Prehospital to Physician -- EM?

[pmdc222]

Out of curiousity -

For those EMTs and paramedics getting/or hoping to get your MD or DO - do you have your heart set on emergency medicine? Want to get away from it? Not sure?


For those ex-paramedic/emt docs who have already chosen EM as a specialty, was it always what you wanted? what else did you consider?

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[emttim]

Out of curiousity -

For those EMTs and paramedics getting/or hoping to get your MD or DO - do you have your heart set on emergency medicine? Want to get away from it? Not sure?


For those ex-paramedic/emt docs who have already chosen EM as a specialty, was it always what you wanted? what else did you consider?

I'm planning to go into emergency medicine myself, but I've also considered cardiology and pulmonary medicine, but I decided against both because they require fellowships as well as residency...and yeah, 5-6 years of hell doesn't sound as appealing as 3 years of EM residency where you barely ever have call and you get to work nights.

 

[146233]

I'm also an EP-to-be, but I've also thought a lot about Trauma Surgery (excuse me, "Surgical Critical Care"). So far, I'm still learning toward EM, since the surgery route is long and I'm already way behind the curve in terms of age. Gotta get through and start earning some of the money EMS never paid.

 

[MavsFan08]

Out of curiousity -

For those EMTs and paramedics getting/or hoping to get your MD or DO - do you have your heart set on emergency medicine? Want to get away from it? Not sure?


For those ex-paramedic/emt docs who have already chosen EM as a specialty, was it always what you wanted? what else did you consider?

I am in the process of applying for emergency medicine residencies. I quit working as a paramedic after I started medical school. I spent my entire third year outside of the ER in other areas and I was miserable. I never had so much fun in my life when I started back in the ER. It is an obvious choice for me.

 

[psychbender]

Out of curiousity -

For those EMTs and paramedics getting/or hoping to get your MD or DO - do you have your heart set on emergency medicine? Want to get away from it? Not sure?

EM (possibly with Critical Care) has been my number 1 for a while; but for the past year or so, I've also been thinking strongly about Anesthesia/Critical Care. Of the other medics in my class, two are hardcore EM, one hardcore Anesthesia, one Orthopaedic surgery or Trauma surgery, one PM&R (weird, and he changes a lot), one in the same boat as me (EM or Anesthesia, but CCM most likely added), and one that I'm not sure of (I think EM or FM).

I suppose things will sort themselves out a bit more in rotations. I'm starting third year with surgery, and hope I have some time to talk to the doc on the other side of the drapes, and finish with EM at our level 1 trauma center (would have perferred the smaller hospital that's also the only certified chest pain center in the region). Mid-level issues keep trying to push me away from Anesthesia--will there be a job for me in anesthesiology, not perioperative medicine when I get out?--and the thought of dealing with the same trolls that I bring in to the ED for the rest of my life sometimes pushes me away from EM. Eh, we'll see what happens.

 

[proman]

I went to school to do EM. Then I realized I hated the ER. Now I'm doing anesthesiology & CCM (+/- cardiac anesthesia). Anesthesiologists routinely take care of sicker patients a greater portion of the time, and that's why I wanted to do medicine.

 

[viostorm]

I'm a 3rd year.

Paramedic/EMT since 1996. I still work once or twice a week throughout med school in a low stress system.

I would never do EM. My reasons are as follows:

1) 95% of EM physicians are burned out, hate (or strongly dislike) their patients. You can't go 5 minutes in the ER without hearing one of them say "Can you believe this BS? The guy does crack 5 times a day and wonders why he has heart problems." I don't want to hate my patients. I don't want to have to do every test under the sun to prevent patients from suing me. I want to like my patients and for them to like me.

2) With sicker patients EM physicians are really just a more advanced triage system... aka finding someone to take care of them. Overall, EM docs don't do trauma, at my hospital they aren't even in the room on a trauma alert. It is the surgeon who takes care of the patient.

