Anyone regret *not* doing Emergency Medicine?

[Tularemia-bunny]

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Seems like EM vs Anesthesia is a very common question, and in the end it ends up being a personal preference. Just curious if any of you who considered EM seriously regretted not going that way (like when you did rotations in the ED, or got up at 530am for the millionth time). Thanks!

 

[Consigliere]

Seems like EM vs Anesthesia is a very common question, and in the end it ends up being a personal preference. Just curious if any of you who considered EM seriously regretted not going that way (like when you did rotations in the ED, or got up at 530am for the millionth time). Thanks!

Nope

 

[Tularemia-bunny]

Nope

That's actually really interesting to read from you! It seems like you have some strong opinions on the anesthesia field, but even with that you don't feel like you missed out on any opportunities/could have avoided frustration in your position? Or does not dealing with rectal exams and vag bleeds make up for all of that? 🙂

 

[TexasDoc2388]

Seems like EM vs Anesthesia is a very common question, and in the end it ends up being a personal preference. Just curious if any of you who considered EM seriously regretted not going that way (like when you did rotations in the ED, or got up at 530am for the millionth time). Thanks!

Heck naw. I like EM but by the end of my month rotation I was tired of seeing those patients. I like the control I get in the OR and the ability to sedate patients when they get annoying 🙂

 

[deleted162650]

I think the bullsh*t:cool stuff ratio is way better in anesthesia.

 

[nimbus]

No. Most of the crazy ER patients never make it to the OR. The ones who do you can put to sleep.

 

[secants]

I liked it as a med student and was a close second to anesthesia when I applied for residency, the only reason I might regret it now is due to their excellent job market and pay/hr ratio that anesthesia doesn't have anymore as a new grad.

Sent from my SM-G935T using SDN mobile

 

[AdmiralChz]

I moonlight in a nearby community almost rural ED a few times a month. After almost every shift I say to myself “I’m glad this isn’t my full time job.” The moonlighting pay is good, but I’ll get more for a call shift next year so I won’t continue working there.

My experience - too many night/evening shifts while the overall hours worked is probably less the rapid cycling between days/nights/evenings is jarring. More specifically, the onslaught of primary care/psych/homeless wears on me. The sick patients provide a challenge, but Id estimate less than 10% fit what I would consider “sick.” Less than 25% of what comes into that ED truly belongs there, the rest could’ve easily been handled at urgent care and primary care offices.

I have great respect for those that enjoy the field, I was a previous paramedic and most that make the leap into medicine go into EM. But the field simply isn’t for me, at all.

 

[AdmiralChz]

I liked it as a med student and was a close second to anesthesia when I applied for residency, the only reason I might regret it now is due to their excellent job market and pay/hr ratio that anesthesia doesn't have anymore as a new grad.

Sent from my SM-G935T using SDN mobile

Head over to the ED subforum or talk to a new grad. You think AMCs are bad, it’s WAY worse in EM (I forget what their terminology is). You think you’re disposable as an anesthesiology group, you’re even more replaceable in EM sadly. Look up what happened at Summa Health last year - new EM group overnight and they lost their ACGME accreditation.

Plus, EM is the bright frontier for aggressive PAs and NPs doing post-graduate “fellowships” - I fully expect the specialty to be the next big target for mid level providers in terms of independence. On the bright side, when/if it happens we (anesthesiology) will probably gain some allies.

 

[Tularemia-bunny]

I moonlight in a nearby community almost rural ED a few times a month. After almost every shift I say to myself “I’m glad this isn’t my full time job.” The moonlighting pay is good, but I’ll get more for a call shift next year so I won’t continue working there.

My experience - too many night/evening shifts while the overall hours worked is probably less the rapid cycling between days/nights/evenings is jarring. More specifically, the onslaught of primary care/psych/homeless wears on me. The sick patients provide a challenge, but Id estimate less than 10% fit what I would consider “sick.” Less than 25% of what comes into that ED truly belongs there, the rest could’ve easily been handled at urgent care and primary care offices.

I have great respect for those that enjoy the field, I was a previous paramedic and most that make the leap into medicine go into EM. But the field simply isn’t for me, at all.

