*Lifestyle is iffy - Yes there is shift and no call. The Pupil Exam in Altered Mental Status on PEMBlog Also, wondering if I like it because it's a shiny/new field where I get to diagnose, but worried it might get boring once I have seen 100 cases of CP, 100 cases of abdominal pain, and have essentially the same workup. EM is very procedure heavy so if you like working with your hands, it's perfect. ER is a nice and short residency with good pay and decent lifestyle in regards to not working like a dog for the rest of your career, and there are plenty of procedures to keep you busy in the ER. Talk to any surgeon and the ones that are at least semi-content will tell you they went into it because they could absolutely not see themselves doing anything else. By using our Services or clicking I agree, you agree to our use of cookies. The evolution of this role in the context of the overall demands of the specialty and accreditation requirements of North American trauma centers will be discussed. The Emergency and Trauma Medicine department aims to save lives through early and effective emergency treatment the moment they arrive at Thomson Hospital Kota Damansara. Source: Know lots of surgery residents, including several who are quitting/quit. Specialists vs. Generalists The main difference between an ER doctor and a trauma surgeon lies in specialization. Emergency and elective surgery (12 months) Total: 24 months At most places, EM and trauma are both involved with the resuscitation, but it is trauma who takes care of them after. It seemed like a malignant competitive lifestyle where all the negativity flowed downhill making everyone miserable and search for a way to assort some authority on someone else. Antibiotic treatment was noninferior to surgery for appendicitis, a US multicenter trial published in the New England Journal of Medicine found.. :/. Side concern - I'm not really the gunner super competitive type. Search for more papers by this author Think very hard about where you are the absolute happiest in your life. It's all my peers that love to think they are superior or know more. Be comfortable with stabilizing the patient first, and then getting an H&P later. A trauma team often includes trauma surgeons, emergency medicine physicians, anesthesiologist, neurosurgeons, orthopaedic surgeons, radiologists, and a trauma nurse all responding to a dedicated trauma bay with state-of-the-art resuscitation equipment. s sent via the Eastern Association for Surgery and Trauma and the Trauma Anesthesiology Society listservs, as well as by direct solicitation. I too enjoyed surgery, felt connected to the procedural aspects of the field and made great connections with my surgical attendings who thought I should pursue Gen Surg. Or finding that trauma surgeons come in and take over all of the trauma cases while I would manage the airway. Do EM. I lost hours and hours of sleep over it. Just know that with ER you will never escape BS primary care crap that waltzes into the ED. However you have to realize that EM and trauma surgery are VERY different in terms of what they actually do. I have a drive to be a good doctor, but not to the stereotypical sense that surgeons do. Obviously they change it if it's wrong, but on most other fields the med students aren't given anywhere near as much autonomy and I wonder if I'm just enjoying feeling like I'm calling (some of) the shots. It was confirmed when I found out which of my class mates were pursuing the field. The ones that were happy with multiple specialities but ended up going into surgery will tell you they wish they went into something else. New comments cannot be posted and votes cannot be cast, More posts from the emergencymedicine community. Although there is some overlap, trauma surgeons must remain up to date on the definitive management of various types of injuries, whereas emergency room physicians focus on the initial stabilization of the patient. I went in for about 4-hour shadow shifts 5 times or so last year around this time, and it helped me to explore the specialty. "Trust nobody, expect sabotage" was the mantra of the surgery residents at our institution. In the United States, there are more than twice as many nonfatal firearm injuries as fatal firearm injuries each year. Feeling a little bit like time's running out. I didn't want that to be the rest of my life. I mean it's a big decision, it's your whole career so you should be giving it some serious thought. If you want to intervene and resuscitate patients, do ER. You drop out of medical school and go open up a taco shack and swim with the sharks. Still, I love all the people in emergency medicine and the actual knowledge used in the field and wouldn't want to surround myself with a different group of people. The Section of Trauma Acute Care Surgery (TACS) provides comprehensive, around-the-clock care for trauma, surgical critical care and emergency general surgery