Miserable in ortho, thinking of switching to EM

[needachange]

I'm a PGY2 at a strong academic ortho program, but I'm totally miserable. I had good scores (250s), honors in everything, AOA, yadda yadda. I had always kind of wavered between the two, ultimately, ortho won out because I missed not going to the OR ever and I liked fixing things. But over the course of the past two years, I think I miss general medicine even more, especially of the acute variety. I'm finding that I don't really care about all the minutiae of orthopedics and that I'm more of a big picture kind of guy, and it's starting to affect my performance as a resident too. My motivation to continue reading ortho after a 14 hour day is near zero, and it's starting to show (this was never a problem for me during medical school, I read like a sponge). The last thing I want to be is a mediocre orthopedic surgeon. Even in the OR, I feel like basic techniques that my co-residents easily grasp, I struggle. It's causing me incredible stress. I feel like I've hit the Peter Principle (you get promoted to your maximum incompetence).

Suddenly had an epiphany while on call last week that I should maybe consider a switch to EM. In EM I don't have to abandon my medical knowledge that I worked so hard to achieve in medical school and actually really enjoyed. I love fixing lacs, EM guys do that too. I like using ultrasound, EM guys do that a lot. I don't mind working hard on a shift, hell I work literally non-stop while on ortho. But most importantly I feel, I want to maintain my medical knowledge, it's what I find interesting after all the initial excitement of the OR or the power tools wear off. I don't think I can do variations of 3 procedures for the rest of my life and see the same clinic patients again and again. I like to learn new things broadly. I like to make decisions quickly, think on my feet and turf things. I love thinking through differentials in my head, something I pretty much never do now in ortho. Also work hours of EM in residency and afterwards is really appealing to me now that I just started a family. To work like a dog in a field that I'm no longer interested in is just killing my soul. I feel like kicking myself for not fully exploring EM while I had the chance.

How do I go about switching to EM though? Who can I confide this to? I feel so alone, all my co-residents are "roar! roar! ortho!" and even my spouse and friends think I'm absolutely crazy for dropping ortho and just need to ride it through. Maybe if I hear enough people in EM who tell me not to make this move, I would be more persuaded. Am I being reckless with my livelihood? How will I even get EM letters? This all seems logistically impossible. My wife suggests getting through ortho residency and just do more sports medicine clinic type of work with 9-5 hours and take the substantial salary hit versus the risk of changing specialties and finding that EM also has its BS.

I wish medicine was more like every other job, where I can just switch specialties laterally to find my best fit. It's a tall order to expect medical students who were exposed to things for a few weeks to set in a stone an entire career.

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[deleted547339]

At the very least, you can't switch right now. It's too late to get a spot for 2015. Honestly, that's good news - it means you have time to figure this out.

Ortho is tough. One of my best friends is a PGY-2 ortho resident and it kicks his butt everyday. But all residencies are tough. There are times in the past year and a half I've thought I picked the wrong specialty.....I miss the OR....I don't like consultants looking down on me/talking down to me when I can tell that I'm more up to date on the literature than they are....I hate working nights/weekends/holidays and realize that I'll have to do that for the rest of my life....I'm jealous of the derm/ortho/ent/whoever who can make 500K a year when I'll cap out much lower than that. All specialties have a downside, every last one of them.

I think everyone has been in your shoes. I think most all residents have been depressed at some point. We just don't talk about it because that's the culture. It's part of the reasons burn out and suicide rates are so high.

Impossible for someone who doesn't know you to give you advice; but I can tell you that I suspect a lot of this is from being overworked and tired. EM isn't perfect. Good luck in whatever you do. Sounds like you need a vacation to spend some time with your family more than anything.

 

[SoyMilk]

I have met 4 people who have switched from gen surg to EM. All did so after completing only an intern year. All ended up transferring into programs in the middle of nowhere by looking for vacancies. All had to start over as an intern

 

[Vandalia]

First, pick up a copy of Hot Lights, Cold Steel by Dr. Michael J. Collins. It is basically an autobiography of his time as an orthopedic surgery resident at the Mayo Clinic and he is a pretty good humorous story teller. Or go to Amazon/Google and read the first couple of chapters. He has some great descriptions of feeling totally incompetent at the beginning (and middle) of his residency. Hint: it ended well. You will probably find that almost every other resident in your situation feels pretty much the same way. It is just that, being surgeons, they are great at hiding it.

So first, read the book. If that doesn't help, then we can talk more.

 

[EctopicFetus]

You can match outside the match.. Here is the list of openings.

http://www.saem.org/membership/services/residency-vacancy-service

 

[erdoc00]

Dont do it. Ortho residency/fellowship is painful for the next 4-5 years. EM will be painful for the rest of your working life.

Thats not even taking into consideration that orthos probably make 3x what an er doc makes.

 

[emergentmd]

Suck it up, finish your second year. It will get better. Suck it up and finish your residency. It will get better. You can find a job in almost all fields that you will enjoy.

When I was a med student, my choices were either EM vs Rad. I picked EM. Why, who knows. How do most really know for sure when they are a 3rd yr med student is beyond me.

When I started internship, I did gen surg at a SUPER Busy inner city trauma center. Yes it SUCKED. I felt dummer than the worse intern. After doing my 120 hr/wk rotation, I wanted to get out. I hated the hospital. Hated medicine. Tired as dog. Yelled at by an upper level. I wanted to quit. I talked to my Then GF about quitting.

Fast forward 2 months after and EVERYTHING was downhill after that Surgery rotation. Residency after my 1st month was a piece of cake relative to that month.

Fast forward 4 yrs and I am an attending. There are days that I hated EM medicine. Always that thoughts about going back to Radiology. Talked to my wife about quitting and going back to Radiology. My wife was supportive and told me to do whatever I wanted. I seriously considered this but didn't after realizing that I would be giving up a 400K job working 15 dys a month switching to a 4 residency program working like a dog making 50K a yr.