3) Minor patients, EM physicians do provide definitive care but at the same time they never follow up to see if their intervention actually worked. That is not my cup of tea. I want to fix someone and then see the fruits of my labor and/or screw ups.

4) It seems ER docs do not get much respect around the hospital. (This is not my opinion)

5) The patient population has some real scum in it. In my opinion, some of these people do not deserve health care. To me, a guy who gives his 6 year old son crack is not someone I want to take care of.

6) The EM patient population doesn't have the same commitment to care. There is a level of commitment when someone calls your office, sets up an appointment, and then actually shows up. Granted, its not huge, but in my opinion it is a huge difference between that and person the person who calls 911 so they don't have to wait in the waiting room.

So, for me ... I could never do the job. And, in my opinion, all the cool stuff is done in the field anyway, and if you have an advanced paramedic system they will RSI the patient before you even get a chance to touch them.

 

[146233]

Before I reply, let me emphatically state that I respect your choice not to go into EM. That said, I take issue with quite a few of your comments. ...all of them, actually.

1) 95% of EM physicians are burned out, hate (or strongly dislike) their patients. You can't go 5 minutes in the ER without hearing one of them say "Can you believe this BS? The guy does crack 5 times a day and wonders why he has heart problems." I don't want to hate my patients. I don't want to have to do every test under the sun to prevent patients from suing me. I want to like my patients and for them to like me.

Then go into IM. And even then, expect people to sue you. ...and for things you couldn't have ever reasonably been expected to do/not do. That's the nature of medicine and American society. EM docs don't hate their patients because of anything in particular, except that they choose to. In just about any specialty you will find those who "should know better" or "keep ignoring" your advice. Time to get used to it. BTW, I'm not even going to ask where you got your "95% of all EM physicians" statistic. I read somewhere that 77.65% of all statistics are made up on the spot.

2) With sicker patients EM physicians are really just a more advanced triage system... aka finding someone to take care of them. Overall, EM docs don't do trauma, at my hospital they aren't even in the room on a trauma alert. It is the surgeon who takes care of the patient.

That's at your hospital. I could show you ten off the top of my head where the EM doc is running the trauma because the surgeons are only in the room in case a chest needs cracking. This particular problem is one of location, not specialty.

3) Minor patients, EM physicians do provide definitive care but at the same time they never follow up to see if their intervention actually worked. That is not my cup of tea. I want to fix someone and then see the fruits of my labor and/or screw ups.

They never follow up by choice. There's nothing stopping them from doing so.

4) It seems ER docs do not get much respect around the hospital. (This is not my opinion)

Again, a problem at your hospital. EM is a baby specialty, so it will take time. Further, EM docs around here are shown as much respect as anyone else.

5) The patient population has some real scum in it. In my opinion, some of these people do not deserve health care. To me, a guy who gives his 6 year old son crack is not someone I want to take care of.

Wow. You know, if you want to play judge, you should consider law school.

6) The EM patient population doesn't have the same commitment to care. There is a level of commitment when someone calls your office, sets up an appointment, and then actually shows up. Granted, its not huge, but in my opinion it is a huge difference between that and person the person who calls 911 so they don't have to wait in the waiting room.

I think this argument is completely specious. You're selecting a specialty because you think your patients care more about their own health because they make an office appointment? The people that truly plot to deceive by calling EMS for a trip straight into the ED are typically benched right out in the waiting room after being triaged. Relax.

So, for me ... I could never do the job. And, in my opinion, all the cool stuff is done in the field anyway, and if you have an advanced paramedic system they will RSI the patient before you even get a chance to touch them.

Chicago's is pretty advanced. There are still plenty of tubes, needle decompressions, surgical airways, chest tubes, etc. for the EP's to do upon arrival. Your problem there is again one of location. Perhaps you're already burned out from EMS, and that's soured your opinion of Emergency Medicine. That's fine; it happens to the best of us. That's why there are low-stress specialties like Derm. Good luck.

