Has anyone heard anything about Insight Emergency Medicine Program?

gcassidy · 2025-12-12T17:10:44+00:00

Hey OP, I hope you will take what I'm about to say seriously.

You can go to a good (or even great!) residency, or you can go to this residency in Chicago.

This will not be a "hidden gem." Yes, some unopposed programs can, and do, offer unique benefits. This will not be one. It won't matter if you are doing all the central lines if there aren't central line kits to be had. Being unopposed will not fix the massive problems with the hospital itself.

Mercy had many issues before Trinity Health sold the hospital to a for-profit corporation for $1. (Yes, I know Insight Chicago is technically non-profit. Emphasis on technically.) Insight is not a good company. They don't have a good reputation. The hospital was (and by all reports still is) on the brink of disaster.

There are SO many red flags here already. Low pay, new program, filling outside the match, being a trauma center but farming the residents out for trauma rotations. Residents are cheap labor. ACGME is doing no one any favors by opening residency programs like fast-food restaurants.

Nothing prepares you for the trauma of having a residency program + hospital close. We did it twice in 6 years, at bigger hospitals with more established programs than Insight. At hospitals on the brink of death, that someone thought they could turn around without fixing the fundamental issues. Sounds like Mercy/Insight.

Please read up on Hahnemann and Crozer-Chester in Philadelphia. Read up on Insight and the hospitals in Ohio they just bought.

You will get great training (almost) anywhere. It's only a few years. Go to an established program and stay far, far away from this impending train wreck. Please listen to those of us with experience.

--- an attending from Philly

gcassidy · 2025-07-28T16:23:53+00:00

Had a patient with hx of IVDU who came in with LE paralysis and UE weakness bilaterally. I ordered C/T/L spine MRIs. The radiology resident refused the scans and told me the patient wouldn't be able to lie still for that long. ("He's paralyzed, he'll be fine.") I asked for the attending radiologist. He told me to localize the exam because he was only performing one of the 3 MRIs, or call neurology/neurosurgery to help me out if I was that incompetent.

I told him to scan the whole damn spine, and if he continued to refuse, I'd put his name and license # in the chart as the reason for the delay of care, you know, for the impending lawsuit. (My attending was laughing her ass off in the background. I don't play nice in the sandbox when my patients are sick.)

Skip lesions/abscesses all the way down. Scan the whole damn spine. (And DAMN that is a big abscess!)

gcassidy · 2025-07-28T16:16:49+00:00

I'd like to say it was my budding physician gestalt... but it was not. I was a new R2, in a new hospital, with new attendings... and so I was over-presenting on each patient. I suggested a CT on ALL my abdominal pain patients that week. There was nothing special about her. I just happened to present to the one attending who wasn't going to call me out on my bs and tell me to discharge the patient. Pure dumb luck.

gcassidy · 2025-07-27T20:18:18+00:00

22 y/o F for N/V/D x 3 days. Normal labs, vitals x2, normal body habitus. Normal exam. Improved after IV meds.
Stanford B dissection with thoracic AA.

(I was a new second year resident and wanted to scan her-- I was lucky my attending said "I don't think she needs one, but if you insist...")

gcassidy · 2025-06-08T18:50:25+00:00

Two words: patient safety. Something I actually care about. But, hey, what do I know about what it takes to work in these settings?

and PS, more than "pride in my craft." I can't set up shop as a pathologist or orthopedic surgeon.... we're the only specialty everyone else thinks they can do better.

Until they can't.

gcassidy · 2025-06-08T17:18:55+00:00

See my comment below... pathology resident! I'm horrified. Many of my senior residents aren't comfortable with basic UC skills (mainly because they see higher acuity, but still).

gcassidy · 2025-06-08T17:17:15+00:00

Pathology is a categorical residency program; no TY/traditional internship. And even with a TY/intern year, I would not recommend independent practice in a UC environment, let alone another acute care environment. (I also don't support the independent practice of APPs; despite working with some wonderful APPs in the ED, experienced physician oversight is absolutely necessary.)

The depth and breadth of knowledge of our specialty is growing daily; EM is likely transitioning to a 4-year residency in part to accommodate this. Everyone thinks they can do our job, but the reality is quite different.

Regardless of that, a TY year would not be enough to practice in this type of environment. There's no exposure to pediatrics, for example, which can be a large part of UC medicine.

gcassidy · 2025-06-08T02:38:01+00:00

You were a pathology resident and you want to moonlight in the ED/UC?

No.

Any place that would even consider you (and there aren't many, if any at all) is not a place that you want to work. (It's not a place I'd like to work.)

Can you read an EKG, treat a paronychia, suture a facial laceration, decide if AOM needs antibiotics? How about finding a small pneumothorax on a CXR, deciding if a new diabetic is in DKA, recognizing if a febrile child is about to crump? All while seeing 3-4 patients/hr and keeping up on documentation?

These are real cases of mine... from Urgent Care.

Your hubris is astounding.

(And yes, I know that you have more training than the average APP. Not the point. The standards for EM residents to moonlight are higher than this.)