Fast forward to NOW. I would not do radiology (or any other field) if someone begged me to. I love EM. I love the Field. I love all of the greatness of this field (work 15 dys a month) and the cons of this field doesn't even bother me anymore. Drug seeker? Admin complaints? Metrics? Pffftttttt..... I do not even give this a second thought.

My point is...... grass not greener on other side. Stick with ortho. You will be happy. You will grow up. You will get more mature. You will figure out that work is a small part of your life. You will figure out that there are more important things in life.

I can come home from work knowing that my family is well cared for. I will never be without a job. They will have a dad that will be home with them often. EM medicine is a small part of my life.

 

[two guys]

I'm sorry you're going through this, doesn't sound like fun.

A couple of points:

- You've got to have buy in from your wife for any of these changes. She's going to be the one having to hear the groaning that results from staying or going.

- Residency is the worst time to evaluate what a specialty will be like. Even if I got my dream job (NFL linebacker), I would hate it if I had to work >80hrs/week and read afterwords. That doesn't mean you should stay in ortho, it does mean that it is hard to know how you'll feel in 5 yrs.

- I would try to talk to some ortho and EM attendings (feel free to PM me) about how they feel now and how they felt during residency. I wanted to quit during the 2nd year of EM but didn't because it was pretty easy to see the end. I'm glad I didn't have something else I wanted to switch into. I'm thoroughly happy now.

- It is hard to get into ortho. Because of that, you won't hear many ortho guys say it wasn't worth it and you won't see many transfer out. It's similar to the MD/PhD crowd. It is damn hard to get into one of those programs - most people figure out they aren't going to use both degrees halfway through but can't quit b/c they feel they are giving up such an opportunity. It is NOT an opportunity if you don't like it.

- No matter what you do, you're going to want to try hard this year in residency. You will be happier if you get better in the OR and feel back to that same level with your peers. I agree, being a half ass anything would not be cool. Since you've got at least another year - you should try to commit to being an awesome resident. It will help you whether you switch or not.

As far as the logistics of switching, plenty of people have been through this hopefully they'll chime in. There's a program director for IM on here - I think his screen name is aprogramdirector. He can probably help you a little with the logistics. My understanding is you want to try to do it with the graces of your current program director.

As far as EM vs Ortho: I really wanted to love ortho in med school but I just didn't. The OR was cool, but I was not that interested in the knowledge base. The upsides I can see of ortho are:
- Aside from academics and Level 1 trauma centers you work mostly 9-5 and you probably only work 1 weekend a month. There's just not that much that you need to get out of bed for. I call ortho in maybe once every 10-15 shifts. Part of this is because they're happy to see someone in clinic the next day.
-You are an expert. It will be rare for you to see something you've never seen before and it will be rare for you to have to go look something up. This is both good and bad.
-You will be well paid and can easily work into your elder years making good money.

The downsides of EM are:
- You will work all manner of hours, sometimes without much rhyme or reason to why you're flipping around.
- You will work at least 2 weekends a month and half of all holidays. It is guaranteed that you'll spend Thanksgiving or Christmas getting your hands dirty.
- Most consultants you call will think they know more than you (sometimes they do) and might not be shy about thumping their chest in front of you. Every time you call someone it will be for them to do work. Hearing grown adults with coveted jobs whine about having to take care of patients while simultaneously being condescending can get old. Most of us learn how to let this roll off us, but some don't and it can be pretty ugly for them.
- There is not an easy way to scale back in EM. There are options but most of them involve a little bit of forging your own path.
- You have less power. Someone wrote on here that in EM you are like the hot dog vendor at a sporting event - you provide a valuable service but don't bring in the main income. If you ask for something you might get it or they might just find a new hot dog vendor. The surgeons are more like one of the athletes - they bring in a lot of money. If they want something and threaten to leave the hospital will work hard to make it happen. I think that analogy is not completely true these days but it does have some truth to it.

Upsides:
- Occasionally you truly save lives.
- You get to see some variety and there is almost always something more you can learn.
- Work and home boundaries are clear.
- Pay is pretty good for the hours. It is possible to work 100-120hrs/month and make >300k while working at a decent place.


You've got a lot to think about, good luck

 

[Birdstrike]

I don't know. This is tough. Ortho is such a good specialty, it's hard to advise someone against it. They're some of the highest paid doctors. There's call but in a big group it can be divided so that it's only a few times per month depending on group size. You can focus on one area (joint replacement; spine; hand; foot/ankle). You tend to be the darling of the hospital's since you rack up goofy amounts of facilities fees for the hospital's off your surgeries. Private practice as well as ASC ownership are still options with enough independence you aren't as likely to get as dumped on by the admin types. For the most part, in Ortho you'll get to eat when you want to eat, sh¡t when you want to sh¡t, and have functioning circadian rhythms (most of the time). I don't know, man. Ortho is a pretty damn good specialty.

On the other hand, I can't advise you to do something you hate. What you need to decide is whether or not it's just residency getting you down, or the specialty of orthopedics itself. If it's residency itself, EM won't be much better, only shorter, since EM rotates though some pretty tough specialties.

I don't know, man. Ortho is a pretty damn good specialty, as far as specialties in Medicine go. But you need to decide what's best for you.

 

[SoyMilk]

- There is not an easy way to scale back in EM. There are options but most of them involve a little bit of forging your own path.

Really? I can't tell you how many female attendings I know that are on the mommy track working 3-4 shifts per month. There are so many options to scale back while still working a physician after completing a EM residency.

Compared to other specialties, EM seems more conducive to part time work.

 

[Birdstrike]

Someone wrote on here that in EM you are like the hot dog vendor at a sporting event - you provide a valuable service but don't bring in the main income. If you ask for something you might get it or they might just find a new hot dog vendor. The surgeons are more like one of the athletes - they bring in a lot of money. If they want something and threaten to leave the hospital will work hard to make it happen. I think that analogy is not completely true these days but it does have some truth to it.

