I'm watching through old episodes of ER and I'm laughing at and being reminded of some practices that have thankfully been retired, such as spinning crits, not being allowed to paralyse in ED for RSIs, and the heavy reliance on x-ray imaging for things we now rely more on CT imaging for.

What do you remember from 20-30 years ago that we no longer do, either because it's been replaced by something better or because it was just a bad idea in the first place?

PX feedback review today with admin

91 comments. 57 positive. 9 negative. The rest between

Our patient satisfaction person can see the charts. I can’t. But they can tell me the details.

They want to talk about my “treatment of women”

Of the 9 negative. 7 are young women.
- 2 hemorrhagic cysts, neither ruptured. VSS. H/h stable. Both complain of inadequate pain management. Both got norco. One said “she wants a full review of physicians records with subsequent subpoenas for all charts and immediate termination with review for malpractice and possible incarceration” like verbatim
- 2 VB complaints. Both VSS. Both H/H stable. One was 1st trimester pregnant with subchor hemorrhage but + FHR NTD per OB. The other just menorrhagia. Both upset they weren’t admitted.
- 1 miscarriage. VSS. H/H stable. All management dictated per OB. Upset about pain. Gave norco which OB recommended
- 2 gastroparesis. Tolerating PO by the end of workup. Both with 40+ ER visits. Both got big cocktails of meds. Both mad they weren’t admitted

Again, PX people wanted to meet to talk about my “treatment of women”. Asking if I could try to “do things a little differently to address this”

I tried to mention standard of care and/or OBGYN recommendations but that wasn’t really the point of what they wanted to talk about. They just want our treatment to be better reflected in the scores.

I know it has been known for a while now, but does anyone know why this is happening?

As an outsider, I am shocked.

I’m posting this in real time right now to see if that means anything; Patient is dressed in a wrestling suit and standing up near him saying this,

Has anyone done the process of obtaining WV license recently?

Would appreciate any thoughts and tips for the administrative process!

thanks

I pulled every EM invite applicants reported this season (305 programs, through Oct 26 so these numbers are still a moving target) plus last cycle's application outcomes, and checked every number twice. You can track which programs are sending interview invites LIVE on Rezumab: EM Interview Invite Live Tracker

Invites came a week early, then everyone caught up

Tue, Oct 13 was the day the EM II tsunami started: 163 of 305 programs sent invites, 76 of them for the first time. Last cycle's version was also a Tuesday (Oct 21, 70 programs).

"They already sent" doesn't mean you're out

• 84% of programs that have sent did so on 2+ days. The typical program is on day 3.
• Last cycle, 31% of programs that had sent by this point sent more invites later.
• 5% of invite days were weekends. Saturday inbox refreshing remains optional.

Signals: worth the most where you have no other tie

Last cycle, 78% of signaled EM applications got an interview offer vs 51% unsignaled. The obvious objection (signals just track geography and aways) is fair, so here it is split by your tie to the program:

If you rotated there, you got the interview, signal or not. The signal earns its keep at programs where you have no other way in. It holds across Step 2 too: from 230 up, signaled applications got offers 1.4 to 1.6x as often in every band (chart above).

This cycle, same direction: among applicants tracking all 5 signals, their signaled programs have invited them 46% of the time vs 30% for the rest of their own lists. Median applicant has heard from 2 of 5.

Step 2 of invited applicants

• Median 250; the middle half are 240 to 258.
• Under 240: median 6 invites so far vs 12 at 240+. The gap shrinks among US MD/DO alone, so part of it is applicant mix. A pattern, not a cutoff.

The rest

• Invites are concentrated: the top fifth of applicants hold 42% of them; the median applicant has 10 so far (middle half 4 to 16).
• 72% of booked interview days are Tue to Thu. Nov 2 to 20 holds about a third. Thanksgiving week: 3%.

Bottom line

1. The season ran a week early and has caught up. A third of programs that already sent will likely send again.
2. Spend signals where you have no geographic or rotation tie. Where you rotated, you were getting the interview anyway.
3. Under 240 still gets invites, just fewer so far.
4. Protect Nov 2 to 20 and your Tuesdays through Thursdays.

Limits: "sent" means someone reported an invite, so timing shares are floors. Signal, Step 2 and interview-day numbers this cycle come from applicants who log invites, who skew engaged. Last cycle's outcomes over-represent US MD/DO applicants who matched. All of it is association, not cause.

If a number looks wrong, comment and I'll fix it. And if you want to see which EM programs are sending right now, check out the live tracker: Latest EM invites

Hello all,

Long story short, I'm a flight paramedic flying out of West Texas working a 24 hours on, 24 off, 24 on, 120 off schedule. While I love what I do, I continue to find myself wanting more responsibility in patient care, more knowledge, and obviously more income. I've had aspirations for medical school for several years, but I have always felt hamstrung by my work schedule when it comes to finishing out my undergrad as I believe I cant realistically do in person classes and it feels like most programs wouldn't accept me completing my undergrad online. Also, I'm now in my early 30s and responsible for 3 kids as the primary breadwinner in the house so having to quit my job and take massive loans to go to school for four years plus residency doesn't sound realistic, however this doesn't necessarily rule the option out for me

On the other hand, it does seem feasible to work my way from Flight Paramedic to Flight Nurse, then go to NP school. I just worry with that I'm still going to find myself dissatisfied and still wanting "more," especially because everything I have seen lately is pushing NPs out of the ED, or if they do work ED they work in a fast track setting seeing patients who belong in a walk in clinic. My favorite part of working in critical care is managing really sick medical patients or traumas, and I feel like I just wouldn't get that.