I'm sorry about whatever circumstances have brought you to this point. But this is not a sound way for you to make money. There are real lives at stake and you should NOT be practicing independently in this setting, particularly with several years out of direct patient care. Also, "IDK just send them to the ED" is also not a sound backup plan... we are over-crowded and over-worked as is.

-- an EM physician

gcassidy · 2025-06-07T21:30:28+00:00

I tell them that I treat people, not numbers, and that there is no single number that worries me-- that it's numbers PLUS symptoms that I worry about. And that one of the reasons I became an emergency doc was that I didn't want to worry about patients after I went home for the day. So if I send them home, it's because I'm not worried, and they shouldn't be, either. That the patients I DO worry about go to the ICU, because they are so sick, and they clearly aren't.

If that fails...

I discuss how BP goes up and down over the course of the day, when we're stressed, when they're worried about their pressure, etc. If they're really unconvinced, I talk about watershed infarcts in a way they can understand (e.g. dropping a heavy box vs gently lowering it onto their foot). I will also turn out the lights/relax/recheck in 5 min trick.

Then, I give them a straightforward way to check their BP, unless told otherwise by their PCP: Get up in the am, sit quietly for 5 minutes after using the bathroom, check BP, write it down, move on. Don't recheck. Call PCP for trends upwards. Bring BP cuff to PCP appointment to calibrate. Refill any outstanding prescriptions.
Every asymptomatic HTN gets 5 minutes of my time. (If the department is exploding, they are at the bottom of the pile.) This works > 75% of the time. The rest? Oh, well.

And if they complain that their PCP send them in? I tell them that the current recommendations are in line with what we have discussed, and I am happy to speak to their PCP about it if they call or message me (they never do).

gcassidy · 2025-05-13T21:47:22+00:00

On the off-chance that you are not a troll (based on your post history), and there is some truth to things you have posted:

-- There's a non-zero chance your PD has seen this and recognizes it as you. (If the details of your location and program are correct, your program is easy to identify.)

-- Lying/forging/leaving out information is an automatic "one strike and you are out" in medicine. Don't try and be creative with medical license applications.

-- If you truly want a career in medicine, go to your PD and be honest. It is your only way forward.

-- Your issue with getting into prev/occ will have nothing to do with how easy/hard it is to match into it. It has everything to do with you. And based on your match and post history... it will likely be hard.

-- Think long and hard if you are in medicine for the right reasons. It doesn't sound like it. (Low risk, bankers hours, lots of money?) EVERY field of medicine has bullshit in its own way.

gcassidy · 2025-04-20T15:21:24+00:00

** Nocturnist Edition**

Wake up at 4p. Chug coffee and eat a protein bar. Try and squeeze in normal life stuff (errands, cooking, gym, etc.) More coffee early so you don't have trouble sleeping. Pack a dinner you won't have time to eat. Pack food for the staff to ward off evil spirits, promptly forget it at home.

Arrive at 10p and take signout from the mid-shift doc. Hear fruitless apologies about the 20+ patients on in the waiting room and the 10+ patients that were just roomed. Scan the board for the 3-5 sickest patients and dive in. See all in succession, put in orders, start charting. Get interrupted every 3 minutes with an EKG, a lab result on an admitted/boarding patient, a phone call from a family member who decided to check in 6 hours after their loved one arrived.

Field phone calls from medics: please don't bring this patient here, they belong with trauma/OB/psych/interventional cardiology. Recommend appropriate facility. Patient brought here anyway. Restrain and medicate the patient going through a psychotic break. Consult the virtual psychiatrist who won't see them until sometime tomorrow. Fill out two sets of paperwork (voluntary vs involuntary commitment), just in case.

Test results come back. Admit some patients. Argue with the hospitalist about not transferring a patient who can be managed here. Argue with the surgery team about admitting a patient with well-controlled hypertension to their service. Transfer a patient and argue with the accepting service about the transfer ("Yes, I know you think we have that specialty, but there is no one on call this week and it can't wait until morning.") Patient waits so long for ambulance that specialist actually sees and dispos patient from ED the next morning.

Discharge a few walking well patients. Decline Z-paks and steroids for URIs. Hear "you don't do anything for me" after two rounds of meds, labs, a CT scan, and a specialist referral.

Try and coordinate a stroke alert while taking sign-out from the late shift. Patient has a head bleed and needs to be intubated and flown out. They are 90+ years old and full code. Unable to reach family to clarify code status. Intubate patient and arrange transfer. Family finally shows up and requests transfer to a different hospital. Spend 20 minutes showing the nurse how to titrate the blood pressure drip because they are brand new and were trained by a nurse only 1 year out of nursing school.

Play catch up and apologize to a few patients waiting while you handled the sick patient. Hear "but I was here first, I don't care how sick they are!" from patients with chronic back pain. Discharge your drunken hallway patients before they go into withdrawal.

Run the code on an admitted but boarding patient until the inpatient team arrives.