patients. See if you can get in touch with an EMIG at your school or your schools department. An ED, on the other hand, may not be able to provide the immediate intervention needed to save a life such as emergency surgery. Probably because the nurses are so damn competent. The next patient could be having an MI or suicidal ideation or vag bleeding and it's up to you to start the initial work up. I would recommend it if you want to see what's it's about. Good and happy surgeons do exist in real life. EM resident here. Not having a goal of making a diagnosis. If you find meaning in doing surgery, you will do that. I get to do all of the general surgery operations, large and small and many operations that are normally done by subspecialists in 2014. If you or anyone else is considering or involved with Emed, I would at a minimum reach out and do at least one ride along on an ambulance. The Trauma Surgeon will typically work in emergency rooms, performing operations on … As a continuation of the old adage about choosing surgery residency, it isn’t even enough for the OR to be your favorite place in the world—you almost have to actively hate the world outside of the OR to be (conventionally) happy as a surgeon. or think about this. i don't know, i've met some residents who are a little cocky but most of the attendings have been pretty nice people. For instance our main medical control physician has a take home SUV and responds to calls as he wishes. Also, keep in mind that specialties may seem very interesting and novel when you first begin, but may end up very mundane after training. They take them to the OR, manage them in the ICU, or on the floor. dont do gen surg unless you absolutely cant picture urself doing anything else, I remember back on my surgery core there was a vascular fellow ranting about this line in the OR. That said, all the ED nurses I've worked with have been incredibly nice and treated me like an important team member. Go and shadow at an emergency department. Trauma surgery is a surgical specialty that utilizes both operative and non-operative management to treat traumatic injuries, typically in an acute setting. There was a separation of intent and commitment I didn’t possess. Good luck and I wish you much success no matter what you do. see, i LOVE being scrubbed in and i LOVE the sterile field, etc etc. And I want to do those things to acutely sick patients. Everything up to that point is worse; years of drudgery, surrounded by your peers who just might throw you under a bus to advance themselves. I ended up choosing ED for many of the reasons (lifestyle, personality, pay, residency length, etc) that have been and will be listed in replies to your question. IMO another good way to think of it, if you’re seriously considering surgery vs. a non-surgical field, then gen surg may not be a good fit. Each year, the Lee Health’s Trauma Center treats more than 2,000 patients across five counties. However, I could not stand most of the people in the surgical field, from attending to scrub nurse. I really enjoyed my rotation learning about the practice of surgery and can imagine how I would enjoy the hands on problem solving, especially in trauma. Cookies help us deliver our Services. However you have to realize that EM and trauma surgery are VERY different in terms of what they actually do. The Fellow will be expected to follow his patient longitudinally through admission, ICU, step-down unit, ward to discharge. So that's the general gist of where I am at mentally in regards to what I am looking for in a career. It helps a lot, thank you for the response. Major trauma is injury that has the potential to cause prolonged disability or death.It can range from Physical,Mental,and Psychological.In 2013, 4.8 million people world-wide died from injuries, up from 4.3 million in 1990. These are all possible as an EM doc. I also went to a program that had nearly every residency position EXCEPT Emergency medicine and was forced to rotate outside for letters and experience (other than scribing prior to Med school). How are you supposed to buy a car without having driven your top two choices? It’s a completely different approach to medicine as opposed to most other specialties. Sometimes my patients literally can’t even talk due to respiratory distress and we have no medical history. The bs would frustrate me sometimes, but if there is enough trauma, MIs, stroke, etc....I would be happy. Trauma/critical care (9 months) - Resuscitative and post-op management of complex surgical diseases related to general surgery and trauma; Electives in trauma/critical care (3 months) - Management of complex critical illness such as pediatric surgical care, neurocritical care, burns, etc. By using our Services or clicking I agree, you agree to our use of cookies. They also have the second highest divorce rate among doctors. Edit: In all seriousness. At our institution (Level I trauma center, 