4th year with late interest in Psych

[DOswag]

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So I'm a 4th yr med student here doing air force hpsp. I've been interested in EM as a career since I worked in an emergency department while in undergrad. I just found out last month I did not match EM in the military match(deferred transitional year), which was kinda expected given the spots-to-applicants ratio and me having no prior military experience to add points to my application. At first I was a little disappointed but recently I've been seeing this as an opportunity to explore other specialties since I was pretty dead set on EM from the beginning and didn't really consider much else except family med (pretty much because where I'm from a lot of ER docs are family med trained.)

Whilst going through 3rd year I pretty much hated everything except for EM, FM, and much to my surprise Psych! I actually loved my psych rotation but didn't really consider it as an option at the time because I had not even done an EM rotation in school and was still pretty set on it due to prior experience. But now here I am wondering if I was really that happy all those months at the beginning of 4th year on away rotations, working night shifts, weekends, holidays, working up another cp,sob,ap. I found myself dying a little inside when I would look up at the board and see another patient check in, and watching the clock waiting for my shift to end so I could go home and anxiously wait to do it all again. I've heard all this time that EM is a lifestyle specialty. The shift work is great, when you're off you're off, no call, no patient follow up, work half the month yada yada yada. I bought into it and kept waiting for it to hit me that this is the life for me. Well it never did and now I'm really questioning if that is what I want to go into at all.

I think this transitional year might be a blessing in disguise and possibly save me from a career of misery. Well now looking back I realize I really did enjoy my psych rotation. The hours were great, the stress level low, and I loved the amount of time I got to spend with my patients and really get to know them. Just wondering if this is senioritis/burned out med student talking, or am I really not cut out for EM, despite getting good evals and feedback from programs, and destined to go into psych. Anyone else have a similar situation, decide on psych late in their med school years, or just any advice? Thanks.

 

[Darkskies]

Hey,

I just thought I'd bump this thread since he hasn't received an answer yet especially since he created it because other people instructed him to do so instead of derailing the other thread.

 

[notdeadyet]

Whilst going through 3rd year I pretty much hated everything except for EM, FM, and much to my surprise Psych! I actually loved my psych rotation but didn't really consider it as an option at the time because I had not even done an EM rotation in school and was still pretty set on it due to prior experience. But now here I am wondering if I was really that happy all those months at the beginning of 4th year on away rotations, working night shifts, weekends, holidays, working up another cp,sob,ap. I found myself dying a little inside when I would look up at the board and see another patient check in, and watching the clock waiting for my shift to end so I could go home and anxiously wait to do it all again. I've heard all this time that EM is a lifestyle specialty. The shift work is great, when you're off you're off, no call, no patient follow up, work half the month yada yada yada. I bought into it and kept waiting for it to hit me that this is the life for me. Well it never did and now I'm really questioning if that is what I want to go into at all.

We have some similarities. I entered medical school thinking I wanted to be an EM doc as well, largely based on my experience as an EMT. Through med school, I was in the opposite boat in that I liked everything. But EM did not particularly rock. I didn't dread it like you seem to in the bolded parts above, but it didn't rock me.

What was helpful for me in the decision process is to divorce the type of medicine you want to practice from the type of doctor you want to be. In other words, a lot of folks like the idea of EM because they want to be That Guy/Gal that can handle anything that walks through the door. To be the person that is wanted on the desert island. All of these kind of fantasies.

The fact is that most of us AREN'T That Guy/Gal. And you learn that pretty quickly on a rotation like EM whether or not you're cut out for it. For me, as much as I wanted to be like that, the fact is I LIKED having more time with my patients. I LIKED kicking around a differential in my head a while before acting on it. I LIKED learning about their life outside the hospital.

It sounds like you've discovered EM isn't for you, even though you might be like me and want to be the person that EM IS for. I'd recommend now realizing that whatever specialty you go into, your other skills will atrophy, so don't worry about "losing" something but look at the portions of medicine you really want to keep. If it's the various facets of psychiatry (abstractions, thinking outside the box, reading, getting to know patients well, enjoying ambiguity, enjoying non-medical stuff's impact on health), it's a good fit. You will not be good at dealing with, say, rashes, but neither is a cardiologist.

I think this transitional year might be a blessing in disguise and possibly save me from a career of misery.

I agree. I'm not sure what branch you are, but if you have any choice, try getting a psych elective worked in there if you can. Going in with both eyes open, you'll likely find whether you have a passion for it. Look to psychiatrists you'll be working with and check their thoughts on it. You have a boon in that since you're military matching, you'll likely go straight through, so you won't have an interruption in training.

