EM as backup

[taco bell]

So I am going to apply for ophthalmology, in next years cycle, and seeing as they are early match, and fairly competitive I am thinking about applying to EM as a back-up in case I don't match.

My question is.. Is that possible, or even feasable? I got an H in my 3rd yr EM rotation and can get a fairly solid LOR from the clerkship director, but do I HAVE to do an externship during 4th yr? I dont think I will have time to do any externships in 4th year as most of my externships will be for ophtho.

My step 1 score is 240, and ranking upper/middle third borderline.

Would it be wise to not apply to the same program for ophtho, and EM?

Any advice is appreciated. Thanks

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[BADMD]

With a 240 on Step I, an honor in an EM rotation and I assume a US medical school, you are competitive for EM and would be able to match, assuming applications to appropriate programs. It would help to have more than one SLOR and a similar Step II score. These aren't critical, but it would help.

You probably want to address why EM as a back up in an EM personal statement and be honest with programs. It will be obvious from your transcript that EM is not your first choice. Once you know the SF match results, let the EM programs know, ASAP.

Do you know if the clerkship director filled out a SLOR for you or a regular LOR? If no SLOR, go back and get one.

 

[EMRocksmyworld]

It sounds like you will definitely be competitive for EM in terms of grades/scores. I think the more important question is whether you will really be fulfilled in EM. As I am sure you know, EM has very very little in common with ophtho. They specialties are vastly different in numerous ways. Will you really be happy if you have to settle for EM? Would you be better served to take a year off and do some research if you don't match into ophtho, and then reapply? Furthermore, it sounds like you will be a pretty competitive ophtho applicant. Is this all about lack of confidence in your application? Maybe you should consider owning it, showing them what you have to offer, and making good connections through your ophtho rotations.

With all that being said, I think you would be fine to match in EM, although some PDs will likely be turned off by your lack of sincere interest in the specialty. There are plenty of strong EM applicants out there who are going into the specialty because they truly love it, not as a back-up plan. But if you approach the process positively and enthusiastically, you SHOULD be fine. Most applicants do EM away rotations but it is by no means required, as it is in (for example) ortho. I met multiple people on the interview trail who did not do away rotations, although I personally did.

Good luck with this big decision.

 

[Gandalf the Pearly Gray]

I know this post is old, but I just wanted to chime in and say I can relate to the OP. Ophthalmology is a very distinct field and compares badly to any other specialty in terms of tangibles, but I think the intangibles between Ophtho and EM are quite similar. Both comprise a nice mix of medicine and procedures, exclude tedious rounding/charting on wards, have short patient encounters, have quick tangible results, decent compensation, little to no call, sane total working hours weekly, and lots of room for extracurriculars. Both have their annoying, non-compliant patient personality types, but at the end of the day you've made noticeable differences in lives, work is left at work, and tomorrow will bring a new set of patients. Both sound quite nice to me!

 

[Birdstrike]

The two specialists couldn't be more different. They are in two completely different ends of the spectrum. If they seem similar, in anyway, you need to dog a little deeper and get some more exposure to both.

 

[Gandalf the Pearly Gray]

The two specialists couldn't be more different. They are in two completely different ends of the spectrum. If they seem similar, in anyway, you need to dog a little deeper and get some more exposure to both.

That depends on which spectrum we're referring to, and there's probably nothing I need to do since I'm not interested in ophtho. As a future EM physician though I could see the OP's point of view, as I've done rotations in both fields. There is more than one way to frame and classify specialties, so it's funny to see people insist that their perspective must be correct, and that somebody who disagrees must need "more exposure"...lmao.

 

[Birdstrike]

That depends on which spectrum we're referring to, and there's probably nothing I need to do since I'm not interested in ophtho. As a future EM physician though I could see the OP's point of view, as I've done rotations in both fields. There is more than one way to frame and classify specialties, so it's funny to see people insist that their perspective must be correct, and that somebody who disagrees must need "more exposure"...lmao.

I'm, "Lmao...plus 1! Ha, ha, ha, I win!"

