Are you happy in EM??

[deleted547339]

I couples matched and it has been HARD. We are a pretty stable and happy couple, but I have had 10+ days without even physically laying eyes on my SO (we live together), and much longer stretches where we've not had any meaningful interaction. We've had three days off together (total) since residency started. But we like our jobs, like our lives, and force ourselves to be social or hang out together when we're exhausted or when it's inconvenient. It's also difficult when one or both of us is on a month we hate because it's hard to check that grouchiness or general dissatisfaction at the door. We're doing fine but it's not ideal, and it's the most stress we've felt in our 5+ year relationship. This would not be sustainable for me long term but I'm okay with it as a temporary necessary evil.

Doesn't sound fine, man. Good luck.

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[asdf123g]

1st year attending Here. Married , 1 child at start of residency, second during. Wife worked during residency and we were 1000 miles from friends and family. It was very straining on our relationship, wife hated it but we made it through alive. There were some nice times but often was just a stressful mess at home. 1st yr as an attending things are much better. Wife quit her job, I'm working far less and things are better at home. The nights and weekend are still very stressful. I worked every weekend in december, Christmas eve, day and new years. Complained to the director because that did not seem fair. If it continues to happen I'm outta here. Gotta spend time with family some holidays and weekends.

Sent from my VS986 using Tapatalk

do you get compensated more at least for working nights/weekends/holidays?

 

[BoardingDoc]

do you get compensated more at least for working nights/weekends/holidays?

It depends on the group you work for. Some places offer a night/holiday differential, some don't.

 

[shoal007]

do you get compensated more at least for working nights/weekends/holidays?

We get a an extra 33 percent for holidays but nothing more for nights or weekends

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[deleted109597]

C suite can make a good job bad. Hospital and local politics can make taking care of people nearly impossible.
Still, some days I save lives acutely, most days I save them at least subacutely.
And other days I earn nearly $600/hr because there are more hospitals than there are emergency docs. It's nice to be wanted.

 

[Birdstrike]

Yea birdstrike, back when I lurked and didn't post, you were fairly active. What's happened? Just got bored of the same ol' rigmarole? I always enjoyed your posts

I've just been busy with other things. I haven't worked day to day EM in 4 years now, so I'm drifting away, I suppose. Many of my posts those couple of years came out of a time where I was thinking through some major changes, specifically moving towards my post-clinical EM career, which is where I am now. I have been wanting to write one of my old-style long posts about my new phase, and I will, but I've just been super busy. Also, I haven't decided whether or not to publish it here, or under my real name in either ACEP News or EP Monthly. I'm happy to get into discussions, but the best way for that now would be for someone to private message me, since I'm not checking the threads as often. That's if anyone cares. Lol. My new life is a little more boring, but better. I'm happier, more content & better rested, and therefore less likely to post. I'm like a fat cat laying in the sun now, full of the inertia of contentment.

 

[emergentmd]

15 yr attending, 3 kids under 7. Wife stays at home. Big Key to a happy/stable marriage as an EM attending (I am a lucky one)

1. Set expectations. Wife needs to know that work comes first. Yes, it sucks that I am working weekends, nights. As she would like to say.... "you work less than a 40hr/week but its doesn't seem that way b/c my schedule is so erratic". But again, this is my profession. This is what pays the bills. This is what allows her to stay home and be involved in the kids lives completely. This is what allows us to take vacations which we do alot. This is what allows our kids to be in the private school that we chose. This allows her not to have to worry about money or live check to check.

I do not know how anyone can have a meaninful relationship in residency. I have alot of respect for people with kids b/c I did residency bf any hour restrictions. When I am working 120+hrs/week on my off service, I would never see my kids. I would rarely see my wife. When I am home, all I wanted to do was sleep. I was completely useless. That really requires a strong wife and relationship.

 

[emergentmd]

C suite can make a good job bad. Hospital and local politics can make taking care of people nearly impossible.
Still, some days I save lives acutely, most days I save them at least subacutely.
And other days I earn nearly $600/hr because there are more hospitals than there are emergency docs. It's nice to be wanted.

I love EM medicine. I really believe we have the best Job overall. Even after 15 yrs, I look forward to going to work 95% of the time. But really there should be an end and an exit.

I get 500+/hr when I do my Locums. Hopefully in a yr, i can just do 6 locums a month and pick the days i want to work.

 

[ERTECH]

Lots of things could change with the ACA ("Obamacare") and/or lots of things could change depending on who gets elected president and which political party is in power that will affect doctors' salaries, lifestyle, etc. This isn't necessarily unique to EM though (except for issues involving EMTALA).

Pray, Trump or Cruz wins..bye, bye Obama care.

