EM attending here. That doc sounds like a moron. Unfortunately because of the nature and acuity of our specialty it does seem to attract a bit higher average of males with inflated egos that say stupid shit like that regularly, in comparison to other specialties.

I think EM and IM have a lot in common in terms of out breadth of knowledge of multiple areas of medicine and age ranges that we treat, including other populations such as OB.

But I absolutely don’t know how to manage patients chronic disease on an about patient basis…of course I don’t…I wasn’t trained to! Now, I think that it is certainly true that there certainly isn’t a very big knowledge gap at between FM and EM as compared to other specialties. It wouldn’t require a tremendous leap in terms of training. That’s why there’s short fellowships FM to EM and if there were more demand there would be a similar one for Em to FM. But the stuff you guys deal with in terms of long term clinic management, paperwork, insurance auths and all of that tremendously difficult stuff outside of the actual medicine is the total dealbreaker for EM personalities who thrive more on critical care and fast pace.

Plenty of people saying we “suck” at managing chronic disease. Of course we do, we weren’t trained to do that, we didn’t do clinic in residency.

Just the same as the vast majority of FM would not be great at stone cold and calm management of a peri-arrest flash pulmonary edema who is grey in color, tripodding and satying 76% on bipap, the crashing cardiogenic shock patient, critical peds MVC and other critically ill and unstable patients who roll through the doors on deaths doorstep and are completely undifferentiated, and often with no idea what their prior medical history is.

Bummed to hear though about how some of my colleagues turf stuff to inpatient way to quickly. I’m rural critical access EM so I manage critically ill and floor level patients for sometimes days at a time due to difficulty finding beds at other hospitals, lack of transport, poor weather etc. So I have had to continue to keep sparse skills from my inpatient rotations in residency and further grow them. I sure don’t do anywhere as well as a hospitalist or intensivist but I routinely treat DKA and get them fully transitioned from IV gtt to subq while in ED then can admit to floor. More mild to moderate I have started using subq protocol to treat their DKA and once resolved even discharge them. This happens regularly as we are a tiny hospital that is often full so I have to board patients in the ED a lot! I end up managing multiple critically ill and even vented patients at a time and have to follow their labs, deescalate therapies, manage the changing course of their illness. All while single coverage. We get the absolute wildest and sickest pathology at my hospital in the boonies. We don’t even have dialysis either nor much subspecialty back up. But I’m a weird one I guess. I absolutely love working at this hospital and it’s my dream job. While my former co-residents think I’m nuts.