Anesthesiology vs Emergency Medicine

[otherstuff12321]

3rd-year med student here stuck in the middle.

Should I go for anesthesia, do the 4-year residency, and have a somewhat stable, well-paying, and happy albeit possibly repetitive and slow job (relatively speaking)?

Or should I go into emergency, do the 3-year residency, see all the crazy, ****ed-up **** that society has to offer (which draws me in for some reason) and feel like a doctor but also burn out by the time I'm 40 and call it quits?

Also, EM makes more $$$ per hour, and rural shops especially make bank. But the hours are more intense, and I don't necessarily like talking to patients to begin with.

Anesthesiology is pretty bad ass too, but don't you lose your diagnosing skills and knowledge of general medicine with something so specific?

Do you ever with you did anesthesiology instead?

Thought I was set on anesthesia, but now I'm worried I'll regret not going into EM. My GF is an ED nurse and they never have a dull moment. The environment, team work, pathologies and stories are best in the ED. Makes me jelly.

My step score is 240-250ish and I honored pretty much all of third year.

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[Mr. Vandemar]

I very much regret not doing anesthesiology. Or something else. Grass is always greener or whatever, but as someone that was first an EMT and thought for years that EM was the sexiest **** in medicine etc etc I wish I could go back and kick myself in the nads. Do anesthesia.

 

[turkeyjerky]

You would be insane to go into EM.

Like objectively, certifiably insane. If you were rotating with me, I would have you registered as a patient and put on an emergency hold.

 

[Tenk]

Pre Covid I could see the merits of both and if you asked me I would have picked EM again but could have seen myself happy in anesthesia. Now, if I could go back I’d probably pick anesthesia or ortho. Covid has made me basically hate at least half of humanity and also made me realize the entire human race is doomed.

 

[CoolDoc1729]

3rd-year med student here stuck in the middle.

Should I go for anesthesia, do the 4-year residency, and have a somewhat stable, well-paying, and happy albeit possibly repetitive and slow job (relatively speaking)?

Or should I go into emergency, do the 3-year residency, see all the crazy, ****ed-up **** that society has to offer (which draws me in for some reason) and feel like a doctor but also burn out by the time I'm 40 and call it quits?

Also, EM makes more $$$ per hour, and rural shops especially make bank. But the hours are more intense, and I don't necessarily like talking to patients to begin with.

Anesthesiology is pretty bad ass too, but don't you lose your diagnosing skills and knowledge of general medicine with something so specific?

Do you ever with you did anesthesiology instead?

Thought I was set on anesthesia, but now I'm worried I'll regret not going into EM. My GF is an ED nurse and they never have a dull moment. The environment, team work, pathologies and stories are best in the ED. Makes me jelly.

My step score is 240-250ish and I honored pretty much all of third year.

EPs average I think around 30-35 hours/week. Anesthesia works more hours in general. We both have the “when you’re off you’re off”, which is nice but also means we lack ownership of our patients.
That said I enjoy my job very much. I work exclusively nights and mostly weekends , which makes it easier to attend kids’ activities and work around husband’s schedule. I enjoy the camaraderie of the ER and the occasional actual save (subtle stemi, getting a flash pulmonary edema off the edge, and having an abdominal disaster in the OR before telerad even calls me are my faves).
The job market problem is real. It is not because of covid and it’s not going to get better. The contract groups are creating extra residency programs , from this they get both cheap labor (residents) and oversupply of attending EPs. Meanwhile midlevels continue to get more autonomy and EPs are being nearly written out of the script at many places.
It would not be rational to pick EM right now, truly, coming from someone who a) has never needed or wanted “doctor lifestyle” and b) enjoys the job.. I would project our income will decline by 1/3 by the time you would finish residency , which will be a cut by half in buying power due to inflation .. and then unless someone does something about t the oversupply of residents it will continue to worsen. Yikes.

