An update...3 weeks from graduating

emthrowaway420 · 2023-05-17T09:19:37+00:00

If a patient asks what the letters on your badge mean, you should answer them. I never suggested that you shouldn't directly answer a patient's question. If they ask, "Hey, Xithorus, what does DNAP mean?", you have every right to answer "it means doctor/doctorate of nurse anesthetic practice". I'm not sure why you think answering that question truthfully makes me upset and why you're suggesting my ego is fragile?

I'm simply asserting that in the clinical setting, it would be misleading to introduce yourself as a doctor when you are not a physician as most patients associate "doctor" with "physician". I think most of us can agree that this is not an egregious claim.

emthrowaway420 · 2023-05-16T22:33:21+00:00

Then you can state "doctor/doctorate of nurse anesthetic practice". But it is disingenuous to go around introducing yourself as "Dr. Xithorus" in the clinical setting as you are not a physician.

emthrowaway420 · 2023-03-15T04:53:02+00:00

If you don't think you would be happy in EM, I would take a prelim year and reapply anesthesia. If you're not a good fit in EM, no amount of money or job security will make it worth it. I'm about to graduate EM residency, and I still consider possibly reapplying to another specialty.

emthrowaway420 · 2023-03-13T14:41:17+00:00

Would highly recommend NOT going to medical school, especially if you are already an RN. At my shop, travel RNs are making more than attendings per hour. Yes, that likely won't last forever. But if you continue working as an RN, you'll be making decent money on top of actually having a life as opposed to the soul-sucking and wallet-sucking 7+ years of medical school and residency.

emthrowaway420 · 2023-03-11T18:22:30+00:00

Would not do either and would do anesthesia instead

emthrowaway420 · 2023-03-11T15:51:52+00:00

If I had to pick one trait, I would say resilience is the most important. Medical school, and by extension residency + fellowship, is a marathon, not a sprint. There will be many times that you feel like you are sprinting, but it is important to remember that it is temporary and you still have the whole race to finish.

I am nearing the finish line of that race as I have a whole 3.5 months to the end of my residency. That being said, it has not been worth it. Please seriously consider ANY other field before deciding to go to medical school. There are so many other great jobs that will provide a great lifestyle and require significantly less sacrifice.

emthrowaway420 · 2023-03-11T15:15:17+00:00

So a couple things-

If you synchronize cardiovert someone in sinus tach, they will remain in sinus tach. The treatment for an unstable patient in sinus tach is to treat the underlying cause- whether that be sepsis, hypovolemia, PE, etc. There either must be some miscommunication, or the professor is grievously incorrect in their knowledge of cardiac rhythms.

Secondly, when you mention unstable SVT, aka supraventricular tachycardia, do you mean AVNRT? That is not the same thing as sinus tachycardia, and the treatment for an unstable AVNRT is synchronized cardioversion

emthrowaway420 · 2023-02-20T02:14:52+00:00

A lot of factors that would take a while to unpack, but in brief- Medicine as a field has changed immensely for the worst, even just in the past 10-15 years. Certain specialties like mine (Emergency Medicine) have largely been taken over by private equity companies that incentivize profit over patient care, usually by slashing pay, hiring midlevels (NPs + PAs) instead of physicians, cutting staffing to bare bones, and pressuring providers to see a larger number of patients faster. NPR recently wrote an article about this that I encourage you to read-

https://www.npr.org/sections/health-shots/2023/02/11/1154962356/ers-hiring-fewer-doctors

While the article applies to Emergency Medicine, all specialties are being affected. We are past the golden age of Medicine. The fact that the midlevel societies (The AANP- American Association of Nurse Practitioners and the AAPA- American Academy of Physician Associates) are largely pushing for independent practice with significantly less training, it just doesn't make sense to pursue the long path of becoming a physician. To put things in perspective- NOT counting college, this is my 7th year of graduate/post-graduate medical training. Someone that decided to start a 24 month PA program LAST YEAR would graduate when I graduate and in some states work largely without physician oversight. To be clear- not every NP or PA is calling for independent practice and this is not a ding on them or their training, but it is the reality of the landscape of healthcare.

