Ask questions about emergency medicine here

[The Bunny 16]

On 4/8/2020 at 8:12 PM, magneto said:

I wanted to write a small post in this thread regarding emergency medicine.

In general, every single specialty is important and crucial.

This is not a post about how emergency medicine is better than other specialists. IT IS NOT (READ line above).

But the current situation with COVID-19 highlights need for passionate emergency physicians who love to help others.

It is a stressful and challenging time in all parts of medicine. But emergency physicians, nurses, RTs, admin, cleaners, other ED workers etc. are at the front line in this challenging environment.

I am very proud of medicine as a whole.

I think we will continue to need more passionate emergency physicians so if you are on the fence, please ask any question here so that I can persuade you to join the effort.

If emergency medicine is not your gig, that's fine. We need our consultants and family physicians too!!! They back us up and provide support - I cannot do my job without them.

Great post @magneto 

very true

[magneto 46]

I wanted to make a post to explain the two training pathways to emergency medicine in Canada (5 year FRCPC and 2+1 CCFP-EM program).

There is a lot of great information on the two programs on this forum but there is also not-so-great information and sometimes plain wrong information based on opinions and anectodes.

I believe this false information is not helpful for anyone.

If you want to read more about history of emergency medicine in Canada, and history of how CCFP-EM and FRCPC (EM) program started, please search the following on your favourite search engine:

1. The birth of a new specialty: the history of emergency medicine in Canada by Remon Elyas

2. Emergency Medicine Training & Practice in Canada: Celebrating the Past & Evolving for the Future by Collaborative Working Group on the Future of Emergency Medicine in Canada.

3. Past, present, and future of emergency medicine by CAEP

4. The Multiple Paths to a Career in Emergency Medicine by Andrei Karpov and Maurice Agha

5. Practice patterns of graduates of a CCFP(EM) residency program by Catherine Varner, Howard Ovens, Eric Letovsky, Bjug Borgundvaag

6. Emergency medicine training in Canada: learning from the past to prepare for the future by Tim Rutledge

7. Emergency medicine certification in Canada: the years march on but the questions remain the same by Riyad B. Abu-Laban

 

Some of the articles might be behind a paywall but can be easily accessed through your university library. I will summarize these in my next post.

[magneto 46]

Before emergency medicine developed as a specialty, emergency departments were run by general practitioners and interns/residents of specialists (e.g., internal medicine, pediatrics, trauma etc.).

Slowly emergency medicine started emerging as its own specialty and countries across the Globe started developing training pathways to train future emergency physicians.

In Canada, there was a long discussion and debate between the College of Family Physician and the Royal College of Physicians and Surgeons of Canada.

In College of Family Physician view, emergency medicine was a sub-specialty of family medicine and they proposed a training pathway where family physicians can get extra training to become emergency physicians.

The Royal College of Physicians and Surgeons of Canada proposed that emergency medicine is its own specialty and the training should be under the guidance of royal college.

The two colleges were not able to come with a common solution. So each of them came up with their own training pathway around the same time, and started accreditation process for residency programs around the same time, and developed board exams for their graduates around the same time.

The scope of practice is same for emergency physicians regardless of whether they trained through CCFP-EM pathway or FRCPC (EM) pathway. This is reflected in two things: (1) almost every tertiary care center in Canada employs both CCFP-EM and FRCPC-EM graduates (except for very few and the reason is political/bureaucracy) and (2) both CCFP-EM and FRCPC-EM graduates use the same billing codes and are paid the same (except a few places, I believe Quebec is one of them).

[magneto 46]

Here are some common myths regarding CCFP-EM and FRCPC-EM:

- CCFP-EM is inferior training. This is false. Graduates of both programs have the same scope of practice. There is no limitation to scope of practice of CCFP-EM residents.

- CCFP-EM graduates only work in rural areas and the purpose of CCFP-EM is to train emergency physicians for rural areas. This is false. Majority of CCFP-EM graduates in large urban areas and work along FRCPC-EMs. There are also many FRCPC-EMs who have decided to work in smaller towns due to their preference.

- CCFP-EM graduates are not eligible to do fellowship training. This is false. Many fellowships, such as ultrasound fellowship are open to CCFP-EM graduates. Fellowships that are accredited by Royal College are not open to CCFP-EM graduates (this includes critical care fellowship and pediatrics emergency medicine fellowship).