Post back if you have other questions... Many people come to psychiatry late. You're far from alone.

 

[Leo Aquarius]

Dear OP,

I had the EM bug big time in med school and was convinced that's what I wanted. So I shadowed doctors in the ER and did my rotation in EM and learned 4 valuable things: the great EM lifestyle everyone speaks of is not so great, the work can be very draining and stressful (more days than not), there's no good exit strategy, and you have to have a certain personality because people get very testy, rude, and unfriendly when they are in the ER. The following are strictly my opinions and are the reasons I stepped away from EM. Let's address each one.

Inhumane Hours:
Human beings aren't designed for the hours you work in EM. In EM you work on rotating shifts that have crappy hours either for starting or ending times. One EM doctor I know is on rotating sleeping pills. This means a couple things. #1 You are always tired. Even on your day off you usually sleep for a part of it or are a zombie for the other part. The EM clerkship director warned me that a life in EM means a life of always being tired. #2 You often come home when your wife and children are sleeping or at work/school. You see you family even LESS than if you had a steady 8 to 5 job. I'm a family man, and miss seeing my family when two days go by and I haven't been around. #3 You will have shift work sleep disorder which puts people at high risk for diabetes and who knows God what else. More memory loss in older age? Who knows. So lets call a spade a spade here. EM is not family friendly or a lifestyle specialty. What you say? You can walk away from your work after a shift? Well you can do that too in psychiatry depending on your job.

Exhausting Work and Litiginous Mistakes:
The work is, by far, draining. And when you mess up, people like to sue you. EM has a higher malpractice rate than average. Try running around for 12 hours with no potty break or food break, and being in charge of juggling one acute patient after the next because they don't stop coming in and there's a huge line out in the waiting room. I thought this would be exciting until I did it. No, it was tiring, and it pissed me off when I had to do it at 3am. It's extremely tiring and draining. Here's the rub - the demands of the job pull you in the direction of making more mistakes (ie. fatigue, stress, fast decisions), not fewer mistakes. That frankly chaps my hide. I hate putting myself in a situation that's set up from the get go to work against me. Why do that to yourself?

Demanding Rude Customers:
I say customers because more and more these days EM is measuring your success based on patient satisfaction. And guess where you find some of the most unhappy patients in the ENTIRE hospital? Answer #1 the morgue, yes. Answer #2, the ER. Guess who else are your customers? Accepting doctors in the hospital because they too can evaluate you and eventually receive your admissions. Here's the other rub - in academia and non-private hospitals, attendings hate the ER because they don't want another admission. One hospitalist I know has a dart board in his room with the letters ER in the middle and he likes throwing darts at it. In a private hospital it's admittedly different. Attendings welcome admissions so they can capture more patients for their practices. More money for them. But going back, people are pissy in the ER (and understandably so). I wanted the opposite - long term care to see how a patient improves, and a positive fostering interaction.

Difficult Exit Strategy:
Can a 70 year old practice psychiatry? Sure! Many do! Can a 70 year old be at the top of his or her game in the ER? Less sure about that one. You need a good exit strategy at an age prior to burning out. It's not easy to step out of the EM role into something else as interesting. Administration? Urgent care? Nothing quite compares. Versus psychiatry. You can keep practicing, and with age you get better! Like fine wine! Imagine that. How wonderful.

In the end I really saw how EM doctors are candles burning at both ends. On the patient end, more and more people need to see you and demand this and that in a time crunch, and on the other end doctors on the wards are pushing back not wanting to take your admissions. You get squeezed big time. You tell me if you want to get squeezed for 20 or 30 years.

Psychiatry made a lot of sense when I found myself caring all about the background and dynamics leading up to a patient's presentation. My personality was also well-suited for psychiatry because I bring a very calming element to people with a tendency to talk with them for a long time to understand and listen on a deeper level. That doesn't fly so high in a hackishly busy ER. That's for jumping jack flash types. God bless em, it's a tough job.

 

[DOswag]

Thanks for the responses guys. Notdeadyet, you are exactly right. With my prior experience in the ER I wanted to be that guy that EM is for. Unfortunately I've slowly realized I am not that guy. And Leo, you pretty much hit the nail on the head with all the things that worry me about EM. Especially the hours (which I finally figured out weren't as conducive to having a wife and recently added 2nd kid) and the lack of an exit strategy after the inevitable burnout I'll face after half the career I could have in a field such as psychiatry.

