Cold Feet?

[emletters]

Anyone ever second guess their choice in EM (or any specialty for that matter)? I guess I'd put myself into the category of people who overanalyzes everything, but before med school and throughout the first half of med school, I thought I was going to be a surgeon. When I finally went through the clerkship last year, I don't think I had a good experience: never felt like I was doing anything, so it's easy to dislike something and be bored when you're not really involved. And I feel like I was at one of the more malignant sites we have where residents are stressed through the roof and not really interested in med students (not that many are! haha).

So after that clerkship, I found myself pursuing EM because I already had connections in the field and things just kind of fell into place. I did my home sub I and it was ok, but it didn't wow me or give me that epiphany that if I can't do this I don't want to be a doctor type thing. I had more fun at my away rotation, but again it was just more comfortable than enjoyment I guess. Now looking back I'm wondering if I just took the path of least resistance and went into the field where things just lined up. I've already gotten 2 SLOE's and a non EM letter and submitted my app on ERAS to 40 places. It feels like I've pretty much gone down the path and can't turn around at this point. Can't take a year off or add an extra year.

Maybe I'm just being my naturally anxious self, but does has anyone felt like this before? Is this just cold feet or did I actually make a mistake? As always, you guys are a big support. Thanks

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[theseeker4]

Anyone ever second guess their choice in EM (or any specialty for that matter)? I guess I'd put myself into the category of people who overanalyzes everything, but before med school and throughout the first half of med school, I thought I was going to be a surgeon. When I finally went through the clerkship last year, I don't think I had a good experience: never felt like I was doing anything, so it's easy to dislike something and be bored when you're not really involved. And I feel like I was at one of the more malignant sites we have where residents are stressed through the roof and not really interested in med students (not that many are! haha).

So after that clerkship, I found myself pursuing EM because I already had connections in the field and things just kind of fell into place. I did my home sub I and it was ok, but it didn't wow me or give me that epiphany that if I can't do this I don't want to be a doctor type thing. I had more fun at my away rotation, but again it was just more comfortable than enjoyment I guess. Now looking back I'm wondering if I just took the path of least resistance and went into the field where things just lined up. I've already gotten 2 SLOE's and a non EM letter and submitted my app on ERAS to 40 places. It feels like I've pretty much gone down the path and can't turn around at this point. Can't take a year off or add an extra year.

Maybe I'm just being my naturally anxious self, but does has anyone felt like this before? Is this just cold feet or did I actually make a mistake? As always, you guys are a big support. Thanks

No one can tell you if you made a mistake, but it would help if you discussed what you like about surgery, what you hated about it, what you like about EM, what you hate about it, etc. Maybe you made the wrong choice, but I have seen a lot more people switch out of surgery into EM than vice versa. Not sure that means anything to you, but at a minimum it means EM is a more tolerable residency. Most of your career, however, will be as an attending, so it is not a good idea to determine your career choice based on what residency is like. At the end of the day, since no one can tell what you are thinking, worried about, feeling, etc, it is hard to give useful advice. Good luck!

 

[gro2001]

Anyone ever second guess their choice in EM (or any specialty for that matter)? I guess I'd put myself into the category of people who overanalyzes everything, but before med school and throughout the first half of med school, I thought I was going to be a surgeon. When I finally went through the clerkship last year, I don't think I had a good experience: never felt like I was doing anything, so it's easy to dislike something and be bored when you're not really involved. And I feel like I was at one of the more malignant sites we have where residents are stressed through the roof and not really interested in med students (not that many are! haha).

So after that clerkship, I found myself pursuing EM because I already had connections in the field and things just kind of fell into place. I did my home sub I and it was ok, but it didn't wow me or give me that epiphany that if I can't do this I don't want to be a doctor type thing. I had more fun at my away rotation, but again it was just more comfortable than enjoyment I guess. Now looking back I'm wondering if I just took the path of least resistance and went into the field where things just lined up. I've already gotten 2 SLOE's and a non EM letter and submitted my app on ERAS to 40 places. It feels like I've pretty much gone down the path and can't turn around at this point. Can't take a year off or add an extra year.