That was yours truly, "Ruminations On Hot Dogs & Emergency Medicine" on the Respect For Physicians thread:

http://forums.studentdoctor.net/index.php?threads/Respect-for-physicians.1003921/#post-14037516

 

[Groove]

Stick with ortho. I love EM, but I also hate aspects of it on some days. It's almost impossible to make an objective decision about your ability to find fulfillment with your chosen specialty as a PGY2 in ortho. Your professional life and enjoyment is almost guaranteed to improve once you finish residency. If I were listening to myself as a PGY2 ortho resident, I'd give myself the same advice.

I've always felt that most people could pursue a variety of medical specialties and still find a modicum of happiness to fulfill professional enjoyment and satisfaction. I could have done a variety of specialties and life would probably have worked out just fine. Don't get me wrong, I'm glad I chose EM, but it's not the only thing I could have done well. I have never bought into the notion that we are genetically programmed for one and only one specialty and all others are sure to bring absolute misery to our lives and the ones we love.

Stick it out, you'll likely be glad that you did in the long run. I know of many gen surgery --> EM switches but I've never met an ortho --> EM switch if that makes you feel any better.

It's not that switching to EM as a PGY2 ortho resident is impossible. It would just be very risky from your current perspective and level of training. I would only encourage you to consider it if you were so disillusioned with your field that you felt your residency training was being seriously jeopardized. Good luck.

 

[The White Coat Investor]

Whatever you do, you're going to be doing it for 30-60 hours a week for the rest of your life. More than anything else, it's important that you enjoy it as much as possible. If you really think you'd be a lot happier in EM, switch. First step is talking to the EM program director in your hospital, confidentially. You don't want any of this getting to your current program director until you're absolutely 100% positive you're leaving ortho forever. Once you've decided to go, it's just about matching into the best program you can get into as soon as possible. You'll get a few months credit, but not much. Hopefully you did an EM rotation as an intern. That will be where you will get your letters.

 

[emergentmd]

There is no way to tell you if switching is right or wrong. I would just say finish out the year, and if it gets bearable stick with it. If you truly hate it and miserable, start looking.

 

[emergentmd]

Really? I can't tell you how many female attendings I know that are on the mommy track working 3-4 shifts per month. There are so many options to scale back while still working a physician after completing a EM residency.

Compared to other specialties, EM seems more conducive to part time work.

I would say EM medicine is the easiest to wind down and wind down any time you want. It is also very easy to ramp up when you are ready to.

I can work 1 day a month to 25 days a month if I wanted to. And I could make this switch in 2-3 months.

Not many fields allows such flexibility without the need to ramp up a practice.

 

[Hair Police]

Contrary to what others have posted, ortho is generally not five years of residency followed by banker's hours. It takes another 5-10 years post-residency of being the do-anything, always on-call guy to affect existing referral patterns and actually set your practice up properly.

 

[Brigade4Radiant]

Contrary to what others have posted, ortho is generally not five years of residency followed by banker's hours. It takes another 5-10 years post-residency of being the do-anything, always on-call guy to affect existing referral patterns and actually set your practice up properly.

This is true you have to get a good referal base before you can reject ER call.

ER is no cake walk either sometimes I would like to wind down and think a medicine residency would be easier then I realize that I'm not making sane decisions.

 

[emergentmd]

Contrary to what others have posted, ortho is generally not five years of residency followed by banker's hours. It takes another 5-10 years post-residency of being the do-anything, always on-call guy to affect existing referral patterns and actually set your practice up properly.

This is funny but so true. The ortho (and all surgical specialists) but more so ortho guys are the nicest docs when they first come in to town. They will do anything, any time, take funded/unfunded patients.

2 yrs later and they won't even come to the ED to see their own patients.

 

[two guys]

I would say EM medicine is the easiest to wind down and wind down any time you want. It is also very easy to ramp up when you are ready to.

I can work 1 day a month to 25 days a month if I wanted to. And I could make this switch in 2-3 months.

Not many fields allows such flexibility without the need to ramp up a practice.

I guess I should clarify. Yes, there are multiple options to work less hours (although I disagree that it is super common. It is hard to get hired somewhere super desirable if you only want to work 5 shifts a month and a lot of partnerships have a minimum hours requirement that doesn't scale back as quickly as you might want).

My point was more that your shifts are likely to be as demanding (if not more) when you're 60 as they are when you're 35. There are some options to slow down a little (urgent care, fellowships, admin, etc), but they're not as available as an ortho saying he's only going to schedule 3 procedures on an O.R. day instead of 6 or just deciding to do sports med clinic work. If there's particularly long or demanding procedures you can just stop doing them. In EM, we can't choose to see only the patients we want as we get older.

I guess I'm just trying to say that the demands don't change much over time. Th hours can if change if you want but not the demands. Ortho is more demanding to start and less demanding as you get a good patient base and older. EM is probably about as demanding 25 years in as it is 10 years in.

 

[DeadCactus]

Residency blows. It's enough to make people regret going into medicine period let alone their chosen specialty. I love EM, I don't think there is a better fit for me but there are definitely days I'm hating life and the idea of switching to another specialty to make things "better" pops up.

I love EM for a lot of the reasons you quote. I love the broad scope and using that stuff we learned in medical school and beyond. I love the breadth and that I can learn about so many things and make it applicable to my practice. I love that the patient is undifferentiated. I love that I can work 2 or 3 days a week. I love that the "sexy" medicine like wilderness, EMS, tactical, international, etc all fall under my speciality. I love that I can take care of patients without worrying about insurance as much as other people.