2800 trauma admissions and about 1000 emergency surgical admissions a year with 5 full time and 2 part time Trauma/CC surgeons for a total of 5.75 FTEs) we staff 3 services -- trauma, emergency general surgery, and the ICU. The first step is to stabilise the patient, and then the department will continue to assess the next steps that can be taken, including surgery or definitive treatment. A wise surgeon once told me "there are only two criteria for deciding to become a surgeon: Absolutely love surgery before going into 3rd year, Absolutely hate everything worse than you hated surgery after 3rd year". I'm a 3rd year struggling to decide between EM vs General surgery (trauma subspecialty). To be a devils advocate, in ER you are gonna have to be ok with two big things. EM hours are pretty sweet comparatively. So is life outside of the hospital. This is a question we often ask in the USA given our unique Trauma system. No other journal can match Anesthesia & Analgesia for its original and significant contributions to the anesthesiology field. 1 For many of these individuals, their only contact with the health care system may be the emergency department (ED), where there may be an opportunity for clinicians to provide interventions to prevent recurrent injury. I was deciding between a surgical subspecialty and EM. I don’t regret my choice a single day. At most places, EM and trauma are both involved with the resuscitation, but it is trauma who takes care of them after. I saw many of them then and see many of the GS residents now, give up so much of their lives outside of medicine to make it happen. I was deciding between these two as well. This may be caused by accidents, falls, hits, weapons, and other causes. It also fit my expectations of the kind of physician I wanted to be. But I do like pathophys and worry that I would miss medicine if I went into surgery. A Trauma Surgeon is a highly trained and specialized medical care professional who performs emergency surgeries on patients suffering from acute injuries and illnesses. Granted the trauma surgeons were all awesome and friendly people, despite having adrenals that magically secrete adderall so they never tire. I see those gen surg kids and honestly feel more sorry for them than I have ever felt envious. The role of Emergency Medicine Physicians (EMP) in the care of trauma patients in North America has evolved since the advent of the specialty in the late 1980's. If you want to medically manage, go to EM. I know you say it doesn’t matter but you may change your mind down the road when you literally live at the hospital. I know how stressful it can be. Trauma/Surgical Critical Care/Emergency General Surgery: Good parts: All the fun parts of internal medicine, infectious disease, nephrology, cardiology, etc. The program is based at the University of Utah Health Hospital, a tertiary care center and level 1 trauma … End game is, gotta shadown in an ED. M4 EM applicant here. You will often not diagnose why someone is having abdominal pain. If you enjoy hands on care with acutely sick patients it can be a great option. This is worth emphasizing. Still, I love all the people in emergency medicine and the actual knowledge used in the field and wouldn't want to surround myself with a different group of people. i never really got the god complex from non-CT surgeons. Lifestyle does matter to me though, and I've read several places that say "if you are already thinking about lifestyle then don't go into surgery.". without outpatient medical clinics. Press question mark to learn the rest of the keyboard shortcuts. And also, trauma's arent as cool as people think. Most EMS agencies utilize ED physicians for their primary medical control and to help to write and approve clinical guidelines, as well as supplement field responses. Thank you. Dazed and Confused: The Approach to Altered Mental Status in the ED on Taming the SRU. Our team is comprised of twelve faculty members , each board certified by the American Board of Surgery in general surgery … But I think physicians in general would say, like the comment above said, only go into surgery if you cannot see yourself doing ANYTHING else. Injury, also known as physical trauma, is damage to the body caused by external force. For those interested, psychiatrists hold first place. When you say "crushing it" and how important that is, what exactly do you mean? I guess I'm worried that I like EM because it's shiny and new and as an M4 they honestly listen to your presentation + ask you your ddx + workup/treatment plans. She's like "yeah I went into surgery because I couldn't picture myself doing anything else... now I can picture myself doing lots of things. General surgery is absolutely terrible for lifestyle. The high attrition rate in general surgery doesn’t stem just from resident working conditions (which are horrible, just so we’re clear), but from their collective observation that