- CCFP-EM are like GP-A, GP-OB etc. This is false. There is clear distinction in scope of practice between other PGY3 enhanced skills program and their royal college colleagues. For example, GP-OBs do not routinely train to do C-sections. This does not apply in emergency medicine and graduates of both CCFP-EM and FRCPC-EM have same scope of practice.

- CCFP-EM graduates do not work in tertiary centers. This is false. There are CCFP-EM graduates working at tertiary care across the country.

- CCFP-EM graduates only do part-time emergency medicine. This is false. The majority of CCFP-EM graduates do 100% emergency medicine.

- CCFP-EM graduates make more mistakes. This is false. There is no objective data to make up for this claim. And malpractice insurance is the same for all emergency physicians.

- CCFP-EM graduates do not engage in research. This is false. Many CCFP-EM graduates are leaders in research. Many have extra training (Phd, MPH etc.).

- CCFP-EM graduates do not engage in administration. This is false. Many department and hospital chiefs across the country are CCFP-EM graduates.

[magneto 46]

CCFP (EM) program

Advantages:

- Shorter residency (3 years)

- Can work as family physician and emergency physician

- Can diversify practice if you want (OB etc.)

Disadvantages:

- Not recognized by some international countries (e.g., USA)

- Cannot apply to Royal College accredited fellowships (e.g., critical care, pediatrics emergency medicine)

- Need to apply to CaRMS twice

Potential disadvantages:

- Hiring prospect. In theory, when both CCFP-EM and FRCPC-EM graduate apply to only one spot at their home program, there is a greater likelihood that FRCPC-EM will get hire. This is for 2 reasons: (1) home program knows FRCPC-EM resident for 5 years vs CCFP-EM resident for 1 year; (2) FRCPC-EM resident had 2 additional years to become a more competitive candidate (e.g., PGY4 fellowship, more time to get research papers published, more time to present at conferences, more time to network etc.)

[magneto 46]

FRCPC (EM) program

Advantages:

- Cannot apply to Royal College accredited fellowships (e.g., critical care, pediatrics emergency medicine)

- Credentials recognized internationally

- Only need to apply to CaRMS once

- Extra 2 years of training helps with networking, job prospects, finishing research projects etc.

Disadvantages:

- Longer residency (5 years at least)

Potential disadvantages:

- Can potentially only practice as emergency medicine physician (or within the sub-specialty niche)

[Total Gunner 29]

3 minutes ago, magneto said:

FRCPC (EM) program

Advantages:

- Cannot apply to Royal College accredited fellowships (e.g., critical care, pediatrics emergency medicine)

- Credentials recognized internationally

- Only need to apply to CaRMS once

- Extra 2 years of training helps with networking, job prospects, finishing research projects etc.

Disadvantages:

- Longer residency (5 years at least)

Potential disadvantages:

- Can potentially only practice as emergency medicine physician (or within the sub-specialty niche)

How do you get into the 3 year program? Do you match to fam med for 2 year and have to match again to some sort of EM specialty? Or do you directly match to the three year FM-EM combined residency?

[magneto 46]

It is disheartening to see that current group of physicians, residents, medical students and pre-meds have started creating a divide in medicine. Sometimes I feel that new incoming medical students have lost sight of becoming a doctor first but instead are focused on specialty-of-choice from day 1. This has led to us vs them situation. And that is not helpful for anyone.

I think instead of arguing which program is better or worst, we should talk about how to work together to provide great care to our patients and service to our society.

This debate does not only apply only to CCFP (EM) vs FRCPC (EM). There are other examples out there such as whether pediatric emergency medicine training should be through emergency medicine residency training or pediatrics training. A few years ago, it was vascular surgery direct entry vs vascular surgery fellowship post general surgery.

I am happy to answer any questions about the two program.

[magneto 46]

2 minutes ago, Total Gunner said:

How do you get into the 3 year program? Do you match to fam med for 2 year and have to match again to some sort of EM specialty? Or do you directly match to the three year FM-EM combined residency?

3 year program:

- Finish CCFP (family medicine training - 2 years)

- Apply for PGY-3 CCFP-EM (emergency medicine training - 1 years)

Total number of years = 3

Dalhousie (I believe) has a dedicated CCFP-EM program that is 3 years long and is direct entry from medical school so you only have to apply to CaRMS once but spots are very limited.