The flip side as someone who was torn with ortho and even thought about trying to switch to ortho. Ortho fixes people more than any speciality. They may not save lives often, but they very obviously and concretely fix things while the rest of medicine is mentally masturbating about the NNT. Tied to this is a unique patient relationship and, in general, true gratitude from the people they fix. You get to be an expert in a field. You get to bring serious money to a hospital which translates to having more pull and putting up with less bull****. EM lives in constant fear of being replaced by a contract group or, worse, midlevels while ortho threatens to leave and go to another hospital because they don't like something. Longer hours but more stable circadian rhythm and control.

Both fields are great. To be honest, I doubt anyone would regret either once they were an attending...

 

[Pigg-O-Stat]

For what its worth, I can tell you that I would not be happy in any specialty other than EM. If you are really miserable in ortho and what to make the change then do it. Just make sure you know what you're getting into. The last thing you want is to make the change and regret it.

 

[NinerNiner999]

There are very few fields in medicine that will remain autonomous, lucrative, and always in demand by hospitals. Ortho is one of them. Be mindful of the future of medicine, and the creep of employment, contract groups, and care organizations. Your current specialty will always have command of job security and hospital preference without the concern of contract buyouts, CMG competition, service line merging, and the other pitfalls of emergency medicine practice. You won't be held to the numerous (and fluctuating) time requirements, LWOT, AMA, and LWBS statistics, and your group won't be a slave to the monthly, weekly, or daily administrative meetings pushing their metrics and expectations upon you.

Yes - your residency will be painful, and filled with moments that you don't feel you can grasp your trade. That is why it is called residency, and also why there are so many years of training for you to learn.

 

[Robinson EM]

Dont do it. Ortho residency/fellowship is painful for the next 4-5 years. EM will be painful for the rest of your working life.

Thats not even taking into consideration that orthos probably make 3x what an er doc makes.

You just have to be flexible and enjoy what you do.

People who don't enjoy EM and/or aren't flexible won't be happy.

Build other skills and you can reduce your clinical hours by 50%. There are many options in this field if you're getting burned out.

 

[Robinson EM]

I would say EM medicine is the easiest to wind down and wind down any time you want. It is also very easy to ramp up when you are ready to.

I can work 1 day a month to 25 days a month if I wanted to. And I could make this switch in 2-3 months.

Not many fields allows such flexibility without the need to ramp up a practice.

Exactly.

I think the people burned out haven't managed their money well.

How can you get burned out working 2 days a week?

The flexibility in this field is ridiculous. For every horror story about EM there is another guy living the life and enjoying every minute. Life is what you make it, so is your career. Adjust your hours and working environment as you see fit.

 

[Robinson EM]

There are very few fields in medicine that will remain autonomous, lucrative, and always in demand by hospitals. Ortho is one of them. Be mindful of the future of medicine, and the creep of employment, contract groups, and care organizations. Your current specialty will always have command of job security and hospital preference without the concern of contract buyouts, CMG competition, service line merging, and the other pitfalls of emergency medicine practice. You won't be held to the numerous (and fluctuating) time requirements, LWOT, AMA, and LWBS statistics, and your group won't be a slave to the monthly, weekly, or daily administrative meetings pushing their metrics and expectations upon you.

Yes - your residency will be painful, and filled with moments that you don't feel you can grasp your trade. That is why it is called residency, and also why there are so many years of training for you to learn.

Can you be sure that orthopedics won't be mostly employed by hospital groups? Many general surgeons are being pushed in this directions already. While you have a good pulse on EM, I find it hard to believe that you can picture where orthopedics will be in a decade. I don't mean to say that they won't have more bargaining power than EM, just that it's a difficult prediction to make. Most doctors are losing out to corporations now - I don't think surgery will be different.

 

[Robinson EM]

I guess I should clarify. Yes, there are multiple options to work less hours (although I disagree that it is super common. It is hard to get hired somewhere super desirable if you only want to work 5 shifts a month and a lot of partnerships have a minimum hours requirement that doesn't scale back as quickly as you might want).

My point was more that your shifts are likely to be as demanding (if not more) when you're 60 as they are when you're 35. There are some options to slow down a little (urgent care, fellowships, admin, etc), but they're not as available as an ortho saying he's only going to schedule 3 procedures on an O.R. day instead of 6 or just deciding to do sports med clinic work. If there's particularly long or demanding procedures you can just stop doing them. In EM, we can't choose to see only the patients we want as we get older.

I guess I'm just trying to say that the demands don't change much over time. Th hours can if change if you want but not the demands. Ortho is more demanding to start and less demanding as you get a good patient base and older. EM is probably about as demanding 25 years in as it is 10 years in.

Are you kidding?

Ortho is more flexible than EM? I think this is grass is greener talk.

Who is to say the orthopedics group will be happy to let you do half as much when they are paying all the expenses to keep you in their group?

And how is EM not flexible? You mention that Ortho can do sports clinic? Well, EM can do a sports fellowship and do sports clinic. If you want to scale back and do very little, you can switch to urgent care. Bored with that? Go back. Then you can work half the shifts - you can work in academics. There are fellowhsips in ultrasound, critical care, EMS, tox, etc. There are many ways to limit your clinic hours if you don't want to be crazy and work 40 hrs a week. I find it very hard to believe there is something as flexible as EM. Now, you may argue you can't earn the money you want when you do these changes - but that's a money issue and not a specialty issue.

If this is about earning more money then I agree, ortho is much much better. Save your money and pay off your debt. If you have zero expenses then even 100k is a lot.

 

[The White Coat Investor]

Exactly.

I think the people burned out haven't managed their money well.

How can you get burned out working 2 days a week?

The flexibility in this field is ridiculous. For every horror story about EM there is another guy living the life and enjoying every minute. Life is what you make it, so is your career. Adjust your hours and working environment as you see fit.

Seriously. I have partners working 6-10 shifts....a month. Burned out? When you spend more time cleaning your house, backcountry skiing, or tinkering in the garage than you do at work, which are you going to get burned out on first?

