hospital. yes i also do birthing classes for those on missions and i do check ups.

i have a landrover fully kitted out so i can do basic lab tests and anything else ....i'm the dr.Hank lawson of australia (for those that have seen royal pains) and yes i carry a silver tray with me so i can do blood typing in emergencies.

i spend about 3 days a week in an ER and 4 days doing wilderness work. this is how i like it and i'm up for attending next year

Thats awesome, so are hired/funded by someone for the wilderness work and how did you get that gig?

 

[deleted109597]

While the Aussie has an appealing job situation (except for working 7 our of 7), it isn't feasible in the US. Nobody in the US is going to pay you to be a doctor in the boonies when they have to have volunteer firefighters and EMTs in many counties. Sure, you can do it for free, and still have the malpractice risks, but don't ever expect it to be financially rewarding.

 

[BushDoc20]

i set it up, i saw the need for mission healthcare in a minority and i do it off my own back, the chopper is mine and i pay the pilot. It's not that financially rewards like dr.mcninja said, i'm actually only paid for 5 days the other 2 are seen as overtime because of how i set it up and therefore

 

[sylvanthus]

While the Aussie has an appealing job situation (except for working 7 our of 7), it isn't feasible in the US. Nobody in the US is going to pay you to be a doctor in the boonies when they have to have volunteer firefighters and EMTs in many counties. Sure, you can do it for free, and still have the malpractice risks, but don't ever expect it to be financially rewarding.

Who gives a **** if it is financially rewarding or not. It is a cool job nonethless, quit being a fukin buzzkill.

 

[deleted109597]

Who gives a **** if it is financially rewarding or not. It is a cool job nonethless, quit being a fukin buzzkill.

Classy.

Unless you own the items, and pay for it yourself, as he does, you cannot simply do what you want. This isn't an occupy movement, it is a way to feed your family.

 

[sylvanthus]

Classy.

Unless you own the items, and pay for it yourself, as he does, you cannot simply do what you want. This isn't an occupy movement, it is a way to feed your family.

We are constantly told what we can and cannot do, are inundated with depressing statistics about declining reimbursements, etc etc etc. It is occasionally nice to see someone doing something rewarding that is different than the norm.

We return to the reality of how ****ty the US healthcare system is, carry on.

 

[BushDoc20]

i started saving from when i was a first year med student so that i could pay for what i needed, it's part of the reason I became a doctor. missions gave me so much and as a orphan half cast the elders treated me like a non half-cast and respected me in my aims and ambitions. I had a tremendous amount of support when I left so I could do what i dreamed of, I felt that it was one way to give back to a community that gave me so much

 

[HOHOHO]

This student wilderness medicine conference looks interesting. Paul Auerbach is the keynote! Anyone going?

http://phillywildernessconference.org/MASWM/Welcome.html

 

[jbar]

I see from old threads that wilderness medicine seems to be a fellowship after EM residency. So what sort of "jobs" does this unlock and how hard these to obtain?

I am also confused...if you are far from a clinic and have no labs, no imaging, very few medications...wouldnt your abilities be limited to that of an EMT or paramedic? Is this the purpose of the fellowship, or what I am missing?

This is why many of the wilderness medicine fellowships are combined with international medicine fellowships. There is a lot of overlap between the two, mainly that you are working in a resource poor situation. These fellowships teach about things like developing emergency medicine as a specialty in other countries, refugee medicine etc.

As to what an MD can do that a wilderness EMT can't when you are just out hiking/backpacking/kayaking, the answer is not much. But I think the training would be good for dealing with some of the following questions:

1: You work at an ER in the southwest that sees regular rattlesnake bites, is there a protocol that may improve outcomes beyond the current Crofab treatment regime?

2: You have been contact to see if you are interested in being the medical director for an adventure race through the Utah desert. What equipment do you want your field medics to carry? What gear should the participant be required to have? What is your disaster plan? How will you deal with varying levels of hyperthemia/dehydration/ hyponatremia?

3: You work in the Pacific Northwest and you are working with the local Mountaineering club to prepare people for climbing Rainer with the lowest chance of developing AMS. What does the research recommend? NASIDs? Diamox?

I think most people who are doing wilderness medicine either do it part time (with a ski patrol, search and rescue group or like in the above situations), or are using it for their recreational activites/ international medical work.

There are how many full time true wilderness medicine jobs out there? I can think of like 6 or 7 (medical director for national ski patrol, medical director for NOLS, Everest base camp doc, etc) The reason to do the fellowship is because you find the topic interesting and you want to explore it. And there are people who make it the focus of their career. I just think people should be realistic about how many full time jobs there are out there where they will be hanging from the side of a chopper with Mountain Rescue.

(Disclaimer, I'm not a wilderness fellow. Just an EM resident who spent a fair amount of time doing search and rescue, ski patrol, and teaching wilderness medicine.)

 

[BushDoc20]

my wilderness job is upwards of 60hrs+ a week all packed into 4 days out bush and 3 in the ED

 

[acr2627]

I want your life.

 

[BushDoc20]

every med student, american or non Australian wants my life but to be honest.....no you don't.
i love it because i grew up around missions and know what healthcare is lacking but if some stranger just rocked up and started telling indigenous elders that they do and don't need, what they should and shouldn't do....it doesn't go down so well..

it's like telling a puppy not to do something when you've let it get away with doing it for so long...you cant just decide it cant do it anymore.

i've seen missions health slip over the years (i'm a half cast but don't associate with being an aboriginal because my personal view...theyre white when they wanna be and black when they wanna be...i'm helping the community and they don't like it ) so i work my ass off to make things better for the week. i could deliever 6 babies in a day, diagnose diabetes in 25-30 elders and help with housing or be a mental health worker....*shrugs* then i spend 3 days in the ER where patients of 3 and four years old come in with runny noses and say 'wad do i do' and i say 'catch it before it gets away!' , broken bones from heavy stuff falling on them or partners breaking certain fragile areas sooo yeah.

 

[Hamhock]

I want your life.

No you don't.

I don't know you anymore than BushDoc, but I am comfortable with the odds that you aren't yet another person who wants to work seven days a week.

I know there are a few people who are nearly 8 feet tall, but I'll play the odds and say you are not one of them.

7 days a week? For nearly everyone, this is not healthy...and I have been called a workaholic many times.

HH

 

[BushDoc20]

No you don't.

I don't know you anymore than BushDoc, but I am comfortable with the odds that you aren't yet another person who wants to work seven days a week.

I know there are a few people who are nearly 8 feet tall, but I'll play the odds and say you are not one of them.

7 days a week? For nearly everyone, this is not healthy...and I have been called a workaholic many times.

HH

HH is right....it's really not good for you, why would you want that befor you even finish med school??

-do you know how many holidays i get where i can leave the country...none
-do you know how much of my annual leave, long service leave, sick leave and unpaid leave i've taken.....none
-do you know how many mobile phones i have....4
- wanna know how much sleep i get before getting up at 5am to start my day....about 4.5hrs
- wanna know how i don't kill people....my patients think i'm amazing and let me nap before i take off, they feed my pilot and tell him dreamtime stories, then they feed me and my day really begins at about 9am