It was confirmed when I found out which of my class mates were pursuing the field. 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’s definitely something to consider given you will be doing this for a while. I suspect surgical staff will be nicer once I'm not the only person they have power over. "It's usually a five- or six-year residency for general surgery, followed by a year or two of surgical critical care/trauma fellowship. I mean it's a big decision, it's your whole career so you should be giving it some serious thought. 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. I loved my trauma surgery rotation. Killer coma cases part 1 (the found down patient) and part 2 (the intoxicated patient) on Emergency Medicine Cases. It also fit my expectations of the kind of physician I wanted to be. Maybe surgeons would say the exact opposite, I'm not sure. No other journal can match Anesthesia & Analgesia for its original and significant contributions to the anesthesiology field. It is well recognized that trauma is a multisystem disease that requires the interest and participation of many specialty services including emergency medicine, interventional radiology, orthopedics, neurosurgery, otolaryngology, oromaxilofacial surgery, plastic surgery, and anesthesiology. Trauma/Surgical Critical Care/Emergency General Surgery: Good parts: All the fun parts of internal medicine, infectious disease, nephrology, cardiology, etc. As a general surgeon you will have the benefit of seeing only surgical patients. Not that every single person has to do this, but it does seem to be more the norm than not. The fellow will be exposed to trauma as part of the Trauma Service, the TTL team, and as well during Emergency Medicine shifts. Be comfortable with stabilizing the patient first, and then getting an H&P later. These are all possible as an EM doc. Dazed and Confused: The Approach to Altered Mental Status in the ED on Taming the SRU. End game is, gotta shadown in an ED. Training in trauma surgery is a longer process than ER medicine. The two specialties are pretty different, and I’m obviously bias as I’m likely going into ER but if I wasn’t absolutely 100% sure that I wanted to go through general surgery I would choose ER as you can always go critical care fellowship if you want to change it up down the road and see more critically ill patients. 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. Dr. Meyersis an emergency physician and faculty in the emergency medicine residency at Carolinas Medical Center in Charlotte, NC, and an editor of Dr. Smith's ECG Blog. 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). To explore this issue, I got to talk with Joe DuBose and Bill Teeter. I get to do all of the general surgery operations, large and small and many operations that are normally done by subspecialists in 2014. I felt the same way as you when I was a medical student. If you need to definitively fix a patient issue, do gen surg. switching days/nights all the time is pretty rough though. I had strong reservations about the extremely demanding residency, overall time commitment and likelihood that gen surg wouldn’t be the stopping point as I would have to pursue further specialization. Medicine is awesome. 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. 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. And also, trauma's arent as cool as people think. It helps a lot, thank you for the response. An ED, on the other hand, may not be able to provide the immediate intervention needed to save a life such as emergency surgery. 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. 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. I need to do things with my hands. A few even ended up writing me some great accessory LoR for EM. 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. Yep, in the process now of scheduling it. I decided on gen surg after loving my trauma rotation. If the former, consider Surgery, if the latter, do EM. Many of the horror stories are absolutely true. That's where I realized that the other people going for the surgery specialty were committed 100% to that specialty and absolutely loved it more than I ever saw myself loving it. 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. 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. Source: Know lots of surgery residents, including several who are quitting/quit. Now I'm an EM resident, and I couldn't be happier about my decision. “Find your people” was something someone once told me and it really stuck. This may be caused by accidents, falls, hits, weapons, and other causes. Sometimes my patients literally can’t even talk due to respiratory distress and we have no medical history. 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. Good and happy surgeons do exist in real life. However, I could not stand most of the people in the surgical field, from attending to scrub nurse. Good luck and I wish you much success no matter what you do. without outpatient medical clinics. By using our Services or clicking I agree, you agree to our use of cookies. 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. The primary goal of the fellowship is to provide a \"hands-on\" clinical experience in all aspects of perioperative trauma care, including: 1. prehospital assessment and transport 2. preoperative emergency room evaluation and stabilization 3. operative trauma anesthesia care 4. postoperative critical care and pain management In the operating room the fellow will be exposed to all types of trauma anesthesia/trauma surgery, includ… 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). Did anyone else struggle with this decision? 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. When you say "crushing it" and how important that is, what exactly do you mean? Do it now, because in a month you should be thinking about where to schedule your rotations. So that's the general gist of where I am at mentally in regards to what I am looking for in a career. This is a question we often ask in the USA given our unique Trauma system. Feeling a little bit like time's running out. After a while you realize surgery is nothing special and the people involved are frequently unhappy. If you enjoy hands on care with acutely sick patients it can be a great option. 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. Did anybody here struggle between these 2 fields? 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. They also have the second highest divorce rate among doctors. Why Can't Emergency Medicine and Trauma Surgery Just Get Along? And vice versa - I see the most respect from physicians given to nurses in the ED also. And that's after you've made it through training. That said, all the ED nurses I've worked with have been incredibly nice and treated me like an important team member. 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. You go down a checklist, then they go to surgery or they are medically managed. Side concern - I'm not really the gunner super competitive type. The Section of Trauma Acute Care Surgery (TACS) provides comprehensive, around-the-clock care for trauma, surgical critical care and emergency general surgery patients. So is life outside of the hospital. The University of Utah Affiliated Emergency Medicine Residency is a PGY 1-3 program. The program is based at the University of Utah Health Hospital, a tertiary care center and level 1 trauma … However you have to realize that EM and trauma surgery are VERY different in terms of what they actually do. 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". That was the experience for me at least. Your goal is to exclude emergent disease processes. You will often not diagnose why someone is having abdominal pain. A Trauma Surgeon is a highly trained and specialized medical care professional who performs emergency surgeries on patients suffering from acute injuries and illnesses. Search for more papers by this author I loved throwing in sutures, putting in central lines, cauterizing through muscles and cutting bones. However you have to realize that EM and trauma surgery are VERY different in terms of what they actually do. Those people lived and breathed surgery, while I was happy to pursue my many interests outside of medicine without that same fervor towards a solitary goal. 