There was a similar thread on this topic, but it didn't hit on what I'm getting at. What made you choose to pursue EM over trauma surgery? Did any of you do an EM residency and years later regret not doing the surgical one? Is there enough exciting airway/resuscitation/vascular stuff attached to EM that feeds your adrenaline-seeking personality? The diagnostic core of EM is appealing to me and I lean towards being a physician over a surgeon, but I wonder if any of you had a similar perspective that got flipped as your career progressed.
Anyone choose EM and regret not doing trauma surgery?
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I went to med school to be a surgeon.
The first lap appy was really cool.
The second was pretty neat.
By the third, I was sort of over it.
The same pattern played out with choles, too.
I never actually contemplated trauma surgery - that's a very different beast.
And no, I do not regret not taking the surgical path, not one iota.
If you can't imagine your life without being in the OR, do surgery. If you can, well, don't!
Do some rotations - you'll know pretty quickly.
A lot of EM is bread-and-butter. A really good adrenaline rush is a rare thing these days, for me. Sure, it's neat, and it helps make up for the demoralizing day to day stuff, but even in trauma surgery, it's not exactly all adrenaline, all the time. Your poor adrenals would be toast.
The first lap appy was really cool.
The second was pretty neat.
By the third, I was sort of over it.
The same pattern played out with choles, too.
I never actually contemplated trauma surgery - that's a very different beast.
And no, I do not regret not taking the surgical path, not one iota.
If you can't imagine your life without being in the OR, do surgery. If you can, well, don't!
Do some rotations - you'll know pretty quickly.
A lot of EM is bread-and-butter. A really good adrenaline rush is a rare thing these days, for me. Sure, it's neat, and it helps make up for the demoralizing day to day stuff, but even in trauma surgery, it's not exactly all adrenaline, all the time. Your poor adrenals would be toast.
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They are actually pretty different so what is it that you're getting at that wasn't addressed in threads previously? When people talk about the adrenaline aspect, that is usually a function of how decisions need to be made right now. The need to make important decisions immediately is EM and is the "exciting" aspect that most people are alluding to.
Airway at most community places is either EM or anesthesia so if you want that, don't work at a shop where EM isn't involved in the airway. The only time surgery usually gets involved is for surgical airways, but if you're an EP, you do those, too.
Resuscitation is a broad concept and if the surgical resolution is what interests you, you won't get that in EM. Likewise, if the final solution is catherization, neurosurg, etc, you won't get those in EM, either.
What I like about EM is the timing - we are involved in the critical, time-sensitive aspects of the any specialty's emergency. Honestly, I couldn't care less how hard/easy/interesting the repair of a arterial lac/GI bleed/occluded coronary is. Those parts seem boring to me so I don't feel any FOMO there.
Specialists manage patients longitudinally in their respective fields. If the thought of rounding on the same "exciting" GSW for the next who-knows-how-long and then seeing them in clinic months after that doesn't make you die inside, maybe you should look into other fields more closely.
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When I watch MASH, I wish I'd been a surgeon. When I think back to digging through a morbidly obese abdomen to remove some colon, the narrow scope, rounding on the same jackass who just needs placement but doesn't have insurance, and spending a large chunk of the day babysitting other services' patients; I'm happy I chose EM.
There are definitely part of surgery I think I would really enjoy, but the positives don't outweigh the negatives...
There are definitely part of surgery I think I would really enjoy, but the positives don't outweigh the negatives...
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God no
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The vast majority of trauma "surgery" is not surgery. It's running around checking CT scans, X-ray reports and coordinate surgical Subspecialty consults and transfers to rehab. One of my surgery attendings on Trauma in residency said,
"The trauma service is the garbage service of the hospital. We go around picking up everyone's garbage."
It didn't really make sense at the time since that attending was kind of crazy, but by the end of the month I totally got it. If you like "surgery" per se, trauma surgery might not be what you think it is.
"The trauma service is the garbage service of the hospital. We go around picking up everyone's garbage."
It didn't really make sense at the time since that attending was kind of crazy, but by the end of the month I totally got it. If you like "surgery" per se, trauma surgery might not be what you think it is.
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No.
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I thought I might go for trauma surgery but I didn't like being in the OR, or just seeing trauma patients, or rounding on placement nightmares 100 days out from their injuries.
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This is so true. Most surgeons I know hate their trauma months and the ones that I know that are going into "trauma" are going into it because they like the ICU.
More and more trauma is becoming non operative. You are also the dumping ground for urology, ortho, ent, optho vascular, Cardio thoracic and neurosurg if the patient has two different "trauma" complaints in different systems. So you babysit while the other services do the surgery.
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Having spent the last 2 years doing trauma-based research at the local level 1 trauma center is that most places don't have a dedicated trauma team. I got the feeling that out of the 5 or 6 hospitals in my city, only 1 or 2 has a dedicated trauma team that runs trauma + SICU. The rest have trauma being covered by general surgery, and those surgeons cover trauma say for 1 night per week. Then those surgeons end up having to still build up a practice, operating on post-call days, getting referrals for general surgery type stuff, etc.