Maybe I'm just being my naturally anxious self, but does has anyone felt like this before? Is this just cold feet or did I actually make a mistake? As always, you guys are a big support. Thanks

A little anxiety/buyer's remorse is normal around this time of year. Also right around the time of the ROL submission deadline.

There is really no way to tell from the information you've posted whether you rushed into EM or not. At least not without a much more detailed discussion of what exactly you liked/did not like about EM and surgery. Even then, it might be impossible to tell. It is a little concerning to hear that you seem to not have done the appropriate amount of introspection though.

If you do realize EM is not for you, I do want to impress upon you that you should never feel like there is no way out. Sure, things become harder to turn around the later in the process you are, but they are never impossible. People even switch mid career.

I would offer you a bit of unorthodox advice: apply to a few prelim surgery spots and do a surgery elective ASAP. But don't do a cush surgery elective. Do something like a general surgery sub internship at a place that works their SubI's. If you come to the conclusion you are a surgeon at heart after all, this will give you a chance to match as a prelim into surgery, do an awesome job in intern year, and hopefully stay on for a categorical spot next year. If you realize that you don't like surgery, all you've sacrificed is a few weeks extra work and a bit more money for the application.

 

[TheComebacKid]

I was in a similar boat. Was going to do surgery up until August of my 4th year, when I switched out at the last minute.

It is hard to overstate the amount of questioning I had regarding whether or not I made the right choice. There are times, even in residency, when I have said to myself, "I should've done surgery, EM sucks"

As already stated above, you can't really get a sense of what you want to do based solely on your residency experience. Residency is challenging across the board, and not really indicative of what your life and experience will be like as an attending.

 

[emletters]

I really appreciate all the honesty guys. I know it's tough to give advice on stuff like this.

As one of you already mentioned, I'm not great at introspection. Sitting here trying to make pros/cons for both, what I can come up with is in EM the people in general seem to be a bit nicer and easier for me to get along with. But I'm sure this is absolutely location dependent. The hours of EM are less but as I've gone through two rotations now, I can see how the recovery period and the randomness of it can negate that. Cons for EM is the fact that while I've had some really great shifts, I'm worried this might be more due to me just feeling like I impressed attendings or made a good impression for the goal of just getting into the field, not necessarily that I enjoyed the work. Mind you, I don't hate it, just don't love it.

For surgery, it really is just more of a feeling, as cheesy as that sounds. It's hard to separate whether or not it's surgery itself I enjoy, or just the idea of it (I'm aware of how important making the distinction is). I like being a consultant rather than consulting a ton of other specialties. It really does just come down to that feeling I can't shake. Sorry I can't be more specific.

I know someone said it's not too late, but it is more difficult now. I just don't know if I have enough to go on to make such a monumental shift. But I don't want to always be looking back with that twinge of regret, ya know? If this is frustrating for people to read (why can't he just make up his mind????), it's 100x worse dealing with the conflict in my head. You guys are great, thanks again.

 

[EMregrets]

I really appreciate all the honesty guys. I know it's tough to give advice on stuff like this.

As one of you already mentioned, I'm not great at introspection. Sitting here trying to make pros/cons for both, what I can come up with is in EM the people in general seem to be a bit nicer and easier for me to get along with. But I'm sure this is absolutely location dependent. The hours of EM are less but as I've gone through two rotations now, I can see how the recovery period and the randomness of it can negate that. Cons for EM is the fact that while I've had some really great shifts, I'm worried this might be more due to me just feeling like I impressed attendings or made a good impression for the goal of just getting into the field, not necessarily that I enjoyed the work. Mind you, I don't hate it, just don't love it.

For surgery, it really is just more of a feeling, as cheesy as that sounds. It's hard to separate whether or not it's surgery itself I enjoy, or just the idea of it (I'm aware of how important making the distinction is). I like being a consultant rather than consulting a ton of other specialties. It really does just come down to that feeling I can't shake. Sorry I can't be more specific.

I know someone said it's not too late, but it is more difficult now. I just don't know if I have enough to go on to make such a monumental shift. But I don't want to always be looking back with that twinge of regret, ya know? If this is frustrating for people to read (why can't he just make up his mind????), it's 100x worse dealing with the conflict in my head. You guys are great, thanks again.