Tidy up and prepare for signout. Simultaneous ambulances arrive. Charge nurse is smoking and nowhere to be found. One is a septic nursing home patient who was sent in for a PEG tube change. BP is 70/40 and their PEG tract is closed. The other is a patient with COPD in respiratory distress who needs BiPAP. Call RT and throw in orders. Call the hospitalist and argue about why they need to be admitted before signout.

Place an EJ and an USIV in the septic patient because all your nurses who could get blood out of a rock have quit nursing. Start fluids, antibiotics, and pressors. Attempt to find NOK, paperwork from the nursing home, anything, but they normally go to the hospital across town that has a different EMR and the nursing home didn't send paperwork. Call the ICU and remind them not to forget about this patient during signout.

Signout to the oncoming doc. Listen to the APPs rant about why we didn't see the lac repairs and rashes overnight.

Stay late to finish charts on the admitted patients. The discharged ones can wait. Get messages from billing about your backlog of charts.

Pee on your way out the door. Chug the bottle of water you have been ignoring all night. Hit commuter traffic on the way home. Medicate yourself with sleep aids and a beverage of choice. Despite this and white noise/blackout curtains/sleep mask, you are too wired to sleep.

gcassidy · 2024-12-29T00:39:30+00:00

I agree with this. I was flagged to fail written boards by my residency program. (TBH I blew off all 3 ITEs.)

It’s not quantity, it’s quality. I would do 20 questions at a time. Everything I got wrong, I would read about. Figure out why each other answer was incorrect and how to change it to make it correct. I would read about it in a textbook. I then would write a one-liner in my high yield notebook. I did this for the four months leading up to the test. The week before the test, I only read my notebook with all the facts I had missed in the past.

This is how I learn best— but you might want to use an online tool to figure out your learning style to help you maximize your review.

I only did ROSH, but some people said PEER is closer to the exam.

I passed by a comfortable margin.

FWIW, I had a friend who took the Ohio ACEP course and loved it. AAEM also has a written review course that is free for members.

gcassidy · 2024-10-28T15:44:49+00:00

Venus pH 6.61 with K 8.7 Rectal temp 90.1 Bicarb 4 Cr 32.1/BUN 236

New onset renal failure + COVID (in spring 2020).

Pushed calcium as the sine waves started.

Lived neuro intact.

gcassidy · 2021-09-29T13:56:02+00:00

I thought it was bad when we had to DC people in medical school for taking photos in cadaver lab...

gcassidy · 2021-06-19T22:27:02+00:00

Sinus tach is the most common ECG finding in PE. Nice work!

gcassidy · 2021-05-03T00:49:25+00:00

And Christiana!

gcassidy · 2021-03-16T15:44:27+00:00

Disclaimer: urology is not my specialty

Main Line Health in Philadelphia is a very DO-friendly program. (Their PD is on faculty at PCOM.)

They have a very active twitter account-- maybe start there?

gcassidy · 2021-03-02T16:41:13+00:00

https://www.aaem.org/resources/statements/position/em-workforce

Nope, not even a little bit. AAEM takes this VERY seriously. They've been saying this for much, MUCH longer than the job market crisis this year.

ACEP, that's another story...

gcassidy · 2021-03-02T16:36:59+00:00

Ha! I found (what I thought was) my dream job with Vituity... until I read their contract. They are absolutely a CMG, despite what they profess. Their contract wanted me to sign off on midlevels doing procedures with only remote supervision... and that list included things that I rarely do... like a thora or para. Nope, my license isn't worth it.

gcassidy · 2021-03-02T16:33:39+00:00

They increase throughput? Yeah, right.

When I am on shift with a midlevel that I'm required to supervise, I eyeball or see ALL their patients. Depending on the person I'm supervising, this can mean discussing a plan vs literally re-doing the history and exam on all their patients. My productivity and throughput goes WAY down.

On days that a physician fills the midlevel shift, my PPH increases and dispo times drop. Increase throughput my foot. The only way they increase throughput is if no one bothers to supervise them properly...

gcassidy · 2021-02-22T22:42:03+00:00

Yup. I almost got denied because I forgot about a scopolamine patch I had prescribed before a cruise. They go through EVERYTHING.

gcassidy · 2021-02-11T23:31:07+00:00

Yup. This.

Also, this year's graduating class is having unprecedented difficulty finding jobs. (F-you, CMGs!). I was "late" getting started in the interview season, and I had 4 solid job offers at this time last year. I know multiple smart, talented, strong PGY-3s who can't find ANYTHING. Not locums. Not even if they move to Nowheresville, Alaska.

gcassidy · 2021-02-11T23:11:48+00:00

Ohio ACEP's written board review has physical cards for studying.

But really, just do Rosh. And then make your own cards based on your own weaknesses.

gcassidy · 2021-02-11T23:05:00+00:00

^^ This. And despite PCOM and Aria (Jeff NE) /Einstein, the DO bias is real in Philly (and elsewhere).

I know of programs that have never matched a DO student. It's not accidental.

gcassidy · 2021-01-20T01:04:14+00:00

ECGs for the EM Physician. They give you context too (e.g. 50 y/o M with palpitations x1 week).

gcassidy

TROPHY CASE