I am a current EM resident at UW-Harborview and would like to chime in, as there has been quite a bit of incorrect and outdated information shared here.
1) Trauma Airways - The anesthesia attending is supposed to come for all "Full Trauma Codes". These are typically hemodynamically unstable patients who have a high likelihood of being crashed to the OR. Many of them have been transported by helicopter EMS from rural hospitals and are therefore already intubated. The primary purpose of anesthesia coming down is to scope out the situation and assess the patient before they get down to the OR, which makes sense for them. 95% of the time this means anesthesia walks into the resus bay, looks at the patient briefly from the foot of the bed, and walks back down to the OR to go drink some more coffee. I have only seen anesthesia intubate 2 trauma patients within the past year. One was during a hectic MCI where 3 patients needed to be emergently intubated in the same ED resus bay at the same time, so the anesthesia attending helped out by intubating a patient while the EM resident and EM attending each tubed the other two. The other anesthesia intubation was one where the senior EM resident allowed an anesthesia intern to intubate since they asked if they could do it. Our senior residents are in general very confident with airway management and have had ample opportunities for ETTs of their own, and the PGY4s are expected to supervise intubations for junior residents. The only circumstance in which an anesthesia attending directly supervises an EM resident in the ED is if we had called them for help with backup for an awake intubation or other another anticipated difficult airway. In those (rare) cases, the anesthesia attending usually just stands around as backup while the EM resident and EM attending manage the airway.
2) Other procedures - Harborview is a very busy trauma center and there is no lack of other procedures available to us. The only procedure I could imaging someone having trouble getting enough of would be chest tubes, since we don't have a formal system like some other shops where EM and Gen Surg alternate procedure days. Since as an EM resident your primary job is "Trauma Doc" (aka running the trauma code and managing the airway), Surgery does do the majority of chest tubes. That said, we have a very good relationship with the surgery residents and it is common to tell the gen surg resident that you would like to do the chest tube while the EM attending takes over for you and runs the trauma code. This happens often and there is no fighting or drama between EM and surgery for procedures. The Trama Doc role in general is excellent for getting procedures since you are often managing 15+ trauma patients at once- your role being to run the trauma codes, do procedures, and supervise 3 interns (who write all the notes leaving you with no charting!). I have had shifts where I have placed a Cordis, intubated, and done a lateral canthotomy all in one 8 hr trauma shift. The myths about Medic One paramedics placing central lines in the field are pretty much just that...myths. I've yet to see that happen.
3) Stigma & Feelings - The vast majority of the IM and Surgery attendings wanted and advocated for the creation of an EM department/residency for over a decade before it was created (when you think about it, we make their jobs much easier by not having to staff the ED). The issue was one with Dr. Copass and his own biases/egomania, rather than some sort of systemic hatred for the field of EM. Just to reiterate, Surgery does not run the "trauma side" of the ED. Rather, surgery residents rotate there as "Trauma Doc", under the direct supervision of an EM attending and often under the supervision of an EM PGY4. Compared to some well-established programs (Highland, Vanderbilt, etc.) where general surgery runs all trauma codes and the EM resident rotates under the supervision of a surgery attending, the EM-run system at UW seems preferable. Our already very good relationships with IM/Surgery/Anesthesia were demonstrated when the hospital's other departments voted unanimously this year to grant the ED departmental status. There is also no stigma in the community towards UW EM. Some of our recent grads have gotten very competitive jobs in the Seattle metro area, and others have been accepted into competitive fellowships. This is something that I was concerned about before matching here, but having talked to a few local ED directors (many of whom are actively recruiting our senior residents), I am not concerned about job prospects at all.
Other things:
Benefits - it's true that UW historically payed their residents poorly. Fortunately, last year our resident's union (the UW Housestaff Association) negotiated a new salary and benefits package with UW and I feel like we are now fairly compensated. Interns now make around $60,000 annually when you factor in some of our extra stipends, and PGY4s can expect around $70,000. Remember that WA state has no state salary tax too.
Rotations - I agree that our Ortho rotation as a PGY2 is fairly low yield. Fortunately, our program leadership has been very responsive about listening to resident feedback about rotations and making changes. They recently dropped our general surgery rotation as interns since it had abysmal reviews, and are considering changing our ortho rotation as well. We get 6+ total ICU months which is as many or more than just about any other EM rotation. In general I think our schedule is very good...not too easy but not soul-crushingly unrelenting either. We do work a lot as interns (21 shifts of 10-12 hrs in 28 days) but by the time you are a senior resident your schedule improves and is pretty cush (closer to 16-17 shifts of 8-10 hrs per 31 days, about half of which are "pre-tending" roles where you are supervising junior residents and have no note writing obligations).
General thoughts:
You will get plenty of procedures here and do not need to worry about fighting between services (any more so than you would have to deal with the run-of-the-mill dick measuring contests encountered at all teaching hospitals). That said, don't pick your residency based on where you will get the most procedures or where your department has the most relative prestige compared to others. I agree above with the "geography and gestalt" advice. For UW, the geography is undoubtedly great and the gestalt part for me was largely the faculty (very young, approachable, and geographically diverse) and residents (outgoing, outdoorsy, and good at drinking beer), who make working here a ton of fun.
In general, the training you get at UW is excellent. As mentioned above, the mix of County/Academic/Peds/Community is really great and having been here now I couldn't imagine training in an environment without that diversity...working in any of the above settings gets old after awhile and each setting has different challenges to offer. The EM program here has become insanely competitive in a short period of time and I would be shocked if UW is not an EM powerhouse residency in a short period of time.