 

[ERTECH]

C suite can make a good job bad. Hospital and local politics can make taking care of people nearly impossible.
Still, some days I save lives acutely, most days I save them at least subacutely.
And other days I earn nearly $600/hr because there are more hospitals than there are emergency docs. It's nice to be wanted.

Wow! Only $600.00 an hour lol

 

[Emerbeamer]

I went into Emergency Medicine for a love of variety. I enjoy seeing different things and not doing the same thing everyday. I couldnt see myself doing anything outside of medicine. I would shoot myself if I had a desk job or had to do something without a bigger purpose.

I'm a newer attending, and I like my job now. Residency was painful, but mostly because of off-service stuff. ER time was fine. Now, as an attending, I'm enjoying myself. I consider myself lucky, because my group is flexible and I'm well compensated. I work 15shifts/a month by choice. I could work less, but I like the extra cash for now. Within that, i do work a fair amount of evenings and nights. But, I'm able to schedule off whatever I want in advance. If I ask, I get it. I've worked one weekend out of the month. I've been off for 10 days and still fit in my 15. I have the power, and thats unique to EM. As someone who loves to travel this is amazing. I dont have a family yet, and I do worry if the schedule will be an issue when I do have one.

The pay is great. When i went into medicine i didnt imagine making as much as I do, and it affords me the ability to do what I want in life. Its freedom. I'm no Bill Gates and I'm not a label ***** but I can buy what I want for the most part. I look at my friends in other fields, and they make a good living but I hear a lot of "i can't afford to xyx". Or they have like 3 weeks off in a year and arent able to just go somewhere for a few weeks. That makes me feel better about the weekends and nights. i work hard, but I feel more free than most.

If i had to do it again, maybe I would look into other science/tech things like architecture or engineering. But i think i'd still do medicine. Within medicine I dont see doing anything other than EM.

What I'll say is advice: who knows what the future holds in this field....medicine changes so rapidly. Do it for the right reasons and you can sustain the changes. I try to save money so that if theres anything I can't sustain, I can get out. lol

 

[Daiphon]

What I'll say is advice: who knows what the future holds in this field....medicine changes so rapidly. Do it for the right reasons and you can sustain the changes. I try to save money so that if theres anything I can't sustain, I can get out. lol

#truth

 

[Angry Birds]

There are a lot of positives to EM for which I am very grateful for. The job security is amazing. I am not at all worried about getting fired (not that I've done anything to warrant that). I could get another job on the same day. There really is a shortage of EM doctors and there are ER's across the country, a great majority of whom are constantly hiring. The reality is that you can even find a job within 15-30 minutes of highly competitive areas of the country.

I have friends and family in other career paths, including engineering, business, and law. They have decent jobs, but if they lose their job, it would cause a serious problem for them. They'd be unemployed for at least a couple months and would desperately looking for another job. This is simply not the case for EM. It's a buyer's market, as they say. When you interview for an EM job, they are actively recruiting you--you get the job as long as you don't have any red flags.

We often get annoyed by recruiters calling our cell phones or emailing us... But, people in other fields will often become wide-eyed when they find out about this. It's quite a blessing to be so sought after.

The salary is solid... not super rich by any stretch of the imagination, especially with student loans holding you down. Even so, it's good, solid money.

So, job security and salary is good, and it makes me cautious of ever expressing unhappiness toward my profession. That being the case, I can't help but hate the grind. The constant flow of patients coming into the ER gets highly annoying and wears on you as a provider. I'm a single provider in the ER, and it seems that even though I see patients very quickly and disposition them even quicker, without fail someone else waddles in to the ER. And, in that moment, I hate that patient who walks into the ER for their B.S. complaint. I know I shouldn't, but I do.

Overall, I think the issue is that I never wanted to go into medicine to begin with. I didn't know at that time what I wanted to go into, so I just did the standard medical route. I'm regretting it a bit now, even though I'm grateful, as noted above. Even so, I'm taking steps to transition out within five years, although I never intend to leave clinical practice altogether. The goal is to get into academics, teaching, and research, with a minimal clinical component--although I think this may be tough to get.

 

[TheBoneDoctah]

There are a lot of positives to EM for which I am very grateful for. The job security is amazing. I am not at all worried about getting fired (not that I've done anything to warrant that). I could get another job on the same day. There really is a shortage of EM doctors and there are ER's across the country, a great majority of whom are constantly hiring. The reality is that you can even find a job within 15-30 minutes of highly competitive areas of the country.

I have friends and family in other career paths, including engineering, business, and law. They have decent jobs, but if they lose their job, it would cause a serious problem for them. They'd be unemployed for at least a couple months and would desperately looking for another job. This is simply not the case for EM. It's a buyer's market, as they say. When you interview for an EM job, they are actively recruiting you--you get the job as long as you don't have any red flags.