Lots of good advice above. Totally understand where you're coming from. I'm a current PGY-2 in EM. Late in 3rd year, I was set to apply to a surgical sub but enjoyed my EM rotation too. Since I was undecided, I considered my options and I went with the specialty with the shorter, more tolerable residency versus a much longer, more brutal residency. At the time I also thought I liked the idea of being a generalist with a broad knowledge base. Now I'm convinced I made the wrong choice and should have gone into surgery. But this isn't about me...just saying I understand the indecision.

My advice is not to discount "that feeling" about surgery that you mention. If you're not enjoying the day to day work of EM, that's a red flag. Definitely try to do a surgery rotation to get a better idea of what you want. If you want surgery, you have to be pretty certain in order to survive residency. Surgery has plenty of negatives, but so does EM. And many of those negatives did not become as apparent to me until I was in residency. As a student, you're shielded from (at least I was) some of the rougher aspects of EM: difficult patients/consultants, having to consult so many people and cater to them, having to see whatever walks in the door no matter how ridiculous, weird schedule, metrics, etc. EM also has great variety, the occasional sick patient where you make a difference, more flexible schedule, etc. so I don't want it to seem like I'm only focusing on the negatives. After some more thought and experiences, you may decide that EM is for you.

It may be difficult, but try to envision what kind of attending life you want because residency is a temporary, albeit difficult, state. Switching is tougher at this point (something else I can relate to) but not impossible. Good luck!

 

[thegenius]

I struggled with the decision during M4. Have, in general, no regrets now.
I began medical school thinking I would be an EM doc, as I just spent 1.5 years volunteering at SF General in their ER.
During medical school I quickly liked other areas like Orthopedics, Surgery, frankly I liked many of my rotations. I even liked Psych!

Decided I didn't want to do Surgery as they work too hard, the residency was too hard and I was already in my early 30s.
Decided against Orthopedics...after I got to know it more, I found it very dull.

I chose between IM and EM and it was rather last minute. Choose EM because I couldn't see myself sitting behind a desk. The single best thing about EM is you get to diagnose (with much more certainty) than any other profession. And the second best thing about EM is the gratitude / the satisfaction / the high you feel when you truly save someone's life.

The lows of being an EM is the inability to fire patients. You have to see them every single time they come in. It might seem straight forward to give them a medical screening exam and then just discharge them, but patients and doctors alike believe that ER is the last place to go to fix your problem. They won't leave. They will write bad things about you. They will yell at you. Now some of this happens in clinics, but you can boot them out. So people expect a tremendous amount going to the ER. I guess another way to phrase this is patients don't understand our training and how we think. I often wonder if there should be a national advertising campaign sponsored by ACEP or ABEM telling people what to expect and the purpose of going to an ER.

 

[thegenius]

My advice is not to discount "that feeling" about surgery that you mention. If you're not enjoying the day to day work of EM, that's a red flag.

One of my friends switched to CT surgery after his first year in EM. Never looked back and was quite happy with the decision.

 

[emletters]

Hearing that I'm not the only one to experience this situation, and reading perspectives on both sides, it really helps to not feel so lost and hopeless. Can't thank yall enough. For there to even be a decision to be made, I have to make sure it's possible that both avenues are still open. If I was somehow able to switch the medicine sub I that starts in a couple of weeks for a gen surg sub I, would getting a letter or two from this in the middle of November while simultaneously adding programs on ERAS around that time be feasible? Typing this out I feel like I have my answer, but just trying to prepare myself as best I can and work with what I've got.

 

[Cute_Boy_4_u_69]

depends how comfortable you are with risking your license for / being replaced by midlevels

if ur cool with it EM is good

 

[Groove]

You are all over the place and beyond vague in your ability to be more specific about your disillusionment. This makes it impossible to provide you any useful advice. What I can say is this....Inability to list any more reasons than you have for pursuing EM is a red flag. I mean, you list things such as "path of least resistance", "the people are nice", "things fell into place", etc.. These are intangibles. Even your reasons to be attracted to surgery are vague. I'm not convinced you need to do either. You've got some real soul searching to do. Why not do a categorical IM residency where you've got tremendous variety within fellowship options. That would give you much more time during residency to really figure out what type of medicine that you enjoy.

