Monday, August 09, 2004
If you're in the Class of 2006...
If you fall into the above group, or will be graduating with the above group (MD/PhD, DO/PhD, MD/MPH, DO/MPH, etc), please move on to another post. I don't want any added competition. Just kidding.
This post is about Emergency Medicine (EM). Yes, that's how you say it. It isn't the Emergency Room - it's the Emergency Department. It's not an ER doctor, it is an EM Physician. Would you call a surgeon an operating room doctor? Or a radiologist an x-ray room doctor? I didn't think so. The phraseology is very important here.
That said - I am interested in Emergency Medicine. If you go to my school, you would probably know this. If not, and I have met you at any of the several conferences I have gone to, you probably know this.
With my background being in Emergency Nursing, I've known for awhile that I am interested in EM. I'm almost 100% positive that I will be applying for an EM residency. So, now I have the daunting task of deciding which programs I might be interested in. The important factors for me include (but are not limited to) - in no particular order:
1. Is the ED an independent department, or a division of Surgery or Medicine? Independent is, of course, more desired.
2. Is it a 1-3, 1-4, or 2-4 program? Allopathic vs Osteopathic (yes, I have to decide this too...)?
3. How established is the program? I would rather go to a program that is established within the hospital and within the EM community.
4. What have graduates done after leaving the program? What fellowships are available in the area (I don't want to have to move around alot to get my training)?
5. How is the educational system within the program set up? What is the balance of clinical to didactic time?
6. Who are the clinical faculty? Are they known and active in the community?
7. What is the off-service rotation schedule like? I think that EM physicians are best trained in the ED; so I would like a program where the vast majority of the rotations are in the ED, or other critical care area.
8. What is the average amount of pathology seen in the department. What is the yearly census? What is the acuity (% of total that are admitted to floor/ICU)?
9. Will I be happy there?
10. Where is the program located? Large, tertiary hospital vs community hospital. I'll take large any day, if only for volume/acuity sake.
So, I've been looking around - and so far, I like Drexel's program. I think they have most of the above criteria. I've exchanged emails with Ms. Delgado there, and she said they have a new DO intern, so I know that matching there is a possibility. I've also emailed a 2nd year resident there, named Scrubbs (from SDN forums) and she said Drexel ROCKS! So, Drexel is #1 right now. If you're not a member of the class of 2006, I'd invite you to check out their web site - you might want to check out their program! Now, if only I could get a 4th year rotation set up there...:)
Other places I've looked at pretty seriously include Charity Hospital in N'awlins (web site down), Cook County in Chicago (new, cool web site), Scott & White in Temple, Tx (I've met a few of these guys - they are really cool and would be good to train with), and a few others that I don't feel like digging up their web sites right now. I'll talk more on that later.
For now, I'd like to tell you why EM -
When I first graduated from nursing school, I got a job on a med/surg floor. After about a year there, I couldn't stand it any longer. I was tired of picking up everyone else's slack because they didn't want to do something on their shift. [Now that I'm seeing things from the medical side - I realize that medicine isn't as bad as I thought it would be. I actually find it quite thought-provoking and really interesting. Of course, I've heard that EM docs LOVE every rotation they go through in med school...] I knew I had to get out.
So, after applying a few times, I got a job in an ED at a very small hospital (about 8 beds in the ED). I absolutely LOVED IT! I enjoyed the face time with the EM Docs (very nice for a premed), I loved the team spirit, even the frequent flyer patient's weren't so bad! I knew I'd found my calling. I started asking questions - what's it like being an EM doc, how long do you have to go to school, etc. Just trying to educate myself about this field. Pretty much everything I heard I liked. I remember one of the first docs I worked with, Dr. S.K. told me about why he went into EM: He lifted up his shirt and said, "See this, no beeper!" and then he walked out of the department on his way home. That is a powerful statement, and one I will never forget. What a testimony to the lifestyle an EM physician lives.
Of course, that's not the whole story... Everyone who has read for 2 minutes about EM realizes that it's not REALLY like all the TV shows depict it to be. Roughly 60-80% (or more) of the ED visits in a day are not trauma-related. They are medical cases: CHF, chest pain (from various causes), kids with fever, kids with rashes, adults with rashes, etc. You get the picture. The fun comes when you actually get to have that multiple trauma victim that jumped in front of a train (or a moving vehicle). It's the knowledge that something good could come in that keeps you going.
EM physicians are adrenaline junkies. They are looking for something fun to do. They work hard, but they play the entire time, and then they go home (without a pager or call) to play some more - hard.
There are downsides to all the fun and glory.
* Respect: a lot of other fields do not respect EM physicians. They call them "glorified triage nurses" and other such things. Believe me, I've heard it. Surgeons hate EM docs, Internists hate EM docs (because we admit patients to them at 0330 and call them before-hand to tell them about it).