We often get annoyed by recruiters calling our cell phones or emailing us... But, people in other fields will often become wide-eyed when they find out about this. It's quite a blessing to be so sought after.

The salary is solid... not super rich by any stretch of the imagination, especially with student loans holding you down. Even so, it's good, solid money.

So, job security and salary is good, and it makes me cautious of ever expressing unhappiness toward my profession. That being the case, I can't help but hate the grind. The constant flow of patients coming into the ER gets highly annoying and wears on you as a provider. I'm a single provider in the ER, and it seems that even though I see patients very quickly and disposition them even quicker, without fail someone else waddles in to the ER. And, in that moment, I hate that patient who walks into the ER for their B.S. complaint. I know I shouldn't, but I do.

Overall, I think the issue is that I never wanted to go into medicine to begin with. I didn't know at that time what I wanted to go into, so I just did the standard medical route. I'm regretting it a bit now, even though I'm grateful, as noted above. Even so, I'm taking steps to transition out within five years, although I never intend to leave clinical practice altogether. The goal is to get into academics, teaching, and research, with a minimal clinical component--although I think this may be tough to get.

How long have you been working as an attending?

 

[Angry Birds]

How long have you been working as an attending?

A little over a year.

But, don't take me as typical. I realized well into medical school that I had made a mistake going into medicine.

 

[wonderbread12]

A lot of people over on the ROL thread have made points about shift length in residency factoring into happiness and general fatigue

any current residents care to share their experiences with how many 8s, 9s, 12s, etc your program has you do and how this has impacted your overall happiness

 

[da8s0859q]

A lot of people over on the ROL thread have made points about shift length in residency factoring into happiness and general fatigue

any current residents care to share their experiences with how many 8s, 9s, 12s, etc your program has you do and how this has impacted your overall happiness

8s here. Much prefer 8s. Give me a few extra days in the month in exchange for not still picking up charts at hour 10 of my day anytime, thank you. Occasionally have longer shifts at my moonlighting gig which make me miss my 8s.

I do work at fairly busy places with decent volume, though.

 

[asdf123g]

A little over a year.

But, don't take me as typical. I realized well into medical school that I had made a mistake going into medicine.

what made you realize med isnt for you? what would you rather do? Now that you are where you are now, do you regret going into med?

 

[Angry Birds]

what made you realize med isnt for you? what would you rather do? Now that you are where you are now, do you regret going into med?

I was always interested in humanities. (I don't want to be more specific here due to wanting to remain somewhat anonymous.) However, when I was in high school, I did not think one could make a career out of humanities. (This is probably true for 95% of people, especially in this economy.) Also, I had always been a top student, and I thought--as a top student--I had to go into a competitive field. (Now, I realize that the market for PhD's in humanities is far more competitive than professional schools, although this is due to the overproduction of PhD's and the broken higher educational system. EDIT: To clarify, it is easier to get into a PhD program, but it is harder to actually get a professor job when you come out... In fact, the easiest way to become a professor in America is to go to medical school and become a clinical professor.)

So, I went into sciences and medical school even though I found it--and continue to find it--dull and boring. Further, I feel that as a practicing physician I am a highly paid mechanic (even though I argue elsewhere in the forum that we shouldn't think of ourselves as that). I don't want to be a worker-bee. I want to be a knowledge producer. Granted, you can do this in medicine (i.e. David Newman, Scott Weingart, etc.), but in order to do that you need to have a passion for bio-medicine, which I simply don't have (as described above)...well, at least not the technical side of bio-medicine.

Having said that, I am now taking very concrete steps to actually do what I want to do. The good thing about EM is that you have enough time and days off to pursue something else, which I am... Although what I am doing is not altogether unrelated to medicine. Basically, my long-term goal is to get a dual appointment as a professor in medicine and the humanities. This is very tough to do, but let's see how it goes.

 

[asdf123g]

I was always interested in humanities. (I don't want to be more specific here due to wanting to remain somewhat anonymous.) However, when I was in high school, I did not think one could make a career out of humanities. (This is probably true for 95% of people, especially in this economy.) Also, I had always been a top student, and I thought--as a top student--I had to go into a competitive field. (Now, I realize that the market for PhD's in humanities is far more competitive than professional schools, although this is due to the overproduction of PhD's and the broken higher educational system. EDIT: To clarify, it is easier to get into a PhD program, but it is harder to actually get a professor job when you come out... In fact, the easiest way to become a professor in America is to go to medical school and become a clinical professor.)