But in all seriousness, please educate me on how EM and Optho are similar. I'd live to hear it, Mr. Gandalf.

 

[Gandalf the Pearly Gray]

I'm, "Lmao...plus 1! Ha, ha, ha, I win!"

But in all seriousness, please educate me on how EM and Optho are similar. I'd live to hear it, Mr. Gandalf.

lol well refer back to my first post on the thread! They're obviously very different fields in the specifics, but similar in the intangibles like procedures, lifestyle, and little to no inpatient medicine. It's not really THAT big a surprise to hear of someone backing up Ophtho with EM.

 

[namethatsmell]

lol well refer back to my first post on the thread! They're obviously very different fields in the specifics, but similar in the intangibles like procedures, lifestyle, and little to no inpatient medicine. It's not really THAT big a surprise to hear of someone backing up Ophtho with EM.

That's like saying pro football players and pro golfers have basically the same gig. Both involve balls, there are short bursts of activity/using ones hands, both are usually played on grass, there's the potential for lots of money with both, and there's lots of "non-work" time to relax with both. Yet they could not be more dissimilar.

That said, I will grant you that optho guys can be pretty chill...not dissimilar from EM docs.

 

[Hook_EM]

It kind of is surprising. I've never heard of anyone doing it. As far as similarities, you're right about what you said earlier, but the practice differences and just subject matter are so different that it negates those similarities. They just don't make any real world sense to make those connections.

 

[Gandalf the Pearly Gray]

It kind of is surprising. I've never heard of anyone doing it. As far as similarities, you're right about what you said earlier, but the practice differences and just subject matter are so different that it negates those similarities. They just don't make any real world sense to make those connections.

And that's a valid point, but in the medical student world very dissimilar fields might be equally interesting for reasons like procedures or avoidance of the wards. It definitely takes time and thought to tease out which field is best for each person, and from what I've seen all these factors have to be considered or else you could find yourself changing residencies or just hating life down the road. It's also worth noting that someone could also like two very different fields for different reasons. Needless to say, I'm very glad this process is over for me!

 

[Gandalf the Pearly Gray]

That's like saying pro football players and pro golfers have basically the same gig. Both involve balls, there are short bursts of activity/using ones hands, both are usually played on grass, there's the potential for lots of money with both, and there's lots of "non-work" time to relax with both. Yet they could not be more dissimilar.

That said, I will grant you that optho guys can be pretty chill...not dissimilar from EM docs.

Yea they are pretty chill! And I didn't say they are basically the same gig, but that they're both definitely good gigs for similar reasons.

 

[Gandalf the Pearly Gray]

I wonder what actually happened with the OP... maybe if Taco Bell still keeps up with SDN he could let us know how the EM backup plan went or if he even needed it!

 

[Birdstrike]

lol well refer back to my first post on the thread! They're obviously very different fields in the specifics, but similar in the intangibles like procedures, lifestyle, and little to no inpatient medicine. It's not really THAT big a surprise to hear of someone backing up Ophtho with EM.

The procedures couldn't be more different. Draining butt abscesses at 3am on Christmas morning, stellate fac lacs on drunk and violent Harley Man vs tree, in patients with the worst payer mix in the medical world, vs clean, elective, retinal detachment repairs/cataracts/LASIK and other scheduled outpatient eye procedures in robustly insured patients, ie, cherry picked payer mix.

Lifestyle: couldn't be more different. Shift work, rotating back and forth at all hours of night and day with constant circadian disruption, versus what is essentially a "no nights, no weekends, no holidays, (practically) no call" specialty, with the exception of eye trauma which is rare in most private practices (unless ER call at a trauma center). Frenetic pace of ER with appointments scheduled by the Gods of Chaos with no respect to physician bodily functions, vs optho and it's 99% scheduled office visits and surgeries scheduled to doctor preference, and the ability to cancel clinic, block off any clinic OR day/hour/week of own choosing, have clinic closed from noon-1pm everyday to eat, sh--, and have rep provided lunch from trendy restaurant of your choosing.(Again.)

