EM vs. Psychiatry

[Darkskies]

Hello,

I'm a third year medical student trying to decide what field to go into. My favorite subject from the didactic years was microbiology and although I am interested in Infectious Disease, I do not know if I would enjoy having to go through 3 years of Internal Medicine(haven't had my IM rotation yet though) and then 2 years of fellowship to ultimately have a lower salary than any other field and have a more restricted job market in which to work. I've only spent a week in the peds ER as the sum total of my ER experience thus far and it seems like there is a fair amount of microbiology involved in ER visits based on this brief experience. I also like having to deduce what could be wrong with a patient and the detective work involved. I dislike having to manage multiple comorbidities or having a lot of uncertainty as that stresses me out. I like toying with the idea of outreach and advocacy and I think there may be opportunities to do so as an ER physician. Is there a lot of uncertainty and long term medical management in EM?

Now, attributes that might make me less fit to pursue EM is that I like taking the time to ponder and think and do not do well under high stress, quick paced environments. That being said, if my duty as an ER physician would be just to stabilize and treat the patient's immediate issues that may be more suited to my character. I keep hearing about burn-out is a major issue among EM doctors so that doesn't make it appealing either. I also do not like doing procedures but I suppose this might just be a fear that I can overcome. Is it possible to be an EM physician who doesn't do procedures?

I like Psychiatry in the sense that there are many opportunities to work with marginalized communities, and it is a procedure-less specialty. Although there is a lot of uncertainty in the field, in the case of Psychiatry, this can be a positive as it lets you have more fodder to think over and analyze when evaluating and treating patients. I would really hate to lose the ability to treat and diagnose microbial diseases which I suppose I'd have very little opportunities to address in Psychiatry. However, I know there are opportunities to work with HIV patients which is a positive but I presume I would only be managing their Psychiatric issues. The other downsides to Psychiatry is that the patient's illnesses are usually chronic and some of the mechanisms of the drugs are not clearly elucidated. What I really fear is whether patients are helped much at all in Psychiatry. Can someone disabuse me of this fear? Thanks in advance!

---

Members don't see this ad.

 

[racerwad]

Hello,

I'm a third year medical student trying to decide what field to go into. My favorite subject from the didactic years was microbiology and although I am interested in Infectious Disease, I do not know if I would enjoy having to go through 3 years of Internal Medicine(haven't had my IM rotation yet though) and then 2 years of fellowship to ultimately have a lower salary than any other field and have a more restricted job market in which to work. I've only spent a week in the peds ER as the sum total of my ER experience thus far and it seems like there is a fair amount of microbiology involved in ER visits based on this brief experience. I also like having to deduce what could be wrong with a patient and the detective work involved. I dislike having to manage multiple comorbidities or having a lot of uncertainty as that stresses me out. I like toying with the idea of outreach and advocacy and I think there may be opportunities to do so as an ER physician. Is there a lot of uncertainty and long term medical management in EM?

Now, attributes that might make me less fit to pursue EM is that I like taking the time to ponder and think and do not do well under high stress, quick paced environments. That being said, if my duty as an ER physician would be just to stabilize and treat the patient's immediate issues that may be more suited to my character. I keep hearing about burn-out is a major issue among EM doctors so that doesn't make it appealing either. I also do not like doing procedures but I suppose this might just be a fear that I can overcome. Is it possible to be an EM physician who doesn't do procedures?

I like Psychiatry in the sense that there are many opportunities to work with marginalized communities, and it is a procedure-less specialty. Although there is a lot of uncertainty in the field, in the case of Psychiatry, this can be a positive as it lets you have more fodder to think over and analyze when evaluating and treating patients. I would really hate to lose the ability to treat and diagnose microbial diseases which I suppose I'd have very little opportunities to address in Psychiatry. However, I know there are opportunities to work with HIV patients which is a positive but I presume I would only be managing their Psychiatric issues. The other downsides to Psychiatry is that the patient's illnesses are usually chronic and some of the mechanisms of the drugs are not clearly elucidated. What I really fear is whether patients are helped much at all in Psychiatry. Can someone disabuse me of this fear? Thanks in advance!