Notdeadyet I'm in the Air Force and doing a transitional intern year next year. I'm going to try to squeeze in a psych elective here at the end of 4th year and try to do one in intern year as well. Considering whether to reapply in mil match next year or bide my time as a flight surgeon and come back to train civilian.

 

[DOswag]

The TY is civilian as I will be deferred from the AF for a year.

 

[IamPsychiatrist]

Dear OP,

I had the EM bug big time in med school and was convinced that's what I wanted. So I shadowed doctors in the ER and did my rotation in EM and learned 4 valuable things: the great EM lifestyle everyone speaks of is not so great, the work can be very draining and stressful (more days than not), there's no good exit strategy, and you have to have a certain personality because people get very testy, rude, and unfriendly when they are in the ER. The following are strictly my opinions and are the reasons I stepped away from EM. Let's address each one.

Inhumane Hours:
Human beings aren't designed for the hours you work in EM. In EM you work on rotating shifts that have crappy hours either for starting or ending times. One EM doctor I know is on rotating sleeping pills. This means a couple things. #1 You are always tired. Even on your day off you usually sleep for a part of it or are a zombie for the other part. The EM clerkship director warned me that a life in EM means a life of always being tired. #2 You often come home when your wife and children are sleeping or at work/school. You see you family even LESS than if you had a steady 8 to 5 job. I'm a family man, and miss seeing my family when two days go by and I haven't been around. #3 You will have shift work sleep disorder which puts people at high risk for diabetes and who knows God what else. More memory loss in older age? Who knows. So lets call a spade a spade here. EM is not family friendly or a lifestyle specialty. What you say? You can walk away from your work after a shift? Well you can do that too in psychiatry depending on your job.

Exhausting Work and Litiginous Mistakes:
The work is, by far, draining. And when you mess up, people like to sue you. EM has a higher malpractice rate than average. Try running around for 12 hours with no potty break or food break, and being in charge of juggling one acute patient after the next because they don't stop coming in and there's a huge line out in the waiting room. I thought this would be exciting until I did it. No, it was tiring, and it pissed me off when I had to do it at 3am. It's extremely tiring and draining. Here's the rub - the demands of the job pull you in the direction of making more mistakes (ie. fatigue, stress, fast decisions), not fewer mistakes. That frankly chaps my hide. I hate putting myself in a situation that's set up from the get go to work against me. Why do that to yourself?

Demanding Rude Customers:
I say customers because more and more these days EM is measuring your success based on patient satisfaction. And guess where you find some of the most unhappy patients in the ENTIRE hospital? Answer #1 the morgue, yes. Answer #2, the ER. Guess who else are your customers? Accepting doctors in the hospital because they too can evaluate you and eventually receive your admissions. Here's the other rub - in academia and non-private hospitals, attendings hate the ER because they don't want another admission. One hospitalist I know has a dart board in his room with the letters ER in the middle and he likes throwing darts at it. In a private hospital it's admittedly different. Attendings welcome admissions so they can capture more patients for their practices. More money for them. But going back, people are pissy in the ER (and understandably so). I wanted the opposite - long term care to see how a patient improves, and a positive fostering interaction.

Difficult Exit Strategy:
Can a 70 year old practice psychiatry? Sure! Many do! Can a 70 year old be at the top of his or her game in the ER? Less sure about that one. You need a good exit strategy at an age prior to burning out. It's not easy to step out of the EM role into something else as interesting. Administration? Urgent care? Nothing quite compares. Versus psychiatry. You can keep practicing, and with age you get better! Like fine wine! Imagine that. How wonderful.

In the end I really saw how EM doctors are candles burning at both ends. On the patient end, more and more people need to see you and demand this and that in a time crunch, and on the other end doctors on the wards are pushing back not wanting to take your admissions. You get squeezed big time. You tell me if you want to get squeezed for 20 or 30 years.

Psychiatry made a lot of sense when I found myself caring all about the background and dynamics leading up to a patient's presentation. My personality was also well-suited for psychiatry because I bring a very calming element to people with a tendency to talk with them for a long time to understand and listen on a deeper level. That doesn't fly so high in a hackishly busy ER. That's for jumping jack flash types. God bless em, it's a tough job.

Holy crap. Amazing how accurate and spot on this is.

All the bolded points are HUGE. I thought about EM too, but after hearing from enough attendings - I saw the above points were highly prevalent (i.e. norm for the majority)