 

[MavsFan08]

I'm a 3rd year.

Paramedic/EMT since 1996. I still work once or twice a week throughout med school in a low stress system.

I would never do EM. My reasons are as follows:

1) 95% of EM physicians are burned out, hate (or strongly dislike) their patients. You can't go 5 minutes in the ER without hearing one of them say "Can you believe this BS? The guy does crack 5 times a day and wonders why he has heart problems." I don't want to hate my patients. I don't want to have to do every test under the sun to prevent patients from suing me. I want to like my patients and for them to like me.

2) With sicker patients EM physicians are really just a more advanced triage system... aka finding someone to take care of them. Overall, EM docs don't do trauma, at my hospital they aren't even in the room on a trauma alert. It is the surgeon who takes care of the patient.

3) Minor patients, EM physicians do provide definitive care but at the same time they never follow up to see if their intervention actually worked. That is not my cup of tea. I want to fix someone and then see the fruits of my labor and/or screw ups.

4) It seems ER docs do not get much respect around the hospital. (This is not my opinion)

5) The patient population has some real scum in it. In my opinion, some of these people do not deserve health care. To me, a guy who gives his 6 year old son crack is not someone I want to take care of.

6) The EM patient population doesn't have the same commitment to care. There is a level of commitment when someone calls your office, sets up an appointment, and then actually shows up. Granted, its not huge, but in my opinion it is a huge difference between that and person the person who calls 911 so they don't have to wait in the waiting room.

So, for me ... I could never do the job. And, in my opinion, all the cool stuff is done in the field anyway, and if you have an advanced paramedic system they will RSI the patient before you even get a chance to touch them.

1) The EM physicans that were paramedics or have always wanted to do ER (and actually did an ER residency) aren't this way. They actually enjoy their job. This is at least true where I have worked.

2) This is only true in trauma centers.

3) Personal preference. Many don't want to do this.

4) If you need constant praise, then you have other issues to work out. Most of the public loves ER doctors, and ER docs are called for actual emergencies in the hospital.

5) These same patients are admitted to the hospital and seen by all other doctors.

6) This is the only valid argument I see here, but many patients will not be seen again (i.e. laceration.)

7) If you are in an urban or suburban area, many of the advanced EMS techniques are not used as they would be in a rural area. Many times you would need to reintubate the patient and start central lines, chest tubes, etc.

 

[viostorm]

I understand what you guys are saying. For me, it is not the right career.

I think the biggest thing for people to realize is that EM physicians are not specialists (except perhaps in the stablization of patients), they are generalists. A "jack of all trades master of none." Everyone has to make the choice whether they want to be a specialist or generalist in medicine.

Heart patients patients will be taken care of by a cardiologist.
Trauma patients will be taken care of by a surgeon.
Stroke patients will be taken care of by a neurologist.
Sick medical patients will be taken care of by medicine.

For the majority of patients, its not the ER doctor that will save their life, its the surgeon, cardiologist, neurologist, or medical team. Occasionally the ER doc will perform a life saving intervention (cric, ett, et cetera). Hospitals survived and patients survived before there were ER doctors (maybe not as promptly or as well), a patient showed up, the nurse called their doctor, the doctor came into see them. Most of the specialty has evolved out of a need for indigent care (people without physicians) and convenience for the primary physician and surgeon who now doesn't need to come in to take care of minor medical problems.

Its not like ER on TV.

Additionaly, you better be sure you want to work in an ER the rest of your life. There are few fellowship opportunities that would allow you to work in other parts of the hospital. For the most part, when you leave you will be qualified to work in an ER or "doc in the box."

Before you ER people jump down my throat, I am aware of tox fellowships, critical care, et cetera. If however you think that is a career goal (critical care) when starting residency it is better to follow the traditional path because it will give you more opportunities and better training. The core of EM training remains taking care of minor problems and stabilizing critical patients in the short term.

