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. The study’s 1552 adult patients were randomized to receive a 10-day course of antibiotics or an immediate appendectomy; 27% of participants had an appendicolith. And I want to do those things to acutely sick patients. Now I'm an EM resident, and I couldn't be happier about my decision. The attending trauma surgeon also leads the trauma … Press question mark to learn the rest of the keyboard shortcuts. Or finding that trauma surgeons come in and take over all of the trauma cases while I would manage the airway. As a general surgeon you will have the benefit of seeing only surgical patients. 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. We had two gen surg transfers into our EM program while I was there. Another difference between trauma surgeons vs. ER doctors involves their contact with patients. Cookies help us deliver our Services. Press question mark to learn the rest of the keyboard shortcuts. I like that general surgery involves both medicine and surgery. 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. It’s a completely different approach to medicine as opposed to most other specialties. or think about this. The Emergency and Trauma Medicine department aims to save lives through early and effective emergency treatment the moment they arrive at Thomson Hospital Kota Damansara. The Trauma Surgeon will typically work in emergency rooms, performing operations on … 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. Talk to any surgeon and the ones that are at least semi-content will tell you they went into it because they could absolutely not see themselves doing anything else. Yep, in the process now of scheduling it. If you need to definitively fix a patient issue, do gen surg. 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. Lifestyle does matter to me though, and I've read several places that say "if you are already thinking about lifestyle then don't go into surgery.". I was deciding between these two as well. 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 felt the same way as you when I was a medical student. Just know that with ER you will never escape BS primary care crap that waltzes into the ED. Ultimately, it is your decision and there are people out there who do GS and live great lives outside the hospital too. The Pupil Exam in Altered Mental Status on PEMBlog Source: Know lots of surgery residents, including several who are quitting/quit. 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. Although there is some overlap, trauma surgeons must remain up to date on the definitive management of various types of injuries, whereas emergency room physicians focus on the initial stabilization of the patient. I loved my trauma surgery rotation. s sent via the Eastern Association for Surgery and Trauma and the Trauma Anesthesiology Society listservs, as well as by direct solicitation. I could be a house wife, a bartender, a stripper... literally anything else". Thank you. It was confirmed when I found out which of my class mates were pursuing the field. They take them to the OR, manage them in the ICU, or on the floor. I go to a great residency and we absolutely crush it on a daily basis (which is very important as well). Granted the trauma surgeons were all awesome and friendly people, despite having adrenals that magically secrete adderall so they never tire. The trauma surgeon is responsible for initially resuscitating and stabilizing and later evaluating and managing the patient. It seems custom built to create conflict in the trauma bay. 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. Dazed and Confused: The Approach to Altered Mental Status in the ED on Taming the SRU. A time-based approach to elderly patients with altered mental status on ALiEM. 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. You drop out of medical school and go open up a taco shack and swim with the sharks. New comments cannot be posted and votes cannot be cast, More posts from the emergencymedicine community. It was phenomenal. 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. 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. I lost hours and hours of sleep over it. Think very hard about where you are the absolute happiest in your life. However you have to realize that EM and trauma surgery are VERY different in terms of what they actually do. 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 loved throwing in sutures, putting in central lines, cauterizing through muscles and cutting bones. If you want to medically manage, go to EM. If the former, consider Surgery, if the latter, do EM. They also have the second highest divorce rate among doctors. Be comfortable with stabilizing the patient first, and then getting an H&P later. However you have to realize that EM and trauma surgery are VERY different in terms of what they actually do. Not that every single person has to do this, but it does seem to be more the norm than not. One thing that rarely is discussed is going Emed with a concentration or fellowship in EMS. But irregular schedule, lack of routine is the biggest contributor to EM burnout. Trust me you’ll be happier. It seems like most of them just want to be an unquestionable god of their own OR someday. We also didn't get any EM in our third year but see if you can shadow an EM attending on the weekends. 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. I would recommend it if you want to see what's it's about. Information was collected on trauma center level, geographical location, department responsible for intubation in the emergency room, department responsible for intubation in the trauma bay, whether these roles differed for pediatrics, … I would second this. 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 It's all my peers that love to think they are superior or know more. It’s definitely something to consider given you will be doing this for a while. Training in trauma surgery is a longer process than ER medicine. So that's the general gist of where I am at mentally in regards to what I am looking for in a career. EM resident here. Why Can't Emergency Medicine and Trauma Surgery Just Get Along? EM hours are pretty sweet comparatively. The fellow will be exposed to trauma as part of the Trauma Service, the TTL team, and as well during Emergency Medicine shifts. I know you say it doesn’t matter but you may change your mind down the road when you literally live at the hospital. :/. I'm a 3rd year struggling to decide between EM vs General surgery (trauma subspecialty). 