Truly, I think the key to happiness in EM is in your personal financial management. Clinical work is so much more fun when you don't have to do it, or at least not very often. Sure, there are aspects that suck. Drug seekers get old. Undiagnosable belly pain gets old. Psychiatric BS gets old. Bizarre admin requests get old. Nights, weekends and holidays suck too. Combine all five of them and you may have a bad day or two. You think you're not going to have that in any other job or non-job?

I'm 8 years out of residency. I have a relatively tiny mortgage as my only debt. I have a side job that would pay for all my expenses. I have a portfolio that by itself would pay for most of my expenses (especially if I paid off that mortgage.) I go on vacation at least once a month, I work less than 30 hours a week, and someone puts tens of thousands of dollars in my bank account every month that I have to figure out how to pay taxes on, invest, spend wisely, or give away.

What do people complain about? "Man, this sucks. I had to work four shifts in a row!" Seriously, first world problems. EM rules. Ortho looks pretty good too, but if you hate it, then come on over. We've got plenty of jobs to go around.

 

[two guys]

Are you kidding?

Ortho is more flexible than EM? I think this is grass is greener talk.

Who is to say the orthopedics group will be happy to let you do half as much when they are paying all the expenses to keep you in their group?

And how is EM not flexible? You mention that Ortho can do sports clinic? Well, EM can do a sports fellowship and do sports clinic. If you want to scale back and do very little, you can switch to urgent care. Bored with that? Go back. Then you can work half the shifts - you can work in academics. There are fellowhsips in ultrasound, critical care, EMS, tox, etc. There are many ways to limit your clinic hours if you don't want to be crazy and work 40 hrs a week. I find it very hard to believe there is something as flexible as EM. Now, you may argue you can't earn the money you want when you do these changes - but that's a money issue and not a specialty issue.

If this is about earning more money then I agree, ortho is much much better. Save your money and pay off your debt. If you have zero expenses then even 100k is a lot.

Whatever, either I'm not writing it well or your not reading it well. EM is very flexible in hours, yes you can do fellowships (not necessarily an easy way to scale back) if you want to change your daily practice (so can FM, IM, Peds, etc). Yes you can do the same things FMs can do (UC, sports med, etc). But no, without a fellowship or a change in practice you can not pick some part of your practice and only do that in EM. It is not possible to only see the abdominal pains or whatever floats your boat. In Ortho you sure as hell can only see outpatient cases after 5-10 years and your partners will be happy as hell to have you work in clinic all week while they generate money in the OR.

Maybe flexible isn't the right word, maybe it is that ortho has a "transition" in practice that is common for almost all orthos to work through. There is no transition of practice that is common to all of us in EM. The work of an unfellowshipped EM doc is essentially the same at 60 as it is at 35. Yes, you can retrain or work less or re-invent yourself as an UC doc but these options do require a little bit of forging your own path.

I'm not talking about not being burnt out. Read any of my posts, they all talk about being debt free and working enough to be competent and happy but not a shift more. I'm just trying to help the OP see some of the differences.

I don't think anyone on here has complained about EM, not sure why this is turning into a rah-rah EM thread. I can't find a single post on here that says "EM is bad" or "I'm burnt out." I know thats the common thread on this forum but I don't think its really the case here. The guy is trying to make a tough decision, I'm just trying to find the differences for him since he doesn't have the benefit of our experience.

 

[Robinson EM]

Whatever, either I'm not writing it well or your not reading it well. EM is very flexible in hours, yes you can do fellowships (not necessarily an easy way to scale back) if you want to change your daily practice (so can FM, IM, Peds, etc). Yes you can do the same things FMs can do (UC, sports med, etc). But no, without a fellowship or a change in practice you can not pick some part of your practice and only do that in EM. It is not possible to only see the abdominal pains or whatever floats your boat. In Ortho you sure as hell can only see outpatient cases after 5-10 years and your partners will be happy as hell to have you work in clinic all week while they generate money in the OR.

Maybe flexible isn't the right word, maybe it is that ortho has a "transition" in practice that is common for almost all orthos to work through. There is no transition of practice that is common to all of us in EM. The work of an unfellowshipped EM doc is essentially the same at 60 as it is at 35. Yes, you can retrain or work less or re-invent yourself as an UC doc but these options do require a little bit of forging your own path.

I'm not talking about not being burnt out. Read any of my posts, they all talk about being debt free and working enough to be competent and happy but not a shift more. I'm just trying to help the OP see some of the differences.

I don't think anyone on here has complained about EM, not sure why this is turning into a rah-rah EM thread. I can't find a single post on here that says "EM is bad" or "I'm burnt out." I know thats the common thread on this forum but I don't think its really the case here. The guy is trying to make a tough decision, I'm just trying to find the differences for him since he doesn't have the benefit of our experience.

Oh, I guess I read the "don't do it" posts and the "EM isn't as flexible". "EM will be painful for life", etc. These people chose the wrong career or haven't had the ability to find a good working environment/situation. So I'm defensive of EM so we continue to have great people coming into this field. I want to work with great people.

As I explained and WhiteCoat did, this career is what you make it. It's incredibly false that you can't transition or work less in this field when you see fit. There are tons of physicians doing it. I know docs working 8 shifts a month and spending 2 weeks a month on a beach property in Mexico.

You can say it's forging your own path - but stop and think how easy we have it. "Forging your own path" in this case means looking for a job instead of having people constantly trying to hire you. This is a luxury 95% of employees don't have. So I don't think searching for a job is that bad.

1st world problems.

I'm sure we can argue the finer points of, "oh, ortho is better because of ________". But this isn't about money - it's about doing what you enjoy and then having PLENTY of options on how to design your career. That's available in EM. Ortho is great too. Do what you enjoy the most.

 

[WilcoWorld]

...formatting problems...

