Emergency Medicine

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Emergency Medicine

• Larry Raney, MD, FACEP, FAAEM
• Associate Professor
• Director of Emergency Services
• Director of MEDUCARE
• Residency in EM Richland Memorial, Columbia, SC

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• Interested in EM?
• Take the ER-MCAT!

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• 1) Its 3 a.m. Christmas morning. You would
  like to be
• snuggled in bed with your honey.
• expanding your knowledge of profane words by
  listening to an alcoholic vent his spleen.
• dodging the emesis from an awakening heroin
  addict.
• listening to a intern with an IQ of 85 explain
  why a comatose diabetic does not need admission.

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• 2) Can you drink 5 cups of coffee at the start of
  a 12-hour shift and then refrain from urinating
  until your shift is over?
• You couldn't possibly be serious!
• No one needs to drink 5 cups of coffee.
• Don't I get a 15-minute break every 4 hours, as
  mandated by federal law?
• Yes

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• 3) Sleep experts recognize that shift work can
  shorten your life span by up to 10. How do you
  plan to deal with decades of sleep deprivation?
• I will get drunk and pass out.
• I will drink 5 cups of coffee at the start of
  every shift.
• My shortened life span means less night shifts
  Ill have to work
• I dont have sleep problems now that wont be
  an issue!

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• 4) How many times per day can you wash your hands
  before your skin becomes as dry as parchment?
• 2 times
• 4 times
• 6 times
• 50 times

Unless you answered (d), you will be spreading
more disease than you will be curing.
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• 5) Can you touch a maggot-infested person without
  wincing?
• Yes
• No

Obviously, only (a) is acceptable. In the ER,
you will be called upon to deal with far more
revolting problems.
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• 6) Can you take physical and verbal abuse from
  patients without retaliating?
• Sometimes
• Invariably
• Almost always
• Never

This one isnt intuitive there is the
occasional patient that really needs a hard
take-down
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• 7) Imagine working as hard as you possibly can
  for 12 hours. Can you do that year after year
  without pulling out your hair, getting an ulcer,
  or going crazy?
• Hell no!
• For the privilege of being able to call myself an
  ER doctor, I'm willing to subject myself to any
  level of abuse.

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• 8) Why do you really want to be an ER doctor?
• After watching the TV show ER, I'm convinced it
  will do wonders for my sex life.
• I enjoy being exposed to a wide variety of
  communicable diseases.
• My skin is too bad to make me a credible
  dermatologist. or plastic surgeon, etc
• Accepting the many inherent drawbacks to this
  branch of medicine, I choose to devote my life to
  providing excellent care to patients who need a
  caring, competent, and thorough physician.

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ER-MCAT Results

• Score
• Six or more Welcome to EM!!
• Five or less You are NORMAL!
• Congratulations!

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Training
Seriously, now...

• Residency
• Three to four years
• First year rotating internship
• More heavily in ER itself next two
• Very competitive

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Training

• Boards and Continuing Certification
• Written
• Taken first year out
• Oral
• Year after completion of written
• ConCert/LLSA
• Yearly online 40 question open book test
• Recert every ten years

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Pros

• Can be very exciting
• You can treat ANYTHING!
• Initial stabilization
• The first hour or so
• You are a Real Doctor
• No call
• Fixed hours

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Cons

• To specialists, you are NOT a Real Doctor
• Changing??
• Shift work
• See the intro

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Average Week

• From 32 t0 50 hours
• Academic, from none to 32 clinical
• Scheduled hours, no call
• Range from full shift work to set shift
• Days only gets paid least
• Nights only higher pay, higher burnout

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Pay/Malpractice

• Low of about 150,000/year
• High around 300,000/year
• Lower pay most desirable jobs
• And visa versa
• Malpractice about mid level, but rising
• Average ER doc in US gets sued once every 5 years.

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Demand

• About 25,000 ED jobs in US alone
• About 5,000 current ABEM certified
• Residencies graduate about 1,000/yr
• Just keeps up with retirement/turnover

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So Why Did I Choose ER?

• Be a real doc
• No call
• Nothing I cant handle
• I hate call

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So Why Did I Choose ER?

• Action and excitement
• I really hate call
• I hate seeing the same patients repeatedly for
  the same problems
• Did I mention I hate call?

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So Why Did I Choose ER?

• I liked the thought of being able to travel
  extensively (Locum Tenens work)
• I loathe and despise call
• I hate the idea of not knowing how to handle a
  problem that is given me
• I like the idea of being a Renaissance doc

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So Why Did I Choose ER?

• AND I REALLY, REALLY HATE CALL!!!

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For More Info

• On the web
• ACEP.org
• AAEM.org
• SAEM.org
• ABEM.org

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Questions?