So, I went into sciences and medical school even though I found it--and continue to find it--dull and boring. Further, I feel that as a practicing physician I am a highly paid mechanic (even though I argue elsewhere in the forum that we shouldn't think of ourselves as that). I don't want to be a worker-bee. I want to be a knowledge producer. Granted, you can do this in medicine (i.e. David Newman, Scott Weingart, etc.), but in order to do that you need to have a passion for bio-medicine, which I simply don't have (as described above)...well, at least not the technical side of bio-medicine.

Having said that, I am now taking very concrete steps to actually do what I want to do. The good thing about EM is that you have enough time and days off to pursue something else, which I am... Although what I am doing is not altogether unrelated to medicine. Basically, my long-term goal is to get a dual appointment as a professor in medicine and the humanities. This is very tough to do, but let's see how it goes.

that makes complete sense. I wish you luck!

 

[racerwad]

A lot of people over on the ROL thread have made points about shift length in residency factoring into happiness and general fatigue

any current residents care to share their experiences with how many 8s, 9s, 12s, etc your program has you do and how this has impacted your overall happiness

We work 18 9s (chiefs work slightly less due to admin obligations). I am definitely much happier on my ED months, but part of that is just being in the dept versus off service. With the circadian changes and non-shift obligations, I still feel pretty tired on my ED months.

 

[Roy7]

I saw a similar of thread from 2011 and just wanted to see how the view on EM has changed/or not over the years.

Residents and EM docs...are you happy working in
EM?
What was your reason for going into EM in the first place?
What's the best/worst part of your job?
Do you like your hours?
Do you feel like you have enough time with your family?
Do you work in an academic center?
Do you feel you are fairly compensated?
Would you choose EM again?
If you HAD to choose a different specialty, what would it be?
Anything else you want to add?

I was posting in the dental forum for my fiance and I decided to come back here for a quick visit and felt obligated to respond. So I've been an attending for nearly 3 years and am happy to answer the question.

Residents and EM docs...are you happy working in
EM?
Yes, love the job and would do it 100x over in a heartbeat.

What was your reason for going into EM in the first place?
The scope of the work and breadth of the patients we see and genuinely like the variation from day-to-day.

What's the best/worst part of your job?
Best part: High acuity patients, grateful families.
Worst part: Having to depend on specialists.

Do you like your hours?
Yep, I work a pretty robust shift load, and even after 3.5 years of nearly 180 hrs a month I still don't feel like it's a lot.

Do you feel like you have enough time with your family?
Yep, plenty of time with the family and no complaints.

Do you work in an academic center?
Nope.

Do you feel you are fairly compensated?
I am very fairly compensated.

Would you choose EM again?
Yep in a heartbeat.

If you HAD to choose a different specialty, what would it be?
I'd go with critical care.

I hope that helps, emergency medicine is a great profession and as long as you go into it for the work and not the hours you'll be in for a career with plenty of job satisfaction.

 

[kmp0410]

Thanks for all the replies in this thread. This is the kind of stuff you can't get anywhere else.

 

[throckmortonDO]

For all the med students reading this thread, I want to implore you to consider something.

When I was a med student, I did well, top boards etc. I explored lots of options, nsurg, cards, ortho, EM, radiology. On EM I was in my element, the pace, movement, medicine knowledge, etc seemed to come alot more naturally to me than other fields, where I was trying to memorize something that didn't come more naturally to me.

If pediatrics or IM comes easily to you, and you like it. Do it. If its neurosurgery. Do it.

Do not worry about the money or political standing of the specialty. Every field in medicine has ups and downs. Every field of medicine is at risk from political threats malpractice, reimbursement issues and commoditization (to degrees).

Lets be honest with ourselves, we are here for the long run. We bought in, we are pot committed.

Do what you want, and do what comes easy to you. Don't do a specialty because of what you read about others' experiences on a message board.

 

[SeekerOfTheTree]

I guess I will respond...happiness at 5/10

Residents and EM docs...are you happy working in EM?
- I am happy with the work, it is fun and I have enjoyed it.

What was your reason for going into EM in the first place?
-Money, hours, diversity, 3 year residency, shift work.

What's the best/worst part of your job?
-Making patients feel better is the best. The worst part is watching them die. Watching a 10 year old die in his mothers arms was the worst. Things like that stick with you. If you care for your patients it will stay and won't leave you. If you can stop caring for them it is much easier. Everyday you end up bringing it back home.

Do you like your hours?
-Shift work...it's supposed to be great right? Sure I think.

Do you feel like you have enough time with your family?
-It takes me a day to recover after I have worked a string of 4-5 but I guess I have enough time with the family.

Do you work in an academic
-I am a resident so yes I do.

Do you feel you are fairly compensated?
-Can't complain I signed my contract for next year and the money is great.