 

[RustedFox]

Pre Covid I could see the merits of both and if you asked me I would have picked EM again but could have seen myself happy in anesthesia. Now, if I could go back I’d probably pick anesthesia or ortho. Covid has made me basically hate at least half of humanity and also made me realize the entire human race is doomed.

I didn't need Covid to achieve this.

 

[PianoMedic]

Some good replies in here to your question. I was in your shoes a few years ago, now a first year EM attending. I was an EMT then paramedic, but shadowed extensively and was actually planning anesthesia/critical care fellowship (I think that is usually 5 years). Here is where the irony is: I didn’t like the “team care model” of anesthesia. I wanted to be sitting my own cases. Anesthesia has significant midlevel creep and has had it longer than EM. As an EM attending, I have FAR less control over my midlevels than what you have in anesthesia. In the anesthesia world, you have the time to go see each patient and do an eval on them, create a plan with the CRNA/AA if the patient has other pathology you’re worried about, and you know which midlevels you have to watch more closely. Some just don’t know when to ask for help and that can be of concern, but I’d argue of more concern in EM where they may have multiple patients at once and may not realize what they don’t know. In anesthesia, they only have one patient at the time and most anesthesiologists are capped at 4 rooms to supervise.

I also really liked the diagnosing aspect of EM, and the other procedures that anesthesia doesn’t do: reductions, lac repairs, chest tubes (usually surgery does this not anesthesia). I also despised epidurals which is a pretty big part of their practice. I can give it the ole 2 poke college try on a 400-500 lb patient and then send them to IR if they need the LP from the ED. After being an attending and having to run a department where you don’t have residents at your beck and call, procedures aren’t always a lot of fun. They start getting a bit tedious and in the way of moving the department. I will put in fems and subclavians preferentially without ultrasound as it is WAY faster for me.

Diagnosing things starts getting old after awhile. I’m still new to this so I think probably more than most of my partners but my workups are pretty formulaic. I can use the ultrasound if absolutely needed but the tube of truth is used in any elderly belly pain and on far more traumas than I thought I would. Trying to argue with people about why a lab test or rad study isn’t technically indicated is very tiring after a few months, let alone years. I won’t scan kids unless I’m truly concerned or unless they fall out of PECARN for some reason.

Medicolegal liability is one area I thought I’d be frustrated in anesthesia. As a paramedic student, I had one patients lip touch the laryngoscope blade. It peeled off the top layer of skin. Literally the lip just touched the blade, that was all it took. Doc freaked of course, and I learned about their liability: primarily bunged lips and chipped/breaking a tooth. There is the occasional patient is going to die during routine surgery liability or when I’ve called them for a terrible airway that I could in theory do but safest place for the patient would be the OR. But they have some control over the vast majority of that liability and know when/where it is coming from. As an EM doc, I have no clue where my liability will come from. I’m going to get sued at some point, we all will. I just don’t know if it’ll be someone I discharged or admitted that the admitting team messed up on, or a procedure gone wrong, or really anything.

The ER is chaos in so many ways, the OR is much more controlled. One bright side of EM is that while hours might have been cut at the beginning of the pandemic, most docs kept the job but may have been underemployed for a time. Pay rates also went down for EM. But anesthesia had total work stoppage when elective cases were canceled. So their income is dependent on that side of things. That said, that’s an easy risk to mitigate by living within your means, having an emergency fund, and saving well early in your career.

If I could go back, would I pick EM again? If I could be with this same group again, yes. We are at risk of having pay cuts like elsewhere due to reduced insurance reimbursement with the balance billing changes, but midlevel encroachment is less likely, as we employ our midlevels directly. There is an oversupply in our area already and we’re full on all of our midlevel shifts right now. Also not a desirable area for most people to live. I’m going to save as much as I can and try to have an exit plan for 20 years down the line guaranteed, and much shorter if markets cooperate. I’m using a 5% nominal rate of return to plan which is almost excessively conservative but then I’ll be sure I make it to my goals. If I wasn’t guaranteed to be with this group, definitely wouldn’t do EM. Would have taken the 4 years instead of 3 and worked more with some call, but I would have had a routine schedule and flexibility still and been making similar money overall. May not have done critical care, but would have definitely gone anesthesia instead. I debated it partway through second year (just before covid) but we decided to stick it out. Can’t say as I’m glad I did for sure but it definitely was a decent decision from an opportunity cost standpoint.