Look, people either love EM or hate it. There are very few in between. In fact, the "in between" med students who try to rationalize themselves into wanting EM do themselves a real disservice in the end because they lack any real passion or genuine interest in the specialty. These are the docs who are most prone to burn out as they are thrust into a high stress specialty that they never really loved. Sure, I get burned out some months and have my moments of "grass is greener" envy among other specialists but when it really comes down to it....I still really enjoy this field and wouldn't want to do anything else.

If you end up choosing EM, it saddens me knowing that you'll be taking a spot in your ambivalence from perhaps a less competitive applicant, but one who loves EM and has sacrificed everything to match into this specialty only to be denied and forced to scramble or match into something else because someone like you took their place.

Good luck to you, but if "that's all you got" for why you're considering EM, you don't belong in the field. I don't mean to be harsh, but I think you need brutal honesty.

 

[emletters]

I appreciate your candor, and I apologize for not listing out better reasons in the argument for and against each.
EM:
+undifferentiated pt
+shorter residency (and fellowship)
+More flexible hours
+the PEOPLE (yes, this is important to me)

-Constant consulting/coordinating
-Seems like 75% of pts seen should have gone to UC or PCP
-Midlevel creep

Surgery:
+Gut Feeling (people having been relying on theirs for a while)
+Long but more predictable hours
+Definitive action being carried out

-People more likely to be malignant
-Longer training

The things you quoted as my reasons for wanting EM are not my reasons; I said those as examples as why I was unsure if it really was what I wanted.

I know people want to those choosing a field to absolutely love it, to vow to quit practicing medicine if they can't have their spot in that field. And I'm sure there are a lot of people like that. It's great and they make the field that much better. But I'm going to venture a very naive 4th year med student guess that the majority aren't like that-they found the specialty more interesting than the others, that it "felt" like a better fit for them, and they could see themselves enjoying enough aspects of the work to keep them happy over the course of their career. But most people don't treat their specialty choice like a lust filled rollercoaster of a high school romance where if they can't have their specialty, they'll hide in their room in bed like it's the end of the world.

I'm sorry if you feel like I'm taking away a spot to someone who deserves it more than me, but telling me to go to IM so I have more time to figure out what I enjoy seems a bit hypocritical- wouldn't I be taking a spot from someone who knows they want IM?

With all that said though, I do really still appreciate you, as a busy physician, taking time out of your day (or night) to advise confused students. It really is a great thing yall do.

 

[TheComebacKid]

If you end up choosing EM, it saddens me knowing that you'll be taking a spot in your ambivalence from perhaps a less competitive applicant, but one who loves EM and has sacrificed everything to match into this specialty only to be denied and forced to scramble or match into something else because someone like you took their place.

Good luck to you, but if "that's all you got" for why you're considering EM, you don't belong in the field. I don't mean to be harsh, but I think you need brutal honesty.

Sorry, but I pretty much disagree with much of what you said in your post. Maybe you didn't do it intentionally, but in essence if I was in the OP shoes and I was reading this I would feel really bad after reading your comments. Do you not think the OP has thought this through? Sometimes you can spend all your time searching for an answer, for that one specialty that checks all the boxes, but for many individuals, that specialty does not exist. I was one of those people.

EM has TONS of downsides. I don't believe this idea that people either love EM or hate it. It is not black and white. People like many parts of EM, and hate others. That goes for every specialty. Maybe you were one of the lucky ones that loved every aspect of EM, but I can tell you for the vast majority of people in any given specialty, there will be aspects of the job that you flat out detest and make you question your decision.

Did I absolutely love EM when I applied? Was I head over heels, gung-ho and pot committed? Absolutely not. To be honest, it was the specialty that I hated the least, which is I why I chose it. Now when I go to work, it's fine, I enjoy it some days, I don't like it other days. But that's every single job. I would say overall on most days I like it more than I hate it, but I don't think I took away spots from other applicants. Overall, in spite of the problems with EM, it is still the best possible choice for me out of all the other options out there.

