FDNY Ride Along...

[Kiwiology]

Good points there AA I didn't think of haemolysis

hmm it would appear sterile water is super duper hypotonic which is really bad haemotajuju

Hey I was right, awesome

[zmedic]

I agree; but what's this I hear about in US you can do a four year medical degree with between none and very little patient contact in first two years, then do a one year internship which bestows upon you an unlimited license to practice medicine then hook up to a three year vocational training program and at the end of that you're a qualified emergency medicine physician?

Kiwi, (MBChB, FACEM FANZCA(c. 2026))

Couple of things

1: You have any data that patients have better outcomes in countries with a 6 year residency versus 4 years? You can assume more time is better, but why not just have a 10 year residency? I'm glad I'm not spending 6 months doing anesthesia, you don't need that much time to learn how to intubate. And most of the other stuff you do during those months don't really apply to emergency medicine (I don't whip out much isolflurane in the ER)

2: I think it's a bit insulting to call an emergency residency "vocational training." Therefore a pedatrics residency is just vocational training for treating kids, surgical residency is vocational training for surgery etc. You are also putting too much stock into what someone can do after just an internship, sure you can write perscriptions but you aren't going to get hired anywhere.

3: Sure medicine is tough, but I think if you can't learn to safely treat patients in 7 years of training (med school plus residency) you are doing something wrong. There is always more to learn, which is why many people spend another 1-2 years in fellowship. I would also remind you how expensive medical education is in the US. When you are $200,000 in debt, a system where you don't start making real money until you are 40 doesn't sound so good.

4: None of this really has to do with what's being discussed. The fact that a paramedic didn't know hypotonic doesn't have much to do with how doctors are trained in our two countries. I agree there is a big gap in the education between paramedics in the US and other countries. But I don't think how doctors are trained really comes into that.

[Kiwiology]

2: I think it's a bit insulting to call an emergency residency "vocational training."

Take it up with the Medical Council then; all post-graduate programs are called "vocational training" here

3: Sure medicine is tough, but I think if you can't learn to safely treat patients in 7 years of training (med school plus residency) you are doing something wrong. There is always more to learn, which is why many people spend another 1-2 years in fellowship. I would also remind you how expensive medical education is in the US. When you are $200,000 in debt, a system where you don't start making real money until you are 40 doesn't sound so good.

All vocational training programs lead to Fellowship of the appropriate college here, same in AU and I think in the UK; e.g. Emergency Medicine is five years and you become a Fellow of the Australasian College for Emergency Medicine.

The cost of medical education in US is absolutely unbelievable; it's roughly NZD75,000 (USD63,000) for NZ, AUD45,000 (USD46,000) in AU, GBP55,000 (USD79,000) for UK compared to like USD200,000 plus ...

I'm not having a hack at your blokes system I'm just taking a bit of the piss and I am liking this gig where your doctors (depending on speciality) get paid several hundreds of thousands of dollars per year and get treated like pseudo royalty. I know several anaesthetists who make probably a quarter of a million dollars a year; sorry Intensive Care Medicine my dual-specialisation just changed to emergency medicine and anaesthesia; I need a couple years working in US to pay off my medical school debt of seventy k and save up for a private jet

I wonder if that Emergentologist bloke needs an anaesthetist for his private practice in a few years ...

And I'm not even going to go near the "unlimited license to practice medicine" thing ... you may find it interesting to note the Medical Council defines cardiology as "The diagnosis and management of patients with complex medical problems which ...include ... cardiology" so you are limited to performing procedures and prescribing medicines specific to that scope (and your general scope which is like generalist GP type medicines) so Conrad Murray wouldn't have been able to prescribe propofol here; that would be restricted to an appropriate vocational scope (emergency medicine, anaesthesia or intensive care medicine and maybe, maybe at a reach palliative care and rural hospital medicine)

Edited April 1, 2012 by Kiwiology

[ERDoc]