Little to no inpatient medicine? EM = 100% hospital based. Optho = almost entirely outpatient clinic visits or office and/or ASC procedures.

EM: a radically broad specialty taking care of wildly different patients some with diseases and conditions you much or nothing about, vs a tiny Subspecialty that deals with a part of the body the size of two marbles.

I'm not saying one's better, I'm just saying they're very, very different. They are as different to each other, as Derm is to Trauma Surgery, and Pain Medicine is to Pathology.

 

[Gandalf the Pearly Gray]

The procedures couldn't be more different. Draining butt abscess, stellate fac lacs on drunk MCA vs tree, patients with often the worst payer mix, vs clean, elective, retinal detachment repairs/cataracts/LASIK and other scheduled outpatient eye procedures in robustly insured patients, ie, cherry picked payer mix.

Lifestyle: couldn't be more different. Shift work, rotating back and forth at all hours of night and day with constant circadian disruption, versus what is essentially a "no nights, no weekends, no holidays, (practically) no call" specialty, with the exception of eye trauma which is rare in most private practices (unless ER call at a trauma center). Frenetic pace of ER with appointments scheduled by the Gods of Chaos with no respect to physician bodily functions, vs optho and it's 99% scheduled office visits and surgeries scheduled to doctor preference, and the ability to cancel clinic, block off any clinic OR day/hour/week of own choosing, have clinic closed from noon-1pm everyday to eat, sh--, and have rep provided lunch from trendy restaurant of your choosing.(Again.)

Little to no inpatient medicine? EM = 100% hospital based. Optho = almost entirely outpatient clinic visits or office and/or ASC procedures.

I'm not saying one's better, I'm just saying they're very, very different. They are as different to each other, as Derm is to Trauma Surgery.

Wow! Are you trying to talk me out of EM? Obviously the procedures aren't the same, but both have procedures. And the ED is NOT inpatient medicine. Yea it's in a hospital, but we send more out the front door than we do upstairs, and we don't have to round on any of them, thank God!

 

[BoardingDoc]

Wow! Are you trying to talk me out of EM? Obviously the procedures aren't the same, but both have procedures. And the ED is NOT inpatient medicine. Yea it's in a hospital, but we send more out the front door than we do upstairs, and we don't have to round on any of them, thank God!

I certainly don't think birdstrike is trying to talk you out EM. He's just pointing out (rightly so IMHO) that your comment about the two fields being similar is utterly absurd. Yes, they both have procedures. So does derm. And Ortho. And Uro. And OB/Gyn. And anesthesia. Are those all similar fields?
Yes, they both don't round. Neither does any outpatient practice in any field. Peds. IM. FM. etc etc etc....

Again, I don't think anyone here is trying to talk you out of anything except for this ludicrous notion that Optho and EM are remotely similar fields.

 

[Gandalf the Pearly Gray]

I certainly don't think birdstrike is trying to talk you out EM. He's just pointing out (rightly so IMHO) that your comment about the two fields being similar is utterly absurd. Yes, they both have procedures. So does derm. And Ortho. And Uro. And OB/Gyn. And anesthesia. Are those all similar fields?
Yes, they both don't round. Neither does any outpatient practice in any field. Peds. IM. FM. etc etc etc....

Again, I don't think anyone here is trying to talk you out of anything except for this ludicrous notion that Optho and EM are remotely similar fields.

There are different ways to categorize things. Dermatology and radiology are even less similar, and yet we put them together all the time when talking about "road" specialties. My point was not to say the two specialties are all that similar, but to relate to the OP's notion of an EM backup. Again, they aren't similar gigs, but are both good gigs for similar reasons, albeit peripheral reasons. Someone looking to do Ophtho obviously likes procedures, decent hours, a laid back attitude, and so forth. EM provides these, so that's how they are similar. Sorry if I wasn't clear enough, but that's what I've been trying to say the whole time.

 

[Birdstrike]

Are you trying to talk me out of EM?

No. If you like EM, I think you should do EM. If you like Optho, I think you should do Optho.