Hope something in this behemoth post is helpful for you.

 

[Tenk]

I didn't need Covid to achieve this.

Sorrowful be the heart, penitent one.

 

[The Knife & Gun Club]

anesthesia and EM have a ton of similarities in terms of critical care education, lifestyle, shift work, not rounding, procedures, etc.

The big difference is as EM you’re a generalist. Anesthesia is a specialist.

 

[nimbus]

Never wished I did EM. I greatly respect EM, I think it’s one of the harder jobs in medicine. From the outside it looks like those folks suffer juggling chaos. I like one patient at a time and challenges like sudoku and wordle

 

[nimbus]

EPs average I think around 30-35 hours/week. Anesthesia works more hours in general. We both have the “when you’re off you’re off”,

But often in anesthesia “you’re basically off when you’re on”. For example after launching a 4-6 hr spine case in a healthy patient Agree the hours are longer in anesthesia but generally I think they’re less busy/less taxing.

 

[lucid_leprechaun]

These are very different fields in terms of day to day, as previous posters have alluded to. Procedures and potential for vasopressors, resuscitation are the overlap. Figure out whether you want to see whatever comes in or if you want to put people to sleep

 

[James McGill]

I have been an ER attending for about 7 years now and I also went back and forth between the two. In retrospect, I regret not doing anesthesia, but who knows how I would have liked it. That is one of the big problems I see with medicine in general. You have to pick a specialty after only very limited exposure and then stay in that career the rest of your life. You can always go back and do a second residency or do a fellowship, but these (fellowships) are also limited based on your residency choice. If you're a PA and want to switch fields, no problem. Same for nursing. I do wish there was a way or track to more easily switch specialties when you get burned out. Too many stay in a field they hate and are miserable based on a decision they made when they were in their early twenties and had a very different view of the world. I do enjoy the time off I have in EM, but that should not be a reason that you choose a specific field. Like has been said many times before, EM is NOT a lifestyle specialty.

 

[cyanide12345678]

3rd-year med student here stuck in the middle.

Should I go for anesthesia, do the 4-year residency, and have a somewhat stable, well-paying, and happy albeit possibly repetitive and slow job (relatively speaking)?

Or should I go into emergency, do the 3-year residency, see all the crazy, ****ed-up **** that society has to offer (which draws me in for some reason) and feel like a doctor but also burn out by the time I'm 40 and call it quits?

Also, EM makes more $$$ per hour, and rural shops especially make bank. But the hours are more intense, and I don't necessarily like talking to patients to begin with.

Anesthesiology is pretty bad ass too, but don't you lose your diagnosing skills and knowledge of general medicine with something so specific?

Do you ever with you did anesthesiology instead?

Thought I was set on anesthesia, but now I'm worried I'll regret not going into EM. My GF is an ED nurse and they never have a dull moment. The environment, team work, pathologies and stories are best in the ED. Makes me jelly.

My step score is 240-250ish and I honored pretty much all of third year.

EM does not pay more than anesthesia. Not in absolute terms, but probably not in hourly terms either.

Anesthesia attendings have a ridiculous 8 weeks of paid vacation. Do you know what happens if I take a week off? All my shifts still have to be done that month. Once you start putting a dollar value to paid time off then even the hourly rates become similar. Though, anesthesia has always historically paid more than EM. And an hour working in Anesthesia is very very different than an hour working in EM.

Also, not to mention that EM salaries have had a significant downward pressure. By the time you graduate from residency which is 5-6 years, you might not even have many job options left.