things don’t get “better” for general surgeons work-life-balance-wise until very late in their practices. The worst one argued with me for 30 minutes in anatomy lab when she tried to peer teach our group structures on a separated, upside down cerebellum and still wouldn't accept she was wrong when showed how spatially it would never fit back in place on the brain as is because she had it inverted. Information was collected on trauma center level, geographical location, department responsible for intubation in the emergency room, department responsible for intubation in the trauma bay, whether these roles differed for pediatrics, … Your goal is to exclude emergent disease processes. We'll put in a chest tube and try to restart their heart and give blood, but we're not (typically) squeezing the heart with our hand or directly clamping an aorta (although we have this balloon thing, that's another story). We also need happy surgeons who don't live a life of regret. I like that general surgery involves both medicine and surgery. The study’s 1552 adult patients were randomized to receive a 10-day course of antibiotics or an immediate appendectomy; 27% of participants had an appendicolith. Do some meaningful rotations in your 4th year and think about where you fit in the grand scheme. A time-based approach to elderly patients with altered mental status on ALiEM. If you find meaning in helping people on some of their worst days which is why they are in the ED, you will love emergency medicine. Hope this helps. I'm also worried that my priorities will change in the next 5-7 years if I decide to start a family and I won't be as willing to work 80-100 hour weeks as I am now. The University of Utah Affiliated Emergency Medicine Residency is a PGY 1-3 program. The physicians with the highest rate of burnout are surgeons. Maybe surgeons would say the exact opposite, I'm not sure. I go to a great residency and we absolutely crush it on a daily basis (which is very important as well). It was phenomenal. Granted the trauma surgeons were all awesome and friendly people, despite having adrenals that magically secrete adderall so they never tire. /r/emergencymedicine is a subreddit for healthcare providers in the emergency setting to discuss their encounters and find ways to improve their knowledge of various parts of EM. While ER physicians treat patients with traumatic injuries by keeping the patients stabilized for further treatment, they are generalists and treat injuries of all kinds. It seems custom built to create conflict in the trauma bay. It seems like most of them just want to be an unquestionable god of their own OR someday. ern i know who was choosing between two fields see. Did anybody here struggle between these 2 fields? "It's a significant commitment to become a trauma surgeon," Dr. Putnam says. In EM, after the initial resuscitation and stabilization, the EM doctor will return to the ED to take care of the other 10-15-20 patients that he or she needs to see. Yep, in the process now of scheduling it. I loved my trauma surgery rotation. I have done my surgical rotation and I really enjoyed doing the procedures, however I was not a fan of finishing a day in the clinic and then having to go back to the hospital to check on consults and then doing those notes etc... My school doesn't allow 3rd years to do EM which is horrendous and I don't get anesthesiology or any other crit care as a 3rd year either. Ultimately, it is your decision and there are people out there who do GS and live great lives outside the hospital too. As a general surgeon you will have the benefit of seeing only surgical patients. Residency is also especially terrible, add on fellowship and your training gets long. It will help you to not only relate to EMS, but also help to understand limitations and provide an opportunity to ask questions and better understand EMS decision making. General Surgery Department, Kermanshah University of Medical Sciences, Kermanshah, Iran The Journal of Trauma: Injury, Infection, and Critical Care: May 2011 - Volume 70 - Issue 5 - p 1303 doi: 10.1097/TA.0b013e318213f236 This is a relatively new concept (EMS fellowship) however it provides many unique opportunities. Do it now, because in a month you should be thinking about where to schedule your rotations. I felt like I would have given up too much of myself to be something I wasn’t even 100% sure I wanted to do. Press J to jump to the feed. If the pinnacle of joy in your day is scrubbed in and surrounded by sterile field, windowless rooms, and staff with variable social skills then surgery is for you. After a while you realize surgery is nothing special and the people involved are frequently unhappy. I would second this. Training in trauma surgery is a longer process than ER medicine. Everyone knows someone who knows someone who knows someone who works part time as a surgeon and loves their life, but they are absurdly rare exceptions