But you have to know what they are.

Some people love the crazy circus EM can bring. Other people love being confined to a 1 inch sphere in the head and if the diagnosis is as far away as the nose, they are out of their comfort zone.

Some people go crazy being bored. Some people get board of "crazy."

Why does my post make you think I'm trying to talk you out of EM?

 

[Gandalf the Pearly Gray]

No. If you like EM, I think you should do EM. If you like Optho, I think you should do Optho.

But you have to know what they are.

Some people love the crazy circus EM can bring. Other people love being confined to a 1 inch sphere in the head and if the diagnosis is as far away as the nose, they are out of their comfort zone.

Some people go crazy being bored. Some people get board of "crazy."

Why does my post make you think I'm trying to talk you out of EM?

Well you sorta contrasted several less desirable things about EM with some desirable things about ophtho, so wasn't sure. I'm probably like you in that I go crazy being bored.

 

[Birdstrike]

Well you sorta contrasted several less desirable things about EM with some desirable things about ophtho, so wasn't sure. I'm probably like you in that I go crazy being bored.

Undesirable? See, that's my whole point. EM is messy, the patients can be wild and chaotic and the hours can be chaotic. But that has to be desirable to you, not the other way around. Desirability is in the eye of the beholder. You gotta like the "messy," the "crazy," the "wild," and "chaotic," to survive in EM.

But there's stretches of boring stuff, too. Uri's, ankle sprains, that hopefully are seen as a break from the other wilder stuff and not so much seen as "boring."

I won't tell anyone what to do with their life, I just give my opinion on here for free, like everyone else. You decide if it's worthwhile or junk. I've been told both, and I'm cool with that. It's all good, man. I was just struck by your comparison of Optho and EM, when I see them as being so different. No worries.

 

[Gandalf the Pearly Gray]

Undesirable? See, that's my whole point. EM is messy, the patients can be wild and chaotic and the hours can be chaotic. But that has to be desirable to you, not the other way around. Desirability is in the eye of the beholder. You gotta like the "messy," the "crazy," the "wild," and "chaotic," to survive in EM.

But there's stretches of boring stuff, too. Uri's, ankle sprains, that hopefully are seen as a break from the other wilder stuff and not so much seen as "boring."

I won't tell anyone what to do with their life, I just give my opinion on here for free, like everyone else. You decide if it's worthwhile or junk. I've been told both, and I'm cool with that. It's all good, man. I was just struck by your comparison of Optho and EM, when I see them as being so different. No worries.

Thanks, and interesting thoughts about EM. I like the crazy as long as there is a "break" (uri, uti, sprain, etc.) at some point on a busy shift. EM seems like such a popular specialty these days. Do you think a lot of new residents are getting into something they're not ready for?

 

[Birdstrike]

. Do you think a lot of new residents are getting into something they're not ready for?

Yes. I think the percentage would be roughly equal to those reporting "burnout" in the surveys mentioned. I think there needs to be a complete paradigm shift in EM. It needs to be standard that one has a Phase II plan for age 45 and up. Rotating shift work, just isn't healthy to do for a 20-30 years career, physically or mentally, for the majority of people. It should be standard, to be on a 9-5, or something similar in Phase II of the career. The 9-5 is the same for a 28-yr-old and a 48-yr-old. Yet, rotating shift work absolutely is not the same for many 28-yr-olds, compared to their 48-yr-old selves, often then married with families.

Ideas:

Do fellowships that allow one to work normal hours at one point, such as Sports Medicine, Hospice and Palliative Care, interventional Pain Medicine (up for vote soon as next possible EM Subspecialty), Administration, entrepreneurship ( no fellowship exists to date; Urgent Care ownership/Free Standing ED) or anything that allows one to live a normal life. The problem is that young EM hopefuls generally gag at the thought of doing anything other than adrenaline-rich EM, ever. I think it's a big mistake. I can't tell you how many times I heard an EP grumbling about being be burned out, tired or wanting to get out of shift work but revolt at the thought of doing one of the above specialties for whatever reason. Yet none of the above show burnout rates anywhere near EM, despite the perceived downsides. Why is that?