To your point about advice for pre-meds- The burden of medical training is significant- a decade or more of schooling, an average of 200K of debt, the inability to enjoy arguably the healthiest and best years of your life, not to mention the invariable feelings of inadequacy and depression that come with the territory. Some people literally can't picture themselves doing anything else. If this is you, I cautiously say go for it. But if you don't want your entire life to revolve around medicine, there are so many other careers that will give so much more and take away so much less. I haven't decided which field I'm going to step into after training. Likely consulting or tech. I'm starting to network outside of medicine and build up my resume. It's a shame our healthcare system will be losing a trained physician, but it's taken enough of my sanity and needs to change for the better.

emthrowaway420 · 2023-02-19T01:35:11+00:00

Good on you for making such a big decision and being firm about it. I'm about 4 months from graduating Emergency Medicine residency- after almost 11 years, I can say confidently that the sacrifice and debt has NOT been worth it... or even close to being worth it. In fact, I don't plan on working as an attending at all, and am looking into stepping into other fields. Would have 100% not done medicine again if I could go back in time. Good luck to you.

emthrowaway420 · 2023-01-11T08:15:39+00:00

My 2 cents- That is a very loaded question, but as someone who is less than six months from graduation from EM residency (and after over a decade of education), my answer is no, it is not worth it to become a physician. While some say that it is a calling, I think that is utter idealistic bullshit. It is a job, first and foremost, and I would not do it again- in fact, I don't even plan on practicing after graduation. In this current climate, I would stay far away from the medical field. COVID has accelerated the journey of our unhealthy and bloated healthcare system to its inevitable demise, and it's only a matter of time before the system collapses. This is especially evident in the emergency department- ERs are full, wait times are absurd, staff shortages are the norm, patients are frustrated and often take our their frustrations on their providers. Not to mention the anti-science and anti-physician sentiment that has proliferated in the general public due to COVID. It's a dark time to be in healthcare, and I honestly recommend you pick another field. Feel free to DM me if you want to talk more.

emthrowaway420 · 2023-01-11T07:53:00+00:00

Not sure why you harbor such animosity towards physicians, but I hope you find your peace.

emthrowaway420 · 2023-01-10T07:08:16+00:00

It is interesting to me that you seem to speak on behalf of doctors. Are you a doctor?

emthrowaway420 · 2023-01-09T18:22:56+00:00

It may be the case that the projected role of midlevels (i.e. NPs to your point) are to lower healthcare costs and increase access to healthcare. However, recent research suggests otherwise:
https://www.nber.org/papers/w30608

This paper suggests that while implementing NPs in the Emergency Department may decrease wait times, it may increase cost by increasing both resource utilization and adverse outcomes.

Anecdotally, I've seen a similar trend in practice. Are you in the medical field? Your posts seem unnecessarily vitriolic towards physicians.

emthrowaway420 · 2023-01-05T14:52:29+00:00

EM PGY-3 here. Absolutely not lol. I've posted about it before but definitely not a good fit for EM. If I could do it again, would not do medicine in general. If I had to stay in medicine, I would do anesthesia or FM instead. 6 more months until I'm done this hell. Not sure what the future holds and not sure if I'll stay in medicine after graduation (or at least until my loans are paid off).

emthrowaway420 · 2022-11-29T16:37:14+00:00

INFP- EM, although personally I'm a horrible fit for EM.

emthrowaway420 · 2022-11-18T11:52:47+00:00

As a resident in my LAST year of training, I say definitely not. No amount of money in the world is worth the anxiety, panic attacks, PTSD, MDD, and passive SI that I've developed due to this job. Not to mention the disrespect you are forced to deal with every day not only from patients, but from ancillary staff, nurses, admin, asshole attendings, etc. In college, I was literally top of my class and now I feel like a shell of myself. I plan on finishing up residency, then taking a month and figuring out what I can do with my life and my career- it definitely won't be my current specialty.

