Chicago, EM fit in general

[ButImLETired]

Hey everyone!

I'm a second year med student and I realize it is probably too early for me to declare a definite interest in a specialty, but I just got home from an ED shift (an elective I'm taking) so please bear with me.

Having always been a planner, I find the fact that I don't know what I'll be doing 2 years from now really mentally exhausting so I've been trying to get exposed to as many fields as I can. Last year I shadowed a critical care doc (anesthesiologist by training) and loved it- the high acuity of patients, the fact that he was dealing with systemic medicine instead of just one organ, the personality of the fellows working the ICU, the procedures. I worked with a few surgeons and honestly the personalities really didn't work for me, plus the hours are really brutal and I hate the idea of being "on call" (I'd rather have a crazy but predictable schedule).

I am definitely a control freak and am very "mentally organized", and a good person to have around in a crisis because the more stuff is going on at once, the better I can kind of organize it in my head. I definitely can't say that I'm an adrenaline junkie- I like high pressure situations, but I've never jumped out of a plane and frankly I have no immediate plans to do so. On the other hand, I have a painfully low boredom tolerance and all the subspecialties within internal medicine make me totally restless and miserable. Chronic diseases are depressing and I have zero interest in spending my days preaching at people about their diet and exercise regimens. I don't mind staying up all night but I really hate waking up super early in the morning.

So, my first question is, do you think that I sound like a "good fit" for EM? I realize that generalizations are inherently imperfect, and that many people can fit the bill of the EM doc. But one of the main things I'm looking for in my future career is a strong comraderie with my colleagues so I wouldn't want to be totally different from everyone else.

So now here's a second dilemma (I do know it's probably WAY too early to worry about this). I picked my med school based on the school itself and not really based on location, and while I don't hate the city I'm in, I'm becoming more and more cognizant of location as a legitimate criterion for picking where to train next. I am certain of the fact that come residency time, I want to be in a bigger (actual) city, with public transportation and foreign people and culture and a really diverse patient population. I recently visited Chicago and fell in love with the city- yes, I actually love the cold- and am now really considering its residency programs. I looked at the residency interview feedback pages and those were really helpful, but I guess I'm hoping y'all can give me an idea of what programs I should eventually look into if I do end up going the EM route. As I said, I love critical care, and I know for sure that I want to go into academia (teaching, not research).

Based on all of this, do you think Chicago is a good city for what I'm looking for? What do you think are the most important things for me to do in order to make myself more attractive to EM programs? Do you think I'm even on the right track at all?

Thanks so much for your time. I realize this was a long post so I appreciate anyone who actually reads it

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[RxnMan]

Caveat/context: I am a MS4, who is hopefully going to match into EM this March.

...Having always been a planner, I find the fact that I don't know what I'll be doing 2 years from now really mentally exhausting so I've been trying to get exposed to as many fields as I can...

...What do you think are the most important things for me to do in order to make myself more attractive to EM programs?...

I am a planner too. However, I think the most important thing for any MS2 is to focus on studying and Step 1. Then, work as hard as you can during 3rd year and learn as much as you can. I think it's great that you're trying to experience all of those specialities, but I wouldn't stress because you'll be doing a lot of that already during 3rd year.

Also, there is a place for everyone in the house of medicine, and don't allow your need to plan (usually a good trait) to force you into making a decision early. If you end up liking EM, then that's great. If you like something else, that's great too.

...I like high pressure situations, but I've never jumped out of a plane and frankly I have no immediate plans to do so...

I don't see what's so great about exiting a perfectly good airplane either. I'm sure skydiving EM physicians exist, but I didn't meet any on the interview trail.

...So, my first question is, do you think that I sound like a "good fit" for EM?...

There's a good post about this in the FAQ by Desperado.

...(I do know it's probably WAY too early to worry about this)...I am certain of the fact that come residency time, I want to be in a bigger (actual) city, with public transportation and foreign people and culture and a really diverse patient population...

There are many other cities that match those traits, and depending on how warm you want to get, you could pretty much apply all along the east coast.

 

[WilcoWorld]

I agree that the best thing an MS2 can do for his or her chances of matching into EM is to study for Step 1 and that the best thing an MS3 can do is to work very hard on his or her rotations.

Your personality sounds a lot like mine and I'm an EM attending, for whatever that's worth. Honestly, I don't know if I'm a "good fit" for EM, but it would seem that if I'm not I at least managed to cram myself squarely into this round hole.