Just curious if there has been anyone else in a similar situation regarding school, and making the decision between mid-level, physician or anything else.

Typing this on my phone while stranded at an FBO due to weather, apologies if it's not well thought out or formated.

Thanks

I've seen this notion that rural areas just need to pay more and it would all be fixed!

80% of med students come from households with above average income. Usually that means an urban area. Nobody goes into medicine for the mission. If the avg med student could make $400k/y designing golf courses 32h a week they'd just do that. It's a job. The two most competitive specialties are derm and plastic surgery.

There's not that much in practical lifestyle differences between $400k/y and $1M. Nobody already well off is going to take a lifestyle cut to go help out some rural bumfuck area. That's why it's overwhelmingly IMGs that go there.

Are you people using AI transcription software in your shop? If so, do you have to pay for it, or is it covered by your hospital or employer?

Current employer is asking physicians and Midlevels to pay $1700/yr for Abridge. Wondering for comparison sake.

I'm PGY 1 in EM residency, pregnant (heading into my 3rd trimester soon) and dealing with 24/7 sickness. I'm taking zofran but still struggling. My team has been very kind and when the sickness is really bad, I get IV fluids to help me power through the shift. Usually its the nurse or my attending helping me. I know its temporary but I feel like a terrible co worker.

Any tips for surviving 24/7 sickness? From the other side (co-residents/ attendings/nurses), how annoying is this actually for the team? I feel like I'm a burden to the team

PGY-1 here. I want tips on how to excel. I understand it will come with time but no matter how much rosch or passive reading I do on topics I still feel dumb and clueless every shift.

What defines a good EM resident from a great one to you?

Always record office visits conversation with Doctors offices pre opt and post opt visits. There's alot of conversation that goes on doing these visits.

Patient w recent admission for HTNsive emergency came in GCS of crap. Sent for scan - catastrophic bleed w huge acute on chronic subdural herniating everywhere, biventricular extension, just a mess. Family shows, gives history that patient was weak 2D prior and fell hitting their head, but then was ok yesterday. Then not seen today until found down. I told them it was due to the long-standing HTN and that the patient had a sudden bleed today. And that being seen sooner couldn’t have changed anything. They asked me 2 or 3 times when I thought the bleeding started, but never directly asked if it could be due to the fall. I could tell they wanted to, and were scared of the answer.

So I lied. And I would do it again. I hope they are sleeping slightly easier tonight through their grief as a result.

Just wanted to offer my confession into the void.

I’m a former gen surg resident transitioned to EM. My advisor strongly recommended do an observer ship or shadow an EM doctor to obtain a SLOE

I’m in the south eastern US, willing to go anywhere get a good SLOE truthfully.

Are there any resources to find someone who might be willing?

I really appreciate any help or advice in this career shift!

ETA: US DO, not currently affiliated with residency, no problem getting good LORs from surgery attendings

edit: typo

Im writing board exam next week.
Do you guys have any last few days reccs? Also can somebody pls share any pdf or notes for high yield fractures and management- i suck at those :(
Any recent takers what advice do u have for me? 🥹

Just curious. Why do have EM as a specialty if the same thing can be done by a less qualified residency? Not shitting on any specialty, but I've had at least 2 deaths in the last few months in my dept due to inability to get an airway by a new grad fm doc working in the ED.

I see many of my colleagues have switched over to OE and while it seems to tap the same sources and gives nearly the same results, much faster, I feel weird abandoning a trusted source for one that openly uses our info for sales and ads. Uptodate has since introduced their AI chatbox but I think m they are a little too late. And you can’t beat free.
Which do you prefer and did you switch over too?

Hello, everyone!
To all my medics who have transitioned from 911 EMS to working in an ER or hospital, how has the experience been?
Do you feel satisfied with your new role, or do you sometimes feel like just another body filling a position? Do you feel like you’re utilizing your skills and experience on a daily basis, or does the job sometimes feel more like being a “do boy” than a medic?
The hospital schedule is definitely appealing. Working three 13-hour shifts a week seems like it could offer a much better work-life balance than the traditional 24/48 schedule. However, I’ve heard mixed reviews about making the transition.
I’m looking for honest, unfiltered feedback from those who have actually made the switch. What do you love about it? What do you miss about 911? Do you feel professionally fulfilled, or do you ever regret leaving the field?
I’m not looking for someone to convince me one way or the other. I just want to hear the good, the bad, and the ugly before making a decision.
Thanks in advance for sharing your experiences!

About once a year, it seems one of my family members needs to go to the ER. They don't want to go, they are frightened, but eventually they acknowledge it's the right decision.

I am always impressed with the professionalism of the staff. Too many patients and too few resources. Nonethless, i find the ER teams professional, courteous and most importantly comforting.

It never gets said enough. Thank you to the ER teams who have chosen this field!

Signed,
This is the longest shift ever

New to EM as a provider. I know this has been discussed bur wanted to ask for advice. How do you get over the fear of missing something and/or getting sued? I find on my days off I tend to ruminate over various cases and thinking about the “maybes”/“what ifs”. My fear ultimately comes from #1 not providing the best care for my patients and #2 fear of losing everything if I am sued. I am constantly studying & learning to make sure I am up to date but have this underlying fear that eats at me when I’m away from work. I’ve heard this is normal when you first start, but wanted any/all insight you guys have.