A lot EM attendings seem to regret EM and are trying to get out. If you're confused between EM and anesthesia, just pick anesthesia. It's the better and more stable life.

And I don't know about you, there's nothing so great about coming in and working your a** off like a crazy person and seeing patient after patient after patient and just getting exhausted because the flow of patients just doesn't stop.

 

[WilcoWorld]

I hope you've posted something similar in the Anesthesia thread to learn their view of the grass on the other side - might provide some perspective.

 

[narcusprince]

I am Anesthesia my wife is EM. Financially Anesthesia job market is red hot. Very different environment. EM you do not know what you will see day to day. Very unpredictable. Anesthesia very predictable. I will say as a Anesthesiologist you need to be good at predicting tendencies, timing, reproduce the same results everytime. EM is exciting, unpredictable, fitting patients into a spectrum of understanding and management, in addition you bring consultants business not the other way around. I could never do EM, my wife would not be happy in Anesthesia. All the best!

 

[Arch Guillotti]

Anesthesia attendings have a ridiculous 8 weeks of paid vacation.

Not necessarily. In private practice there is no free lunch.

 

[GassYous]

EM does not pay more than anesthesia. Not in absolute terms, but probably not in hourly terms either.

Anesthesia attendings have a ridiculous 8 weeks of paid vacation. Do you know what happens if I take a week off? All my shifts still have to be done that month. Once you start putting a dollar value to paid time off then even the hourly rates become similar. Though, anesthesia has always historically paid more than EM. And an hour working in Anesthesia is very very different than an hour working in EM.

Also, not to mention that EM salaries have had a significant downward pressure. By the time you graduate from residency which is 5-6 years, you might not even have many job options left.

A lot EM attendings seem to regret EM and are trying to get out. If you're confused between EM and anesthesia, just pick anesthesia. It's the better and more stable life.

And I don't know about you, there's nothing so great about coming in and working your a** off like a crazy person and seeing patient after patient after patient and just getting exhausted because the flow of patients just doesn't stop.

You get paid for doing a case. If you don't work, you don't get paid. "Paid vacation" is basically the employer taking some of the money from your billings and spreading out when you get the money.

 

[ERRES2288]

I’m an anesthesiologist, love my job. Have several friends who do ER. What they do sounds very challenging on a daily basis. I truly feel like ER is the hardest job/most taxing job in medicine. They tell me regularly they wish they did anesthesia.

 

[RuralEDDoc]

EM is getting worse because society is getting worse. Cracking social safety nets, political polarization, COVID, etc. I would absolutely not go into EM at this point. Imagine spending the rest of your career seeing people and bearing liability in a dysfunctional hospital with severe bed and nursing shortages. Some would say that’s always been EM but no, it hasn’t been. COVID broke this specialty and it won’t heal quickly.

 

[RuralEDDoc]

So to answer the question: anesthesia

 

[nimbus]

I hope you've posted something similar in the Anesthesia thread to learn their view of the grass on the other side - might provide some perspective.

It was but the thread was closed because it was duplicated here. So we all came here to comment

 

[WilcoWorld]

It was but the thread was closed because it was duplicated here. So we all came here to comment

Well thanks for stopping by!

 

[WilcoWorld]

FWIW: I am primary EM trained (do 50/50 EM/Palliative) and I still find work satisfying. My best doctor friend is in Anesthesia (of note, in Bay Area Cali) and he is miserable in his job. That's all to say - it's not JUST about your specialty.

 

[nimbus]

FWIW: I am primary EM trained (do 50/50 EM/Palliative) and I still find work satisfying. My best doctor friend is in Anesthesia (of note, in Bay Area Cali) and he is miserable in his job. That's all to say - it's not JUST about your specialty.

This. I love my job but a couple of my partners are miserable. We have exactly the same job.

 

[ScarfTheVerb]

I was in this exact same position and remember scouring similar SDN threads trying to answer this question. I ultimately chose anesthesia and have no regrets.