 

[SmallTownEMT]

Right now, I'm thinking of going into EM if I get into med school. I'm completely fine with being a generalist... I would rather know a bit of many aspects of medicine then a great deal about one speciality. Going into EM also wouldn't limit the types of patients I would see- young and old, medical and trauma... etc.

 

[MavsFan08]

Right now, I'm thinking of going into EM if I get into med school. I'm completely fine with being a generalist... I would rather know a bit of many aspects of medicine then a great deal about one speciality. Going into EM also wouldn't limit the types of patients I would see- young and old, medical and trauma... etc.

I agree. Another downfall to being a specialist and not a generalist is that you do the same thing over and over again. Sure you are an expert in that one area, but you don't have a clue about any other organ system after time passes by.....

 

[12R34Y]

Long time paramedic since mid '90's. Loved working EMS in the field. Am now in second year of EM residency and couldn't love it anymore than I do.

It's absolutely, in my mind, the perfect specialty. I literally get nauseous when I am not in the ER on other services (medicine, peds, neurosurg, ortho, cards, pulm etc...).

These guys work their brains out (read: long hours and call) during residency and THEN then graduate and work long hours and have call.

Not for me. My pager goes in the trash my last day of residency.

I'll be working 12-14 days a month (8 hour shifts) with no call and a part-time gig as an EMS medical director/educator etc...

gotta love it.

good luck with all of your career choices.

 

[MAnthony]

where in the US can you go from paramedicine (degree) to EM or any other specialty in doctoring?I'm curious as to which states these are. I think when you start crossing borders,educational standards start changing.



edit: Borders as in US/Canada

 

[psychbender]

where in the US can you go from paramedicine (degree) to EM or any other specialty in doctoring?I'm curious as to which states these are. I think when you start crossing borders,educational standards start changing.



edit: Borders as in US/Canada

Every state. Medics can go to medical school just like any other college student/graduate with the prerequisites. If I understand your question right, I think you misunderstood what we have been discussing in this thread.

 

[pmdc222]

where in the US can you go from paramedicine (degree) to EM or any other specialty in doctoring?I'm curious as to which states these are. I think when you start crossing borders,educational standards start changing.



edit: Borders as in US/Canada

huh????

paramedics who have their bachelors apply to medical school. Go to medical school and then choose a specialty like everyone else. If they choose EM, they do an EM residency and then become an attending...

I'm very confused by this question...

 

[gotmeds?]

I plan to keep an open mind in med school and explore what all the other specialties have to offer......oh God, that almost sounded believable! It's EM for me, all the way.

 

[146233]

Haha, we see through your clever ruse...

 

[oudoc08]

Paramedic x 7 years prior to med school.

Anesthesia all the way. It's all the fun parts of EMS (critical care medicine, procedures, medications, sick sick sick patients, etc) w/o the clinic & primary care BS that makes up 95% of emergency medicine. No snotty-noses, OD's, coughs, sinus infxn's, splinters, bug bites, funny-looking rashes, random rectal insertions, etc.

I'm still amazed that people who enjoyed prehospital medicine as medics, are able to enjoy EM in the hospital which is almost entirely different.

For those worried about mid-level providers in anesthesia, wake up. It's in almost every field besides surgery and radiology. A problem? Yes, but not exclusive to anesthesia for sure.

The psychiatrists have psychologists, the optho's have opto's, family docs and EM docs have PA's/NP's, etc. etc. etc. CRNA's just happen to be anesthesia's particular mid-level.

 

[deleted87716]

family docs and EM docs have PA's/NP's, etc. etc. etc. CRNA's just happen to be anesthesia's particular mid-level.

In FM, however, it's possible to choose whether or not you want to work with mid-levels. I choose not to.

 

[psychbender]

The psychiatrists have psychologists, the optho's have opto's, family docs and EM docs have PA's/NP's, etc. etc. etc. CRNA's just happen to be anesthesia's particular mid-level.