 

[Junge]

Yes. I think the percentage would be roughly equal to those reporting "burnout" in the surveys mentioned. I think there needs to be a complete paradigm shift in EM. It needs to be standard that one has a Phase II plan for age 45 and up. Rotating shift work, just isn't healthy to do for a 20-30 years career, physically or mentally, for the majority of people. It should be standard, to be on a 9-5, or something similar in Phase II of the career.

Ideas:

Do fellowships that allow one to work normal hours at one point, such as Sports Medicine, Hospice and Palliative Care, interventional Pain Medicine, Administration, entrepreneurship (Urgent Care ownership), anything, anything, anything that allows one to live a normal life. The problem is that young EM hopefuls generally gag at the thought of doing anything other than adrenaline-rich EM, ever. I think it's a big mistake. I can't tell you how many times I heard an EP grumbling about being be burned out, tired or wanting to get out of shift work but revolt at the thought of doing one of the above specialties for whatever reason. Yet none of the above show burnout rates anywhere near EM, despite the perceived downsides. Why is that?

Interesting point but brings up a question. I have actually thought about this before, and while at 27 I love the ed, I know at 50 I may not. I actually planned on doing a sports medicine fellowship for just the reasons you stated i.e. For an "out" if it comes to that. The thing is there seems to be conflicting information on this board. It's been talked about ad nauseam that it's hard to do EM part time. With that said I figure it would take me a minimum of one day/week of sports medicine clinic to stay proficient. I understand that the ED presents plenty of orthopedic complaints but still it's different than being in the actual sports med clinic. My thoughts are either adding an additional day on top of the ED schedule to be in clinic or cutting a shift in the ED to be in clinic. Working full time in the ED then adding a clinic day sounds like a recipe for disaster. That said cutting a shift from the ED means you are not full time and may cause a problem with partners or even benefits. I guess to make it short is a fellowship for an "out" really possible? How would you really make your schedule during the period where you are still "an ED doc" so that you could really transition to the other career?

 

[ihearttriangles]

Aristotle famously said, "Take any two things, and they will have some things in common, and some things not in common." Meaning, person A could say, "This chair and this table have a lot of things in common. They're both made of wood, they're both sold in the furniture section, they both belong in the kitchen, etc..." But person B might say, "A chair and a table are two totally different things! On one you place your ass, and on one you place your food!" Is this a right v wrong issue, or is this a semantic issue? I vote for the latter.

 

[Birdstrike]

Interesting point but brings up a question. I have actually thought about this before, and while at 27 I love the ed, I know at 50 I may not. I actually planned on doing a sports medicine fellowship for just the reasons you stated i.e. For an "out" if it comes to that. The thing is there seems to be conflicting information on this board. It's been talked about ad nauseam that it's hard to do EM part time. With that said I figure it would take me a minimum of one day/week of sports medicine clinic to stay proficient. I understand that the ED presents plenty of orthopedic complaints but still it's different than being in the actual sports med clinic. My thoughts are either adding an additional day on top of the ED schedule to be in clinic or cutting a shift in the ED to be in clinic. Working full time in the ED then adding a clinic day sounds like a recipe for disaster. That said cutting a shift from the ED means you are not full time and may cause a problem with partners or even benefits. I guess to make it short is a fellowship for an "out" really possible? How would you really make your schedule during the period where you are still "an ED doc" so that you could really transition to the other career?

Yes, and here's how:

This "part time EM" debate mainly applies to people that literally want to work part time. If you are EM and have done a fellowship, it's different. You'd have a whole different practice situation available to you. The usual rules wouldn't necessarily apply. You'd be a rare breed. It's uncharted waters; to a certain extent you'd have to make your own way. Since you bring up Sports Med, I'll bite on that one. An option would be to maket yourself to ortho practices, as non-operative orthopedics ie Sports Medicine. I know of at least one big ortho group that has 2 non-operative MDs. A sport medicine guy (happens to be Fam med) and a PMR person who does basically the same. You see if a group like that will take you on for 3-4 days a week, doing joint injections, sprains, tendonitis, sports injuires, ER follow ups, whatever. Then, you get credentialed as an IC for a Locums hospital or two and work as many shifts as you can in the ED. This would be the way to blend them. The other option would be academics, marketing you'self to an EM department as a unique double boarded, person. The other two obvious easier to arrange options would be either dialing in full-time Sport med, or full time EM (with sports med on the back burner).