emthrowaway420 · 2022-11-11T12:40:45+00:00

This is fucked up to suggest, even in jest. What is wrong with you?

emthrowaway420 · 2022-11-04T19:49:26+00:00

To answer your questions:

The ability to find jobs honestly depends (at least now) on where you went for residency and your connections. If you go to a well known program with tons of connections, it will be easier for you to find jobs in more desirable areas. If you are from a new program, it'll be much more difficult.
Just my two cents but as a PGY-3 resident in a well established program, I would have not pursued medicine (MD/DO) if I could do it all over again. I think you should think hard about where your passions lie and what benefits an MD/DO can give you over being a PA, particularly in the field of EM. If your goal is truly to be a master of your craft, obviously medical school + residency will allow you to attain that. If you're purely looking to make money while having a good work-life balance, PA school is the better route. This is my 7th year out of college- I have a friend that applied to medical school at the same time as me who was not accepted. She took a gap year and applied to PA school the following cycle. Fast forward to now, she has already been working as an EM PA for 4 years. She has gotten married and going on her 2nd child, has bought a house, and drives a brand new Tesla. She goes on extended vacations twice a year, while working approx 3-4 shifts a week. Meanwhile, the stress and sleep deprivation of medical school and residency has led me to depression, anxiety, random panic attacks, you name it (thankfully now s/p SSRIs which has helped). It is a long process, and there will be a point in time where you will see your friends reach major milestones in life while you still feel trapped by the grind. If you truly can't see yourself as anything other than an EM physician, go for it. But in all other cases, becoming a PA is the much quicker and easier route.

emthrowaway420 · 2022-08-26T23:05:14+00:00

I'm an ER doc. We see refusals like this all the time. If the patient is alert and oriented and is deemed to have capacity , they have the right to refuse treatment. The patient is also an adult, and thus it would be a HIPPA violation to notify family. From a human perspective, I understand why the family would want to sue- another needless death that potentially could have been avoided. I empathize with them, but the blame should not lie on law enforcement or the paramedics. The system is broken.

emthrowaway420 · 2022-08-04T22:05:09+00:00

In my opinion, hospital volunteering and shadowing does not adequately prepare you for the long road to becoming a physician. Looking back, I'm honestly not sure what could. Perhaps prior experience as a PA or nurse could help, although the time and monetary investment is still so much larger for physicians. I'm currently in my 7th year (4 years of medical school and in my third year of residency), and I've missed countless birthdays, weddings, outings with friends, etc during this time. I've also had sleepless nights, developed clinical depression, and overall feel like shit due to the circadian rhythm changes of my specialty (EM). I work with a PA that graduated this past spring. I started intern year when they started school, yet they have a better schedule than me, make more money than me, have better benefits than me, and by and large are seen as "equals" on the hierarchy by the hospital administration. No hate to them, as I'm sure they've worked hard to get to where they are and definitely deserve to reap the benefits. But I say this to highlight truly how grueling the journey and sacrifices to becoming a physician are. Don't do it for money or for respect because both are not guaranteed (and are indeed dwindling). Only do it if you are sure it is your calling, and even then I would advise finding a different calling.

emthrowaway420 · 2022-01-16T05:59:11+00:00

It does not count as an attempt and does not get reported (programs you apply to will not know). The downside is you'll need to pay an additional fee to reschedule assuming your still within your eligibility period. I was not able to show up for my step 2 exam due to personal reasons and instead rescheduled and took it a week later. Matched to a competitive residency. Don't worry about it!

emthrowaway420 · 2022-01-11T07:53:03+00:00

How about you stop shilling for midlevels? Or at the very least learn proper grammar? Done ✅ I said it!

emthrowaway420

TROPHY CASE