[Total Gunner 29]

1 minute ago, magneto said:

3 year program:

- Finish CCFP (family medicine training - 2 years)

- Apply for PGY-3 CCFP-EM (emergency medicine training - 1 years)

Total number of years = 3

Dalhousie (I believe) has a dedicated CCFP-EM program that is 3 years long and is direct entry from medical school so you only have to apply to CaRMS once but spots are very limited.

How hard is it to get into the PGY-3 CCFP-EM vs the 5 year program? Only concern is if you only did FM trying to get into the EM program, but if you fail to then you're stuck in FM. Does that happen often? Or is it generally safe to say you can get into EM this way? 

 

Only curious because I've heard EM is quiet competitive, and if this 3 year method was much easier everyone would just do it and then not worry about any competition? I've onlt heard things and have no idea what's true, so really appreciate your help

[rmorelan 2,561]

2 minutes ago, Total Gunner said:

How hard is it to get into the PGY-3 CCFP-EM vs the 5 year program? Only concern is if you only did FM trying to get into the EM program, but if you fail to then you're stuck in FM. Does that happen often? Or is it generally safe to say you can get into EM this way? 

 

Only curious because I've heard EM is quiet competitive, and if this 3 year method was much easier everyone would just do it and then not worry about any competition? I've onlt heard things and have no idea what's true, so really appreciate your help

not safe particularly (in matching terms) depends on the number of applicants which can vary of course year to year. Somewhere around half to 2/3rds of the applicants make it. 

[magneto 46]

23 hours ago, Total Gunner said:

How hard is it to get into the PGY-3 CCFP-EM vs the 5 year program? Only concern is if you only did FM trying to get into the EM program, but if you fail to then you're stuck in FM. Does that happen often? Or is it generally safe to say you can get into EM this way? 

 

Only curious because I've heard EM is quiet competitive, and if this 3 year method was much easier everyone would just do it and then not worry about any competition? I've onlt heard things and have no idea what's true, so really appreciate your help

Both programs are very competitive.

Most medical students who want to do EM will apply to the 5 year program first.

CCFP-EM is very competitive so if anyone who does not want to do family medicine should not apply to FM.

[Sunshine! 18]

If you don't match into PGY-3 CCFP-EM in PGY-2, could you re apply the following year?

[Wachaa 46]

14 hours ago, Sunshine! said:

If you don't match into PGY-3 CCFP-EM in PGY-2, could you re apply the following year?

I suppose you can.

Things will be more difficult if you don't already establish electives/ references letters...both of these things are hard to get once you've completed your residency.

Another reason people don't go back into residency is that you get used to the staff lifestyle and income.

 

One other way is that you could work in an ER (eg. small community where CCFP-EM or FRCPC is not required) and challenge the exam. Here is the reference for the eligibilty to challenge the EM exam (note the 2017 link; if anyone knows the rules have changed, please comment):

Eligibility and Application. College of Family Physicians Canada. http://www.cfpc.ca/EligibilityandApplication/

[magneto 46]

15 hours ago, Sunshine! said:

If you don't match into PGY-3 CCFP-EM in PGY-2, could you re apply the following year?

Yes but only a few schools accept applications from practicing physicians. Look at the CaRMS website as majority of programs only accept applications from FM PGY2s.

There is also a possibility of obtaining CCFP-EM certification by working in ED without CCFP-EM and accumulating a certain amount of ED hours and then challenging the exam. It requires a lot of work and dedication. And the pass rate is lower than physicians who did a dedicated PGY3 EM program.

[magneto 46]

1 hour ago, Wachaa said:

I suppose you can.

Things will be more difficult if you don't already establish electives/ references letters...both of these things are hard to get once you've completed your residency.

Another reason people don't go back into residency is that you get used to the staff lifestyle and income.

 

One other way is that you could work in an ER (eg. small community where CCFP-EM or FRCPC is not required) and challenge the exam. Here is the reference for the eligibilty to challenge the EM exam (note the 2017 link; if anyone knows the rules have changed, please comment):

Eligibility and Application. College of Family Physicians Canada. http://www.cfpc.ca/EligibilityandApplication/

Thanks for excellent input.

[JohnGrisham 1,698]

On 5/21/2020 at 6:09 AM, Sunshine! said:

If you don't match into PGY-3 CCFP-EM in PGY-2, could you re apply the following year?

Some schools don't accept practicing physicians. In my personal discussions with 3 CCFM-EM program directors, the general sentiment was the reason for a strong preference for PGY trainees is because they are still malleable, and aren't set in their own ways/style of practice. Hard to take a practicing physician 10 years out of residency and plop them back into the role of a resident.  