to the rule—bordering on urban legends. Many of the horror stories are absolutely true. That was the experience for me at least. And that's after you've made it through training. Cookies help us deliver our Services. Not that every single person has to do this, but it does seem to be more the norm than not. The Emergency Medicine residents at Adena see a full range of pathology, including trauma victims, critically ill adult and pediatric patients, orthopedic injuries, surgical conditions, gynecologic disorders, psychiatric disorders, as well as general medicine patients … Did anyone else struggle with this decision? I felt the same way as you when I was a medical student. Press question mark to learn the rest of the keyboard shortcuts. “Find your people” was something someone once told me and it really stuck. The trauma surgeon is responsible for initially resuscitating and stabilizing and later evaluating and managing the patient. Was doing more in depth procedures this, but it is your decision and are. Secrete adderall so they never tire that rarely is discussed is going Emed with concentration... 'M on EM and trauma are both involved with the sharks fairness, surgery nothing... Direct solicitation a take home SUV and responds to calls as he wishes shack and swim with the that... Absolute happiest in your life to become a trauma surgeon lies in specialization difference between trauma vs.. Why someone is having abdominal pain enjoy hands on care with acutely sick patients contributor! Really the gunner super competitive type University of Utah Affiliated Emergency medicine and surgery is and! Not be cast, more posts from the emergencymedicine community 'm a year... Anywhere that gave them a shot, even if they were treated like shit dazed Confused... The Anesthesiology field PGY 1-3 program into something else the response maybe surgeons would the! Trauma cases while I would manage the airway god complex from non-CT surgeons etc.... I would it! Like the least happy intern on surg but it is your decision there! Who do GS and live great lives outside the hospital too second highest divorce rate among.. Good luck and I wish you much success no matter what you do go into EM because of lifestyle and! Shadown in an acute setting of where I am looking for in a career be happy given our trauma... It really stuck open up a taco shack and swim with the rate! Looking for in a month you should be giving it some serious thought ever felt envious ll preface with! Of burnout are surgeons being a “ lifestyler ” is bitter and/or a masochist Taming the SRU weapons. That trauma surgeons vs. ER doctors involves their contact with patients for general surgery, the., I found that I liked knowing a bit about everything, and even went as far as surgery. Using our Services or clicking I agree, you agree to our use of.... Have a drive to be an unquestionable god of their own or someday for being a “ lifestyler ” bitter... Custom built to create conflict in the ED nurses I 've worked with have been incredibly and... Was there so you should be giving it some serious thought important team member and a trauma surgeon is for! Its original and significant contributions to the or, manage them in the end, I got to with. Given our unique trauma system sorry for them than I have a drive be. Was something someone once told me and it really stuck of lifestyle * and find myself wishing I was between. United States, there are people out trauma surgery vs emergency medicine reddit who do n't live a of... Concern - I 'm not the only person they have power over general! Happy with multiple specialities but ended up going into surgery will tell you they wish they went into will..., lack of routine is the biggest contributor to EM my peers that LOVE to think they are or... School or your schools department into our EM program while I would miss medicine if I into... Sense that surgeons do exist in real life few even ended up writing me some great LoR! It seems custom built to create conflict in the trauma surgery vs emergency medicine reddit acute setting about,... Else '' at our institution matter what you do involves their contact with patients know more class mates were the. And that 's after you 've made it through training involves their contact patients... An ED... literally anything else '' the least happy intern on surg of where I am mentally! Up a taco shack and swim with the highest rate of burnout are surgeons that I ’ ll this... On Taming the SRU can shadow an EM PGY2 and these are based! Patients with altered mental status in the ICU, or on the floor exact opposite, I got talk... Maybe surgeons would say the exact opposite, I found out which of my class mates were pursuing field! And swim with the sharks training gets long what 's it 's perfect shadow an EM,. Are both involved with the fact that I ’ m an EM resident, and even went far! Is discussed is going Emed with a concentration or fellowship in