Would you choose EM again?
- No...It's complicated. This was not a first career. After having done all that I did to get here I realize that the grass isn't always greener on the other side. I would have never picked medicine. I enjoy what I do, but you have to understand i am a guy that can enjoy pulling weeds out of a yard or watching paint dry. After a certain amount of time passes it all seems the same. You go in, you do your job, you rinse and repeat. While trying to do all of this you waste your 20s.

If you HAD to choose a different specialty, what would it be?
-None. I like EM. If I was in any other field I would quit.

Anything else you want to add?
-Shift work isn't that great. Trust me.

 

[TheTruckGuy]

Thanks for everyone that responded above. I just wanted to hop in on this rather than create a new thread.

Did any of y'all consider general surgery? I'm kind of torn right now on which path to proceed down. I really like high acuity care and trauma, but I'm not a very cerebral person (like I don't think I can do IM/Crit Care and sit in an ICU all day thinking through my patients' problem list). I like I really like procedures, and enjoyed the OR a lot, but I was always completely exhausted on my surgery rotation. I hated rounding, and I hate the idea of being on call. And I see a lot of surgeons who are very terse people, and have seen a number whose marriages have ended in divorce. I like variety and the work environment of the ED (easy access to patients and nurses, rapid work up and dispo), and especially like the fact that once you leave, you're out. Overall I'm concerned that if I choose surgery I'll look back and regret not being around more for my family (which I don't have yet). And afraid that if I choose EM, that I'll always wonder if I could've made it as a surgeon. I've worked w/ surgeons that have transitioned to EM, and I also think sometimes that if I choose surgery I can always work in EM (likely a smaller/free standing ED), but if I choose EM I can never operate.

Tl;dr: I could go into more about what I like about each, but I was wondering if any of you chose EM over general surgery, why you did so, and if you're glad you did.

 

[deleted547339]

Thanks for everyone that responded above. I just wanted to hop in on this rather than create a new thread.

Did any of y'all consider general surgery? I'm kind of torn right now on which path to proceed down. I really like high acuity care and trauma, but I'm not a very cerebral person (like I don't think I can do IM/Crit Care and sit in an ICU all day thinking through my patients' problem list). I like I really like procedures, and enjoyed the OR a lot, but I was always completely exhausted on my surgery rotation. I hated rounding, and I hate the idea of being on call. And I see a lot of surgeons who are very terse people, and have seen a number whose marriages have ended in divorce. I like variety and the work environment of the ED (easy access to patients and nurses, rapid work up and dispo), and especially like the fact that once you leave, you're out. Overall I'm concerned that if I choose surgery I'll look back and regret not being around more for my family (which I don't have yet). And afraid that if I choose EM, that I'll always wonder if I could've made it as a surgeon. I've worked w/ surgeons that have transitioned to EM, and I also think sometimes that if I choose surgery I can always work in EM (likely a smaller/free standing ED), but if I choose EM I can never operate.

Tl;dr: I could go into more about what I like about each, but I was wondering if any of you chose EM over general surgery, why you did so, and if you're glad you did.

You cannot go from surgery to EM.

 

[TheTruckGuy]

You cannot go from surgery to EM.

You mean like it's going to be less likely to be able to do it in the future as more EM trained docs predominate in the field. Or you mean a surgeon can't be one at all? I've seen several that have worked in decent sized community EDs, as well as free standing EDs. Different skill set in patient management, for sure, but not impossible I would reckon.

ETA: Also, I don't mean to ruffle any feathers suggesting that EM easy and that it's easy to switch into it or anything like that. I worked full time as an ER scribe for over a year and worked with some great, very smart, docs that I admire a lot. But I'm also Navy, and regardless of if I do EM or surgery, I will likely have spent 2-3 years as a GMO in a primary care setting after intern year before returning for PGY2 and beyond.

 

[deleted547339]

You mean like it's going to be less likely to be able to do it in the future as more EM trained docs predominate in the field. Or you mean a surgeon can't be one at all? I've seen several that have worked in decent sized community EDs, as well as free standing EDs. Different skill set in patient management, for sure, but not impossible I would reckon.

ETA: Also, I don't mean to ruffle any feathers suggesting that EM easy and that it's easy to switch into it or anything like that. I worked full time as an ER scribe for over a year and worked with some great, very smart, docs that I admire a lot. But I'm also Navy, and regardless of if I do EM or surgery, I will likely have spent 2-3 years as a GMO in a primary care setting after intern year before returning for PGY2 and beyond.

In 2016, there is no place for a surgeon practicing emergency medicine. I know a couple people who did that >20 years ago, but that was a very different time.