Palliative care:

People write this off as boring. I think this is a mistake. Codes can become boring too after a while. I do know this, it's pretty regular hours from what I hear. Comparitively low stress and you get to ease suffering, reduce pain and maybe help people even more than you can in the ED. These are patients you see in the ED anyways. From what I hear, Palliative care doctors sleep at night and are awake during the day. Circadian rythms aren't an issue.


Pain:

People write off Pain because of the obvious. I think this is a mistake, too. Pain does lots of procedures (all elective and pre-approved by insurance). Pain can have policies such as "no script on the first visit," zero tolerance drug testing, Rx report and criminal background checks, before even accepting a patient. The can fire patients without EMTALA or Press Ganey. This may be the next EM Subspecialty per ABEM. The younger crop of Pain MDs seem to be much less in favor high dose opiates. I don't see Pain guys having circadian related burnout issues. Think outside the box: The hours are Derm-like.


Urgent Care/Free Standing EDs and Entrepreneurship:

This seems to have to be self taught, which I think is outrageous. Why is there is no formal training on how to open and run your own UC? Why the absence of EM leadership, that people have to jump out of a proverbial airplane with no parachute and learn how to fly on their own with this? What's wrong with us that there isn't a sponsored track that fosters EPs who want to take this road? EPs are left to cry and whine about EMTALA and Press Ganey when 30 years ago we could have built in educational pathways to practice outside of these oppressive and toxic zones. We neglected this so long and slept while Obamacare has banned doctor owned hospitals. No one saw that EMTALA would be a disaster? No one saw that being entirely hospital based would make EPs vulnerable to the whims of businessmen who had never placed a single stitch? Who's looking beyond next week around this place? This is a tragic failure of historical EM leadership, in my opinion.


Admin:

Self explanatory.

 

[@JackShephard]

Yes. I think the percentage would be roughly equal to those reporting "burnout" in the surveys mentioned. I think there needs to be a complete paradigm shift in EM. It needs to be standard that one has a Phase II plan for age 45 and up. Rotating shift work, just isn't healthy to do for a 20-30 years career, physically or mentally, for the majority of people. It should be standard, to be on a 9-5, or something similar in Phase II of the career. The 9-5 is the same for a 28-yr-old and a 48-yr-old. Yet, rotating shift work absolutely is not the same for many 28-yr-olds, compared to their 48-yr-old selves, often then married with families.

Ideas:

Do fellowships that allow one to work normal hours at one point, such as Sports Medicine, Hospice and Palliative Care, interventional Pain Medicine (up for vote soon as next possible EM Subspecialty), Administration, entrepreneurship ( no fellowship exists to date; Urgent Care ownership/Free Standing ED) or anything that allows one to live a normal life. The problem is that young EM hopefuls generally gag at the thought of doing anything other than adrenaline-rich EM, ever. I think it's a big mistake. I can't tell you how many times I heard an EP grumbling about being be burned out, tired or wanting to get out of shift work but revolt at the thought of doing one of the above specialties for whatever reason. Yet none of the above show burnout rates anywhere near EM, despite the perceived downsides. Why is that?

Like the above poster said, doing a fellowship then not practicing it for 20 years would make for a tough transition.

Urgent care sounds good though.

 

[Killa Beez MD]

76 out of the 1640 US MD Seniors that applied for EM in last year's match actually ranked another specialty besides EM as their first choice. This is from page 35 of the NRMP Results and Data: 2013 Main Residency Match.

Thoughts?

 

[Birdstrike]

Like the above poster said, doing a fellowship then not practicing it for 20 years would make for a tough transition.