 

[WilcoWorld]

There are a lot of good points made above...by both "sides". However, I'd like to refocus the conversation by quoting the original post, "I'm a PGY-2...suddenly had an epiphany while on call last week that I should maybe consider a switch."

Is there anyone on this forum who completed a PGY-2 year without considering quitting during a long call?

If you have found that you truly hate Orthopedics, maybe you should switch to EM. But it's more likely that you hate residency, and that's something that switching to EM aint gonna fix.

 

[Brigade4Radiant]

Whatever, either I'm not writing it well or your not reading it well. EM is very flexible in hours, yes you can do fellowships (not necessarily an easy way to scale back) if you want to change your daily practice (so can FM, IM, Peds, etc). Yes you can do the same things FMs can do (UC, sports med, etc). But no, without a fellowship or a change in practice you can not pick some part of your practice and only do that in EM. It is not possible to only see the abdominal pains or whatever floats your boat. In Ortho you sure as hell can only see outpatient cases after 5-10 years and your partners will be happy as hell to have you work in clinic all week while they generate money in the OR.

Maybe flexible isn't the right word, maybe it is that ortho has a "transition" in practice that is common for almost all orthos to work through. There is no transition of practice that is common to all of us in EM. The work of an unfellowshipped EM doc is essentially the same at 60 as it is at 35. Yes, you can retrain or work less or re-invent yourself as an UC doc but these options do require a little bit of forging your own path.

I'm not talking about not being burnt out. Read any of my posts, they all talk about being debt free and working enough to be competent and happy but not a shift more. I'm just trying to help the OP see some of the differences.

I don't think anyone on here has complained about EM, not sure why this is turning into a rah-rah EM thread. I can't find a single post on here that says "EM is bad" or "I'm burnt out." I know thats the common thread on this forum but I don't think its really the case here. The guy is trying to make a tough decision, I'm just trying to find the differences for him since he doesn't have the benefit of our experience.

You also have do do a sports fellowship in ortho if you want to make any money. Orthopedic surgery is pretty intense and isn't easy it gets tiring as you age. You can absolutely scale back in EM by working in areas of the department that don't see higher acuity patients. It is also hard to just scale back if you live in a competitive area and have other surgeons competing for your patient base

 

[Birdstrike]

It really comes down to what's right for an individual person. Which speciality is "better," is different for different people. I hope you get it sorted out, Needachange.

 

[Birdstrike]

Contrary to what others have posted, ortho is generally not five years of residency followed by banker's hours. It takes another 5-10 years post-residency of being the do-anything, always on-call guy to affect existing referral patterns and actually set your practice up properly.

There's no doubt Ortho's work hard, but from what I've seen its not nearly as pathological as some of the surgical specialties. Most of the ones I know socially are pretty happy and seem fairly balanced socially. I haven't sensed too much, if any, burnout.

 

[Birdstrike]

Alright. Y'all brought the "B" word out from under the rug, not me. Now I've got to address it.

I think the people burned out haven't managed their money well.

Certainly for some, but not all.

Burnout rankings:

EM- #1

Ortho- #12

Slide two:

http://www.medscape.com/features/slideshow/lifestyle/2013/emergency-medicine#2


Somehow this reality persists for a significant number of EPs, despite a certain segment of the specialty campaigning that it doesn't exist, is a myth, or is the fault of the physicians in question for what they feel. I think some of this distortion is due to recruiting. Some is due to a small percentage of EPs being in 90th+ percentile jobs and not understanding the plight of the middle pack of EPs. Some of it self denial. I believe there's some truth to this data. I know I've felt it personally. Just know it's an inherent risk of the work of a physician, and particularly so for EM, so you can manage that risk properly.

 

[emergentmd]

I always hear about how EM has such a high burn out rate. I just don't see it. I am in a group of 100 docs and sure there are some unhappy docs but most of the time its due to home life rather than work life.

I guess working an EM schedule leads to a dysfunctional family life and thus burn out. I guess if your wife is always complaining that she is home in the evenings while you are working or that she has to sleep in bed at night by herself then that leads to stress at work.

But I just don't see EM medicine as intense as any other field. I guess I have the personality for EM. I would be burned out doing Gas watching the dam machine all day in a cold bright room. Forget about it.

Anyone who thinks EM is not flexible then they need to look around. If you want to make the big bucks then you have to work in the ED. If you want to make 400K a yr, then you have to work in the ED.

But you can work Urgent care, FSED, wound clinic, occ health clinics, etc... Some of my partners do this.

I just worked a FSED shift and in 12 hrs saw 7 pts with quick care complaints. I would get burned out from sheer boredom.

But to say that EM is not flexible is insane. You can decrease/increase shift as you like. You can work in high stress vs low stress environment.

i see other docs stressing out from taking 2 wks off b/c of their patients. I can take 2 wks off any time I want.

 

[da8s0859q]

Just for perspective, OP, I'm an EM PGY-2, and as much as I tend to align myself with the more encouraging posts above, I still have my "days." Feel like all residents everywhere, particularly as interns and mid-residency, have similar feelings from time to time.

 

[Birdstrike]

I always hear about how EM has such a high burn out rate. I just don't see it.

You just don't "see it." Really? Not ever, or even a little bit? I'm confused. Why, again, did you post what's below?

...Please help me with my dilemma. I am 36 years old, finished an ED residency 7 years ago and ...I am getting somewhat burned out and am looking into a radiology residency... I think I can work longer and be happier as a radiologist.
Please help me...

...all the info I have posted are not exaggerated...the point is I am getting somewhat burned out and don't want to work more...

 

[Birdstrike]

Don't do it. Don't.

With all due respect that was a little "depressing," if you know what I mean.

i am yet again depressed by Birdstrike.

 

[womp]

You just don't "see it." Really? Not ever, or even a little bit? I'm confused. Why, again, did you post what's below?