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Gonna jump on the bandwagon here. No, I do not regret going into EM. Especially compared to trauma surgery. They have a rough job, rough patients, and a rough lifestyle. While I work on the uninsured crack addict who got shot in the pelvis a mere hour or two, they have to manage that patient for weeks in the hospital and months afterwards in clinic.
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I have said for nearly 20 years now that, if I was told to be a surgeon or do nothing in medicine, my response is, "would you like fries with that?"
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lol, interesting how you put surgeons vs physicians.
As a rising M4 (lowly on the totem pole over many of the attendings and residents here), I really loved my surgery rotation, actually. But lifestyle does matter, and I don't want to continually be in training, also in an environment that generally tends to be more malignant than other environments. (Yest there are tough EDs, but I'd say EPs are generally more chill than surgeons. Also, the challenging part of EM is typically the clientele EPs have to manage (chronic pain, homeless, etc) which I personally find more interesting than "OMG YOU RUINED MY STERILE FIELD".
Anyway, I like the idea of 'anytime, anyone, and anything' being a mantra of EPs and that's a big reason why I'm choosing to go into it. And for the county places, there's a good social mission there too, which is something really cool too. (I'm sure others who have been doing this for years will say I'm naive but oh well haha)
As a rising M4 (lowly on the totem pole over many of the attendings and residents here), I really loved my surgery rotation, actually. But lifestyle does matter, and I don't want to continually be in training, also in an environment that generally tends to be more malignant than other environments. (Yest there are tough EDs, but I'd say EPs are generally more chill than surgeons. Also, the challenging part of EM is typically the clientele EPs have to manage (chronic pain, homeless, etc) which I personally find more interesting than "OMG YOU RUINED MY STERILE FIELD".
Anyway, I like the idea of 'anytime, anyone, and anything' being a mantra of EPs and that's a big reason why I'm choosing to go into it. And for the county places, there's a good social mission there too, which is something really cool too. (I'm sure others who have been doing this for years will say I'm naive but oh well haha)
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I have 2 months of Trauma service in a row coming up and it's not at all like months in the ED. I like a good Cat 1 in the bay, aside from that Trauma surg and EM are completely different as stated above. No regrets about doing EM at all. We get enough excitement outside the bay, plus all the cool stuff that happens in there we are there for and helping with too. Plus they round. I hate rounding.
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I like emergency care and taking care of sick patients, but I don't like surgery. Wound vacs, epic OR cases, HD fistulas, breast clinic - no thank you… Trauma surgery is largely a task management and CT imaging-based field with an occasional surgical emergency. 7 years of surgical training, 24 hour calls, having a pager - no thanks. I'm happy in EM.
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My thoughts on Trauma Surgery are akin to those of getting malignant melanoma.
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Having just finished a month of trauma: nope.
Not at all.
Not at all.
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I love that people think these two specialties are similar. I guess we can thank ER for that.
One trains for 6 years, the other for 3.
One goes to the OR rarely, the other only when called by the CRNA to rescue his failed airway.
One works for 72 hours straight, the other for 8 hours straight.
One works 80 hour weeks, the other 30 hour weeks.
One gets paid $400-600k, the other gets paid $300-500K.
One gets to be woken up in the middle of the night. The other is already up.
One intubates for the third F-bomb. The other just gives the Succ, knowing that the punk will have learned his lesson, but not quite died, by the time it wears off.
Need I go on?
One trains for 6 years, the other for 3.
One goes to the OR rarely, the other only when called by the CRNA to rescue his failed airway.
One works for 72 hours straight, the other for 8 hours straight.
One works 80 hour weeks, the other 30 hour weeks.
One gets paid $400-600k, the other gets paid $300-500K.
One gets to be woken up in the middle of the night. The other is already up.
One intubates for the third F-bomb. The other just gives the Succ, knowing that the punk will have learned his lesson, but not quite died, by the time it wears off.
Need I go on?
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da8s0859q
No, you don't need to. But would you please? Felt so warm and fuzzy reading that.
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Never. Trauma surgery wasn't even on my list of specialties I considered.
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"One trains for 6 years, the other for 3."
?[/QUOTE]
Trauma surgery can be 7+ years of training:
5 years of surgery +optional research year(s)
+
Acute care surgery fellowship = 2 years (1 yr surgical critical care + additional bonus year)
?[/QUOTE]
Trauma surgery can be 7+ years of training:
5 years of surgery +optional research year(s)
+
Acute care surgery fellowship = 2 years (1 yr surgical critical care + additional bonus year)
I have never run into anyone who switched from an EM residency to a surgery residency, but I have run into a good number of folks who either had switched from surgery to EM or who were attempting to switch from surgery to EM.