The challenge exam route is the more realistic pathway for those who don't get into the +1. But again, anecdotal - but in my region, the ones who went the challenge exam route (in recent years), are simply not as confident in their skills compared to the ones who did the intensive +1 year. Obviously varies, but just a function of extra residency training in a safe, learning environment.  That said, if you practice rural/community and get lots of ED exposure and supportive colleagues/mentors, then the challenge exam route can be very fruitful.  

A lot of it starts with the FM residency you choose. You don't have to go rural or community to get strong FM training, you can do that in a big city as well - but be cautious of some of the "lighter" FM programs that are more focused on training an outpatient FM doc and doing the bare-minimum of in-patient rotations or call-requirements etc etc. 

[casajayo 49]

On 3/2/2020 at 7:03 PM, rogerroger said:

When I applied to CaRMS I knew I didn’t want any surgical speciality. Initially at the start of clerkship I was drawn to surgery but quickly learned the lifestyle and me didn’t mix. A big thing I learned during medical school about myself was that I enjoyed medicine, life long learning, the intellectual and social aspects of the field. But I could not be happy if medicine occupied the majority of my time. I simply had too many other interests that I enjoyed to give up more than 50% of my time to medicine. 

During my ward based rotations I also learned that these jobs would crush my soul. I just found the environment depressing, bureaucratic, and inefficient. To be frank, I just found it terribly boring. 

I still liked procedure based medicine, one of the things that drew me to surgery initially. For me, I also had zero interest in longitudinal care, but I really enjoyed the mystery solving aspect of medicine, and talking to various people, and getting undifferentiated cases on their way to being resolved. That was deeply rewarding, more so than the longitudinal care aspects of medicine. That’s how it was for me. 

Once I realized these things, I saw that there was few fields that were action oriented, quick paced, diagnostic in nature, involved direct patient care, had procedures, and avoided hospital wards. This pretty much only left emergency medicine. By the time CaRMS came around I couldn’t imagine doing anything else and enjoying a life in medicine as much as I could. The certainty on this realization was why I pursued the RCPSC track for EM. 

Time always brings out more nuances. The same goes with a choice of speciality. 
 

Nearly a decade ago when I was entering the CaRMS match I was a mid 20s guy living in a bachelors condo. I was basically only responsible for myself. It was awesome being a resident and going golfing on a wed morning, having the links to yourself, when everyone else worked. A single 20 something year old, can’t really fully appreciate how life changes once you are married, have multiple kids and so on. So I did not fully factor in the shift work aspect on these things, I had no real way of knowing, despite thinking I knew back then  

 Now I’m married, have multiple kids, run businesses outside of emergency medicine. I’m anything but responsible only to myself. 
 

I still love the fact that I only spend 30-40% of my time in the hospital - still considered full time in EM. I like my time in the ED. I would like it less if the time was more than what I do. I generally feel well compensated for the time I spend doing EM. I have the means to comfortably do most things I want to do. I feel my work is rewarding. These are both huge factors that protect from burn out in my opinion. I know many other specialities would not as easily provide the time to pursue non-medical entrepreneurial ventures etc. I really enjoy these things, as much as medicine these days. So I’m really happy about this aspect of EM. 

But I certainly did not fully understand how shift work can influence family life. It is not without cost. Although I’m technically home about 60% of the time. About 50% of this time is not during family friendly hours . Don’t get me wrong, this is a great time to do non-family, non-medical things. But it isn’t time generally easily spent with kids or my partner. I did not really fully appreciate this fact back during CaRMS. 
 

For instance, every month I usually have a stretch of evening / night shifts that go about 4-5 days. I often imagine these stretches as similar to going away on a business trip, or maybe working in the airline industry. I sleep most of the day. And see little if anyone outside of the medicine world for these multiple days.

This said, being around during weird times also has it’s benefits come kids. Often I’m free for their school events, or random mornings and afternoons when the rest of the “normal” world is working their day job. Pretty much every month I have a week completely off without EM work. The shift work is a mixed blessing. 

I’m still in my early 30s. The physical aspect of shift work hasn’t really hit home for me. Older colleagues mention this. I know one day it will hit home for me too. Lots of studies demonstrate the physiological ramifications of shift work over the long term. It isn’t pretty. I think this is one of a multitude of good reasons to justify fair compensation for EM physicians. This probably does limit how long you can practice in a physically healthy manner. The timer on a strictly EM based career is likely shorter than is some other specialities. Again this was another factor I knew about come CaRMS, but probably minimized to a certain degree.