Please help me with my dilemma. I am 36 years old, finished an ED residency 7 years ago and ...I am getting somewhat burned out and am looking into a radiology residency... I think I can work longer and be happier as a radiologist.
Please help me... ...all the info I have posted are not exaggerated...the point is I am getting somewhat burned out and don't want to work more...

Checkmate.

 

[NinerNiner999]

Can you be sure that orthopedics won't be mostly employed by hospital groups? Many general surgeons are being pushed in this directions already. While you have a good pulse on EM, I find it hard to believe that you can picture where orthopedics will be in a decade. I don't mean to say that they won't have more bargaining power than EM, just that it's a difficult prediction to make. Most doctors are losing out to corporations now - I don't think surgery will be different.

Last time I looked, there were far more residency slots for General Surgery than there were for Ortho. General Surgeons aren't being gobbled up by hospitals by choice - there are too many of them. Supply and Demand...

 

[Birdstrike]

70% of EPs report feelings of burnout in some surveys (see below). Yet some of the other thirty percent frequently feel the need to tell the 70% they either don't exist, are themselves flawed, are imagining things or are even in denial/forgetting they've had such feelings.

Not my data:

Figure 1

http://amaprod.silverchaircdn.com/data/Journals/INTEMED/25300/ioi120042f1.png

http://archinte.jamanetwork.com/Mobile/article.aspx?articleid=1351351

Denial prevents solutions. Enabling is easier than facing the problem. Change takes courage.

 

[Robinson EM]

You just don't "see it." Really? Not ever, or even a little bit? I'm confused. Why, again, did you post what's below?

Haha. You love that post. I feel like you wrote that down put it under your pillow to sleep with.

He explained that he was young and newly married and stressed out. He now earns more, doesn't work any nights and is more mature/grateful. We've all fallen into the grass is greener idea - that's why it's a common saying. Many have even found a simple change in hours or work environment leads to a drastically different attitude (let alone being more mature).


As I said before, you were bullish on EM as a career but now aren't. It's no surprise that some could be bearish and then be up on it. There are plenty of other posters who aren't burning out and love their job.

Be flexible, manage your money, and find your ideal working environment. It's a reality for many. It's good you continue to promote the negatives though, as that will be the case for some minority.

 

[Robinson EM]

70% of EPs report feelings of burnout in some surveys (see below). Yet some of the other thirty percent frequently feel the need to tell the 70% they either don't exist, are themselves flawed, are imagining things or are even in denial/forgetting they've had such feelings.

Not my data:

Figure 1

http://amaprod.silverchaircdn.com/data/Journals/INTEMED/25300/ioi120042f1.png

http://archinte.jamanetwork.com/Mobile/article.aspx?articleid=1351351

Denial prevents solutions. Enabling is easier than facing the problem. Change takes courage.

Yes. And like 40-50% report burn out in all specialties. So yes, EM has a 15% or so higher burnout rate than other specialties. If you look at satisfaction, you'll find EM above the mean also. It's in the top 70% as far as work life balance.

Magical Ortho, ENT, FM, neuro and general medicine report ABOVE or near 50% burnout... so yes, EM is slightly above that. You were probably in the 15% that wouldn't burnout in other fields but did in EM. On the other hand, a majority of those 70% who burn out - will likely be in the 50% of orthopods burning out.

It's a medicine thing, not an EM thing (at least for 80% of those burning out).

 

[Venko]

To the OP, if you know in your heart of hearts that ortho is not a good fit for you, then you should first have a discussion with the EM residency director where you are to get private guidance on the situation.

I switched residencies after the first year but just like you, everyone told me it was because of burn out or the trials of residency etc. In my heart I knew I wasn't too tired but rather I was too bored and uninspired. Psychiatry, my first residency, was wearing on my soul similarly to what you described.

I will say the switch was amazing for the first eight years afterwards but I'm starting to feel some aches in EM too. I am starting to find the variety less surprising and now even the highly variable encounters seem old and boring. I have one kid and a second coming and the only thing exciting is the stuff at home. I hate leaving the house on thanksgiving and Christmas and New Years and the Fourth of July etx...it hurts deeply and my kids are still too young to say things that will make me feel even more guilty about it. Anyway, I say these things to point out that whatever specialty you choose will become old one day and as much as you may enjoy it, I find it hard to imagine enjoying it more than being home with your family. It will hurt (at least a little) no matter what.

The finances thing is important no matter what you do. I am fortunate that in about three years we will be completely debt free and everything from then on can have less of a financial motivation...but I still feel some fatigue with Em...so it's not all about finances.

There is no perfect specialty, and what is exciting and right as a med student is diff rent than as a resident and different than as an attending and different as a mid career attending and likely different as an end of career attending.

For what it's worth, I am an ultrasound person and work ten night shifts per month as my clinical penance. There is always work outside of that that chews up more of your time though in academics. I don't know what community Em is like and maybe someday I will switch because I may be more aligned with it...i do like the flexibility of my specialty as I can imagine so many different scenarios for change if I ever feel strongly enough .

Switching was one of the toughest things I ever did, but it has been a good decision for me. Just please don't expect everything to be perfect and prepare for when Em gets old because for me it has to a small degree.

Best of luck,
Venko

 

[Birdstrike]

Yes. And like 40-50% report burn out in all specialties. So yes, EM has a 15% or so higher burnout rate than other specialties. If you look at satisfaction, you'll find EM above the mean also. It's in the top 70% as far as work life balance.

Magical Ortho, ENT, FM, neuro and general medicine report ABOVE or near 50% burnout... so yes, EM is slightly above that. You were probably in the 15% that wouldn't burnout in other fields but did in EM. On the other hand, a majority of those 70% who burn out - will likely be in the 50% of orthopods burning out.

It's a medicine thing, not an EM thing (at least for 80% of those burning out).

I just think it's better to acknowledge burnout is a risk and needs to be managed, rather than incredulously pretend it's not relevant. But you'll figure it out on your own, I suppose. I hope feelings of burnout turn out to be as easily dismissed, dealt with or forgotten as you seem to think it should be for those of us who have had such experiences. I wish you the best of luck in medical school and beyond.

