Why Emergency Medicine?
Trying to figure out what kind of doctor you should become? Wondering which specialty you should choose? Then SheMD's Why Specialty Series is perfect for you! We're bringing you female physicians sharing WHY they chose their specialty. Today's post is on why Dr. Parsons (one of our SheMD founders) chose Emergency Medicine and why it is a great field.
When I started medical school, I was planning on taking over my father’s internal medicine practice. I had worked in my father’s office in the summers. I had no CLUE about what would fit me best.
My second year of medical school I traveled to Thailand on a medical mission trip with a bunch of EM physicians and EM-bound medical students. They encouraged me to shadow in the ED. One shift and I was hooked. I loved the pace - it fit my high-energy personality. I tried to keep an open mind during my clinical years.
As I went through 3rd year:
I enjoyed EVERY rotation, but typically only for the first few weeks.
I enjoyed surgery. I loved the trauma patients when they first came in but got bored in the OR.
I enjoyed OBGYN, but was ready to take care of male patients.
I enjoyed Peds, but my one straight week of well-child checks almost made me drop out of medical school.
I enjoyed psychiatry, internal medicine, family medicine and more….
But I was the HAPPIEST when I was in the ED doing consults. And I remember being frustrated that when I went down to consult on the patient, they already had a diagnosis. The ED had “solved the puzzle” in the majority of cases. I found that I LOVED the undifferentiated patient. I loved trying to solve that puzzle myself.
After completing my residency and working for a half a decade since then, I’ve found:
I still love the adrenaline rush when sick patients came in.
I still love the mix of patients we see - every age, race, and socioeconomic status,
I still love the mix of pathology that we see - literally EVERYTHING!
I still love the schedule of EM. I love having days off in the middle of the week to run errands or go fishing when the rest of the world is at work. And I love my Saturday morning drive to work with no traffic, even if it means I’m working a weekend.
I still love trying to solve the puzzle, although I recognize that some puzzle are not for me to solve in the ED.
And I really really love that I can take care of patients REGARDLESS of their ability to pay!
There are things about my specialty that are challenging. Things I do NOT necessarily love. And I think to truly understand a specialty you have to know the GOOD and the BAD.
What I do NOT love:
Missing things is hard. You WILL miss things. Period. I work a lot of 3pm to 11pm shifts. I know that there will be a LOT of nights where I will not be putting my baby to bed with a bath, bedtime story and snuggles. You will find creative ways of making it work.
Also, holidays are hard. You will NOT celebrate Christmas, Mother’s Day, Thanksgiving, and Easter on the assigned dates each year. You will miss holidays.
Nights are hard. When I was a resident, I thought working nights was a piece of cake. I was young. And I was so sleep deprived I could sleep ANYWHERE, ANYTIME. These days, sleeping 8 straight hours during the day post-overnight shift is harder. And I hear it only gets worse as we age. Night shift work can also have negative health benefits, which is something to consider.
Monday Morning Quarterbacking is HARD! We take care of patients with little to NO information when they walk/roll through the door. It is easy for consultants to be critical of our initial management of a patient when more information is obtained. We call this Monday morning quarterbacking. Unfortunately it is common in medicine and it is not just EM physicians that experience it, but we do a LOT!
Not being the EXPERT is HARD. In EM, you are almost NEVER the expert. We are experts at initial resuscitation. We are the expert you want when someone calls for a doctor over the plane loud-speaker. We are experts in our breadth of knowledge, but not our depth of knowledge. For some, knowing EVERYTHING about a subject is important. Doing the same procedure multiple times a day until it is fine-tuned is what they enjoy. In EM, you have to be able to accept that you know a lot about a TON of different things, but then you call an expert that can take the next steps. Our job is to know what WE need to know and then “one step further” so that we know what we need our consultant to do.
If you're considering EM, it is important to know that there are a LOT of different types of EM programs and jobs in your future. When I was a medical student, I had little guidance on entering Emergency Medicine. We did not have an EM rotation during third year. It wasn’t until fourth year that we really got exposure (other than 4 shifts in the pediatric ED). There are COUNTY, COMMUNITY AND ACADEMIC programs, and there are 3-YEAR and 4-YEAR programs.