Would I have done things differently if I was to match again? Nope, no way. I still love EM. Probably more now than I did back during CaRMS. It’s a great career, with so much flexibility, and variability. 
 

It was mentioned that we are not the “experts” in anything. I think this is generally not true. We are the experts in identifying and managing immediately life threatening situations. Often the public may not see this stealthy expertise based on who discharges them after their life is saved. Sometimes other specialities may naively overlook this skill set because we consult them, often once the diagnosis is made, the patient is resuscitated or the differential narrowed to a handful of things... But the reality is that few physicians in the hospital have as much experience in resuscitation of multiple patients simultaneously, immediately emergent procedures, toxicology, environmental emergencies, mass causality management, crash airway management etc etc. This speaks to one of the most satisfying parts of the job. It is receiving a patient on the cusp of death with any various unknown problem every day. Identifying the issue, stabilizing them, then packaging them up for some other speciality has the chance to manage the temporized or mitigated acute issues with a “ribbon attached”. In this way I feel like EM docs are the “ninjas“, “marines” or “shock troops” of the healthcare system.  

 

 

 

 

I'm wondering if you can talk a bit about whether you considered critical care instead of EM? I'm in a similar boat to where you were: I want to do procedure-based medicine, be involved in direct clinical care, be involved in "life/death" situations, and generally feel like I'm actually doing something with my time in the hospital, as opposed to writing another prescription and leaving the work to my juniors. If surgery had a better lifestyle and job prospects I'd be there, but like you, I enjoy my life outside of medicine. 

I'm thinking of doing IM with subspecialty training in critical care, but I'm torn as to whether EM might also be a good fit, and given Covid have lost almost any opportunity to shadow (and likely won't get any pre-CARMS elective time either). Do you know much about the lifestyle of an ICU doc, what their day looks like in terms of hands-on care vs rounding?  Also, what is the bread and butter of EM cases you see? The things that aren't as "exciting" as trauma and immediately emergent cases?

[medigeek 82]

On 5/22/2020 at 12:04 AM, magneto said:

Yes but only a few schools accept applications from practicing physicians. Look at the CaRMS website as majority of programs only accept applications from FM PGY2s.

There is also a possibility of obtaining CCFP-EM certification by working in ED without CCFP-EM and accumulating a certain amount of ED hours and then challenging the exam. It requires a lot of work and dedication. And the pass rate is lower than physicians who did a dedicated PGY3 EM program.

How come you say it's a lot of work and dedication? You're working and making physician income, while accumulating hours. The remaining part is passing the exam, which is the same exam PGY3 people write.  

[medigeek 82]

16 hours ago, JohnGrisham said:

Some schools don't accept practicing physicians. In my personal discussions with 3 CCFM-EM program directors, the general sentiment was the reason for a strong preference for PGY trainees is because they are still malleable, and aren't set in their own ways/style of practice. Hard to take a practicing physician 10 years out of residency and plop them back into the role of a resident.  

The challenge exam route is the more realistic pathway for those who don't get into the +1. But again, anecdotal - but in my region, the ones who went the challenge exam route (in recent years), are simply not as confident in their skills compared to the ones who did the intensive +1 year. Obviously varies, but just a function of extra residency training in a safe, learning environment.  That said, if you practice rural/community and get lots of ED exposure and supportive colleagues/mentors, then the challenge exam route can be very fruitful.  

A lot of it starts with the FM residency you choose. You don't have to go rural or community to get strong FM training, you can do that in a big city as well - but be cautious of some of the "lighter" FM programs that are more focused on training an outpatient FM doc and doing the bare-minimum of in-patient rotations or call-requirements etc etc. 

Do you know what specific things they were not as confident in?

[MDinCanada 27]

18 hours ago, JohnGrisham said:

Some schools don't accept practicing physicians. In my personal discussions with 3 CCFM-EM program directors, the general sentiment was the reason for a strong preference for PGY trainees is because they are still malleable, and aren't set in their own ways/style of practice. Hard to take a practicing physician 10 years out of residency and plop them back into the role of a resident.  

The challenge exam route is the more realistic pathway for those who don't get into the +1. But again, anecdotal - but in my region, the ones who went the challenge exam route (in recent years), are simply not as confident in their skills compared to the ones who did the intensive +1 year. Obviously varies, but just a function of extra residency training in a safe, learning environment.  That said, if you practice rural/community and get lots of ED exposure and supportive colleagues/mentors, then the challenge exam route can be very fruitful.  