 

[Robinson EM]

I just think it's better to acknowledge burnout is a risk and needs to be managed, rather than incredulously pretend it's not relevant. But you'll figure it out on your own, I suppose. I hope feelings of burnout turn out to be as easily dismissed, dealt with or forgotten as you seem to think it should be for those of us who have had such experiences. I wish you the best of luck in medical school and beyond.

I can summarize my points quickly.

- Burnout exists - but it's in all fields (although EM is the worst)
- There is a lot of flexibility (even you found a way to do something else)

I don't discount your experience or the 60-70% of others who are burned out. I just point out that the burn out is a medicine wide endeavor.

I do think you do a service by shining light on the negative sides of the specialty. Although sometimes you appear overly excited to find holes in people's armor (like that post by emergent, as you've shared it multiple times now).

I think you've given wise advice, which is to have options available for 10 years in. It could be one of the 5+ fellowships, academics, urgent care, an entirely different career (for example, you seem to enjoy writing. I'm confident that if you had practiced writing since day one of residency you could easily have created a second income as a writer by now. Whitecoat investor has a side business - anyone can use spare time to build a marketable skill). I plan on taking your advice and to continue to use my free time to pursue other possible endeavors.

I can tell that the nights and holidays thing sucks for families and I don't discredit it, pretend it's not relevant, or easily dismissed. I'm just trying to stay positive and think of all the good things we have instead of all the limitations. In that way, you can continue to proclaim your warnings and I can continue to spread encouragement. I don't think either of us are right or wrong - just different.

I'm on the offensive team and you're on the defensive team.

 

[Birdstrike]

I'm just trying to stay positive and think of all the good things we have instead of all the limitations. In that way, you can continue to proclaim your warnings and I can continue to spread encouragement. I don't think either of us are right or wrong - just different.

I'm on the offensive team and you're on the defensive team.

You're right. What you and I are doing on this forum, couldn't be more different. You're a medical student writing about how you hope the future will go for you. I'm writing about how things have gone for me. They're entirely different. I don't write from any agenda of "defense" or "pointing out negatives" as you say. If you have followed what I post over the years (and I have no idea if you have or not) you should be aware that I have many positive posts. Some are happy, inspiring, or funny. Others are dark, depressing or horrifying. It is this palate of colors that makes up what Emergency Medicine and being a doctor is to me, and no one else. You can continue to write posts about how it will, or as it should be, as you see it. I don't discount that either. It's equally as important, and the two are not at odds. I write what I do on this forum primarily for two reasons.

1- As silly as it sounds, I post here primarily as an art form. If an encounter, thought or subject inspires me, I post about it, primarily because doing so makes me feel better. I don't do it to publish, make money, or gain accolades, and I doubt I even could. Essentially no one knows who I am. When I write a post here, zero, and I mean zero people will pull me aside in my daily life to comment. No one knows who I am. I put some of them on DrWhiteCoat.com because White Coat said I could. From there, some are cut and pasted to KevinMD by Kevin Pho, without him even asking. They're offered to him, open source. For what it's worth, they're donated, just like everything else on here, from everyone else.

2- The second reason I post here, and it's secondarily to #1, is because if only one or two people read a post are touched or inspired, I feel I've helped someone. It has more in common with making a painting, writing a song, or a short story, than anything medical. To the extent it moves, touches or helps someone, is the extent to which something positive has been created. Even a dark or negative post can have a very positive effect, if someone who's been through something similar, identifies with what's written. I see this in the comments on the other blogs. Some people don't get it at all, though. They think it's weird and bizarre. If it doesn't get them an extra point on their exam or increase their chances of matching at their residency of choice, I and what I write, are worthless to them.

3- Truth. When I smell BS, I like to smoke it out with a searingly truthful post. I hate BS, and it's in over supply in this world and in the profession Medicine. It makes me vomit, and I feel the young people on here deserve to have it called out, no matter how ugly the truth and how seductive the lie or half-truths. If you don't look under the surface or pull back the curtain on things in this world, you're in for a much tougher ride, in my opinion.

Those are the things that motivate me to post here. There's no pre-fabricated agenda of positivity, negativity or anything else. I'm not pro- or anti- anything. Some like what I write, others hate it. I suspect most don't care.

If you're needing inspiration, you'll find it in a lot of what I write, but often it's buried in the mess that often is our crazy world and colored by what I've been through. Those who say I'm one sided and negative, don't get it and never will. They would be served best to put me on "block." I even start some posts off with "don't read this," for them.

There's more positivity and encouragement in these posts, than some will post in a lifetime on SDN or anywhere else, I think. You just have to choose to see it. All were first posted here:

http://drwhitecoat.com/blown-away/

http://drwhitecoat.com/what-i-can-tell-you-is-thanks/

http://drwhitecoat.com/an-amazing-little-girl/

http://www.epmonthly.com/whitecoat/2012/09/lighterman/

http://www.kevinmd.com/blog/2014/11/even-life-saved-er-physician-makes-difference.html

http://drwhitecoat.com/tony-the-doorman/

 

[Robinson EM]

We are different. But so are you and emergent, who likes to talk about the positives of his career 10 years in. And you and whitecoat investor are different, as he likes to focus on the positives.

I'm just more like them than you. So we are all different from you.

 

[two guys]

How about trying to help the OP or letting this thread die. Somehow you've had 9 posts on this thread without a single one devoted to actually directed toward the OP and all of them directed towards your agenda of "offense."

I guarantee the guy didn't start this thread to hear your opinion on burnout. I'm not trying to pick a fight but c'mon man - move on. You can start a rah-rah EM thread all on its own. I'll even post on it but I can't belive this thread has devolved into the exact same pro-EM vs EM-has cons thread.