* No follow-up. A major complaint I've heard from prospective EM physicians-to-be is that you never know what happens to your patient after they leave the department. My answer - someone else takes care of them. If you really want to know - while you have that doc on the phone at 3am to admit another patient to their service, ask, "hey, whatever happened to so-and-so?" They'll love you for it!!! :)
* The so-called "FISHBOWL" effect. They say that hind-sight is 20/20. This is especially true in Emergency Medicine. What a lot of clinicians do not understand is that an emergency physician is working under a time crunch with very limited information. They do not have time to sit down and talk with the patient for an hour to ask how they feel about the MI they are having. They have to do something about it right away, so maybe the patient will be alive so the internist and cardiologist can ask those questions tomorrow. The fishbowl effect comes in when, under the time crunch and limited information circumstances they must operate under, they miss something or forget to do something. Then, when the patient is admitted and the admitting physician comes in the next day, they find the missing test or diagnosis and then proceed to call down to the ED and gripe about how the EM doc should have caught this - even a 1st year medical student would know this, blah, blah, blah... Like I said, hind-sight is 20/20 (or maybe better when you have a full history and physical). It's the way we work - we don't know everything. We can't. Get over it. We do our best with what we have.
* Rotating schedules. Yes, EM physicians work shifts. They are 8 hours some places, 12 hours others. The rule is, however, that your schedule will change. There is no "Day shift" or "Night shift." Everyone gets to rotate to share all the wonderful night shifts. Too bad. I really like nights. The people that work nights are just more fun - I think it has something to do with lack of vitamin synthesis from the sun or something. Or maybe it's just sleep deprivation. Who knows. Now-a-days, places are making the schedules more "circadian rhythm friendly," so maybe this won't be such an issue anymore.
That's all the down-sides I can muster right now. I'm sure there are others - feel free to comment below to remind me. Heck, you might know some that I don't and make me re-think my position...:) Doubtful.
Yeah, so that's a "short" synopsis of the who, what, where, when, why, and how of EM and why I want to train in EM and a somewhat thought-out list of a few of the places I've researched so far. If you know of anymore really good ones (or for 4th year rotations) let me know. Time is running out. But I'm tired now and have to go to bed - I'm sure I'll ramble more about this later...
I just didn't want this entire site to be about family practice. I want my EM physicians to feel some love too! Just trying to throw some your way, guys and gals!!
good night, and more to come.... ¶ 9:04 PM
This post is about Emergency Medicine (EM). Yes, that's how you say it. It isn't the Emergency Room - it's the Emergency Department. It's not an ER doctor, it is an EM Physician. Would you call a surgeon an operating room doctor? Or a radiologist an x-ray room doctor? I didn't think so. The phraseology is very important here.
That said - I am interested in Emergency Medicine. If you go to my school, you would probably know this. If not, and I have met you at any of the several conferences I have gone to, you probably know this.
With my background being in Emergency Nursing, I've known for awhile that I am interested in EM. I'm almost 100% positive that I will be applying for an EM residency. So, now I have the daunting task of deciding which programs I might be interested in. The important factors for me include (but are not limited to) - in no particular order:
1. Is the ED an independent department, or a division of Surgery or Medicine? Independent is, of course, more desired.
2. Is it a 1-3, 1-4, or 2-4 program? Allopathic vs Osteopathic (yes, I have to decide this too...)?
3. How established is the program? I would rather go to a program that is established within the hospital and within the EM community.
4. What have graduates done after leaving the program? What fellowships are available in the area (I don't want to have to move around alot to get my training)?
5. How is the educational system within the program set up? What is the balance of clinical to didactic time?
6. Who are the clinical faculty? Are they known and active in the community?
7. What is the off-service rotation schedule like? I think that EM physicians are best trained in the ED; so I would like a program where the vast majority of the rotations are in the ED, or other critical care area.
8. What is the average amount of pathology seen in the department. What is the yearly census? What is the acuity (% of total that are admitted to floor/ICU)?
9. Will I be happy there?
10. Where is the program located? Large, tertiary hospital vs community hospital. I'll take large any day, if only for volume/acuity sake.
So, I've been looking around - and so far, I like Drexel's program. I think they have most of the above criteria. I've exchanged emails with Ms. Delgado there, and she said they have a new DO intern, so I know that matching there is a possibility. I've also emailed a 2nd year resident there, named Scrubbs (from SDN forums) and she said Drexel ROCKS! So, Drexel is #1 right now. If you're not a member of the class of 2006, I'd invite you to check out their web site - you might want to check out their program! Now, if only I could get a 4th year rotation set up there...:)
Other places I've looked at pretty seriously include Charity Hospital in N'awlins (web site down), Cook County in Chicago (new, cool web site), Scott & White in Temple, Tx (I've met a few of these guys - they are really cool and would be good to train with), and a few others that I don't feel like digging up their web sites right now. I'll talk more on that later.