Stupid question: how do you moonlight in EM as an anesthesiologist? Is it because it's rural, or because of your previous EMS background + anesthesiology license?

 

[agammaglobulin]

I decided against EM when I realized I didn't want to be doing pelvic exams or swabbing for STDs (STIs?) at 2am when I'm 60yrs old.

 

[AdmiralChz]

Stupid question: how do you moonlight in EM as an anesthesiologist? Is it because it's rural, or because of your previous EMS background + anesthesiology license?

Sort of a special/unique set up, they allow any physician with a full license to apply for credentials. I had to provide an EM reference (did a couple moonlighting shifts in residency as well). I’m not the only doc there (thankfully), usually it’s FM/IM/Anesthesiology. Last week it was a general surgeon with me, we had a blast and rock-paper-scissored the chronic pain patients.

I often wonder why they don’t have an EM group cover, but for my fellowship year it’s a nice extra source of income as there isn’t an abundance of in-house moonlighting

 

[caligas]

I have yet to walk out of an ED wishing I could stay longer.

 

[Man o War]

Head over to the ED subforum or talk to a new grad. You think AMCs are bad, it’s WAY worse in EM (I forget what their terminology is). You think you’re disposable as an anesthesiology group, you’re even more replaceable in EM sadly. Look up what happened at Summa Health last year - new EM group overnight and they lost their ACGME accreditation.

Plus, EM is the bright frontier for aggressive PAs and NPs doing post-graduate “fellowships” - I fully expect the specialty to be the next big target for mid level providers in terms of independence. On the bright side, when/if it happens we (anesthesiology) will probably gain some allies.

This x1000
EM is having a moment, but I don’t expect it to last. Low hanging fruit for mid levels and hospital admin looking to cut costs with AMCs, independent midlevels, or docs supervising a bunch of NPs/PAs.
I think that sucks because when I’m in the ER, it is serious and I want to see a doctor, not a nurse posing as one.

 

[GravelRider]

Anesthesia is a better choice than EM for all the reasons mentioned here. The biggest thing I see that EM has going for it is schedule flexibility and is probably the reason it is a hot pick for med students now. In EM you can pick your shifts to suit your lifestyle (although maybe less flexibility as the new guy) and it's easier to work more or less as needed. In anesthesia you are beholden to everyone else's schedule and finding shift work types of jobs is not always easy. However, I'm not sure that is the best reason to pick a specialty if you don't like the work. You'll burn out pretty fast in EM if you don't like it.

 

[Ronin786]

No offense intended to any EM physician out there, but I like being a true master of airways, pain control and critical care/resuscitation. The jack of all trades wasn't my cup of tea.

 

[pgg]

The biggest thing I see that EM has going for it is schedule flexibility

Never really understood this. I mean, I know it's "shift work" but that's where the advantages end. Most of those shifts are nights and weekends.

ERs tend to be busy at exactly the times I prefer to not be in the hospital.

 

[Tularemia-bunny]

Never really understood this. I mean, I know it's "shift work" but that's where the advantages end. Most of those shifts are nights and weekends.

ERs tend to be busy at exactly the times I prefer to not be in the hospital.

I think the idea is that you can choose "I only want to work 10 shifts this month, next month I'll work 16" etc? Also easy to pick up shifts at say an urgent care, which from my understanding isn't an option for anesthesia docs.

 

[pgg]

I think the idea is that you can choose "I only want to work 10 shifts this month, next month I'll work 16" etc? Also easy to pick up shifts at say an urgent care, which from my understanding isn't an option for anesthesia docs.

Lots of side work for anesthesiologists ... many of us moonlight. Sometimes its off-hour coverage, but there's plenty of M-F need during daylight hours too.

 

[GravelRider]

Never really understood this. I mean, I know it's "shift work" but that's where the advantages end. Most of those shifts are nights and weekends.

ERs tend to be busy at exactly the times I prefer to not be in the hospital.

No. It's more like you can cluster your hours...say work 3 days of 12 hour shifts in a row then get 4 days off (or more) to go hit the slopes or something. Anesthesia is pretty much mon-fri + 1 weekend every 1-2 months. Hospitalist work offers a similar advantage with the 7 on/7 off types of schedules. Shift work is not for everyone, but it has its advantages.