To the OP, you don't have to LOVE every aspect of EM. You have to love some things and be able to tolerate others, and accept that you will hate some other things. That's the reality of the job.

 

[emletters]

Sorry, but I pretty much disagree with much of what you said in your post. Maybe you didn't do it intentionally, but in essence if I was in the OP shoes and I was reading this I would feel really bad after reading your comments. Do you not think the OP has thought this through? Sometimes you can spend all your time searching for an answer, for that one specialty that checks all the boxes, but for many individuals, that specialty does not exist. I was one of those people.

EM has TONS of downsides. I don't believe this idea that people either love EM or hate it. It is not black and white. People like many parts of EM, and hate others. That goes for every specialty. Maybe you were one of the lucky ones that loved every aspect of EM, but I can tell you for the vast majority of people in any given specialty, there will be aspects of the job that you flat out detest and make you question your decision.

Did I absolutely love EM when I applied? Was I head over heels, gung-ho and pot committed? Absolutely not. To be honest, it was the specialty that I hated the least, which is I why I chose it. Now when I go to work, it's fine, I enjoy it some days, I don't like it other days. But that's every single job. I would say overall on most days I like it more than I hate it, but I don't think I took away spots from other applicants. Overall, in spite of the problems with EM, it is still the best possible choice for me out of all the other options out there.

To the OP, you don't have to LOVE every aspect of EM. You have to love some things and be able to tolerate others, and accept that you will hate some other things. That's the reality of the job.

You really summed up how I've been feeling about it and I can't tell you how great it is to have it right in front of me like this. I clearly have a lot to think about, but thanks so so much

 

[Perrin]

I appreciate your candor, and I apologize for not listing out better reasons in the argument for and against each.
EM:
+undifferentiated pt
+shorter residency (and fellowship)
+More flexible hours
+the PEOPLE (yes, this is important to me)

-Constant consulting/coordinating
-Seems like 75% of pts seen should have gone to UC or PCP
-Midlevel creep

I say this in a helpful approach. Your list of positives for EM only has 1 point that applies to the practice of EM, the undifferentiated pt. Doing a residency that's 2 years shorter is going to matter nothing when you're practicing 10 years out and miserable. The ED is open 24 hours. Our shifts may be shorter, but their flexibility is questionable. You are going to have a hard time getting someone to pick up your night, weekend, holiday, short notice shift. You might say we have better set shifts because we don't have call, but the hours can suck b/c 24/7. "The people", is too subjective. One ED may have sarcastic gallows humor staff and another uptight JCAHO patsies.

What do you like about the practice of emergency medicine? The actual medicine. Schedules can be great or suck. Staff can rock or suck. Consultants can be helpful or suck. Residency will suck whether 3 or 7 years.

Expound more on this undifferentiated patient. What about them is a positive to you? Is it the first contact? The calming assurance you can provide? The testing that confirms/excludes a problem? The procedure that resolves the problem or helps diagnose it? Determining the disposition and coordinating which specialists to involve in their care? Handling socioeconomic aspects of their care? Treating the acutely ill with little to no information? This order of questions is the general likelihood of which they will happen.

I wish you the best of luck.

 

[Brigade4Radiant]

Also keep in mind that based on your location there may be many different gigs in EM you can be a travel doc making $$ working 11 shifts a month or work part-time in two locations and have more control of your schedule

 

[Groove]

To be honest, it was the specialty that I hated the least, which is I why I chose it.

