Thursday, April 28, 2005

FP's in ER's

SuperDuper asked this: "so if youre Board certified in FP ...HOW do you work as ER? (and why???)"

As far as the law goes, as far as I know, any doc can work in the ER. Now, the board certified, residency trained Emergency Medicine docs would argue that they are better, and it would be a good argument. However, the vast majority, and I mean the VAST majority, of all ER shifts worked in the US are not worked by EM trained/certified physicians. There just aren't enough of them. Besides, most ER's don't pay well enough to get those docs. Absolutely no offense meant, but the price they demand can't be met in most small town or rural ER's. Besides, a gung-ho EM trained/certified doc doesn't want to work the ER in a 49 bed hospital in a town of 5000 people with an annual volume of 5000. They would be bored out of their skulls and lose their skills. These shift are filled by a different type of ER doc.

So, most ER shifts are staffed by other specialties, or even docs without residency training or board certification in any specialty.

Personally, I think Family Practice is a great residency to prepare one to work in the ER. However, most FP residency programs are not very strong in EM and especially the trauma part. Besides, just managing an ER requires a very different mindset from the clinic. You have to be able to manage a dozen or so patients, all at the same time, some of whom may be very sick. It's not just the medical knowledge, which most docs can assimilate, but the skill to manage the ER that is one of the best things taught in an EM residency and not taught in any other.

You have to be able to decide: "Do I finish up with this patient or get the next one started? How long can/should that 35 year old with a cold wait while I deal with these other sicker patients? When do I take a few minutes to get him out of here? Do I get involved in this prolonged w/u in this relatively sick but stable patient, or do I see a few of these treat and street types and clear up a few rooms?"

Most docs aren't suited, by training or personality, to work in the ER.

In another life, I thought I wanted to be a surgeon. So, in medical school, I did most of my electives in surgery and did a lot of trauma call. I was on the trauma team at my university hospital, a Level I trauma center. As a surgery intern, I was again on a trauma team at a Level I trauma center, this time in downtown San Diego. As an FP resident, I did my ER rotation and an additional ER elective at Level I trauma centers. Not that I thought I was going to be doing full-time ER; at the time I expected to be doing a clinic practice, but I enjoyed it.

So, I felt well trained to go in and work the ER. I would agree that the average EM trained/certified doc is better in the ER than the average FP, but I think I am pretty good at it. We all know ER trained/certified docs who aren't very good at what they do. One of my recent co-workers just couldn't manage a full ER. We have 23 beds in our ER and sometimes you are the only doc there and the ER is full. This is quite a test. Only one of our full time docs is EM residency trained, and only two of them are EM board certed.

So that's the HOW. I will address the WHY later.