We may make more here, but like you said we have a lot more debt. As for being treated as pseudo-royalty, those days ended in the 80s, especially in emergency medicine. We are pretty much seen as any other service provider such as the garbage man, the pimply teen at McDonalds, etc. As for your rant about the US system, you're just jealous, lol (taking the piss here bro). We do have pt contact during the first two years, though not in an actual clinical setting. We get a great deal of instruction on doing a thorough H&P. As zmedic said, you can, in theory, start your own practice after internship but good luck getting anyone to hire you or become your pt (or get an insurance company to pay you). You are nothing more than a more educated 4th year medical student who actually gets to make some decisions. It is during the second year of residency where you become dangerous because you think you know more than your attendings. Third year is an eye opener because you realize that in less than a year, you will truly be on your own, and have to make ALL of the decisions; it's very humbling and is probably the year that I learned the most. There is never an unsupervised resident in the ER. It is a requirement of the RRC that there be an attending in the ER at all times and they are required to see all of the pts that the residents see. We don't call in the consultant physician here.

[Kiwiology]

A lot of our emergency departments do not have a Consultant (Attending) 24 hours; most are office hours or until midnight only; our local ED has a Registrar on until midnight then it's just two House Surgeons or a House Surgeon and a Senior House Officer. At weekends they have a Reg or Consultant on all night because of the increase in workload due to alcohol, other drugs and assaults.

It varies by hospital system (DHB) but here many House Officers working in ED can independently discharge people without senior review; some can't and must speak to the Reg or Consultant. At my local hospital the House Surgeon can discharge people without Specialist review but cannot admit people without referral to the appropriate services' House Surgeon or Registrar; e.g. the Surgical House Officer must be consulted to admit somebody to surgical ward, you'd think the House Officer on the surgical service would be the House Surgeon but no.

Now I wonder if that Emergentology bloke's hospital is approved by ACEP or ABEM or KIWI or whoever the heck regulates the training of emergency physicians in US; provided I can take three steps and get a post I can do my vocational training in US.

"Yes hello my name is Kiwi and I'm one of the House Officers Junior Doctors; it looks like your bit crook mate you hurt yourself what in the bloody hell did you do to nunnger yourself up that badly how did you manage that? Oh I see you got shot in a gang war, well that's no good be a bit puckeroo eh bro lets have a squiz and if we can't get some number eight wire lets see if we can fix that up, do you have insurance by some chance? you don't hmm well federal law says I have to stablise you regardless but after that it might not be looking so choice for you ow good but I'll be watching telly not at work by then so um yeah ...."

I am having visions of Emergentologist looking like Bill Lumbergh out of Office Space or something eh ...

Edited April 1, 2012 by Kiwiology

[ERDoc]

Any Emergency Medicine residency in the US is governed by the Residency Review Committee who set the standards. People say I look more like an overweight Keiffer Sutherland, minus the facial hair. As for my emergontology, I hate that term. There are people in EM that actually call themselves emergontologists and I just have to laugh. Are we that desperate that we need a fancy name? I'm fine calling myself and ER doctor (there are people that even cringe at the term ER and call it an ED). I may start calling myself a house officer of Kiwiology, but I may seriously nugger myself.

[Just Plain Ruff]

ERDOC just get it over with and start calling yourself ERDOCOLOGIST ok it rolls off the toungue easier and we all know you are going the way of kiwimedic anyway. Just messin with ya.

[ERDoc]

Easy on that bloke Ruff, he's just a few logs short of a barbie.

[Kiwiology]

It's called emergency medicine here; the speciality is governed by the Australasian College for Emergency Medicine

The correct term here is "emergency department" however some old timers still call it A+E for accident and emergency but that term is not used any more as it now (post 2003) refers to the vocational scope of accident and medical practice or what you would call in US the private urgent care / mini ED clinics. Yes, urgent care is its own speciality here defined by the Medical Council as "The primary care of patients on an after hours or non-appointment basis where continuing medical care is not provided". Many urgent care clinics here just have a GP but some have an A&M qualified doctor and there are two professional qualifications for this; Fellowship of the Accident and Medical Practitioners Association or Fellowship of the College of Urgent Care Physicians.

Now we get 75 hot dogs for $25 for our church barbie's so I've got plenty of logs

Oh and Emergentologist you should sign up and become a Kiwiology Registrar; that way in a couple years you get Fellowship and can become a Consultant Kiwiologist.

[chbare]

I've been in health care for well over a decade in the United States and I do not typically see physicians being treated like "psedo-royalty."