Well, last I checked there weren't PAs testifying before state legislatures that Emergency Physicians are completely unnecessary in the ED, and they can handle everything. Yes, every specialty has some level of midlevel encroachment (even surgery), but Anesthesiology has a slightly larger problem of it right now than Emergency Medicine.

 

[MAnthony]

Well,im confused to say the least.

The last time I checked EMS and Emergency Medicine were 2 different ballparks or games to say the least. Here in Canada,If you have a degree in EMS,its not really transferable into any medical school really. Hell,you'll be lucky to get credited for a year of university with a 4 year degree. So with that being said,you have to matriculate at the university for (4) and some places like Toronto (5) years before you can apply to med school. If what your saying is......In the US,you can go out get a degree in EMS and then apply for residency? Thats not the best thing in the world. I dont think I'd want to be visiting hospitals in the US anytime soon.....lol.

 

[MAnthony]

now if you were talking about a PA,then that's a different story.

 

[fiznat]

If what your saying is......In the US,you can go out get a degree in EMS and then apply for residency? Thats not the best thing in the world. I dont think I'd want to be visiting hospitals in the US anytime soon.....lol.

That isn't what anyone is saying.

Just like anywhere else, people apply to medical school with a BA/BS degree and then go through the 4 years of medical school followed by residency. Medics becoming doctors isn't anything special, just people who have BA/BS degrees who also happen to have gone to paramedic school as well. They apply and go through medical school just like everyone else. There is no credit given or bridge program whatsoever for medic-->MD, except I suppose if you count "life experience" or whatever, which most people agree isn't even really considered that much for admission, nevermind credit.

 

[psychbender]

Well,im confused to say the least.

The last time I checked EMS and Emergency Medicine were 2 different ballparks or games to say the least. Here in Canada,If you have a degree in EMS,its not really transferable into any medical school really. Hell,you'll be lucky to get credited for a year of university with a 4 year degree. So with that being said,you have to matriculate at the university for (4) and some places like Toronto (5) years before you can apply to med school. If what your saying is......In the US,you can go out get a degree in EMS and then apply for residency? Thats not the best thing in the world. I dont think I'd want to be visiting hospitals in the US anytime soon.....lol.

No, you're not hearing what we're saying. In order to apply for residency, you have to be in or have completed medical school. In order to get in to medical school, you have to have completed the prerequisites, X credit hours (most applicants have/are finishing their Bachelor's degree), and do well enough in class and on the MCAT. Most medics in this country do not have a Bachelor's level degree in paramedicine (few of those programs exist). Most have a 2-year Associate's degree or certificate, and may possess other degrees. As such, any medic who wishes to go to medical school must first have their Bachelor's degree (in anything) with pre-medical prereqs.

 

[gotmeds?]

In the US,you can go out get a degree in EMS and then apply for residency? Thats not the best thing in the world. I dont think I'd want to be visiting hospitals in the US anytime soon.....lol.

I suppose my Philosophy degree makes me much more qualified than someone with an EMS degree.

 

[Guyton]

My eight years on the check-you-bus gave me an appreciation for how burnt out and dissatisfied the EM physicians were at the hospitals I frequented. When I told a good friend of mine who was EM boarded that I was going to apply to medical school, his response was less than encouraging. He basically told me to get smart and be a dentist. My heuristic appreciation of the specialty is that it is riddled with persons who do not want to be there. However, the plural of anecdote is not data. So, I would encourage those considering an EM residency to do some research. I did a lot of research prior to making my decision of specialty and there were three articles in particular I found influencial.

I think the two most resounding points that set me against pursuing EM were the facts that 1) EM has the highest burnout rate among all specialties, with a sizable minority (28% of surveyed by Doan-Wiggins) of physicians self-reporting burn out by three years post residency and an average practice duration of just over ten years within the specialty. 2) EM is in the top three of all specialties when it comes to substance abuse (number two right behind anesthesiologists), litigation (number 3 by the number of suits filed rather than actual dollar amount sued for), and suicide (number 2 with psychiatrists actually leading the pack).

