Career adjustment advice - back to fellowship?

[ThurmanMcMurman]

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Hi all,
WOuld love your insights on the next steps for me...
I was drawn to both Peds and EM in med school, chose Peds because I loved the nice people and enjoy taking care of sick kids. I LOVED residency due to the variety ( went to a quaternary center where it was zebra land), and honestly would be a resident forever if I could work less and get paid more. I love learning and love variety, which stinks because to be a good doctor you have to really specialize!

I couldn't decide what to do and took a hospitalist job where I have been working for 15 months or so, working on the mountain of student loans trying to decide on PICU vs. EM residency vs Peds ED. My favorite moments at this job are in the ED! It's the variety, the instant gratification, that gets my dopamine receptors going- just like a mind blowing TED talk. I also love the physiology of resuscitation. And as a consultant to the ED I get to teach. So fun.


I would love to do global health work during part of my career, am not particularly confident at this point that I will be a pre-eminent researcher but that would be cool if I could. I feel like Peds needs a lot of good research, but I'm kind of an instant gratification kinda person. Maybe global health telemedicine?

Here are my thoughts:
PICU: I really prefer Peds patients, love teaching, love patient care with sick kids.
I'm worried about burnout in PICU- it's rampant. I also am a sensitive person and worry about the emotional toll. PICU Has some instant gratification but a lot of community PICUs are slow and boring- and big fast paced PICUs seem to require a huge publication history which I would have to build. My tendency is to be interested in everything from social science to economics to medicine so having a research career focused on one area my whole career would be tough.


Peds EM -I'm worried about pulling my husband all over the country to match and the job market afterward- we need to be in an area that supports his industry ( big cities).

EM- if I could get a residency spot I would be marketable anywhere which feels comfortable and secure. ( obviously family/marriage/career balance is important to me- no job change is worth it to divorce the lovely man I married( I got lucky) and though we have a fantastic marriage I don't want to stress it and live apart for a short time(i.e.) fellowship. I will always enjoy seeing kids more than adults, and I know burnout in the ED is a thing too.

What do you think SDN? What should I do? And even if no one answers I learned a lot writing this.

 

[helvetica]

Seems like the real dilemma is peds EM fellowship vs. EM residency. Why do you think you won't have to move somewhere else for an EM residency? You mention it as a con for PEM, but it also applies to EM residency.

If I were in your shoes, I think I would go with PEM fellowship to avoid repeating intern year (and also to avoid taking care of adults), but that's just me. You'll also get more time to do research or global health in fellowship over residency. I think you're right though in that you'll be able to get a job anywhere with an EM residency under your belt (including urgent care centers if that's your thing).

I think figuring out your priorities will be key moving forward.

 

[SurfingDoctor]

Sounds like to want to do EM. I think you are right that there is always going to be a bigger market for EM in general than PEM. Your best chance of landing a job in a big city would be EM. That being said, most pediatric ERs are affiliated with children's hospitals and almost always in a big city, but you are a little more limited in the total number of cities and the job availability since PEM jobs seem unlikely to be as plentiful as adult jobs.

As far as time commit, you have two options, either petition to a program to skip the transitional/intern year (I have seen this done for people who already completed residency) or find a 3 year program in EM. You could also go through PEM fellowship, which is also 3 years, thought 1.5 of those years are dedicated to academics, which honestly, you probably won't use ever again in EM. You mentioned global health, which might be possible as a PEM fellowship scholarly project, but honestly, unless you go to a place where a program or project like that has already been done, it will not be achievable to any great success in the broken up 1.5 years that fellowship allows to pursue such activities.

I think your best bet is to do 3 years of EM and then you are marketable as an EM physician with pediatric experience and essentially made yourself marketable to both PEM and adult EM places. But that's just my opinion. Good luck.