For now, I'd like to tell you why EM -
When I first graduated from nursing school, I got a job on a med/surg floor. After about a year there, I couldn't stand it any longer. I was tired of picking up everyone else's slack because they didn't want to do something on their shift. [Now that I'm seeing things from the medical side - I realize that medicine isn't as bad as I thought it would be. I actually find it quite thought-provoking and really interesting. Of course, I've heard that EM docs LOVE every rotation they go through in med school...] I knew I had to get out.
So, after applying a few times, I got a job in an ED at a very small hospital (about 8 beds in the ED). I absolutely LOVED IT! I enjoyed the face time with the EM Docs (very nice for a premed), I loved the team spirit, even the frequent flyer patient's weren't so bad! I knew I'd found my calling. I started asking questions - what's it like being an EM doc, how long do you have to go to school, etc. Just trying to educate myself about this field. Pretty much everything I heard I liked. I remember one of the first docs I worked with, Dr. S.K. told me about why he went into EM: He lifted up his shirt and said, "See this, no beeper!" and then he walked out of the department on his way home. That is a powerful statement, and one I will never forget. What a testimony to the lifestyle an EM physician lives.
Of course, that's not the whole story... Everyone who has read for 2 minutes about EM realizes that it's not REALLY like all the TV shows depict it to be. Roughly 60-80% (or more) of the ED visits in a day are not trauma-related. They are medical cases: CHF, chest pain (from various causes), kids with fever, kids with rashes, adults with rashes, etc. You get the picture. The fun comes when you actually get to have that multiple trauma victim that jumped in front of a train (or a moving vehicle). It's the knowledge that something good could come in that keeps you going.
EM physicians are adrenaline junkies. They are looking for something fun to do. They work hard, but they play the entire time, and then they go home (without a pager or call) to play some more - hard.
There are downsides to all the fun and glory.
* Respect: a lot of other fields do not respect EM physicians. They call them "glorified triage nurses" and other such things. Believe me, I've heard it. Surgeons hate EM docs, Internists hate EM docs (because we admit patients to them at 0330 and call them before-hand to tell them about it).
* No follow-up. A major complaint I've heard from prospective EM physicians-to-be is that you never know what happens to your patient after they leave the department. My answer - someone else takes care of them. If you really want to know - while you have that doc on the phone at 3am to admit another patient to their service, ask, "hey, whatever happened to so-and-so?" They'll love you for it!!! :)
* The so-called "FISHBOWL" effect. They say that hind-sight is 20/20. This is especially true in Emergency Medicine. What a lot of clinicians do not understand is that an emergency physician is working under a time crunch with very limited information. They do not have time to sit down and talk with the patient for an hour to ask how they feel about the MI they are having. They have to do something about it right away, so maybe the patient will be alive so the internist and cardiologist can ask those questions tomorrow. The fishbowl effect comes in when, under the time crunch and limited information circumstances they must operate under, they miss something or forget to do something. Then, when the patient is admitted and the admitting physician comes in the next day, they find the missing test or diagnosis and then proceed to call down to the ED and gripe about how the EM doc should have caught this - even a 1st year medical student would know this, blah, blah, blah... Like I said, hind-sight is 20/20 (or maybe better when you have a full history and physical). It's the way we work - we don't know everything. We can't. Get over it. We do our best with what we have.
* Rotating schedules. Yes, EM physicians work shifts. They are 8 hours some places, 12 hours others. The rule is, however, that your schedule will change. There is no "Day shift" or "Night shift." Everyone gets to rotate to share all the wonderful night shifts. Too bad. I really like nights. The people that work nights are just more fun - I think it has something to do with lack of vitamin synthesis from the sun or something. Or maybe it's just sleep deprivation. Who knows. Now-a-days, places are making the schedules more "circadian rhythm friendly," so maybe this won't be such an issue anymore.
That's all the down-sides I can muster right now. I'm sure there are others - feel free to comment below to remind me. Heck, you might know some that I don't and make me re-think my position...:) Doubtful.
Yeah, so that's a "short" synopsis of the who, what, where, when, why, and how of EM and why I want to train in EM and a somewhat thought-out list of a few of the places I've researched so far. If you know of anymore really good ones (or for 4th year rotations) let me know. Time is running out. But I'm tired now and have to go to bed - I'm sure I'll ramble more about this later...
I just didn't want this entire site to be about family practice. I want my EM physicians to feel some love too! Just trying to throw some your way, guys and gals!!
good night, and more to come.... ¶ 9:04 PM
