What an awesome article! I’m starting my EM rotation in 1 week and though I’ve enjoyed most of my other rotations, none of them have quite done it for me. You just described my personality to a T… Can’t wait to start my rotation! Just linked your article from my blog.

I just finished a EM 4th year elective in a rural but very busy ER. There were a number of Family med docs as well as EM trained. There was definitely a difference in EM verses FP. One example was a patient that had an anterior dislocated shoulder and the FP would not try to deal with it. He called in a surgeon. He was not comfortable in treating it because this patient had a shoulder joint replacement and it made the FP nervous. After hearing this patient crying for hours as he sat waiting for the surgeon, my attending, who is EM trained asked the FP if she could try and pop the shoulder back . The FP agree reluctently and thankfully she was able to pop in back. This is just one of many examples where the FPs were not able to do things that the EM docs were able to do at that location.

My opinion of family medicine doctors who work in the ED – in rural areas, if there are no EM trained/boarded doctors available, that is the standard of care. However, family medicine and emergency medicine are very different fields, and so having all EDs staffed by board certified EPs would definitely be the ideal. Take a look at family medicine residency rotations vs. emergency medicine residency rotations and you will see what I mean. We do numerous months of critical care/ICU time to gain these skills. (though I have the highest respect for family physicians, my mom is one! I certainly know I couldn’t do her job as well as she can)

UpToDate and eMedicine are certainly not the end-all or the be-all, but I just cited them to point out that emergency physicians are heavily involved in a lot of the most common online medical references, which is what I thought you were referring to the doctors you worked with not using at work. You generally can’t go extensively researching in textbooks and performing literature searches while you’re on shift in the ED. Luckily we have plenty of time outside work to do that kind of thing.

I will be the first to agree with you that EM physicians face less frustration than other physicians and that the job is highly satisfying. However, it is a matter of the type of frustrations people don’t want to deal with, and for some people, not being able to work up the patient’s complaint in depth is more frustrating than having to worry about the kinds of things you have to deal with on the floors – though we DO still have to deal with tracking down nurses and charts (where was this magic land where you did not have to worry about that?)!

Anyway, I cannot speak for the doctors you work with, but I would say on the whole EM physicians love their jobs and are happier than other docs in the hospital. Those grousing folks you worked with sound like they had a bad attitude and should not be mistaken for being representative of the specialty. It sounds like this may have been a community ED? I can assure you that in EM we do look up current articles etc, though oftentimes we would be doing that at home rather than at work – the pediatric ED may give you time between patients for looking up questions, but in a busy adult ED that is definitely not the case.

In short, I think you need to do another rotation in the ED, definitely in an academic center, if you think you may be interested – so you can meet some EM physicians who enjoy their work and read on a variety of subjects. At my program we have teaching rounds every morning in the adult ED, as well as the standard 5 hours of lecture time per week (and monthly simulations in the sim lab) for furthering our knowledge base. We also take an EM test every month on subjects like trauma or toxicology or OB/GYN to review diagnosis and management. The attendings in our program are very sharp and in fact, one is on the staff of UpToDate (UpToDate and eMedicine both have many of EM physicians on staff!- did you know the founder/CEO of eMedicine is an EM physician?). So the degree of being academic really depends on the person and the place.

If you want to be able to see your patients day after day and to really investigate their conditions in depth, you should be going into internal medicine, not emergency medicine. If you like being able to have a lot of face time with patients all day at work and not needing to worry much about writing 2-8 page notes, consider EM! And if you really can’t decide, consider an EM/IM program – you can find such combined residencies on the SAEM website, and you can search this topic in the SDN forums for more information on whether it is for you.