I think that's a miserable way to choose a specialty. Hating something the least? LOL, good grief man... I suppose if I found myself feeling that way about most specialties, I would have questioned why I pursued medicine at all. Regardless, I can't identify with that. I honestly enjoyed most specialties in med school, even psych (except medicine wards, I did hate that...). I just happened to really dig EM. Not only did I enjoy most things about it but I felt like it was the right decision in the center of my being. I enjoyed getting first crack at diagnosing the undifferentiated pt, I enjoyed relatively quick and uncomplicated procedures followed by instant gratification without having to spend hours hunched over an OR table. I loved the medical variety. I loved everything airway, but didn't want to be stuck behind a drape listening to a surgeon tell me to change table positions for hours on end. I loved ICU critical care management but didn't want to BE in the ICU. I loved reducing shoulders, hips and fractures but didn't want to be an orthopedic surgeon. I found the crazies both annoying and utterly hilarious at the same time. I loved coming to a shift and not knowing what was around the corner and the intense rush of having to make multiple split second decisions under pressure with limited information while juggling multiple patients. I enjoyed codes. It was an ADHD/OCD (not formally diagnosed brains' wet dream. I liked the consultant discussions AND I liked arguing with consultants at the same time. In a twisted way, I loved the chess match of coercing and forcing admissions against unwilling hospitalists. Outmaneuvering them on the phone and outwitting them in regards to patient management. I loved "fixing" and "diagnosing" patients and then handing them over to someone else to worry about within a few hours time. I loved the camaraderie; I loved the people. Most of all? I loved walking out the ambulance bay and leaving work completely behind until the next shift. No pager to worry about, no 3a.m. unexpected phone calls... The tremendous compensation potential and mobility of the specialty were unexpected pluses that I didn't particularly anticipate at the time but came to appreciate later.

Do I still get that excited about EM or feel all of those things in the same way? Of course not, try doing anything for 10 years and see how you feel about it. But that's the level of excitement, passion and level of articulation someone needs in order to confidently choose a specialty in my opinion. I just simply can't relate to some of you that really struggle to describe why you even enjoy the specialty, much less why you chose medicine altogether. Hating something the least? Ugh. If that's how some of you feel about EM then God help you. That's how I felt working in the computer industry before jumping into medicine mid career. That just sounds depressing to me but to each his own!

OP, it's nothing personal, I'm just telling you what I think you need to hear. Good luck in choosing what's right for you. I just don't personally think that happens to be EM unless some of my reasons resonated with you.

 

[TheComebacKid]

But that's the level of excitement, passion and level of articulation someone needs in order to confidently choose a specialty in my opinion. I just simply can't relate to some of you that really struggle to describe why you even enjoy the specialty, much less why you chose medicine altogether. Hating something the least? Ugh. If that's how some of you feel about EM then God help you. That's how I felt working in the computer industry before jumping into medicine mid career. That just sounds depressing to me but to each his own!

I am very grateful that there are people in our specialty such as yourself who have a passion for the work to this degree. Your enthusiasm is really what makes our specialty great and will continue to make it be great in the future.

That being said, I think your attitude is not necessarily within the norms of how people feel about EM. Yes, there are things we all love about it, but most people despise certain things: the drug seekers, the metrics/billing, the PPH/RVU numbers, the liability of signing midlevel charts, etc. etc. Are these "deal breakers"? For some people, yes they are. For others, it's a matter of how much of this you can tolerate. This is the real world.

You do realize that not everyone gets off on arguing with consultants/hospitalists, right? I would put you in the minority when it comes to that. Again, more power to you for having that mindset.

I would argue that people who have an understanding of the downfalls of EM are LESS likely to burnout in the long term. People who have the attitude of, "it's always crashing lines and bringing back people from the dead, I am the jack of all trades and I am THE go to guy" are the ones who are more likely to burnout when they realize that's not the real world.

EM is a job. It pays the bills. Some days the job is great. Some days it sucks. We are fortunate to get to do this work and impact patient's lives in the manner that we do, but at the end of the day, everyone in the hospital has a job to do. Much of what we do is not so glamorous. And much of what we do is "putting up with XYZ" so we get to do the stuff we truly like.

 

[Groove]

I hear you... I also certainly don't want to insinuate I feel the same way today that I did as a med student, I was merely giving an example of a few of the reasons I pursued EM in the beginning. I'm just as prone to burnout as the rest of you and even last year went through some fairly intense feelings of fatigue and despair. I even considered other fellowships. Luckily for me, anytime I start to feel that way...it's almost always due to working too many hours. Still...for myself, when I put myself back...it's easy for me to tap into the emotions and reasoning that went in to choosing EM though I realize it's not the same for all of you. I just imagine it would be a miserable specialty for people that really never enjoyed too many aspects of it. I also have a different perspective of medicine when coming from the corporate world. Anything is better than that soul sucking 9-5, M-F, counting down the days until the weekend, inundated with corporate memos, "cog in the wheel" grind. God, that was terrible. My worst days in EM do nothing to compare to how miserable my life was when living in a cubicle/office.

