Emergency Med As A Career

gayGAA

[FONT=Verdana,Arial,Helvetica,Sans-serif]I'm a medical student in Ireland, currently very interested in both surgery and emergency medicine as future careers. Emergency medicine practitioners are the last of the true generalists in the hospital, and having done electives abroad in the specialty, I enjoy the 'buzz' of working with acutely ill patients. I also enjoy surgery, and am very interested in care of the critically ill patient.

One of my major niggling points regarding work in the ED, however, is the fact that yes, surgical training is a gruelling marathon. Once you reach consultant level, however, you can command impressive fees by working privately, as well as paying your dues as it were in a public setting. Would I be correct in saying that EM consultants don't get the opportunity to work privately?

Don't get me wrong, I'm not just about the money. But after twelve odd years of third level education, I'd like to choose a career where I wouldn't be cutting off a significant source of income!

Would anyone else care to comment?[/FONT]

Traumadoc

SOme of them are working privatly in the minor injury clinics and there is one private emergency consultant in the Beacon, They do make some money with medico legal reports this has decreased recently due to PIAB but essentially they make very little compared to other specialists who do procedures. If you want to do it you are probably better leaving to train abroad.

DrIndy

with the new consultants contract though - anyone who opts for a fully public job will gain a well recognised pay rise so this compensates and encourages people to take careers in non-private sector areas.

Vorsprung

gayGAA wrote: »

[FONT=Verdana,Arial,Helvetica,Sans-serif]I

One of my major niggling points regarding work in the ED, however, is the fact that yes, surgical training is a gruelling marathon. Once you reach consultant level, however, you can command impressive fees by working privately, as well as paying your dues as it were in a public setting. Would I be correct in saying that EM consultants don't get the opportunity to work privately?

Don't get me wrong, I'm not just about the money. But after twelve odd years of third level education, I'd like to choose a career where I wouldn't be cutting off a significant source of income!

Would anyone else care to comment?[/FONT]

I'm only familiar with 2 ED SHO schemes in Dublin, the James's one (which I think is more highly regarded) and the Vincent's one. Not sure about Mater/Beaumont.

I'm in final med in Vincent's, so I'll tell you what I know. The ED scheme operating from Vincent's is 3 years long, so you do 1.5 years of ED work, then 6 months Paeds, 6 months Anaesthetics and 6 months Orthopaedics. The non-ED jobs can be hard or easy, eg if you did your ortho in Loughlinstown (hip fracture city) or somewhere harder like Vincents's (disgustingly long hours).

The teaching seems pretty good, there is a pretty enthusiastic consultant there who is big into it. Not sure how it compares to James' though, maybe Indy would know.

gayGAA

Yeah the schemes in Vincents and James are the only two on offer in the country, SHO wise. Pat Plunkett's an excellent teacher in James and the other lad (Jim Ryan?) in Vincents is meant to be very good as well...

To be honest I'm so torn between surgery and medicine I'd probably still do a surgery BST scheme first just to make sure I keep my options open for as long as possible...

Traumadoc

Yes I would not get too hung up on careers just yet. Also dont worry about the money, its better to be doing something that interests you rather than something that pays well - I could never do dermatology despite the financial rewards.

tallaght01

I agree with traumadoc. When you start working you'll gt more of an idea what the different careers are like.

One of our lecturers used to walk in to our class at the beginning of each year and say "hands up those who want to do emergency med as a career" then " hands up those who want to be a GP".

it was really interesting to watch the change over the years (which was his point). In 1st year we all wanted to do a+e (like 40% of the class) and only about 5% wanted to be a GP. By final year, the prety much turned full circle.

I would hate to do general A+E. The hours are crap right up until you're a consultant. You're handing over most of your interesting cases. Most groups of specilists within hospitals bitch about A+E docs, or at leats the department. I didn't really like it. It depends on which hospital you work in, and the ethos there. A lot of A+E docs will just decide something can go home, or needs to be seen by one of the specilaties, and they either just send them home or refer them on.

In paeds in particular, it's not unusual to get referrals that efectively say "presenting complaing: Is a child, Plan:refer paeds". But my friends in gen med constantly complain about getting referred anything remotely medical too.

Having said that, I would happily take a career in paeds A+E. I've done it, and I loved it.

emedd

tallaght01 wrote: »

I would hate to do general A+E. The hours are crap right up until you're a consultant. You're handing over most of your interesting cases. Most groups of specilists within hospitals bitch about A+E docs, or at leats the department. I didn't really like it. It depends on which hospital you work in, and the ethos there. A lot of A+E docs will just decide something can go home, or needs to be seen by one of the specilaties, and they either just send them home or refer them on.

In paeds in particular, it's not unusual to get referrals that efectively say "presenting complaing: Is a child, Plan:refer paeds". But my friends in gen med constantly complain about getting referred anything remotely medical too.

Having said that, I would happily take a career in paeds A+E. I've done it, and I loved it.

