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20 Questions: Lindsay Stokes, Emergency Medicine

Lindsay Stokes, MD, attended medical school and residency at Albany Medical Center in Albany, NY where she still lives with her husband and daughter. She is currently an attending in the Emergency Department at Berkshire Medical Center in Pittsfield, MA.
When did you first decide to become a physician? Why?
I got a Fisher-Price stethoscope for my fourth birthday and after spending my whole party listening to the heartbeat of anyone who would let me, I decided that being a doctor was the coolest possible job. I have always been fascinated by the human body and as I got older, the social aspect of being meaningfully involved in other people’s lives became appealing to me as well.
How/why did you choose the medical school you attended?
I am a proud member of the It-Was-The-Only-One-I-Got-Into Club, and while we are not the most vocal group, we are (statistically) the most populous.
What surprised you the most about your medical studies?
I was always shocked at just how much there was to learn. In first and second year I’d spend two weeks memorizing a 4-inch stack of notes on a body-system and thinking I had a pretty good grasp on every cell and protein that made it work. Then I realized that each of those cells and proteins had their own 4-inch stack of notes!

Why did you decide to specialize in emergency medicine?
Before we started clinicals, one of my professors told us that there was a specialty for each personality type. I liked almost all of my rotations, but none really jumped out at me more as a good fit for myself until I went down into the ED. Suddenly I was surrounded by all of these fast-moving, procedure-loving, extroverts with short attention spans, just like me!
If you had it to do all over again, would you still specialize in emergency medicine?
Absolutely.
Has being a physician met your expectations? Why?
Yes and no. As I said, I wanted to be a doctor from a very young age, and like anything, when you have more imagination than information, you end up with expectations that will turn out to be unreasonable. When I was dreaming about being a doctor as a kid (and even into medical school), I thought that it would all be blood and guts and glory. I didn’t think about things like spending 30% of my shift doing paperwork, or patients screaming at and even threatening me because of their own unreasonable expectations. Medicine, like all jobs, comes with it’s own set of unavoidable cons. That being said, I do get to leave most of my shifts thinking about the people that I genuinely helped. I get to save lives! That is pretty amazing.
What do you like most about being in emergency medicine?
I love the variety. On my last shift I took care of a 99-year-old and a 1-week-old in adjacent rooms. I get to see and treat people of every socio-economic status, age, and disease type. I have worked in departments that range from incredibly busy trauma centers to sleepy little urgent cares, and in any shift I may have everything from multiple ICU-level patients with critical needs to a handful of splinter removals or babies with the sniffles. I also have [what I consider to be] a luxury in that I don’t have to think about almost anything involving the business side of medicine, like insurance and reimbursement, as I would if I were running a practice. In addition, I really enjoy procedures, and I get to performa wide range of them from fracture reductions, lumbar punctures, chest tubes, ultrasounds, and even delivering babies every once in a while. I also really love the flexibility. I am credentialed at 4 different hospitals in the area, but I am only full-time at 2 of those, so if there is a month when my family could use some extra income (like an upcoming vacation or home expense) I pick up a few extra shifts.
What do you like least about being in emergency medicine? Explain.
There is a lot of abuse of the Emergency Department, which certainly gets tiring. We are on the front lines in terms of patients with drug-seeking behavior and prescription abuse, and it is always very discouraging to walk into a room with a genuine concern for a person and then learn hours later (after an expensive and time-consuming workup) that they were not being truthful and had ulterior motives.
What was it like finding a job in your field–what were your options and why did you decide what you did?
By the time I entered my last year of residency, I had an open offer from most of the hospitals in my city. Board Certified Emergency Medicine Physicians are in very high demand and with the exception of a few popular cities (places like San Deigo, Portland, and Denver), it is really a physician’s market. I get offers (usually emails or phone calls) to do Per Diem or Locums Tenens work about three times a week, and when my first job didn’t meet my expectations, I was able to interview and have four offers in hand by the time I resigned.
I am currently working as a “nocturnist” or a EM Physician that only works night shifts. Many hospitals pay a premium if you are willing to work nights, and will also let you choose your own schedule.
Describe a typical day at work–walk me through a day in your shoes.
There is no typical day in Emergency Medicine, which is part of why I love it. I work all nights, which means my shifts start anywhere between 7pm and 11pm. The department is usually packed when I get there, as most ER’s experience a 5pm-9pm rush of patients which can be complicated by the loss of momentum that happens around shift changes. I usually try to see between 5-8 patients in that first hour and start the workup(do my history and physical, get orders put in, and start in on any procedures that are needed). A lot of these patients tend to be of medium acuity (belly pain, headaches, fractures, etc.) and they have usually been waiting around for a while, so this initial burst helps the department to get moving.