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. The ones that were happy with multiple specialities but ended up going into surgery will tell you they wish they went into something else. 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. Working those surgery hours, and living that surgery life, it's no joke. “Find your people” was something someone once told me and it really stuck. 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. Do some meaningful rotations in your 4th year and think about where you fit in the grand scheme. 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. The Section of Trauma Acute Care Surgery (TACS) provides comprehensive, around-the-clock care for trauma, surgical critical care and emergency general surgery patients. Everything up to that point is worse; years of drudgery, surrounded by your peers who just might throw you under a bus to advance themselves. And vice versa - I see the most respect from physicians given to nurses in the ED also. It also fit my expectations of the kind of physician I wanted to be. The first step is to stabilise the patient, and then the department will continue to assess the next steps that can be taken, including surgery or definitive treatment. Did anybody here struggle between these 2 fields? Just FYI, anybody who sneers at you for being a “lifestyler” is bitter and/or a masochist. I don’t regret my choice a single day. I have a drive to be a good doctor, but not to the stereotypical sense that surgeons do. i never really got the god complex from non-CT surgeons. What concerns me is if I go into EM because of lifestyle* and find myself wishing I was doing more in depth procedures. Making critical decisions with incomplete information. 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. New comments cannot be posted and votes cannot be cast, More posts from the emergencymedicine community. By using our Services or clicking I agree, you agree to our use of cookies. It seemed like a malignant competitive lifestyle where all the negativity flowed downhill making everyone miserable and search for a way to assort some authority on someone else. 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. 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. We also need happy surgeons who don't live a life of regret. End game is, gotta shadown in an ED. without outpatient medical clinics. 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. To explore this issue, I got to talk with Joe DuBose and Bill Teeter. I decided on gen surg after loving my trauma rotation. Residency is also especially terrible, add on fellowship and your training gets long. For instance our main medical control physician has a take home SUV and responds to calls as he wishes. "Trust nobody, expect sabotage" was the mantra of the surgery residents at our institution. I really enjoyed my surgery rotations in school, and even went as far as doing surgery AIs. Did anyone else struggle with this decision? Antibiotic treatment was noninferior to surgery for appendicitis, a US multicenter trial published in the New England Journal of Medicine found.. If you find meaning in doing surgery, you will do that. 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. Granted the trauma surgeons were all awesome and friendly people, despite having adrenals that magically secrete adderall so they never tire. 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. You will often not diagnose why someone is having abdominal pain. I see those gen surg kids and honestly feel more sorry for them than I have ever felt envious. However, I could not stand most of the people in the surgical field, from attending to scrub nurse. If you want to intervene and resuscitate patients, do ER. Cookies help us deliver our Services. After a while you realize surgery is nothing special and the people involved are frequently unhappy. Go and shadow at an emergency department. 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. Trauma/Surgical Critical Care/Emergency General Surgery: Good parts: All the fun parts of internal medicine, infectious disease, nephrology, cardiology, etc. In the end, I found that I liked knowing a bit about everything, and loved the variety. 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 … Hope this helps. Press J to jump to the feed. Your goal is to exclude emergent disease processes. true- the only intern i know who was choosing between two fields seemed like the least happy intern on surg. Do EM. Each year, the Lee Health’s Trauma Center treats more than 2,000 patients across five counties. Trauma surgery is a surgical specialty that utilizes both operative and non-operative management to treat traumatic injuries, typically in an acute setting. Good luck and I wish you much success no matter what you do. I’ll preface this with the fact that I’m an EM PGY2 and these are opinions based on my personal experiences. And also, trauma's arent as cool as people think. So is life outside of the hospital. 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. 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. Side concern - I'm not really the gunner super competitive type. And that's after you've made it through training. See if you can get in touch with an EMIG at your school or your schools department. These are all possible as an EM doc. 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. Emergency and elective surgery (12 months) Total: 24 months Specialists vs. Generalists The main difference between an ER doctor and a trauma surgeon lies in specialization. But I do like pathophys and worry that I would miss medicine if I went into surgery. I struggled with this problem also. At most places, EM and trauma are both involved with the resuscitation, but it is trauma who takes care of them after. 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. 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