A lot of it starts with the FM residency you choose. You don't have to go rural or community to get strong FM training, you can do that in a big city as well - but be cautious of some of the "lighter" FM programs that are more focused on training an outpatient FM doc and doing the bare-minimum of in-patient rotations or call-requirements etc etc. 

What would you say are some important criteria when evaluating different FM programs?

[rmorelan 2,561]

5 hours ago, medigeek said:

How come you say it's a lot of work and dedication? You're working and making physician income, while accumulating hours. The remaining part is passing the exam, which is the same exam PGY3 people write.  

first thought - passing an exam without the support and guidance of a full program? That sounds horrible (doing the same with full support and resources for my exam was literally the most academically stressful thing I have ever done ). The exam history you get at the school it extremely valuable. 

[JohnGrisham 1,698]

4 hours ago, rmorelan said:

first thought - passing an exam without the support and guidance of a full program? That sounds horrible (doing the same with full support and resources for my exam was literally the most academically stressful thing I have ever done ). The exam history you get at the school it extremely valuable. 

Exactly this - and doing 12 months of concentrated ED training in a supported and structured learning environment with a mix of academic and community ED preceptors is wildly different than accumulating hours over 5 years in the "real world".  One is a concentrated, constant feedback iteration loop, where you are in a learning environment first and foremost. It is hard to replicate that, even if you do have supportive colleagues/coworkers while you collect your hours- its simply just very different.  The pass rates for the challenge writers is anecdotally much lower for this reason. 

[Pakoon 95]

15 hours ago, JohnGrisham said:

Exactly this - and doing 12 months of concentrated ED training in a supported and structured learning environment with a mix of academic and community ED preceptors is wildly different than accumulating hours over 5 years in the "real world".  One is a concentrated, constant feedback iteration loop, where you are in a learning environment first and foremost. It is hard to replicate that, even if you do have supportive colleagues/coworkers while you collect your hours- its simply just very different.  The pass rates for the challenge writers is anecdotally much lower for this reason. 

Please forgive my ignorance, but is this a written exam, are you unable to just study for it as you would any other exam?

[rogerroger 155]

On 5/22/2020 at 11:11 AM, casajayo said:

I'm wondering if you can talk a bit about whether you considered critical care instead of EM? I'm in a similar boat to where you were: I want to do procedure-based medicine, be involved in direct clinical care, be involved in "life/death" situations, and generally feel like I'm actually doing something with my time in the hospital, as opposed to writing another prescription and leaving the work to my juniors. If surgery had a better lifestyle and job prospects I'd be there, but like you, I enjoy my life outside of medicine. 

I'm thinking of doing IM with subspecialty training in critical care, but I'm torn as to whether EM might also be a good fit, and given Covid have lost almost any opportunity to shadow (and likely won't get any pre-CARMS elective time either). Do you know much about the lifestyle of an ICU doc, what their day looks like in terms of hands-on care vs rounding?  Also, what is the bread and butter of EM cases you see? The things that aren't as "exciting" as trauma and immediately emergent cases?

I went into my emergency medicine residency considering critical care. It was one of a handful of potential options I was considering for the “extra specialization year” built into the 5 year training. 
 

In my first three years of residency I spent just shy of 1/2 year in the ICU, and didn’t like it that much. In the ED sick patients often get better, get worse, die, or stay the same and get admitted over the course of a shift. The ICU with all it’s hours of rounding and the gradual changes in patients status didn’t really fit what I was looking for from a work satisfaction standpoint. Don’t get me wrong. There is also some fascinating medicine going on there. When it was interesting, it was really interesting. But it just didn’t have the turn around of the ED which I really enjoy. 

My impression is that critical care docs work really hard when they are on. There are different models out there, but many cover the ICU for a couple days. Those few days seem to be fairly focused on the ICU with call etc. During the off times most of these folks go back to their regular programming, such as being an emerg doc, anesthesiologist, respirologist, surgeon, etc.. I imagine what sort of overall lifestyle this job presents is probably highly dependent on what else you are doing when not covering the ICU.

As an aside, the ICU rotations during emergency medicine training are some of the highest yield over the five years. Many residents come out of the ICU and return to the ED with a much improved repertoire of knowledge and skills. So even if critical care isn’t your cup of tea, it’s hugely translatable towards determining the type of emerg doc you will be.