Urgent care sounds good though.

That would obviously be a waste of a fellowship and a year.

 

[HarryPlopper]

I really don't see this backup resulting in a 180 degree shift being a good idea by any means. The discussion of how different they are have been beaten to death above so I don't need to explain it.

Although no one can say for certain that OP won't be happy in EM, I just don't see how someone who chooses such a different field and genuinely enjoys that field can go straight to EM and be happy for the rest of his life. This looks like a straight forward case of burnout.

 

[Junge]

Yes, and here's how:

This "part time EM" debate mainly applies to people that literally want to work part time. If you are EM and have done a fellowship, it's different. You'd have a whole different practice situation available to you. The usual rules wouldn't necessarily apply. You'd be a rare breed. It's uncharted waters; to a certain extent you'd have to make your own way. Since you bring up Sports Med, I'll bite on that one. An option would be to maket yourself to ortho practices, as non-operative orthopedics ie Sports Medicine. I know of at least one big ortho group that has 2 non-operative MDs. A sport medicine guy (happens to be Fam med) and a PMR person who does basically the same. You see if a group like that will take you on for 3-4 days a week, doing joint injections, sprains, tendonitis, sports injuires, ER follow ups, whatever. Then, you get credentialed as an IC for a Locums hospital or two and work as many shifts as you can in the ED. This would be the way to blend them. The other option would be academics, marketing you'self to an EM department as a unique double boarded, person. The other two obvious easier to arrange options would be either dialing in full-time Sport med, or full time EM (with sports med on the back burner).


Palliative care:

People write this off as boring. I think this is a mistake. Codes can become boring too after a while. I do know this, it's pretty regular hours from what I hear. Comparitively low stress and you get to ease suffering, reduce pain and maybe help people even more than you can in the ED. These are patients you see in the ED anyways. From what I hear, Palliative care doctors sleep at night and are awake during the day. Circadian rythms aren't an issue.


Pain:

People write off Pain because of the obvious. I think this is a mistake, too. Pain does lots of procedures (all elective and pre-approved by insurance). Pain can have policies such as "no script on the first visit," zero tolerance drug testing, Rx report and criminal background checks, before even accepting a patient. The can fire patients without EMTALA or Press Ganey. This may be the next EM Subspecialty per ABEM. The younger crop of Pain MDs seem to be much less in favor high dose opiates. I don't see Pain guys having circadian related burnout issues. Think outside the box: The hours are Derm-like.


Urgent Care/Free Standing EDs and Entrepreneurship:

This seems to have to be self taught, which I think is outrageous. Why is there is no formal training on how to open and run your own UC? Why the absence of EM leadership, that people have to jump out of a proverbial airplane with no parachute and learn how to fly on their own with this? What's wrong with us that there isn't a sponsored track that fosters EPs who want to take this road? EPs are left to cry and whine about EMTALA and Press Ganey when 30 years ago we could have built in educational pathways to practice outside of these oppressive and toxic zones. We neglected this so long and slept while Obamacare has banned doctor owned hospitals. No one saw that EMTALA would be a disaster? No one saw that being entirely hospital based would make EPs vulnerable to the whims of businessmen who had never placed a single stitch? Who's looking beyond next week around this place? This is a tragic failure of historical EM leadership, in my opinion.


Admin:

Self explanatory.

I appreciate the advice but I think we are missing the exact point. At this time I have no desire to work clinic days and do the M-F 9-5 grind and that's one of the reasons I picked EM over more clinic based specialties. Doing sports med is simply an out for when I get older, the ED gets old, and M-F looks a lot better. I would not want to start out doing 3-4 clinic days instead do that when I'm 45 or 50 if I get tired/burnt out from the ED. I don't plan on burning out of the ED but I'm sure plenty of people that are now burned out thought the same hence me planning on a backup. The only reason I would do clinic is so the skills in sports stays current. I guess maybe something such as an EMS fellowship or some kind of teaching education would be better for me instead of sports med. It would be more related to the ed while giving an option for teaching or more administration later on.