EM vs surgery?

[swoopyswoop]

I'm sure other people struggled with this decision. Fell in love with trauma, decided to pursue gen surg. Now I find myself on my EM rotation also enjoying it. I'm worried I only like the "sick" patients and the idea of treating emergently ill/crashing patients since my residents have been 'shielding' me a bit from reality by advising me not to take random frequent flyers w/o real complaints.

How do i decide?!

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[BoardingDoc]

Figure out which field has a day to day experience you like more. You aren't going to always have a crashing patient in the ED who needs a chest tube and an intubation every day. You also aren't going to have an emergency ex-lap every day in the OR. You're going to have a smattering of one or the other with either a lot of lap choles/appendectomies or back pain/UTI/pneumonia in between.

Don't pick your career for what you're going to be doing 10% of the time without at least considering the other 90%.

 

[swoopyswoop]

True, I havent had any crashing or even acutely ill patients in the ED yet.

 

[The Buff OP]

True, I havent had any crashing or even acutely ill patients in the ED yet.

Are you at level 1?

 

[swoopyswoop]

yea, but most of my shifts so far have been on the mezz/less acute teams

 

[RustedFox]

Not even a question.

 

[The Buff OP]

yea, but most of my shifts so far have been on the mezz/less acute teams

Ah, lol if you are in Texas (in my area) let me know what hospital you are at and we will bring a code or two (I'm an EMT).

 

[alpinism]

I'm sure other people struggled with this decision. Fell in love with trauma, decided to pursue gen surg. Now I find myself on my EM rotation also enjoying it. I'm worried I only like the "sick" patients and the idea of treating emergently ill/crashing patients since my residents have been 'shielding' me a bit from reality by advising me not to take random frequent flyers w/o real complaints.

How do i decide?!

Figure out which field has a day to day experience you like more. You aren't going to always have a crashing patient in the ED who needs a chest tube and an intubation every day. You also aren't going to have an emergency ex-lap every day in the OR. You're going to have a smattering of one or the other with either a lot of lap choles/appendectomies or back pain/UTI/pneumonia in between.

Don't pick your career for what you're going to be doing 10% of the time without at least considering the other 90%.

Yep.


The main question you have to ask yourself is during the other 90% of the time would you rather be:

A) rounding, operating (choles, appys, hernias, loa, etc...), and seeing patients in clinic
B) seeing urgent care type patients (URIs, UTIs, SOB, CP, ABP, Psych complaints)

Another thing is that EM not only sees major traumas but less serious ortho and eye traumas that you'd never see in GS.

I was in the same situation a year ago. Just couldn't see the point of doing a 5-7 year residency when 90% of the time I'd be miserable rounding/seeing clinic patients/doing non trauma surgery. Not to mention I realized that I really only loved the initial trauma resuscitation rather than the long term management in the SICU or on the floor. At least with EM you also have "sick" medical patients as well. So its more like 75% of the time you're not doing what you love instead of 90% (especially if you're at a busy inner city shop). In a perfect world I'd just do resus (medical and trauma) all shift.

 

[lp430]

I was torn between gen surg and emed as well. One big deciding factor for me was life post-residency. I realized I liked the diversity of patients you get in emed. Once you finish a gen surg residency and stop rotating through all of the sub-specialties as a resident, there is very little variety. I also would like to live in a city, which would also reduce the variety of cases you do as a surgeon since there tends to be more sub-specialist surgeons in the city.
I also agree with @BoardingDoc about enjoying the stuff you do on a day to day basis, not just the occasional exciting patient.

 

[OPPforlife]

Yep.


Another thing is that EM not only sees major traumas but less serious ortho and eye traumas that you'd never see in GS.

.

Maybe ortho, but corneal abrasions are not eye trauma. Unless of course you mean the times when you call ophtho to "r/o open globe"


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[alpinism]

Maybe ortho, but corneal abrasions are not eye trauma. Unless of course you mean the times when you call ophtho to "r/o open globe"


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Thinking more along the lines of orbital compartment syndrome w/ no ophtho in house...

 

[RustedFox]

Is this even still a fccuking question?