 

[Angry Birds]

In 2016, there is no place for a surgeon practicing emergency medicine. I know a couple people who did that >20 years ago, but that was a very different time.

Co-signed. It was possible decades ago... Not any more. Even in the rural setting.

 

[exsanguination]

The thought of a moonlighting surgeon taking care of psych boarders gave me a good chuckle

 

[TheTruckGuy]

Fair enough, and good point. I just really don't know what I want to be when I grow up and the pressure is building to figure it out.

 

[Angry Birds]

Fair enough, and good point. I just really don't know what I want to be when I grow up and the pressure is building to figure it out.

I actually had a colleague who switched from Surgery to EM for lifestyle reasons. He continued to regret his decision... till the end of his days.

 

[Brigade4Radiant]

I actually had a colleague who switched from Surgery to EM for lifestyle reasons. He continued to regret his decision... till the end of his days.

How far was he in his surgical training? I know of a PGY5 who switched to EM.... He is so much happier now.

 

[TooMuchResearch]

Co-signed. It was possible decades ago... Not any more. Even in the rural setting.

We have some places outside the city with IM/FP/surgery mix. Based on recruitment emails in my work inbox, they're actively trying to replace them with freshly minted BC/BE emergency physicians.

 

[Angry Birds]

How far was he in his surgical training? I know of a PGY5 who switched to EM.... He is so much happier now.

This could be the same individual we are talking about. Does his name start with M?

I sensed regret from him, but now I feel bad for speaking for him. Glad he is happy if we are talking about the same guy. I thought he was happy with his decision but always still regretted not being able to be in the OR.

He was one of my favorite seniors in residency so wish him all the best.

And I should clarify: by lifestyle I really mean family reasons, I.e. To spend more time with the family.

 

[Old_Mil]

Did any of y'all consider general surgery?

I would sooner get my CDL and be an over the road trucker.

 

[takeurmeds02]

Residents and EM docs...are you happy working in EM?
Anything else you want to add?
I feel like I went into this specialty with my eyes as open as I could have. I've been lurking sdn/this forum for a decade, I had a few very helpful and very honest mentors, and I spent a lot of time in the ED and more or less understood the workflow of a community EM doctor before I was a medical student. I have concerns about longevity and concerns about job satisfaction - I'm not a special snowflake and for the most part my emotional/professional trajectory has pretty closely mirrored what all of the old guard posters here report. I also worry that my career satisfaction will drop precipitously when I graduate because there are parts of academics that definitely do not appeal to me long term but I think I will very much miss the team aspect. That being said, every step of my medical career has been a little bit better than I anticipated, and I'm fairly hopeful that the trend will continue.

What was the nature of your exposure before med school?

 

[RunnerforLife14]

I just really wanna say that I appreciate this thread! As someone entering medical school and at least interested in EM, I'm really glad to get some input we shall see when I get there! Thank you all!


Sent from my iPhone using SDN mobile

 

[bashwell]

I just really wanna say that I appreciate this thread! As someone entering medical school and at least interested in EM, I'm really glad to get some input we shall see when I get there! Thank you all!


Sent from my iPhone using SDN mobile

Just remember....

http://gomerblog.com/2014/05/medical-specialty/

 

[RunnerforLife14]

Just remember....

http://gomerblog.com/2014/05/medical-specialty/

Lmaooooooo this is great


Sent from my iPhone using SDN mobile

 

[RustedFox]

I have never seen an episode of "Game of Thrones". Can someone explain the reference for me, please?

 

[Brorthopedic]

"Always fighting to be called Doctor, but no one respects their claim to the title"

This had me laughing a little too hard.

 

[bashwell]

I have never seen an episode of "Game of Thrones". Can someone explain the reference for me, please?

I'll try, but huge disclaimer because unfortunately it's kind of hard to explain the reference without explaining a lot of the story behind Game of Thrones.

The premise of Game of Thrones is basically that the king (of a place called Westeros) has died and now there are various houses vying to become the next king. (It might help to know that a lot of Game of Thrones is based on the historical War of the Roses). By the way, houses are named after various families (lords and ladies and so on).

One of the houses is House Stark named after the Stark family. There's also House Lannister, House Targaryen, House Bolton, etc.

At the beginning of Game of Thrones, the head of House Stark is a man named Ned Stark. Jon Snow is his illegitimate bastard son. Because Jon Snow is illegitimate, he doesn't stand to inherit much if anything from Ned Stark. Instead, he decides he'll find his own way in life, and heads for the far north to join a group of men called the Night's Watch.

The Night's Watch has sworn for generations to defend the Wall. The Wall is basically a massive wall (worthy of Trump?) running east-west which separates the civilized parts of Westeros from the barbaric north. Think of it like a colossal Hadrian's wall (separating what we think of as modern England from Scotland).