Here are the articles.

Doan-Wiggins L, Zun L, et al. Practice satisfaction, occupational stress, and attrition of emergency physicians. Wellness Task Force, Illinois College of Emergency Physicians. Acad Emerg Med 1995; 2:556-63.

Whitley, Allison, Gallery, et all. Work Related Stress and Depression Among Practicing Emergency Medicine Physicians. Anna of Emerg Med. 1994; 23:1068-1071

Schernhammer ES, Colditz GA. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). Am J Psychiatry 2004;161:2295-2302.

 

[Vee]

as of right now, right this minute, yes i'm planning on going into em. but it does tend to change every few weeks/months/minutes i will need to get more experience during med school clinical rotations to know for sure i suppose.

i've only been out of working ems for 8 days and i already miss it! i miss my partner just as much.

 

[12R34Y]

My eight years on the check-you-bus gave me an appreciation for how burnt out and dissatisfied the EM physicians were at the hospitals I frequented. When I told a good friend of mine who was EM boarded that I was going to apply to medical school, his response was less than encouraging. He basically told me to get smart and be a dentist. My heuristic appreciation of the specialty is that it is riddled with persons who do not want to be there. However, the plural of anecdote is not data. So, I would encourage those considering an EM residency to do some research. I did a lot of research prior to making my decision of specialty and there were three articles in particular I found influencial.

I think the two most resounding points that set me against pursuing EM were the facts that 1) EM has the highest burnout rate among all specialties, with a sizable minority (28% of surveyed by Doan-Wiggins) of physicians self-reporting burn out by three years post residency and an average practice duration of just over ten years within the specialty. 2) EM is in the top three of all specialties when it comes to substance abuse (number two right behind anesthesiologists), litigation (number 3 by the number of suits filed rather than actual dollar amount sued for), and suicide (number 2 with psychiatrists actually leading the pack).

Here are the articles.

Doan-Wiggins L, Zun L, et al. Practice satisfaction, occupational stress, and attrition of emergency physicians. Wellness Task Force, Illinois College of Emergency Physicians. Acad Emerg Med 1995; 2:556-63.

Whitley, Allison, Gallery, et all. Work Related Stress and Depression Among Practicing Emergency Medicine Physicians. Anna of Emerg Med. 1994; 23:1068-1071

Schernhammer ES, Colditz GA. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). Am J Psychiatry 2004;161:2295-2302.

I don't know where you guys work! But , dang the docs I've worked with love their jobs.

Your first two articles are almost 13 years old. hardly applicable, mostly dealing with the folks that grandfathered into the specialty not being trained into it. this was a viable option until late 80's.

I'm in residency and literally half of the staff docs have been in this inner city, urban ER (ie: the ghetto) have been there 20+ years and still love their jobs. None of them are leaving.

I was a medic for years prior to school and that was in the mid 90's and I frequented about 10 suburban/community ED's and they were the inspiration for me going to medical school and specifically pursuing EM.

they were encouraging and literally stated over and over that you couldn't beat the flexibility, pay, variety.

Most worked 12-15 days/month (8-10 hour shifts), many also did community college EMS lecturing, teaching, many were part time medical directors for EMS services.

LIterally, my dreamlife.

Working full time at several of the local community hospitals 12 days a month, as well as being involved with medical direction and lecturing for EMS.

Can't wait.

good luck in anesthesia (they usually watch from the door as we intubate our traumas and who really needs anesthesia anymore now that we have intubating LMA's, fiberoptic scopes, bougies, glidescopes, wands etc...)

just teasing ya a little don't get all riled up. Anesthesia was my second choice.

good luck (for real).


later

 

[MAnthony]

I understand now. Sorry for the misunderstanding.