 

[deleted162650]

For a while in college I had a job helping a one-armed typist do capital letters. It was mostly shift work.

 

[facted]

I love how ER is being looked upon now as a "lifestyle" field. Highest burnout rate of any field.

Medical specialties with the highest burnout rates

 

[deleted697127]

Every time you call someone you’re giving them more work. No one wants to get a call from you. Specialists don’t like walking through cause they get curbsided. Fun stuff like suturing gets done by mid levels. Supervising residents/midlevels and having to sign charts of a zillion patients you’d struggle to remember. Everyone second guessing why you did or didn’t order a test. Pelvic exams. Notes on notes on notes. Your shift ends sure but that complicated patient you got an hour ago, you’re not handing them off to someone whose sole focus is that one patient.

No thanks.

 

[Psai]

I like my field. If I couldn't do this, emergency is a very close second place. I loved diagnosing, doing procedures, calling people to make em work and moving the department.

 

[anbuitachi]

I didn't really mind my ED rotation, i thought it was chill. It was a busy ER but really i thought the key was to work at your own pace (obviously not snail pace either). There really weren't that many true emergencies.. And i haven't experienced attending life yet but the shift change in anesthesiology residency is worse than in EM residency here IMO. Simply because you have way fewer shifts in EM and more time to rest, where as for anesthesiology you are constantly on call
But then again I dont know how much longer the good EM life style can last. Making 250-300$ a hour while working 3 days a week.. is pretty lucrative especially when a lot of the patients are not true emergencies and can probably be handled by a midtier trained for it

 

[facted]

I didn't really mind my ED rotation, i thought it was chill. It was a busy ER but really i thought the key was to work at your own pace (obviously not snail pace either). There really weren't that many true emergencies.. And i haven't experienced attending life yet but the shift change in anesthesiology residency is worse than in EM residency here IMO. Simply because you have way fewer shifts in EM and more time to rest, where as for anesthesiology you are constantly on call
But then again I dont know how much longer the good EM life style can last. Making 250-300$ a hour while working 3 days a week.. is pretty lucrative especially when a lot of the patients are not true emergencies and can probably be handled by a midtier trained for it

ER lifestyle is not that great. Super common misconception. They have the biggest burnout rate of any specialty. See post above.

 

[aneftp]

EM is very like anesthesia where there are very few docs in their late 50s/60s practing “real ER medicine” like u see on tv.

I think most med students have this vision of this cool EM career. But the reality is that crap gets old after a while. The overnight shifts even old. Those 12 hours become draining even if practicing in a low level ER

By the time u are in ur 50s, they get burned out.

Ask urself. How many older docs are practice in real ERs u rotate through? They gradually shift to these suburban glorified outpatient urgent care centers with primarily healthy patients where a “late” shift ends at 9pm.

So would I rather do anesthesia or EM again?

The answer is all medicine gets old. I would feel the same way with rads as well as I age.

(I’ve been out of residency for 13.5 years). I see myself practicing for another 10 years (anesthesia) but gradually switching to administrative healthcare informatics in the future.

 

[Brorthopedic]

I love how ER is being looked upon now as a "lifestyle" field. Highest burnout rate of any field.

Medical specialties with the highest burnout rates

I find it interesting that PM&R is so high (#3) and Neurosurgery is so low (#18) on the list of burnout, makes one question the accuracy of the results

 

[caligas]

I find it interesting that PM&R is so high (#3) and Neurosurgery is so low (#18) on the list of burnout, makes one question the accuracy of the results

Selection bias

 

[dchz]

One major point i think everyone is missing: Anes writes the least notes out of any specialty out there. Yes, even ortho.

 

[anbuitachi]

One major point i think everyone is missing: Anes writes the least notes out of any specialty out there. Yes, even ortho.

Well if you only take the # into account sure, but we are constantly writing in the OR! It's just several giant notes instead of small ones.

ER lifestyle is not that great. Super common misconception. They have the biggest burnout rate of any specialty. See post above.