Beyond the north is a frozen wasteland. A place of forever winter. And barbarians.

Also it's important to know Game of Thrones is a fantasy. It's filled with magic and sorcery (among many other things e.g. dragons). Hence there are magical creatures beyond the Wall too. One group of these is the White Walkers. I guess they look sort of like undead zombies. Here is an image of one of them.

At the beginning of Game of Thrones, most people in Westeros believe the White Walkers are just myths, legends, not real. More like ghosts or something. But they're very real.

As the story progresses, we begin to learn that the White Walkers could eventually breach the Wall. While all the Houses are fighting over who gets to be king, the White Walkers could sweep in and invade and presumably destroy Westeros, bringing with them death, destruction, black night, and winter.

The Night's Guard and the Wall are the only defense against Westeros being invaded by the White Walkers. Only they truly know the danger beyond the Wall.

Eventually Jon Snow becomes a leader of the Night's Watch. Jon Snow is also a beloved character in Game of Thrones because, unlike most of the other characters, he is mostly an honorable person. Game of Thrones is filled with characters who we love to hate.

The last thing to know is that there's a woman whom Jon Snow falls in love with. Game of Thrones often had her character say the phrase, "You know nothing, Jon Snow". The phrase has become a popular meme.

Hope that gives you enough background to understand the reference? But more likely the very fact that I've written so much to try to explain it probably takes away from the joke if not ruins it! Sorry, I probably wrote so much it'd be faster to just watch the show.

 

[TheBoneDoctah]

I'll try, but huge disclaimer because unfortunately it's kind of hard to explain the reference without explaining a lot of the story behind Game of Thrones.

The premise of Game of Thrones is basically that the king (of a place called Westeros) has died and now there are various houses vying to become the next king. (It might help to know that a lot of Game of Thrones is based on the historical War of the Roses). By the way, houses are named after various families (lords and ladies and so on).

One of the houses is House Stark named after the Stark family. There's also House Lannister, House Targaryen, House Bolton, etc.

At the beginning of Game of Thrones, the head of House Stark is a man named Ned Stark. Jon Snow is his illegitimate bastard son. Because Jon Snow is illegitimate, he doesn't stand to inherit much if anything from Ned Stark. Instead, he decides he'll find his own way in life, and heads for the far north to join a group of men called the Night's Watch.

The Night's Watch has sworn for generations to defend the Wall. The Wall is basically a massive wall (worthy of Trump?) running east-west which separates the civilized parts of Westeros from the barbaric north. Think of it like a colossal Hadrian's wall (separating what we think of as modern England from Scotland).

Beyond the north is a frozen wasteland. A place of forever winter. And barbarians.

Also it's important to know Game of Thrones is a fantasy. It's filled with magic and sorcery (among many other things e.g. dragons). Hence there are magical creatures beyond the Wall too. One group of these is the White Walkers. I guess they look sort of like undead zombies. Here is an image of one of them.

At the beginning of Game of Thrones, most people in Westeros believe the White Walkers are just myths, legends, not real. More like ghosts or something. But they're very real.

As the story progresses, we begin to learn that the White Walkers could eventually breach the Wall. While all the Houses are fighting over who gets to be king, the White Walkers could sweep in and invade and presumably destroy Westeros, bringing with them death, destruction, black night, and winter.

The Night's Guard and the Wall are the only defense against Westeros being invaded by the White Walkers. Only they truly know the danger beyond the Wall.

Eventually Jon Snow becomes a leader of the Night's Watch. Jon Snow is also a beloved character in Game of Thrones because, unlike most of the other characters, he is mostly an honorable person. Game of Thrones is filled with characters who we love to hate.

The last thing to know is that there's a woman whom Jon Snow falls in love with. Game of Thrones often had her character say the phrase, "You know nothing, Jon Snow". The phrase has become a popular meme.

Hope that gives you enough background to understand the reference? But more likely the very fact that I've written so much to try to explain it probably takes away from the joke if not ruins it! Sorry, I probably wrote so much it'd be faster to just watch the show.

Went all out!


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[ScarfTheVerb]

Was on the fence in med school and picked anesthesia. EM had its moments, but most of the time I felt like a medicine doc taking 30 new consults/shift. I probably work more hours than most of you guys, but most of them are M-F 7-3. Still lurk here occasionally wondering if I made the right choice--no regrets so far.

 

[TheBoneDoctah]

Was on the fence in med school and picked anesthesia. EM had its moments, but most of the time I felt like a medicine doc taking 30 new consults/shift. I probably work more hours than most of you guys, but most of them are M-F 7-3. Still lurk here occasionally wondering if I made the right choice--no regrets so far.