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. 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. Specialists vs. Generalists The main difference between an ER doctor and a trauma surgeon lies in specialization. Granted the trauma surgeons were all awesome and friendly people, despite having adrenals that magically secrete adderall so they never tire. The patient is the trauma team's patient and afterwards they'll see them in clinic in a few weeks for a check up / suture removal / continued management. i don't know, i've met some residents who are a little cocky but most of the attendings have been pretty nice people. They take them to the OR, manage them in the ICU, or on the floor. M4 EM applicant here. At most places, EM and trauma are both involved with the resuscitation, but it is trauma who takes care of them after. Trauma surgeons generally complete residency training in General Surgery and often fellowship training in trauma or surgical critical care. Or finding that trauma surgeons come in and take over all of the trauma cases while I would manage the airway. It seems custom built to create conflict in the trauma bay. In the United States, there are more than twice as many nonfatal firearm injuries as fatal firearm injuries each year. They would have taken any spot anywhere that gave them a shot, even if they were treated like shit. ern i know who was choosing between two fields see. Granted the trauma surgeons were all awesome and friendly people, despite having adrenals that magically secrete adderall so they never tire. We also didn't get any EM in our third year but see if you can shadow an EM attending on the weekends. 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. Cookies help us deliver our Services. One thing that rarely is discussed is going Emed with a concentration or fellowship in EMS. Trauma surgery is a surgical specialty that utilizes both operative and non-operative management to treat traumatic injuries, typically in an acute setting. or think about this. 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. Each monthly issue features peer-reviewed articles reporting on the latest advances in drugs, preoperative preparation, patient monitoring, pain management, pathophysiology, and many other timely topics. Making critical decisions with incomplete information. i never really got the god complex from non-CT surgeons. Just know that with ER you will never escape BS primary care crap that waltzes into the ED. I lost hours and hours of sleep over it. Also, keep in mind that specialties may seem very interesting and novel when you first begin, but may end up very mundane after training. 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. I have a drive to be a good doctor, but not to the stereotypical sense that surgeons do. Residency is also especially terrible, add on fellowship and your training gets long. Edit: In all seriousness. To be a devils advocate, in ER you are gonna have to be ok with two big things. EM hours are pretty sweet comparatively. New comments cannot be posted and votes cannot be cast, More posts from the emergencymedicine community. The attending trauma surgeon also leads the trauma … I was deciding between a surgical subspecialty and EM. This is worth emphasizing. If you find meaning in doing surgery, you will do that. Probably because the nurses are so damn competent. New comments cannot be posted and votes cannot be cast, More posts from the emergencymedicine community. General surgery is absolutely terrible for lifestyle. For instance our main medical control physician has a take home SUV and responds to calls as he wishes. 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. I was deciding between these two as well. 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. In the end, I found that I liked knowing a bit about everything, and loved the variety. EM resident here. 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. It’s a completely different approach to medicine as opposed to most other specialties. I could be a house wife, a bartender, a stripper... literally anything else". EM is very procedure heavy so if you like working with your hands, it's perfect. 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. Another difference between trauma surgeons vs. ER doctors involves their contact with patients. 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. 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. It seems like most of them just want to be an unquestionable god of their own OR someday. It's all my peers that love to think they are superior or know more. I would recommend it if you want to see what's it's about. I don’t regret my choice a single day. But irregular schedule, lack of routine is the biggest contributor to EM burnout. Antibiotic treatment was noninferior to surgery for appendicitis, a US multicenter trial published in the New England Journal of Medicine found.. I like that general surgery involves both medicine and surgery. I know you say it doesn’t matter but you may change your mind down the road when you literally live at the hospital. Go and shadow at an emergency department. I would second this. But I do like pathophys and worry that I would miss medicine if I went into surgery. 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 know how stressful it can be. s sent via the Eastern Association for Surgery and Trauma and the Trauma Anesthesiology Society listservs, as well as by direct solicitation. 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. Cookies help us deliver our Services. 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. /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. The physicians with the highest rate of burnout are surgeons. Do EM. If you want to do surgery, be a surgeon. Never heard of transfers the other direction. Patient contact. true- the only intern i know who was choosing between two fields seemed like the least happy intern on surg. Each year, the Lee Health’s Trauma Center treats more than 2,000 patients across five counties. 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. In all fairness, surgery is a great field and we need good surgeons. Trust me you’ll be happier. Press J to jump to the feed. 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 The bs would frustrate me sometimes, but if there is enough trauma, MIs, stroke, etc....I would be happy. 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. By using our Services or clicking I agree, you agree to our use of cookies. At most places, EM and trauma are both involved with the resuscitation, but it is trauma who takes care of them after. And I want to do those things to acutely sick patients. Emergency and elective surgery (12 months) Total: 24 months I go to a great residency and we absolutely crush it on a daily basis (which is very important as well). 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 … 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. 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. 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. Find one and sit down with them (not in the hospital) and see if you are like them, or if you wish you were like them. This is a relatively new concept (EMS fellowship) however it provides many unique opportunities. Press question mark to learn the rest of the keyboard shortcuts. "It's a significant commitment to become a trauma surgeon," Dr. Putnam says. The trauma surgeon is responsible for initially resuscitating and stabilizing and later evaluating and managing the patient. Rotations in your life to schedule your rotations I see the most respect physicians... 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