I find it interesting that PM&R is so high (#3) and Neurosurgery is so low (#18) on the list of burnout, makes one question the accuracy of the results

I would take these surveys with a grain of salt especially since the difference between the top 10 specialty burnout rates is only a few percent.. any sort of bias can change the rankings.
And what are PMR docs burning out from? Literally no emergencies, minimal call, no/minimal nights/weekends, low stress job.. And why are dermatologists so high on the list? If i remember correctly they were ranked as one of the happiest specialty.

 

[spacegun]

I am only a med student but if you are asking about EM vs. anesthesia, then maybe you are a med student trying to decide like me. If you are, I have a third option or consideration. One reason people like EM is because you are a "jack of all trades." But FM is a "jack of all trades" too (except for the acute stuff but that might not be so fun when you are older according to what some people are saying here).

EM
1. Make more money ($350k+)
2. But for a shorter period of time until you burn out it seems in your 50's (or work less shifts or switch to something like UC making a lot less)
3. Your schedule is more erratic (nights, holidays)
4. You are dependent on hospital contracts and politics from what I understand

FM
1. You make a lot less money ($250k average)
2. But it is consistent because you can work until the day you die (80's) if you want, that's 20+ years of working (if you want career longevity) than when you are likely to burn out in EM (assuming people are right about burn out and burn out rates)
3. You are in even more demand than EM almost anywhere you want to work in the US (you can start your own practice or join others almost anywhere if you are business minded, don't need the ER/hospital)
4. You have a more regular and controlled schedule and can set your hours with your practice
5. You don't have to fight with drunks or see the worst of society (usually)
6. Outpatient medicine usually offers a better lifestyle
7. In most places you can still be your own boss and independent from hospitals and all the politics and worries there, this is huge
8. You don't have to fight with specialists to get them to see a patient or admit them, specialists depend on you for a lot of their patients
9. Or if you want more money, you can be an FM hospitalist in a lot of places, make $300k+ for a while, then switch to outpatient FM when you get tired of hospitals and hospital politics
10. FM has its downsides for sure (e.g. insurance companies, paper work), but I don't think it's a bad gig depending on what you want, and too many med students (including me) sell it short, but having said that I would probably still pick anesthesia over FM or EM 😉

 

[Consigliere]

That's actually really interesting to read from you! It seems like you have some strong opinions on the anesthesia field, but even with that you don't feel like you missed out on any opportunities/could have avoided frustration in your position? Or does not dealing with rectal exams and vag bleeds make up for all of that? 🙂

Not too interesting...look at the choice: emergency medicine. C'mon! That's like asking "anyone regret NOT sticking their penis in a fan?"

 

[Psai]

Not too interesting...look at the choice: emergency medicine. C'mon! That's like asking "anyone regret NOT sticking their penis in a fan?"

Probably the rolling stones

 

[Gern Blansten]

I love how ER is being looked upon now as a "lifestyle" field. Highest burnout rate of any field.

Medical specialties with the highest burnout rates

The real sad part is that even the lowest specialty still had a huge burnout rate. Medicine, in general causes burnout. Some specialties cause it faster.

 

[calvnandhobbs68]

EM is one of those specialties where you essentially HAVE to be employed by or work for a hospital. I find that idea very disconcerting. Along with all the stupid crap that comes into the ER.

“Hey doc my backs been hurting for 6 months but it really kills tonight.”

“Yeah I’ve have a year of off and on “fatigue” and “body aches” that I’ve never told my pcp about but this time it’s lasted for a whole week so I decided to come to the ER”

“My stomachs been hurting for 3 months straight”

 

[nimbus]

The real sad part is that even the lowest specialty still had a huge burnout rate. Medicine, in general causes burnout. Some specialties cause it faster.

The flip side is to ask which job would be better. Even investment bankers and professional athletes burn out. And an alarming number of rock stars seem to end up prematurely dead. Many business owners are on 24/7, ready to put out fires. I can’t think of many jobs I’d prefer or that are more engaging.

 

[Psai]

The flip side is to ask which job would be better. Even investment bankers and professional athletes burn out. And an alarming number of rock stars seem to end up prematurely dead. Many business owners are on 24/7, ready to put out fires. I can’t think of many jobs I’d prefer or that are more engaging.

