Ask Uncle Panda

1. Say, Uncle Panda, what exactly do you like about Emergency Medicine? I thought the hours were crazy and the burn-out rate was high. What about it?

From the perspective of residency training, Emergency Medicine is far superior to any other specialty. First of all, it’s the most like a regular job of any residency. With the exception of off-service rotations which will fill roughly a third of your three year training (most programs are three years long) you will be working set shifts with a pre-determined start and finish time. (Although you shouldn’t expect to get out exactly when your shift is over as there are usually things to either tie up or sign out.)

To my mind, there is nothing more annoying than coming in early to pre-round on patients only to round on them again with the attending. A tremendous waste of effort. I’m also not exactly sure why we need to come in early on rotations like internal medicine. It’s not like the patients are going anywhere. What invariably happens is a short burst of frenzied activity from 6 AM until ten followed by large patches of dead time until around four…at which point there is usually another burst of frenzied activity. I’m sure this pattern is inevitable but that doesn’t mean I have to like it.

As to burn out, I don’t know. I’m new to the profession and I will have to defer to the opinions of my more senior colleagues. It is my understanding that “burn-out” is greatly exaggerated. Emergency Medicine self-selects for people who like variety, working weird hours, and making quick decisions with incomplete information. While this would quickly burn out someone who likes a more deliberative pace, EM physicians look at this as routine and a good trade for working fewer hours and fewer days.

No questions that the pace is a lot more intense than most other specialties. In a busy emergency department the residents are working all the time. Productivity is critical in the “shop” and second and third year residents are expected to see and “dispo” at least 2.5 patients per hour. On a twelve hour shift this works out to 30 patients which is a lot. It is true that some patients have relatively minor complaints which don’t take that much time but as often as not the next three will be very sick with multiple comorbidities. Not to mention the traumas that roll in periodically. The net result of all this is that a good Emergency Medicine resident has to learn how to juggle multiple patients. If you can’t prioritize, organize, and keep track of multiple plans for many different patients you probably won’t like Emergency Medicine.

As to the hours, they are indeed crazy. While most programs make an effort to accommodate your circadian rhythm, when all is said and done you will be working a lot of nights and leading a vampire-like existence. On the other hand you will be driving opposite rush hour traffic, the banks will be open when you get off work, and academic teaching hospitals are a good deal more laid-back after normal working hours.

Does Family Practice suck?

No, of course not. I didn’t like it but that’s just me. As it emphasizes long-term management of chronic diseases it is not for those with ADD, short attention spans, or who get bored easily. I want to dispel the myth, however, that Family Physicians have some sort of leisurely, non-demanding lifestyle. The fact is that like any other job, productivity is important. In family medicine where the reimbursement for the usual visit is low, patient volume is important. A Family Medicine resident may see as many patients in a day as an Emergency Medicine resident. On the other hand he is unlikely to be working on more than two or three at a time, the presenting complaints are usually less acute, and the chances are good that the resident has seen the patient before and can skip some of the usual history taking.

It is also an unwritten but very real expectation of patients that their family doctor spend some time chatting with them. This is a very important part of the art of medicine but it does add to the time for a patient encounter, especially the family medicine patients that want to talk about everything and who will not shut up. A good family physician masters the art of redirecting the conversation without appearing rude and winnowing down a long list of complaints to the most pressing without appearing callous.

In the Emergency Department it is all right to be a little more brisk as the situation demands.

Just a random thought, maybe if they changed the name of the specialty it might attract more guys. Let’s face it, Family medicine has a decidedly feminine, non-threatening ring to it and calls to mind images of gentle, sensitive men nurturing woman and children. This is not how most guys see themselves. What most of us really want to do is get in touch with our inner Cro-Magnon, not our inner child.