Pros:
-Lower stress overall (occasionally things get hairy but most of my time is doing elective cases in somewhat healthy patients)
-Higher pay. I’m pretty sure I make more annually and per hour than most ER docs. Our group’s ‘base package’ is about 35-40hrs/wk with an embarrassing amount of vacation, but you can always work more if you want to make more.
-Better hours. I take a lot of call but ~80% of my work hours are during weekdays when my spouse is at work and kids are at school.
-Still get to do cool stuff. Plenty of big cases, lines, trauma etc in my job but the excitement from those things fade pretty quick.
-There’s a pretty big filter between us and all the dregs of society that show up in the ER. Also I haven’t had to tell anyone they or their family member are dying/dead since residency. I think it’s a less depressing job overall.

Cons:
- With rare exceptions I never know when I’m coming home. I leave when the case is done, or maybe when the add-on after that is done.
- Sleep in a hospital call room 4ish nights a month
- Screaming pregnant women at 2AM
- I’ve lost some of my general medical knowledge, can’t suture for ****. My kid had a nursemaid elbow and I totally missed it—had to pay an ER doc to fix it on a Saturday.


If you think you could be happy in anesthesia I suggest it pretty strongly. You could always do CT or ICU if you find bread and butter anesthesia boring and want more skills/excitement.

Overall I think I have a better life doing anesthesia than I would have had doing EM, but I sure respect the skills and knowledge of ER docs in the trenches 24/7. Hopefully things improve in your job market—you guys deserve way better.

 

[Dral]

OP, all what I say doesn't necessarily apply to you, but I'll say that the notion of giving up gen medicine knowledge sounds tough. It gives one an internal struggle and forces you to ask the question "Why did I even do this to begin with if I'm going to give up the general base of all of it?"

For most people, it's good to struggle with that concept. However, in the end most of us get over those things without regrets when we're doing whatever we've chosen that doesn't involve them.

I don't do general medicine. I'm personally ok with not remembering how to diagnose Addison disease just as much as I'm personally ok (understatement) with forgetting how to formulate insulin protocols.
I don't ever use a stethoscope, otoscope, ophthalmoscope, or read EKGs.
I can count on one hand the number of times I've worn a white coat over the last few years

I'm perfectly happy with what I'm doing and if I could go back in time, I wouldn't change my path

It sounds like Anesthesiology is what you want to do more.

As a final note, I do on occasion have the urge to wear one of those head mirror things and regret not ever getting and wearing one. They're pretty bad-assed.

 

[GassYous]

FWIW: I am primary EM trained (do 50/50 EM/Palliative) and I still find work satisfying. My best doctor friend is in Anesthesia (of note, in Bay Area Cali) and he is miserable in his job. That's all to say - it's not JUST about your specialty.

Hm where in the bay area
I looked there and the house prices are just insane for the salary

 

[WilcoWorld]

Hm where in the bay area
I looked there and the house prices are just insane for the salary

Marin County is as specific as I'm willing to get.

But your post gets to a good point:
Income to debt ratio may be a bigger determinant of happiness than EM vs Anesthesia

 

[sylvanthus]

Could always hate your life and do a combined EM/anesthesia residency in 6 years. Work EM primarily for a few years, get your fix, transition to anesthesia as primary with supplemental shifts in EM.

Or just avoid the collosal cluster;$(& that is EM.

 

[Birdstrike]

Don't do any specialty where you have to work, nights, weekends, holidays or be on call, unless you absolutely must work in a hospital building, to live. I know you don't want to believe this advice, but ignore it and you'll hate yourself one day.

 

[GassYous]

Marin County is as specific as I'm willing to get.

But your post gets to a good point:
Income to debt ratio may be a bigger determinant of happiness than EM vs Anesthesia

That helps a lot. I was interested in one of the groups in marin because two of the people I know from my residency are there but then I looked at house prices on zillow and I was like oh hell naw

 

[otherstuff12321]

OP, all what I say doesn't necessarily apply to you, but I'll say that the notion of giving up gen medicine knowledge sounds tough. It gives one an internal struggle and forces you to ask the question "Why did I even do this to begin with if I'm going to give up the general base of all of it?"