Bolded are the parts of your post that make it seem less likely that EM is a good match for you. It's true that many attendings don't like doing procedures, but that's more of it's impact on work flow rather than not actually enjoying procedural stuff. I would bet, all things being equal, most EPs would enjoy doing procedures if it didn't impact the overall flow of the ED itself.

Most people also assume that it's only the resuscitations and trauma arrests where the pace is fast and the stresses are high, but that isn't always the case. If the ED is busy, with multiple moderate acuity patients, you're responsible for dispositioning them, negotiating with consultants, nurses, pharmacists, etc. This can get chaotic. In addition, you could be responsible for the local EMS system and have to answer their calls as well.

My best advice is to try and shadow in an adult ED to get a more realistic sense of what the specialty is like. Good luck!

 

[alehar]

racerwad's reply is on point.

From everything you've typed, it's tough to recommend EM to you. A busy department is not only busy and stressful, but the patients themselves are busy in terms of comorbidities (many have a ton of chronic issues with associated meds you need to review to ensure they aren't playing a part in their acute illness). These patients often have multiple consultants that need to be involved. You will have to do procedures (intubations, reductions, central lines, lumbar punctures, etc) during residency and, depending on where you practice, as an attending.

As for one of your other points, there is a lot of uncertainty here. Trying to wade through the uncertainty to a likely diagnosis and then a treatment plan is the ultimate goal of diagnostic emergency medicine. You will find solid diagnoses some of the time, but you need to be able to say "this patient is complaining of chest pain/abdominal pain/headache and we don't have a definite diagnosis, but we ruled out everything really dangerous."

 

[dotcb]

It sounds like you do not have anywhere near enough experience to make an informed decision about this. I'd recommend that you do a psychiatry and emergency medicine rotation. I think a lot of your questions will be answered.

You've mentioned some serious downsides of emergency medicine and your personality that are rather unavoidable. While we do treat a lot of infections in emergency medicine, there is not a lot of involved thinking about microbiology. After awhile, it becomes rather cookbook – you have X problem, therefore we give you X antibiotic....

 

[EM4life]

"I like taking the time to ponder and think and do not do well under high stress, quick paced environments"

Time is a rarely afforded luxury in Emergency Medicine - if you have time to think, you can do some detective work, if not, your job is to determine sick vs not sick and dispo the patient.
The vast majority of time you will work in high stress quick paced environments - this is reality and will worsen with the current healthcare climate.

"Is it possible to be an EM physician who doesn't do procedures?"

No

"I dislike having to manage multiple comorbidities or having a lot of uncertainty as that stresses me out"

Uncertainty is rampant in all parts of medicine - it is especially bad in emergency medicine where patients with many comorbidities frequent the ED with vague complaints. Even most of our tests for ruling out do not definitively rule out badness (case point, just saw a pt who had abd/flank pain, CT scan positive for small kidney stone a week ago, came back with same pain, now with flaming appendicitis on CT) - you have to live with it, you have to communicate with your patients and other staff effectively and quickly.

Based on your own assessment of your personality, it does not sound like you are a good fit for Emergency medicine. You should absolutely do a rotation in Emergency Medicine, you may be surprised at what you like or you may just realize that EM is not what you wanted after all.

 

[primadonna22274]

Definitely not EM.
You sound like Med-Psych to me. Combined 5 yr program--I talked myself out of it cuz I would be 45 when I finished but there is still a lot that draws me to this specialty. Look into it.

 

[Old_Mil]

I ...do not do well under high stress, quick paced environments.

I like Psychiatry in the sense that there are many opportunities to work with marginalized communities, and it is a procedure-less specialty.

Don't go into EM.