I would be loathe to take career advice from anyone who feels the need to denegrate other specialities to this degree. It would seem that Tallaght01 has a problem with Emergency Medicine as well as EMS.

Emergency Medicine hours "are crap" because EM provides a 24/7 service to all patients. I think that's something to be proud of.

Yes we decide if "something" can go home or needs to be seen by a specialist. What else would you suggest?

Also, we can spell.

Seriously though, if you are contemplating EM as a career, there is a lot to be said for a 6 month SHO post in a good teaching hospital (such as James's or Vincent's) which will give you an idea of what the speciality involves. If you decide to pursue a career elsewhere you will still have learnt plenty.

I suspect Tallaght01's negative perceptions of EM stem from experiences in smaller "Casualty" departments where there is often little or no middle-grade or senior input. This is changing slowly. Remember that EM is a new speciality in these islands and consultant numbers are slowly expanding. The College of Emergency Medicine in the UK has just been granted a royal charter, putting it on a par with the other royal colleges.

I would suggest that you drop into the ED in your hospital and ask either one of the consultants or SpRs to have a chat with you about your career options.

Best of luck.

tallaght01

emedd wrote: »

I would be loathe to take career advice from anyone who feels the need to denegrate other specialities to this degree. It would seem that Tallaght01 has a problem with Emergency Medicine as well as EMS.

Emergency Medicine hours "are crap" because EM provides a 24/7 service to all patients. I think that's something to be proud of.

Yes we decide if "something" can go home or needs to be seen by a specialist. What else would you suggest?

Also, we can spell.

Seriously though, if you are contemplating EM as a career, there is a lot to be said for a 6 month SHO post in a good teaching hospital (such as James's or Vincent's) which will give you an idea of what the speciality involves. If you decide to pursue a career elsewhere you will still have learnt plenty.

I suspect Tallaght01's negative perceptions of EM stem from experiences in smaller "Casualty" departments where there is often little or no middle-grade or senior input. This is changing slowly. Remember that EM is a new speciality in these islands and consultant numbers are slowly expanding. The College of Emergency Medicine in the UK has just been granted a royal charter, putting it on a par with the other royal colleges.

I would suggest that you drop into the ED in your hospital and ask either one of the consultants or SpRs to have a chat with you about your career options.

Best of luck.

I never denigrated your specialty. I would be equally loathe to take career advice from somebody who is unquestioningly positive about a specialty. If the OP is interested, I'd happily point out the negatives of a career in paeds or neonates.

I've done a year of A+E. Not in "small" A+Es, but in 2 huge tertiary referral centres.

I'm not going to sugar coat it.

You DO send the majority of your interesting cases to specialties.

A lot of A+E docs do just "send home or refer".

There are a lot of inappropriate referrals from A+E.

I referred inappropriately when I was an A+E SHO.

The hours ARE crap. Of course you're right about the reasons form that. It doesn't change the fact that the hours ARE crap. Most specialties provide a 24 hour service.

I'll bow to the superior spelling of A+E docs. I can't really comment, though, as their notes usually don't contain enough words to make a proper judgment on the issue

Traumadoc

I dont think he denigrated emergency medicine he just said he did not like it. Just a I said I could not do dermatology ( I hate rashes) does not mean I think less of my consultant collegues inthat speciality. Most of the dislike of emergency medicine stems from thefact that it means work for other speciaities.
Its interesting to see what happens in other countries where emergency physicians make the diagnosis instigsate treatment and then refer to inhouse specialists for ongoing care.- But there they have better access to diagnostics.

Headaches are an example where here they are admitted ?? but in other countries the CT ad LP are carried out in the ED-Patient treated discharged or referred

tallaght01

Traumadoc wrote: »

I dont think he denigrated emergency medicine he just said he did not like it. Just a I said I could not do dermatology ( I hate rashes) does not mean I think less of my consultant collegues inthat speciality. Most of the dislike of emergency medicine stems from thefact that it means work for other speciaities.
Its interesting to see what happens in other countries where emergency physicians make the diagnosis instigsate treatment and then refer to inhouse specialists for ongoing care.- But there they have better access to diagnostics.

Headaches are an example where here they are admitted ?? but in other countries the CT ad LP are carried out in the ED-Patient treated discharged or referred

Oz is a great example of this, apparently.

I'm moving there soon from NZ. NZ is very liek A+E here.

But apparently in OZ, they only call the receiving paediatrician after the LP/bloods/CT/whatever is done and treatment started.

I think doing A+E in that environment would be very satisfying.

But the ED docs where I work, for eg, rarely if ever find out what the diagnosis is on any of the kids that I admit from them. That, to me, makes it a specialty I'm not interested in.

I do like the ED ideal of being the very first person to see a patient. Like, when I'm on nights for receiving paeds, I often go to ED when it all gets quiet at my end. I'll just take a room, and ask the triage nurse to send all the kids into me that have probable medical conditions. It keeps me busy, as I can't sleep on nightshift, and it gives the ED docs a bit of a digout.