For most people, it's good to struggle with that concept. However, in the end most of us get over those things without regrets when we're doing whatever we've chosen that doesn't involve them.

I don't do general medicine. I'm personally ok with not remembering how to diagnose Addison disease just as much as I'm personally ok (understatement) with forgetting how to formulate insulin protocols.
I don't ever use a stethoscope, otoscope, ophthalmoscope, or read EKGs.
I can count on one hand the number of times I've worn a white coat over the last few years

I'm perfectly happy with what I'm doing and if I could go back in time, I wouldn't change my path

It sounds like Anesthesiology is what you want to do more.

As a final note, I do on occasion have the urge to wear one of those head mirror things and regret not ever getting and wearing one. They're pretty bad-assed.

Thanks for the response. You got it spot on.

Even if you don't do much general medicine, do you find anesthesia intellectually stimulating and rewarding enough?

Do you feel like you work with a satisfying amount of day-to-day variety?

Any major downsides you've encountered?

 

[holdthemayo]

This. I love my job but a couple of my partners are miserable. We have exactly the same job.

I'm curious about what it is that they hate that you don't seem to mind

 

[HemorrhagicShock]

For your own sanity, for your career longevity, for your coronary arteries... for the love of God do Anesthesiology and stay far far far away from Emergency Medicine. The advice in this thread is absolute GOLD, not just for the OP, but for every single medical student who is considering the field and/or having a similar debate between the two specialties.

I cannot emphasize this enough. DO NOT DO EMERGENCY MEDICINE (Source: EM attending practicing in the PNW)

 

[Drwine]

MD/MBA ER physicians that went corporate ruined Emergency Medicine. I practiced Emergency Medicine for 2 years before I did an anesthesia residency and have no regrets. Maybe if the dual degree was a MD/MSW the specialty would have been better?

 

[nimbus]

I'm curious about what it is that they hate that you don't seem to mind

We are MD only, level 1 trauma center. So the schedule is variable and the end of workday can be unpredictable. There can be many addons or no addons in the late afternoon/evening. We have a general idea of when we’ll be done depending on our call position but things can change quickly. (Low call can be a 2-3 hr day or a day off, high call can be 15-16hrs) If you have primary childcare responsibilities or have rigid expectations of when you’ll go home, it can be very frustrating. If you don’t and have a flexible go with the flow attitude, it’s a great job with mostly awesome surgeons and staff and interesting cases. It’s a self selecting group so the vast majority are pretty happy and it’s not hard to change sites within my larger group of you don’t like it.

 

[e30ftw]

These doom and gloom EM threads always pop up on SDN but seem to be a bit more pointed lately.

I've been practicing under my own license for about 8 years now and I'd do EM again vs anesthesia. I entered med school planning to do anesthesia fwiw.

At this point I get very little emotional response from anything that happens in the ER so going to work is basically cracking jokes with coworkers and nurses for 10 hours, while occasionally having to do something moderately unpleasant but familiar, like a bad i/d or gross pelvic exam. I exist in this environment for about 120 hrs/mo and in exchange get $30k deposited in a bank account. That's basically it. No call, no meetings, no extras. The other 600 hours/month are totally free. That's full-time and I'm on track to FIRE 11 years after graduating residency despite repaying $300k/loans.

Our physician/app group is very stable but the worst part of the job is the constant nursing/tech turnover.. a never ending sequence watching hard-working impressionable young people become good enough at a very difficult job to provide necessary care for our community, then immediately bolting for something easier once they have the necessary experience. Can't blame them though.

In terms of the actual medicine, I still enjoy undifferentiated critical patients, ortho reductions, cardioversions, as well as basic stuff like treating kidney stone pain, reviving mostly dead opiate overdoses, and taking care of all the acute bs that outpt physicians/nps don't know how to manage..

