I will definitely check out code black.
I strongly recommend it.
I guess I'm just confused as to how training under a community ER doc in a community ER fails to qualify me to work in a community ER. I wasn't ever arguing that I would be qualified to work in a level one trauma center. My goal is to work in level threes.
Sigh. This is getting frustrating, but I can understand why for an outsider it's not as obvious as it is to an insider.
It's like comparing an online degree to a regular one. The online degree holder will continue to make arguments, i.e. "I'm taking all the same classes, doing the same coursework, etc." but alas, the two will never be the same. Nowhere even close.
Similarly, working in some random community ER will never, ever be anywhere close to going through an official ER residency.
Let me try this another way...
So, I completed my residency at a university hospital about two years ago. My first (and so far only) attending job has been in a small rural ER. I'm the only doctor in a 20-mile radius. The buck stops at me. In such a situation, I will tell you that I think my intense EM residency is the *only* reason I am able to manage.
You only have 3-4 years of residency training. These 3-4 years must be very high intensity in order to make you strong enough to be a capable ER doctor, even at a small rural hospital ER like the one I currently work for.
Had I done my 3-4 years of residency at this small rural ER (hypothetically speaking since it's not really possible), I would NOT be ready to be an attending at the same hospital... I had to go to an intense residency in order to be capable enough to handle this small ER by myself.
This is because how much you learn is directly correlated to intensity of training. The intensity of a 3 or 4 year ER residency is very high, whereas at a small community ER is too low to make you a qualified ER doctor. You simply won't see enough complexity/volume of patients to adequately prepare you for when the sh** hits the fan, even in your small rural ER.
Like I said, I currently work in a small rural ER. Most of the time, it's pretty chill. But, an hour or so every shift, sh** hits the fan, and then I thank my ER residency training for preparing me for this. I became immune to sh** hitting the fan, since it was always hitting the fan at the university hospital I trained at. The minute I'd walk into my shift, there would be ambulances lined up, patients in the halls, full waiting room, zombies everywhere. I needed that 24/7 for 3 years in order to deal with the 1 hour of that time that happens in my current shifts.
If we're being honest, most of trauma is protocol driven or going to be flown over my head on a helicopter.
I'm a new attending and trauma still scares the sh** out of me (even after doing my 3 years at a trauma center), so I don't know why you'd be so cavalier about it simply being "protocol driven."
And no, they bring the patient to you first, and then you stabilize them--and have to keep them stabilized--until the helicopter folks come in to whisk your patient away. And, let me tell you, it feels like FOREVER in the heat of the moment. Moreover, those are the critical minutes in the patient's care.
For the remaining stuff that requires some serious thought... If I weren't confident I could always *gasp* pick up a phone.
When sh** is hitting the fan and the patient is crashing, you don't have the time to rely on a phone call.
Wouldn't you guys like to be on the other end of that call for once?
Brother, I am currently working at the small rural ER, so I'd be on the same end of the phone call as you. And let me tell you, I can't just call another ER doctor somewhere and ask them what to do. First of all, that would be degrading. Secondly, I'd lose the respect of my entire ER. Thirdly, the ER doctor on the other end would be like WTF. Fourthly, it's just not done.
I just want to be the smallish town, old school doctor that loves his community, makes house calls, has a patient panel, sees his patients during emergencies, delivers their babies, and rounds on them in the hospital afterwards. And I find it interesting that all of the above can be done for the low price of five years of training (FM + ER and OB fellowships).
Now, will I have to give up some respect and cash to pursue that dream? Probably. Will I know if 25 mg of drug A is better than 26 mg of drug B in African American females under age 65 below the level of the equator during the month of June? Probably not. But at some point... And I say this as a nontraditional student with a family... The pissing contest has to end or we'll all be going to school until we're 50 and too expensive to even employ.
I'm not trying to take anyone's job. I'm just researching ways to make my dream (the way medicine used to be) work in areas where you guys don't want to live and where there is no help otherwise.
As I've said before, I'm not trying to piss on your training, or say your plan is necessarily horrible. For you, it may be the most realistic option if you're dedicated to working in the ER.
What I am 10000% against, however, is the idea that doing the same number of months in a community ER is somehow anywhere equal to or comparable to an ER residency. It's not. No way.
And, for the record, me personally had I not matched in EM, I would *not* work in the ER ever. I barely feel capable enough even after doing an ER residency. I certainly wouldn't work in a small rural ER like the one I work in now... I'm it, dude. I got no specialists to call for help.
I'd cut my losses and be a hospitalist.
To me, your dream of working in some hick town seems antiquated... something that might have been fine in the 1960's, but things have changed now. BUT, that's just my personal opinion.