Chicago is a great city for EM training. It has 6 residency programs which run the spectrum from community to county to academic, 3 year programs to 4 years to combined IM/EM, well-respected places to...just kidding. Chicago also has plenty of good pathology to go around and EM is a well-established specialty there.

I strongly recommend that you do your best to get excited about all of your clerkships. Not only will it help you perform better, you may find that you prefer another field. However, if you really think EM in Chicago + you = love then it would be good to start working early on in 3rd year to schedule a rotation there for 4th year. The spots fill up quickly.

Best of luck.

 

[ButImLETired]

Thanks a lot for your replies.

Yeah, with the scary beast of Step 1 looming on the horizon I realize unfortunately that's where I need to focus my energies right now. My school is P/F which is good and bad because on the one hand all I have to do right now is pass my classes, but on the other hand Step 1 is basically the only way to evaluate me before third year, so I'm basically terrified of that thing.

As for next year and changing my mind and such: I wonder. There are a lot of fields I find interesting in theory- cardiology, neurology, rad/onc, transplant surgery, maybe even neurosurg- but whenever I shadow any of those specialties I either get antsy (cardiology), sad (neuro because they don't fix enough things and rad/onc because they're always in the basement), annoyed with the people I'm working with (neurosurg) or just exhausted (transplant surgery). Don't get me wrong, I'm definitely going into third year as a clean slate, and if I happen to fall in love with the wondrous world of endocrinology or ENT or something I'll go with it. But one of the "criteria" I'm using to pick my future specialty is what I like to call the "elevator test"- what kind of doctor would you like to be stuck in an elevator with? The one with good stories and who can handle it if you have a panic attack or pass out or something.

Anyway, thanks again for your replies. I'll definitely focus on the "here and now" and schedule some of the rotations I might be interested in early on so I'll know soon enough if I should do an EM away or stick with something else.

 

[dotcb]

How about do a 3 year EM residency, and if you're still not satisfied, do a 2 year IM critical care fellowship? Then you can do both and mix it up.

 

[sunset823]

I am a lot like you, LET, also a second year with very similar interests (academics, critical care) and similar personality (very low boredom tolerance, though I really want to jump out of a plane, been wanting to go skydiving in forever but need to find a friend to go with haha, and I actually prefer early mornings, but otherwise we're twins), and I am considering EM as well as anesthesia and IM (though if I went with IM I would quickly specialize, general internist is not for me). I'm obviously in no position to comment about career options, since I'm clueless and confused myself, but I could comment a little bit about Chicago - I've never actually physically lived there but have always lived close by and go there often:

Pros
- well, you're in a big city - great restaurants, gorgeous skyline, the lake, lots of fun and interesting people
- Midwest hospitality - though Chicagoans are more like the snotty east coast type than you might find in other smaller Midwestern cities, you still are going to have the friendly Midwest spirit
- O'Hare - though this airport is a pain, for someone who travels a lot (like me), having one of the largest and busiest airports in the country in your backyard (and Southwest for cheap domestic travel) is very valuable

Cons
- the city is HUGE - almost too big for me, and also very spread out
- while public transportation is available, it leaves much to be desired - compared to other cities I've lived in with great public transport (Boston and DC especially), the CTA is a bit rundown and can be scary if you're traveling alone, especially as a woman in the middle of the night
- as a physician you most likely will need to drive, and the traffic is pretty horrendous
- cost of living - depending on which hospital you end up in, you are either going to be shelling out an eye for a crammed apt in the desirable "Magnificent Mile" (i.e., for Northwestern), or going to live in a rather ghetto area (i.e., UIC, U of C, though Hyde Park is getting better)
- violence - is increasing - I grew up in Cleveland and have lived close to Detroit, neither of which are cities friendly to walking alone at night, but Chicago's violence has been skyrocketing recently - not as bad as St. Louis or Baltimore though

In the end, as a lifelong midwesterner, I'm not a huge fan of Chicago and if I stay in the midwest would rather go to a smaller city like Milwaukee or Minneapolis (or back home to Michigan or Ohio, though I feel I've worn out my time at both places), where I'd feel comfortable driving and also being able to afford to pay off some loans during residency. But, especially if you've never lived in this area, it is a great city to experience for a few years, and has many great programs.