 

[nimbus]

These doom and gloom EM threads always pop up on SDN but seem to be a bit more pointed lately.

I've been practicing under my own license for about 8 years now and I'd do EM again vs anesthesia. I entered med school planning to do anesthesia fwiw.

At this point I get very little emotional response from anything that happens in the ER so going to work is basically cracking jokes with coworkers and nurses for 10 hours, while occasionally having to do something moderately unpleasant but familiar, like a bad i/d or gross pelvic exam. I exist in this environment for about 120 hrs/mo and in exchange get $30k deposited in a bank account. That's basically it. No call, no meetings, no extras. The other 600 hours/month are totally free. That's full-time and I'm on track to FIRE 11 years after graduating residency despite repaying $300k/loans.

Our physician/app group is very stable but the worst part of the job is the constant nursing/tech turnover.. a never ending sequence watching hard-working impressionable young people become good enough at a very difficult job to provide necessary care for our community, then immediately bolting for something easier once they have the necessary experience. Can't blame them though.

In terms of the actual medicine, I still enjoy undifferentiated critical patients, ortho reductions, cardioversions, as well as basic stuff like treating kidney stone pain, reviving mostly dead opiate overdoses, and taking care of all the acute bs that outpt physicians/nps don't know how to manage..

Agree.


Also 5-10 yrs ago, radiology had extreme doom and gloom, but now their market is great. My advice would be to pick the specialty where you think you would most enjoy the day to day routine. Where you look forward to going to work and cracking jokes with your friends.

 

[nimbus]

Marin County is as specific as I'm willing to get.

But your post gets to a good point:
Income to debt ratio may be a bigger determinant of happiness than EM vs Anesthesia

One of the groups in Marin work very hard but are fairly compensated for their work. Above average work and pay in a very HCOL area makes for an intense life. Probably not everyone’s cup of tea.

 

[i-doctor]

EM is getting worse because society is getting worse. Cracking social safety nets, political polarization, COVID, etc. I would absolutely not go into EM at this point. Imagine spending the rest of your career seeing people and bearing liability in a dysfunctional hospital with severe bed and nursing shortages. Some would say that’s always been EM but no, it hasn’t been. COVID broke this specialty and it won’t heal quickly.

This. Most of us don’t see it, but the U.S. is in a rapid decline. Many of our institutions—such as healthcare, education, law enforcement, and of course politics—are falling apart. It’s everyone out for themselves. Hopefully things will turn around, but it’s really hard to predict the future in any given field of medicine, given the potential eventually for a complete overhaul of the healthcare system.

 

[nimbus]

EM is getting worse because society is getting worse. Cracking social safety nets, political polarization, COVID, etc. I would absolutely not go into EM at this point. Imagine spending the rest of your career seeing people and bearing liability in a dysfunctional hospital with severe bed and nursing shortages. Some would say that’s always been EM but no, it hasn’t been. COVID broke this specialty and it won’t heal quickly.

EM is probably the closest job to being a police officer in all of medicine, dealing with people in crisis.

Indeed, my best friend from medical school was an NYPD auxiliary officer in college, then got boarded in EM, joined the FBI for 20 years, all while moonlighting as an EM doc, now retired from the FBI, and still doing a few EM shifts/mo.

 

[Apollyon]

EM is probably the closest job to being a police officer in all of medicine, dealing with people in crisis.

Indeed, my best friend from medical school was an NYPD auxiliary officer in college, then got boarded in EM, joined the FBI for 20 years, all while moonlighting as an EM doc, now retired from the FBI, and still doing a few EM shifts/mo.

As Special Agent , door kicker for the Bureau, or as doctor?

 

[nimbus]

As Special Agent , door kicker for the Bureau, or as doctor?

Special agent. He had an interesting career; investigated embassy bombings in Kenya, looked for Eric Rudolph in the North Carolina woods, worked in cybercrime (CS major in college), worked in Chinese organized crime (he speaks mandarin), eventually became a trainer at quantico before retiring.