Over the next 2-3 hours I focus on seeing the patients with the most critical complaints and touching base with the previous ones as their test results come back. I make a point of following every new ambulance crew into the room so that I can get the patient’s story right from the first-responders and get orders going before I get distracted by something else. I also try to do any procedures and sedations that will be needed before my evening shift colleagues leave, since it is very difficult to run a whole department while focusing on a task that I can’t be pulled away from.
By the time 2am rolls around, the department usually starts to settle a little bit. This is when I try to catch up on my documentation, circle back to tests that were still pending when I last checked, or spend time with patients that need a little extra attention. Usually by this time I have been in the department for 7 hours and haven’t eaten, taken a break, used the restroom, or (likely) even sat down, so one of the three PowerBars in my pocket makes a debut and I try to recharge for a few minutes.
Unless of course…
A headbleed rolls in seizing, or a gunshot victim is bleeding all over triage, or an ambulance crew runs past with a cyanotic child. Then the PowerBar goes back in the pocket, and my typical day continues.
On average: How many hours a week do you work? How many hours do you sleep per night? How many weeks of vacation do you take?
I work a combination of 9 and 12 hour shifts, and right now I work anywhere from 18-24 hours a week. I am able to do this and make a full salary because I work all night shifts, and my hospital has a large differential for night hours. When I was working a regular schedule (mostly day and evening shifts), I usually worked 3-4 twelve hour shifts per week, scheduled somewhat randomly, and could count on being required to work 30% night shifts. I get 4 weeks of vacation, which are not paid. I regularly sleep 6-8 hours per night, but that is more a function of the fact that I have a small child and is not affected by my job.
Do you feel that you are adequately compensated?
Definitely. In addition to my hourly rate, we receive quarterly bonuses and an allowance for CME which is more than enough to cover my yearly academic subscriptions and go to a conference or two.
If you took out educational loans, is/was paying them back a financial strain? Please explain.
The first job that I took out of residency offered loan repayment, so I have actually been able to pay quite a bit back in a very short period. I still have about half of my loans remaining, but the monthly payment is very manageable.
In your position now, knowing what you do – what would you say to yourself when you were beginning your medical career?
Oh my goodness, STUDY MORE! Absolutely everything walks through the doors of an emergency department and you never know what kind of esoteric factoid that you learned in year 2 is going to make the difference in a case. As disconnected as my academic years felt from what I do now, they gave me the basis to form a broad differential for every patient that I see, which in the end can be the difference between a misdiagnosis and an amazing catch. Also, don’t forget to eat your veggies, even during boards.
What information/advice do you wish you had known when you were beginning your medical studies?
I wish I had worked in healthcare in another capacity before I started medical school. Like most applicants, I had volunteered at a few clinics and shadowed a few doctors, but I felt like my peers who had been EMT’s, nurses, scribes or held other ancillary staff positions in healthcare had a much better understanding of the system and of the bigger picture of patient care. I think it is really worth it to take a year or two to work in healthcare before jumping into medical school, if only to give yourself a foundation for empathy and teamwork in the years to come.
From your perspective, what is the biggest problem in health care today?
I hesitate to say this is “the biggest”, but fragmented EMR’s really hinder our care of patients and make an already difficult job much harder. When a patient comes into the emergency department obtunded or with an altered mental status, I am at the mercy of whatever documents I can dig up to make a diagnosis. If that patient hasn’t been to the ER in more than 2 years, I won’t have anything, even if they went to their Primary yesterday and their physician recorded their entire life story. A cohesive, single-source EMR would allow us to administer better care all around.
Where do you see your specialty in five years?
In medical school I was told that as soon as we improved the health insurance status of ordinary citizens, Emergency Departments would disappear, but so far every state that has introduced universal healthcare has seen an uptick in ER usage. In addition to this, many ED’s across the country are staffed by non-Emergency Medicine trained physicians (usually Internal Medicine or Family Practice trained) but there has been a push to have as many departments staffed with residency-trained EM physicians as possible. These factors together point to a growing field.
What types of outreach/volunteer work do you do, if any?
I have gone to Africa and the Caribbean for medical mission trips. I usually see patients and do small procedures alongside a surgeon who takes care of the larger surgical issues. I am not currently doing any outreach because I recently had a baby.
Do you have family? Do you have enough time to spend with them? How do you balance work and life outside of work?
I have a non-physician husband and a baby girl. I specifically chose to work night shifts because it allows me to work fewer hours and control my schedule, so I spend much more time at home and have a good family life (even if I am a little groggy for some of it).
What is your final piece of advice for students interested in pursuing a career in your speciality?
Keep the whole picture in mind. Every specialty and career will have pros and cons, so deciding which points are dealbreakers and which ones you can live with is critical. For me, it was that I wanted a lot of variety and that I never wanted to be paged away from my child’s birthday party. Emergency Medicine, though it has other cons, is exactly what I wanted.