Choosing Emergency Medicine...

[DoctorDude]

Hi all,

I hope my question isn't seen as annoying but I'm looking for some good advice from those ahead of me. I will be a rising fourth year student and I'm currently in a dilemma over choosing anesthesia or EM. For most of third year I had my heart set on anesthesia, for a variety of reasons. I had never really given EM much thought, but now it's starting to look quite appealing (even more after spending some quality time with EM docs). My concerns about anesthesia are many. The biggest is midlevel provider encroachment - just look at the anesthesiology forum and you will see just about every thread is somehow related to a bleak future for anesthesiologists due to CRNAs. I know things are still good now for anesthesia, but 10-20 years down the line it may not be. Another is anesthesiology residency classes keep growing at a much faster pace than most specialties. I'm not sure the job market can sustain this. Also reimbursements are said to be declining fast. Many anesthesiologists also complain about feeling like they don't have autonomy in their profession.

Anyways, my recent intrigue for EM stems from a combo of factors: I like the idea of being a "jack of all trades," I like the excitement that can happen, I really like the shift-work idea, and I like being in-charge (vs anesthesia where the surgeons have the autonomy). So my question for those in EM is what are the current and future concerns of this specialty? Is there also a real threat of mid-level encroachment (NPs/PAs)? Are reimbursements declining? From the outside looking in, EM seems really awesome (fun job, decent pay, decent hours quantity wise). The only real issue I have heard are: odd-hours can lead to burnout and drug-seekers are frustrating. Am I missing anything else?

Really appreciate thoughts. Thanks.

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[GTP]

I was also in a similar situation a few months ago. I had no interest in EM initially, but I fell in love within 30 mins of being in the ED. I still tried to fight it since I already had my anesthesiology elective scheduled right after. The elective was great, learned lots of physiology and learned to intubate. While rotating through both, I found that both specialties have a lot of similarities. They are very hands on, think on their feet, and tend to do similar procedures. Both don't have long-term patient follow up or interactions. In my opinion, GAS docs are also the jack of all trades because they are extremely well trained/rounded. The benefit is that even though they would know how to manage that "400 lb patient who is a noncompliant COPDer with multiple comorbid conditions etc" if they were on the floor, they have the luxury of not having to do so. I have a lot of respect for GAS men/women. I think their training is rigorous. Unfortunately, even though money seems to be an issue for you (and I agree that your points are valid), I determined that ultimately, I'd be happier in EM. There is also competition with EM too. We have NPs and PAs to worry about. But just like they cannot completely replace an EM doc, CRNA cannot (am I being naïve?) completely replace the GAS man either. I picked EM over GAS because I like the idea of being able to get a job anywhere (literally) after residency. I like the shift work and no call. GAS still has call.I like being able to pick up extra shifts if I'm a little short on cash, or cut down to 10 shifts a month if I'm not feeling it anymore. I like being able to predict my schedule and schedule trips/family visits ahead of time. I like the idea of urgent care when I have kids and can no longer keep up. Keep in mind the director of the anesthesiology department where I rotated was very close to many PDs in upstate NY and offered to make calls on my behalf. A job was also offered after training (I don't think he was lying because he did it for a newly minted anesthesiologist in the department as well). So despite all that, I still chose EM. I don't know anything about saturation and future job prospects. Maybe someone else can comment on that. With respect to autonomy, I think they are pretty much the same. GAS docs get $hat on by surgeons, and EM docs get $hat on by everyone else. Both fields have their pros and cons and their nuisances. The key is just deciding which you can live with. Good luck with your decision.

 

[Old_Mil]

With the current changes in health care you really need to think hard about whether you want to sign up for a residency that has a significant hospital based component to it. If there is a bright future in health care right now it is in fields that will allow you to have a clinic or concierge cash practices. At least until .gov decides to squash this field by denying DEA certificates to anyone who won't play ball with CMS. But as an FP you will have an easier time finding a job in a foreign country.

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[roguetwelve12]

Agree with a lot of what GTP said. I was also between anesthesia and EM, and just decided on EM for many of the same reasons (knowing schedule, no call, jack-of-all trades (although anesthesiologists are too).

Regarding the PA/NP argument, I had concerns about this too. But frankly, the job market is SO lucrative/open for EM right now there really doesn't matter. If a place can hire an MD vs a PA/NP, they'll hire the MD (no disrespect intended to NPs or PAs). Re: CRNAs and anesthesiologists (I did a yearlong anesthesia externship so I experienced this a lot), from everything I've seen/talked to CRNAs don't pose a great risk to anesthesiologists down the line. As is the case for PA/NP, an MD will get the hire first (again, I intend no disrespect). It's good to consider these things, but with how healthcare is changing, I don't think you can predict the future too clearly (nobody can!).

 

[GTP]

Agree with a lot of what GTP said. I was also between anesthesia and EM, and just decided on EM for many of the same reasons (knowing schedule, no call, jack-of-all trades (although anesthesiologists are too).

Regarding the PA/NP argument, I had concerns about this too. But frankly, the job market is SO lucrative/open for EM right now there really doesn't matter. If a place can hire an MD vs a PA/NP, they'll hire the MD (no disrespect intended to NPs or PAs). Re: CRNAs and anesthesiologists (I did a yearlong anesthesia externship so I experienced this a lot), from everything I've seen/talked to CRNAs don't pose a great risk to anesthesiologists down the line. As is the case for PA/NP, an MD will get the hire first (again, I intend no disrespect). It's good to consider these things, but with how healthcare is changing, I don't think you can predict the future too clearly (nobody can!).

+1. Please chose what will make you happy in the long run. Try not to think about falling reimbursements. You will be well payed no matter what. But it would suck going into anasthesiology for the money. You will be more bitter if the cuts are significant.

 

[msbbc833]

What are peoples thoughts on urgent care? I've heard of FM docs going that route and making $300K+/yr doing 50-60hrs/wk. I feel like if you do EM you will always have to work in the ED to keep your skill set

 

[Hercules]

What are peoples thoughts on urgent care? I've heard of FM docs going that route and making $300K+/yr doing 50-60hrs/wk. I feel like if you do EM you will always have to work in the ED to keep your skill set

EM guys open up urgent cares. Some of us continue to work both in EM and urgent cares.

 

[SoyMilk]

What are peoples thoughts on urgent care? I've heard of FM docs going that route and making $300K+/yr doing 50-60hrs/wk. I feel like if you do EM you will always have to work in the ED to keep your skill set

From a financial point of view that doesn't seem much better than working in the ED.

 

[GTP]

From a financial point of view that doesn't seem much better than working in the ED.

Yeah but its slow pace and less stressful. Colds and strep throats. No psyc patients and crash intubations. Perhaps also better hours. 9am - 9 pm

 

[deleted547339]

Yeah but its slow pace and less stressful. Colds and strep throats. No psyc patients and crash intubations. Perhaps also better hours. 9am - 9 pm

absolutely not slow pace. how do you think they get paid? volume.

 

[GTP]

absolutely not slow pace. how do you think they get paid? volume.

I've volunteered at some that were. But those were salaried and in Canada. I guess maybe they just see the same things over and over again. Not a lot of acuity. What else?

 

[gutonc]

I should point out that if you're willing to put in 60 hrs a week, you can make 300K+ in pretty much any medical specialty without too much difficulty.

If you're looking for supplemental work it should be something that keeps your workload the same (or close to it) while increasing your income dramatically, or it should cut your workload dramatically while keeping your income stable.