Yeah but think of how many fly honeys they jive with before they die young

 

[Erakis]

Seems like EM vs Anesthesia is a very common question, and in the end it ends up being a personal preference. Just curious if any of you who considered EM seriously regretted not going that way (like when you did rotations in the ED, or got up at 530am for the millionth time). Thanks!

After my 100th vague complaint of two years of abdominal pain at 2AM, I felt very good about passing on ED.

 

[rakotomazoto]

an alarming number of rock stars seem to end up prematurely dead.

Rock star was always my plan B if med school didn't work out.

 

[DrOwnage]

My favorite case in the ER as a med student...:

I walked into a room with a gentleman with his wife and kid at his side. The guy was lying in a gurney just staring off into space, not responding, would just stare at you when you talked and looked confused. The wife and kid were like "oh my god hes having a stroke, whats going on?!?!" I got closer for the physical examination and could smell alcohol emanating from his skin. I walked out of the room and went to my attending and basically told him this guy is smashed as hell and I think he didn't want to tell his family. Turns out that was exactly the case. The guy had been getting wasted at work before coming home, just happened to get caught this time lol.

 

[BLADEMDA]

Forget EM. Cryptotrader vs Hedge Fund Manager.

 

[Dr. Bruce Banner]

50% of the EM physicians I have worked with at my institution (one of the biggest academic EMs in the Midwest) told me not to go into EM even though I loved working there. On paper, EM sounds great and it is so hot right now... but I guess attendings have a better picture of what life is really like as an EM physician. One of the residents told me if I like sleep, EM is probably not the right choice, lol, and I LOVE sleep...

 

[deleted859535]

I guess attendings have a better picture of what life is really like as an EM physician. One of the residents told me if I like sleep, EM is probably not the right choice, lol, and I LOVE sleep...

Yes, we do, and this is bull****. Consider your source.

It's more like "you can sleep lots, understanding that you're going to have to plan ahead for some night shifts and very early (e.g., anesthesiologist hour) shifts."

 

[anbuitachi]

No offense intended to any EM physician out there, but I like being a true master of airways, pain control and critical care/resuscitation. The jack of all trades wasn't my cup of tea.

The question is should anesthesiologists be the ones doing trachs? we are one of the best at managing airway for sure, but when theres a super duper difficult airway, we call ENT on standby for trach to bail us out if we fail. It's almost like EM asking us to be on 'standby' in difficult airways. Can you be a true master of airways when you call on another specialty to manage it if it becomes too difficult? If you ask ENTs who is the true master of airways, ENT or Anesthesiology, who would they pick? ENT also do a lot of laryngoscopies, and I'd say they scope way more than we do.

I think we are true masters of anesthesia. Not necc airways. the word airway is pretty much in ENT specialty's name... I guess we could say we are the true masters at intubating

Also your colleagues in Pain management, and CCM may disagree with you about the latter 2

50% of the EM physicians I have worked with at my institution (one of the biggest academic EMs in the Midwest) told me not to go into EM even though I loved working there. On paper, EM sounds great and it is so hot right now... but I guess attendings have a better picture of what life is really like as an EM physician. One of the residents told me if I like sleep, EM is probably not the right choice, lol, and I LOVE sleep...

Opposite experience here. Rotated thru 3 EDs (at different places). I literally didn't meet a single one who didn't recommend going to EM. They were all busy metropolitan EDs, and I imagine the pay probably wasn't too amazing either. The only thing is all 3 places had residents, so the attendings didn't look swamped

 

[BLADEMDA]

I am only a med student but if you are asking about EM vs. anesthesia, then maybe you are a med student trying to decide like me. If you are, I have a third option or consideration. One reason people like EM is because you are a "jack of all trades." But FM is a "jack of all trades" too (except for the acute stuff but that might not be so fun when you are older according to what some people are saying here).

