cold feet

[bobdobaleena]

i'm freaking out here..........don't really know what to do. only five more days until my rank list is due and i'm not sure that EM is for me. i haven't even visited the NRMP website and don't know if i will. i've wanted EM since the get go, but for some reason i'm having second thoughts now.......maybe someone in the field can comment.......i feel like EM is pretty cool, but i feel like you don't ever get to perform the necessary final intervention.....eg appendicitis......surgery does an appy. cardiac issues....cardiology does a PTCA or CV surg does a CABG. open fracture....ortho does an ORIF etc......i just worry that i'll feel like i'm doing nothing but triaging patients.......and i worry that as i progress in my practice, i won't be satisfied with this......anyone want to comment? anyone know how hard it is to switch fields once you've started residency? would it be better to not match and spend an extra year thinking or to match and bail out after a year? this is driving me crazy and depriving me of sleep.

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[gimmedog]

You sound as if you really need to talk to an EM advisor. I wonder how you could have "wanted EM from the get-go" and not thought about this until now.

It all depends on one's perspective. Why is it so important to you to do the "final intervention?" It would only get done if the EP identifies the undifferentiated pt as someone who needs further workup anyway. You could end up the one doing the "final intervention" and be dissatisfied that all your pts come to you with most of the workup done, and all you determine is where to put the stent, etc. The EP sorts out the appy pt from the many pts with every possible kind of belly pain, but the surgeon gets the pt more or less diagnosed and then gets to perform their 342nd appy.

If you're truly freaked out having serious doubts and you'd likely bail in a yr, I think it's better not to match in EM. It really screws the rest of your class if someone leaves--they absorb all your shifts for the rest of their residency. Also, the federal govt only pays for 5 years of training, so a lot of programs won't consider you if you've used up some of those years (they would not get any Medicare funds to pay for you).

Good luck.

 

[Kalel]

I think that you are just getting cold feet, but if you are certain that you do not want to do EM (after talking it over with multiple people in your lives, including advisors, deans, and PD's in whatever specialty you are thinking about), I think that you should either only rank prelim medicine programs that you applied to, or you should not rank any EM programs. If you choose not to rank any programs, you should be able to scramble into a semi-decent prelim or regular IM or surgery spot (decent academically, but probably not in the location that you would like to be). From there, you can use the intern year to go into whichever specialty you choose. If you do the first year of an EM 3 yr program, then many of your rotations will not count and you will end up having to repeat much to all of your intern year. It's not too late to change specialties after you start EM, many successfully do, but if you are 100% sure that you don't want to do EM right now, I think that you would be better off doing what I have advised.

 

[beyond all hope]

If you're all set to do EM, just rank it and go. Try it for a year. If you don't like it, switch to IM/surgery/Peds/whatever. It's much easier to do it that way that they other way around.

Even if you don't stick with EM, a year of EM training will make you a much better doctor. EM these days is like urban FP with some ICU training thrown in - a very broad education in clinical medicine. Also, many first-year EM programs rotate through medicine, surgery and pediatrics, so you can have a taste of all of those.

Don't forget that EM docs can still be GPs. You won't be doing caths or scopes, but you can see patients in clinic.

Sure, you can scramble into a halfway-decent IM/Surg/Peds program out in the boonies, but then you're probably stuck.

 

[drpcb]

just make sure your comfortable doing just caths or just bypasses or just orif's or just endoscopies or blah blah blah for the rest of your life. sound boring to me. of course you could do all of the residencies, and be able to do the definitive therapy of everything for the last 2 or 3 years of your life. that sounds fun.

 

[PimplePopperMD]

Originally posted by beyond all hope
EM these days is like urban FP with some ICU training thrown in - a very broad education in clinical medicine.

Don't forget that EM docs can still be GPs. You won't be doing caths or scopes, but you can see patients in clinic.

Not true

and Not true.

Emergency medicine is not at all like family medicine. We deal with the complications of chronic disease, we do not treat chronic disease. We don't manage patients long term (if you count long term to be more than 12 hours). We aren't expert in the latest screening recommendations. We don't deliver babies (unless we HAVE to!). FPs generally don't handle the acuity we do, don't put in as many lines, don't intubate as much, etc... vastly different.

Finally, DO forget that EM docs can be GPs. They really can't. Down to the letter of the law, sure. All we need is one year (depending on state) of post grad training, and we can obtain our license. Point out ONE person who does this nowadays. Insurance (both malpractice and patient's) will not be happy about/cover your services if you're not board cert/elig. Practically speaking, this option does not exist anymore, though I understand it used to.

 

[NinerNiner999]

Actually, nearly every doc-in-the-box urgent care facility will accept Emergency Physcians into their practices, working essentially as an outpatient EP. I know a Family Practice graduate who works with some of the local EP's part time in urgent care and makes 200K. Emergency is truly broad scope, and practical, but a solo general practice is probably difficult for the reasons given above. Further, EPs are not trained for continuity of care (i.e. tuning blood pressure, scopes, etc) - that being said it doesn't mean they wouldn't be competent to do it.

If I were in your shoes, I'd stick out the Emergency Medicine residency and then go into something like medicine or peds if you really hated it. Being double-boarded offers many options.

 

[KGUNNER1]

It's not uncommon to feel the "grass is greener on the other side" syndrome around rank time. Med school prepares us poorly to what the real world is like in your haphazardly chosen field. Some med students have a lot of pre-med experience (EMT, scrub tech etc...) but most (me included) didn't have much of a clue.

When we hear our buddies talking how great their choices are and why they chose them, it is natural to doubt your own choice.

Just ask yourself why you have been dead set on EM in the first place. You will probably answer your own questions and put your fears to rest.


Good luck,
Kyle

 

[beyond all hope]

>Emergency medicine is not at all like family medicine. We deal with the complications of chronic disease, we do not treat chronic disease. We don't manage patients long term (if you count long term to be more than 12 hours).

Speak for yourself. Working in an overcrowded urban ER, I deal with everyday aches and pains and manage chronic disease. I adjust medications, manage patients for up to 5 days! (12 hours a day, more than any internist), and see them over and over again.

After seeing your sixth 'my jaw hurts' or 'my belly hurts' or 'weak and dizzy' or 'meds refill' in a row, don't tell me the ER isn't a lot like FP clinic.

>Finally, DO forget that EM docs can be GPs. They really can't. Down to the letter of the law, sure. All we need is one year (depending on state) of post grad training, and we can obtain our license. Point out ONE person who does this nowadays.

I know several EM-only trained docs that work in FP or IM clinics, and one that runs cardiology stress lab. That's more than one. Just because you haven't heard of it doesn't mean it don't exist. I agree with you though, there are definately malpractice/reimbursement issues to be handled, and I don't know exactly how they do it.

 

[TheEyesHaveIt]

beyond all hope,
what did you decide? did you submit an EM ROL?

 

[bobdobaleena]

TheEyesHaveIt,
i think you may have meant to address that last question to me.
i ended up ranking 4 programs that i thought i'd be happy with. i originally scheduled 19 interviews, interviewed at 12. we'll see what happens. thanks for all the comments.

 

[beyond all hope]

You'll at least try a year of EM. If it's really horrible and you decide it's not for you, you have many options of switching. If you love it, well, then welcome aboard.

BTW Eyes, if the question was meant for me, I am an ER doc.

 

[TheEyesHaveIt]

nope beyondallhope, was meant for bobdobaleena, my mistake.