 

[Docinthetrenches]

I too initially was considering surgery - but then I saw the abuse the residents suffered, the operating most days at 7:30am, the call, the 5+ days a week of working, etc. I realised also that the only thing that really excited me in medicine was when the s- was hitting the fan (in surgery, ICU, OB, or wherever). EM was perfect for that. Now after having done it for 13 years post residency, I know I made the right choice. Yes there are tons of frustrations (subpar staff, demanding patients, frequent flyers, drunks, etc) BUT the best thing is the flexibility - I now work 3/4 time and add on extra moonlighting shifts as necessary, I only work one weekend a month and if I want, I can work 1/2 time, full time, or go full per deim. All this allows me to spend more time with family and doing a lot other fun stuff. I just don't see that being the case as a surgeon - although I bet I'd make more money but time is worth much more to me.

 

[Birdstrike]

I too initially was considering surgery - but then I saw the abuse the residents suffered.

Me too. Medical training is abusive enough I could never see asking for more by going into general surgery. My general surgery rotation was gad awful abusive. I've never felt so treated like dog s--t before, or after. That's was just my experience. I can't say it applies across the board, but sure as hell turned me off. Plus, I liked EM people. A little crazy, but in good way. Fun. Not that you don't take abuse in EM. You do, but it's more from the patients, administrators, the pace and the circadian rhythm back fips. But that's a whole different thread...As always, it comes down to choosing your poison.

 

[Auvelity]

I'm sure other people struggled with this decision. Fell in love with trauma, decided to pursue gen surg. Now I find myself on my EM rotation also enjoying it. I'm worried I only like the "sick" patients and the idea of treating emergently ill/crashing patients since my residents have been 'shielding' me a bit from reality by advising me not to take random frequent flyers w/o real complaints.

How do i decide?!

Also a medstudent. I was in a surgery rotation at a very busy hospital. And after 3 weeks I've found myself tired of watching lap cholecystectomies and hernias and the same old same old. I felt tired all the time. I had to wake up at 4am everyday and i left at 8pm and most of the times the residents stayed more than I did. I felt exhausted and drained. People are usually mean!! I felt depressed and I hated it. So the advice surgical residents gave to me its to pick surgery if you really can't see yourself outside the OR. The only time I felt alive was or suturing or trauma calls when we had to run to the emergency and well. Idk for me I feel in love with it almost immediately. Even the trauma conferences were EM residents and surgical residents had to participate were more fun that the usual at surgery.
So... you decide. And i know probably emergency have more hours, more stress and more variety (good or bad) but for me i think time runs fast when you do what you like. For me those surgeries became boring and having the residents bitch at me for not doing their job appropriately probably biased me

 

[Zebra Hunter]

Also a medstudent. I was in a surgery rotation at a very busy hospital. And after 3 weeks I've found myself tired of watching lap cholecystectomies and hernias and the same old same old. I felt tired all the time. I had to wake up at 4am everyday and i left at 8pm and most of the times the residents stayed more than I did. I felt exhausted and drained. People are usually mean!! I felt depressed and I hated it. So the advice surgical residents gave to me its to pick surgery if you really can't see yourself outside the OR. The only time I felt alive was or suturing or trauma calls when we had to run to the emergency and well. Idk for me I feel in love with it almost immediately. Even the trauma conferences were EM residents and surgical residents had to participate were more fun that the usual at surgery.
So... you decide. And i know probably emergency have more hours, more stress and more variety (good or bad) but for me i think time runs fast when you do what you like. For me those surgeries became boring and having the residents bitch at me for not doing their job appropriately probably biased me

The bold is very, very, very wrong.

 

[emergentmd]

I tell med students who are deciding this. People decide on what they like which I think can be very wrong such as wanting to go into surgery doing Whipples, bowel resections, etcs all day.

1. Decide what you DO NOT like and can not stand. For me, I could not stand boring clinics and being on call. That cuts it down alot
2. Find out what the doc does 90% of the time and you have to either be able to bear it or like it. You can't hate it.
3. What you find fun/exciting now will not excite you after doing it 100 times. This goes for EM too. People think its exciting running codes, putting in lines, intubating, putting in chest tubes, cracking chests. Guess what, that is about 1% of your job. You better like the other 99% that is not exciting or procedural. If I do not have to put another Chest tube, central line, pelvic exam, reduce joints/fractures, LPs, sutures I would be a happier man. The finest steak takes like rubber after the 3 straight meal.

No different than any seasoned surgeons disliking the appy from the ED. They really hate it at 1am they just fell to sleep from a long day, operate for 2 hrs, and then get back to either the full day of clinic at 8am or surgery at 8am until 5pm.

If you can bear this or even like it after doing it for 5 years, then surgery is for you.

I love not having clinic, not having call, taking days off when I want. Admin stuff, drug seekers, drunks, bland medicine, etc doesn't bother me. I love EM