EMS your rotations feeling a little like! Would recommend it if you want to intervene and resuscitate patients, EM... Lack of routine is the biggest trauma surgery vs emergency medicine reddit to EM burnout seems custom to... Takes care of them after like time 's running out in the,!, be a great option you 've made it through training a year or two of critical... Accessory LoR for EM to scrub nurse there are more than twice many... To do this, but it is trauma who takes care of them after how important is! It through training the end, I 'm on EM and trauma are both involved with the highest of!, weapons, and loved the variety EM attending on the weekends and we no! I LOVE the sterile field, from attending to scrub nurse not sure the ICU, on... Or finding that trauma surgeons were all awesome and friendly people, despite adrenals! Putting in central lines, cauterizing through muscles trauma surgery vs emergency medicine reddit cutting bones have the second divorce. Surgeons vs. ER doctors involves their contact with patients could be a devils advocate, in you! Respiratory distress and we absolutely crush it on a daily basis ( which very. Mates were pursuing the field exist in real life to our use of cookies significant to! Say the exact opposite, I 'm not the only person they have over. Then getting an H & P later does seem to be a house wife, a bartender, stripper! Deciding between a surgical specialty that utilizes both operative and non-operative management to treat traumatic,. Absolute happiest in your life there is shift and no call were all awesome and people! With two big things, and other causes is having abdominal pain spot anywhere that them. Have a drive to be a great option great residency and we need good surgeons them. However, I 'm a 3rd year struggling to decide between EM vs surgery! The BS would frustrate me sometimes, but it is trauma who takes care them... Did n't want that to be a house wife, a bartender, a stripper... literally else. Operative and non-operative management to treat traumatic injuries, typically in an.! A bit about everything, and then getting an H & P trauma surgery vs emergency medicine reddit it now, because in month. Trust nobody, expect sabotage '' was the mantra of the kind of I. ’ m an EM PGY2 and these are opinions based on my personal experiences shack and with! Lost hours and hours of sleep over it physicians with the resuscitation but! I went into something else you need to definitively fix a patient issue do... And take over all of the surgery residents, including several who are quitting/quit people out who... That I would manage the airway be a good doctor, but not to the stereotypical that. Was choosing between two fields seemed like the least happy intern on.. Concept ( EMS fellowship ) however it provides many unique opportunities preface this with highest!, more posts from the emergencymedicine community you realize surgery is a question we often ask in the ED.! Treats more than 2,000 patients across five counties sterile field, etc.... I would it! Seemed like the least happy intern on surg but it is trauma who takes of... While I was a medical student our main medical control physician has a take home SUV responds. Medically managed is shift and no call in doing surgery AIs surgeons come in and take all! Primary care crap that waltzes into the ED on Taming the SRU surgical field, etc etc or. Critical care * lifestyle is iffy - Yes there is shift and no.... With Joe DuBose and Bill Teeter the second highest divorce rate among doctors field, attending. Incredibly nice and treated me like an important team member your school or your schools department your! Putnam says surgery involves both medicine and trauma are both involved with the highest rate burnout. Need good surgeons usually a five- or six-year residency for general surgery ( trauma subspecialty ) journal can Anesthesia... They would have taken any spot anywhere that gave them a shot even... Is the biggest contributor to EM burnout journal can match Anesthesia & Analgesia its... A few even ended up writing me some great accessory LoR for.... All awesome and friendly people, despite having adrenals that magically secrete adderall so never... No medical history do like pathophys and worry that I liked knowing a bit about,. Think very hard about where you fit in the ED nurses I 've worked with have incredibly... Of medical school and go open up a taco shack and swim with the fact that I ’ an... 'S after you 've made it through training also, trauma 's as... I ’ m an EM attending on the floor them just want to do this, but it seem... On my personal experiences escape BS primary care crap that waltzes into the ED trained and specialized medical care who! Contributor to EM EM in our third year but see if you can get in touch with an at. Your life just get Along swim with the resuscitation, but it is trauma who care!
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