What was your reason for ultimately choosing gas over EM?


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[goodoldalky]

Was on the fence in med school and picked anesthesia. EM had its moments, but most of the time I felt like a medicine doc taking 30 new consults/shift. I probably work more hours than most of you guys, but most of them are M-F 7-3. Still lurk here occasionally wondering if I made the right choice--no regrets so far.

The best way I've heard the hours in gas vs EM described is quantity vs quality.

 

[bashwell]

What was your reason for ultimately choosing gas over EM?


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Anesthesia (vs EM)

Some important caveats before I start:
-Since you asked why choose gas over EM, I'll focus on propping up anesthesia against EM. But it's also possible to ask why choose EM over gas, and then focus on propping up EM over anesthesia.
-I'll still try to be very objective though.
-Some of the pros/cons could fit in the opposite category, depending on your personal preferences.
-Ultimately it's all just my opinion, nothing more.

Similarities between anesthesia and EM
-Both involve a lot of variety in patient population and disease (EM is more like being an acute GP or FM, whereas anesthesia you see all types of patients and ages needing all types of surgeries)
-Both allow for shiftwork
-Both have acute care to some degree (though anesthesia is basically all acute care)
-Both get to do procedures (though EM does more procedures meant for treatment than anesthesia)
-Both get to play with fun toys (e.g., ultrasound, laryngoscopes) (though anesthesia has more cool gadgets obviously like the anesthesia machine and workstation)
-Both currently average pay >$300K
-Both don't bring patients to the hospital like cardiologists or surgeons do
-Both are more at the mercy of hospital administrators, AMCs, etc.
-Both can involve high legal liability for malpractice (fairly or unfairly)
-Both don't require a lot of overhead
-Both are mobile, meaning you can pick up and move if you really want
-Both are (mostly) hospital-based specialties
-Both don't require building a referral base, etc., before starting to earn good money
-Both allow for medical missions
-Both face some midlevel threats (though anesthesia seems worse)

Pros
-Acute care (if that's what you like) vs EM where it's a mixture of acute care and other things you find in PCP
-No need to deal with difficult patients, or not for long
-No need to do some of the uglier things in medicine (e.g., rectal exams, drain pus from infected body parts)
-In other words you will face less overall BS than in EM (though anesthesia has its own BS, see "Cons")
-You are an expert in physiology and pharmacology (though EM is expert in quickly working up and managing the undifferentiated patient, the emergent patient, etc.)
-Generally more regular hours than EM (but see "Cons" about hours too)
-Don't regularly have to work nights, weekends, holidays (though sometimes you might, depending on your group)
-Cases are usually more planned than EM (excluding for example emergency ORs or add-ons) where anyone and anything could walk through the door
-Higher pay potential than EM
-Not in the "fish bowl" that is the ED
-Generally busy at the beginning and end of cases, but in the middle there is some down time (depending on the case, and obviously you're still very vigilant throughout the case)
-If you are doing your own cases, it's nice to be able to focus on a single patient at a time, and not always have to "move the meat" (though in private practice, you are facilitating surgeries for surgeons and hospitals, so you are trying to rush every case along)

Cons
-You always have to deal with surgeons, many of whom can be (shall we say) less than pleasant people
-You have to be ok with not being the "captain of the ship" (e.g., "Hey, anesthesia! Tilt the bed!")
-No or not very much diagnosing and working up patients
-Longer hours than EM overall
-Early mornings
-Not all cases will necessarily end when you expect them to end
-Currently a worse job market than EM
-CRNAs (AANA) argue they are as good as anesthesiologists, and they have a growing influence in the healthcare system and market
-The ACT model is the future (and it's already about 50% of all practices) -- i.e., having to supervise 1:1 to 1:4+ CRNAs
-Less likelihood of always being able to do your own cases, which may mean you're not doing a lot of (routine) procedures, but running from room to room "putting out fires"
-Tied to the OR
-Either bored stiff or scared stiff (99% sheer boredom, 1% sheer terror) such as when a patient crashes, and you won't necessarily have a team including other attendings to help like in EM (sometimes you will, but often not)
-EM is a more team oriented specialty than anesthesia, where you are more "on your own" (though there are other anesthesiologists in other ORs, they are either doing their own cases or supervising CRNAs or AAs)

Just some of my thoughts. I'm sure there's a lot more that can be added.

 

[ScarfTheVerb]

What was your reason for ultimately choosing gas over EM?


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I think all the reasons outlined here pretty much applied, plus the fact that I just liked it more. I probably would have been happy in EM too though.

An added bonus is that I get to plead ignorance to family/friend medical questions:

"I'm just an anesthesiologist---I have no idea what that rash is..."