Fort Wayne Emergency Medicine

Finished up my week in the ER yesterday with the best day of the week. It started slow like the rest of the week, but about 10 am we had four ambulances arrive with fifteen minutes. We had some interesting cases like a 14 year old gymnast that had fractured her back and a guy that almost cut the tip of his finger off. I was able to suture the latter back together after injecting a bunch of anesthetic (big hands).

The best part though, was talking to a couple of the ER Docs I hadn't worked with until yesterday. I learned some very interesting things about ER and medicine in general. First, ER Docs typically make what they can bill the hospital for. So a Doc serving a poor population is going to make far less than a Doc serving a fully insured population - like half as much! So ER is in a very good position to benefit from any national health care plan. Even $20 or $30 per patient is better than the $0 they get today from those patients.

On a more scary note, a few ER Docs that have made a killing in the past by "owning" the hospital contracts with busy trauma hospitals. They then created partnerships and locked out any other Docs. By selling ownership into partnerships or just hiring ER Docs on salary and skimming off the top, a few made millions at the expense of their fellow EM Docs! Sounds like EM Residents need to watch out for secretive and closed book partnerships - especially in this age of mega-partnerships of EM Docs.

One of the two Docs finished his EM Residency then decided to do an Anesthesia Residency. After practicing a couple of years, he decided the overnight call every third night or so and poor lifestyle were too much of a sacrifice and went back to working ER! That was eye opening.

The other Doc works pseudo-Locum Tenens: he works odd shifts at four of five hospitals in a couple of Midwest states. His advice was that EM is great because it still allows you to do so different things. Not only do you have a controllable lifestyle, you aren't trapped (as I had assumed) into being a hospital ER employee for ever. Like a lot of creative Family Docs are doing, you can open a "wellness center", do cosmetic or low income medicine, etc. That is, if you don't fill your off time with hobbies like travel, investments, missions or sports you can start a profitable part0time business. It was very exciting to learn that there are still many opportunities opened in medicine if I get burned out or bored with shift work.

The last thing we discussed was Osteopathic EM Board certification versus Allopathic. It sounds like Osteopathic Residency programs allow you to sit for either Board test. So I could do the four year program at Arrowhead's Osteopathic Residency program, but sit for the Allopathic Boards. The difference between them is that the Allopathic Boards is more recognized internationally and probably required to teach at any Allopathic Medical school. The Osteopathic Boards would be required to teach at any Osteopathic school presumably. However, either allows to you practice anywhere in the U.S.

The first three days this week were in the Dupont ER were slow. Felt like an urgent care clinic with the ability to admit the most serious patients. I basically just did a lot of history taking, looking at labs and X-rays/CTs and hoping to see something interesting coming in on the monitors. Yesterday was a nice change and really peaked my interest in EM again.

This happened at the same time I was having great dinners with the Family residents courtesy of local drug reps. Wednesday we had a ton of pretty good sushi at the "best" sushi place in town. Lat night it was a top-rated steak place. The shrimp was ok. And I only got a few strange looks for being the only one of about 50 people not ordering red meat. The residents here are great people, so it was hard to admit my preference for EM as they were soft selling the program to me.

Today I slept in and am just getting started studying surgery. Less than 24 hours left in Fort Wayne. Kind of bittersweet. I can't wait to see the family, but I like the people here and am facing a very hard three months upon my return. We got our Clinical Education schedule from AZCOM this week and I can definitely see why the previous med classes despise the Department. My early summary of tests was a bit optimistic. I have Surgery and Family shelf tests, then a week later third year finals - one written and one with standardized patients. Then we get three weeks of 8 to 5 didactics immediately followed by our fourth year written final! The following four weeks I get to cram for the Osteopathic and Allopathic Boards. Seven tests in about 12 weeks.

My opinion during first year that Clinical Ed is probably the worst run Department at AZCOM has only been reinforced over the last year. Speaking of, before I study for these tests I have to make up (i.e. Lie) my logs for this rotation by inputting a bunch of ICM-9 and CPT codes on Clin Ed's worthless intranet site. They take up so much of our time and teach us nothing. And after ten years they still can't get us decent clinical rotations. The only redeeming value is a few superstars like Linda, the MSIII rotation coordinator who works her butt off for us.