In a survey done in 2016, the TYPE of program was the MOST IMPORTANT factor for medical students in choosing a residency program.
Now BEFORE I have explain the types, I will give my disclaimer. We, as residency program leadership, CANNOT agree on what delineates each of these types of programs. Many programs will be a hybrid of sorts. So these are not hard and fast rules.
(Note: I trained (and work) at a county program. This is where my heart lies, so I may be biased but I very much see the downsides and know a county training environment is NOT for everyone)
Are underfunded programs typically in urban settings that are considered safety net hospitals
Most of them are funded by the county (or state) to keep their doors open.
They may lack some of the resources seen at academic settings.
That does NOT mean that education and research are not still happening however. Most are affiliated with medical schools and have rotating students.
Most county programs allow residents a considerable amount of autonomy (meaning you get to function at a higher level). For example, you may be doing procedures without a faculty member standing next to you. Maybe a senior resident helps you the first time. As a medical student, I really liked more directed learning, but as a resident I surprised myself by flourishing with the autonomy given. It does require YOU to push yourself to read more and learn more at times on your own. That is true for most residency programs though - no one is telling you when to study, how to study or what to study.
These are typically very busy hospitals with long wait times. They are prone to overcrowding. This can be a positive or a negative for education. I enjoyed having the ICU patients in the ED longer as I became responsible for their care for longer periods of time. I did not necessarily enjoy longer visits for the psych patients. You also get VERY good at moving patients and beds around QUICKLY to make space for even sicker patients. Or moving intubation equipment to beds that patients are NOT typically intubated in!
Students and residents may find themselves dealing with more social issues ie. How do I get this homeless patient follow up? How can I help this patient get the needed medications that he/she cannot afford? Where is the nearest shelter and is it open? Etc.
If you’re interested in what county programs are like, watch the CODE BLACK Documentary!
These are at the local hospital and can still be very high volume places. Also these can still take care of impoverished patients but typically will have a better payor mix.
Patients typically will move through the system faster.
May be associated with a nearby medical school and have teaching opportunities or may not.
Faculty may be seeing their own patients while the residents are also seeing patients. This depends on the reimbursement model that the group has.
Are associated with medical schools and universities as well as extensive research
Less autonomy than other programs. More one-on-one teaching. Better for students that really want to be shown how to do things repeatedly and need more guided education.
Great for research. (did I mention that already)
Often have a number of fellowships, tracks and other interests available to students/residents such as medical education, ultrasound, toxicology, pediatric EM, administrative, wilderness medicine, and international EM.
Typically located at quaternary care centers where you may see more atypical pathology, transplant patients, ECMO, LVAD’s etc and less bread and butter EM.
Volumes may vary.
3-YEAR VS 4-YEAR PROGRAM
EM residencies can be EITHER 3 or 4 years. Weird right?!?!
Many students struggle with the question of 3 vs 4 year programs.
First, you DO NOT have to pick between the two - you can apply to and interview at both 3 and 4 year programs and pick which you like best.
Second, many ask WHY would I consider doing a 4 year program? Are 4 year programs better? Do they make me a better doctor?
The biggest difference between 3 and 4 year programs will be the amount of time dedicated to electives and finding your "niche" in Emergency Medicine. If you plan to go into academics, that may be very helpful. If you already know what niche you're interested in and plan to do a fellowship, you really do not need a four year program... you can do 3 years and a fellowship.
NO there are amazing three year programs that will make you phenomenal doctors and there are amazing four year programs that will make you phenomenal doctors. The length of time you spend does not indicate how great of a physician you will be.
All EM programs have the SAME core requirements. Four-year programs have the added requirement to provide an in-depth experience in areas related to emergency medicine, such as medical education, clinical- or laboratory-based research, or global health in order to be approved by the ACGME.
This is truly a CHOICE for you as a student!
Hopefully this helps all those students interested in a career in Emergency Medicine. I am lucky to LOVE what I do each day and to know I go to work and make a DIFFERENCE in the lives of the patients I touch.