 

[Kryptocoin]

If you equally love both, then anesthesia is the obvious choice. I hated the OR and hate being cold, so anesthesia was never really a choice for me. But a few things to consider:

1)I have so much control of my schedule with EM. I block my schedule for 2wks of the month, work 10-12 shifts, and then I'm off for the rest of the month. I can stay home continuously 2wks or travel for 2wks. Every. Single. Month. Schedule control is probably still one of the main driving factors that I'm still in EM. I don't think I can get that with anesthesia. I realize this is might not be possible for every EM jobs, but I'll only work in places where I have schedule control which means primarily travel gigs.

2) Anes, EM and rad are all under the same CMG grip. Pay cuts will happen to us all as CMG continue to expand their reach and consolidate power.

3)Suicide. Depending on which study you look at, anesthesia is #1 in suicidality. Likely due to access to drugs. So if you're struggling with mental health issues or substance abuse, probably something to consider before going into a specialty where you have access to lethal drugs.

So, in the end, find out what is important to you : Schedule control, money, patient autonomy, procedures, being our own boss etc. When you figure that out, THEN find a specialty that matches. Med students tend to pick a specialty first and then try to make it fit.

 

[WilcoWorld]

Special agent. He had an interesting career; investigated embassy bombings in Kenya, looked for Eric Rudolph in the North Carolina woods, worked in cybercrime (CS major in college), worked in Chinese organized crime (he speaks mandarin), eventually became a trainer at quantico before retiring.

And yet he continued to pick up shifts in the ED.

There's a draw to this practice, some feel it.

 

[TrailRun]

One consideration is:

Would you rather be yelled at by surgeons or patients/admin?

I’m EM but perhaps anesthesia would have been a better choice. I can’t think of another line of work where everyone I know is looking for an out as soon as they start

 

[nimbus]

If you equally love both, then anesthesia is the obvious choice. I hated the OR and hate being cold, so anesthesia was never really a choice for me. But a few things to consider:

1)I have so much control of my schedule with EM. I block my schedule for 2wks of the month, work 10-12 shifts, and then I'm off for the rest of the month. I can stay home continuously 2wks or travel for 2wks. Every. Single. Month. Schedule control is probably still one of the main driving factors that I'm still in EM. I don't think I can get that with anesthesia. I realize this is might not be possible for every EM jobs, but I'll only work in places where I have schedule control which means primarily travel gigs.

2) Anes, EM and rad are all under the same CMG grip. Pay cuts will happen to us all as CMG continue to expand their reach and consolidate power.

3)Suicide. Depending on which study you look at, anesthesia is #1 in suicidality. Likely due to access to drugs. So if you're struggling with mental health issues or substance abuse, probably something to consider before going into a specialty where you have access to lethal drugs.

So, in the end, find out what is important to you : Schedule control, money, patient autonomy, procedures, being our own boss etc. When you figure that out, THEN find a specialty that matches. Med students tend to pick a specialty first and then try to make it fit.

I still hate being cold. Sometimes I’ll pull a 2nd bair hugger into the room, one for the patient and one for me.

 

[nimbus]

One consideration is:

Would you rather be yelled at by surgeons or patients/admin?

I’m EM but perhaps anesthesia would have been a better choice. I can’t think of another line of work where everyone I know is looking for an out as soon as they start

My FBI buddy trained at UCLA in the 1990s. Even then, he said many of his residency classmates were writing screenplays. So 30 years ago, EM residents were looking for an out even before they finished training.

 

[Apollyon]

My FBI buddy trained at UCLA in the 1990s. Even then, he said many of his residency classmates were writing screenplays. So 30 years ago, EM residents were looking for an out even before they finished training.

I worked with a guy that was in residency with Pam Dyne all those years ago, and, she was leadership material even then. This guy is a practicing attorney now, along with EM.