EM
1. Make more money ($350k+)
2. But for a shorter period of time until you burn out it seems in your 50's (or work less shifts or switch to something like UC making a lot less)
3. Your schedule is more erratic (nights, holidays)
4. You are dependent on hospital contracts and politics from what I understand

FM
1. You make a lot less money ($250k average)
2. But it is consistent because you can work until the day you die (80's) if you want, that's 20+ years of working (if you want career longevity) than when you are likely to burn out in EM (assuming people are right about burn out and burn out rates)
3. You are in even more demand than EM almost anywhere you want to work in the US (you can start your own practice or join others almost anywhere if you are business minded, don't need the ER/hospital)
4. You have a more regular and controlled schedule and can set your hours with your practice
5. You don't have to fight with drunks or see the worst of society (usually)
6. Outpatient medicine usually offers a better lifestyle
7. In most places you can still be your own boss and independent from hospitals and all the politics and worries there, this is huge
8. You don't have to fight with specialists to get them to see a patient or admit them, specialists depend on you for a lot of their patients
9. Or if you want more money, you can be an FM hospitalist in a lot of places, make $300k+ for a while, then switch to outpatient FM when you get tired of hospitals and hospital politics
10. FM has its downsides for sure (e.g. insurance companies, paper work), but I don't think it's a bad gig depending on what you want, and too many med students (including me) sell it short, but having said that I would probably still pick anesthesia over FM or EM 😉

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[LunchMD]

The question is should anesthesiologists be the ones doing trachs? we are one of the best at managing airway for sure, but when theres a super duper difficult airway, we call ENT on standby for trach to bail us out if we fail. It's almost like EM asking us to be on 'standby' in difficult airways. Can you be a true master of airways when you call on another specialty to manage it if it becomes too difficult? If you ask ENTs who is the true master of airways, ENT or Anesthesiology, who would they pick? ENT also do a lot of laryngoscopies, and I'd say they scope way more than we do.

I think we are true masters of anesthesia. Not necc airways. the word airway is pretty much in ENT specialty's name... I guess we could say we are the true masters at intubating

Also your colleagues in Pain management, and CCM may disagree with you about the latter 2



Opposite experience here. Rotated thru 3 EDs (at different places). I literally didn't meet a single one who didn't recommend going to EM. They were all busy metropolitan EDs, and I imagine the pay probably wasn't too amazing either. The only thing is all 3 places had residents, so the attendings didn't look swamped

I think we should do trachs. 1) We are the ones to respond to airways, and ENT isn't always going to be around or there in a timely fashion. 2) I'm pretty sure the literature shows that surgical trach/cric has vastly superior success rates than needle approaches in emergencies. 3) The way to maintain the required skills would probably be for anesthesiologists to do the routine trachs (like some ENT patients need before their surgery). I don't think ENT is going to complain if they don't get called at 3am to do a trach, or if we take some of the routine OR trachs. High riding innominate or difficult anatomy would still go to ENT. I know of 1 institution that the anesthesiologists do percutaneous trachs across the hospital.

 

[Psai]

I think we should do trachs. 1) We are the ones to respond to airways, and ENT isn't always going to be around or there in a timely fashion. 2) I'm pretty sure the literature shows that surgical trach/cric has vastly superior success rates than needle approaches in emergencies. 3) The way to maintain the required skills would probably be for anesthesiologists to do the routine trachs (like some ENT patients need before their surgery). I don't think ENT is going to complain if they don't get called at 3am to do a trach, or if we take some of the routine OR trachs. High riding innominate or difficult anatomy would still go to ENT. I know of 1 institution that the anesthesiologists do percutaneous trachs across the hospital.

It's really not that hard to learn to steps to obtain a quick surgical airway. I'm always ready to do the scalpel/finger/bougie technique in an emergency, especially after I've heard of emergencies where we just stood around and allowed the patient to pass. I do think it's better to let the surgeons operate if they're close by.

Surgical Cricothyroidotomy

 

[chocomorsel]

For a while in college I had a job helping a one-armed typist do capital letters. It was mostly shift work.

I am on my third glass and can’t put this together. But clearly 20 others before me have.

 

[deleted171991]

Between people saying go into X and people saying don't go into X, I would always care much more about the latter. Why? Because the latter is much more difficult, as is anything that's non-PC or unpopular. The red flags are way more important than the green flags.

Based on my previous experiences with naive medical students or residents, I don't even bother to advise them anymore in real life. Most of them have their minds made up based on the wrong reasons anyway.