 

[TrailRun]

Thought I'd reply to share some thoughts, since I was in a similar position to you.

I grew up thinking about EM. In fact, I grew up watching "ER" and actually recall as a kid thinking I could relate more to Dr. Green and Carter than Benson...

But I was conflicted in med school, for 2 key reasons.
1. EM is **** on by everyone; on my surgery rotation, medicine rotation, in lectures, etc.
2. I thought surgeons "do everything other doctors do AND operate."

So I picked surgery. And did an intern year. But realized fairly quickly I didn't LOVE the OR. Especially during lengthy transplant surgeries that my other colleagues either loved or were like 'yeah, they're long, but it's great anatomy.' And there wasn't much 'thinking' involved, especially as an intern. And really for me it lost its shine very quickly; as people say, the first appy was awesome, the second pretty good, the third ok... So I reapplied and redid the match and the whole thing.

And now am in EM. And overall I think it's a better fit. But at least a few times a week, while I'm getting crushed in the ER, I wonder what it would have been like to have stayed in surgery. I could do a case, have a little down time after to chat with my coresidents, and do another case, etc while the intern runs around and handles the floor and the 2nd year manages consults. And now in EM when I'm on ICU rotations and they insist on paging anesthesia to intubate, cards to float the pacer, etc, things within the scope of practice of EM that I should be doing. But that's the way it is, "no respect." For surgery, the lifestyle gets better as you progress in residency. And the OR is quiet and calm and you can focus on a single task and do a good job, unlike the ER where things are flying at you from every direction and you often can feel overwhelmed and that you're not providing optimal care (which medicine and other specialties will echo). For EM, you work less shifts as an attending so the lifestyle seems to get better in that way but in many ways stays the same.

My advice is that you have to LOVE the OR to do surgery. Otherwise the rest of it isn't worth it. There was never a day where I would rather stay "for an interesting case" than go home. Also, overall it's a weird path because if you stay academic for example then you operate minimally (since you're supposed to walk the residents through the case). Ultimately I think most of us could be satisfied in multiple specialities. The benefit to EM is that you're done faster, make the same $, and have more schedule flexibility. The downsides are you will more work nights and weekends overall than you would in surgery. EM has a lot of fellowship options (most which unfortunately don't pay more or give you a much better schedule), but hopefully you can find something that fits. There's someone on this board who does Pain so maybe that could be your procedural niche. But it would be nice to have something in between EM and surgery, like Pulm crit where they can do ICU and also do bronchs, clinic, etc.

I realize this was a bit back-and-forth. I don't have the answers but I empathize with your questions

 

[emletters]

Ultimately I think most of us could be satisfied in multiple specialities.

This. And I definitely agree with enjoying surgery enough to want to stay later, and deal with all the other stuff so you can get in the OR. It has been a while since my surgery rotation, so I really think I need to figure out if I'm in love with the dream or the field. I'm going to try to see if I can spend a couple of my off days on a service. I know this isn't the same as a full rotation, but at least I'll have something to compare to EM now that I'm just coming off of that rotation.

And ComebackKid, you put my thoughts into words so many times. Made me feel less alone in this super stressful time, so I'm really grateful to have your imput. Thanks to everyone who responded, really do appreciate it.

 

[TheComebacKid]

1. EM is **** on by everyone; on my surgery rotation, medicine rotation, in lectures, etc.

And now in EM when I'm on ICU rotations and they insist on paging anesthesia to intubate, cards to float the pacer, etc, things within the scope of practice of EM that I should be doing. But that's the way it is, "no respect."

I just wanted to touch upon these two points as they discuss the idea of "respect", which I considered to have definitely entered my mind when choosing specialties.

Your view of EM getting S*** on by other specialties really only falls within academic circles and ivory towers. When you look at where 80% of EM docs practice, where you are the only doc around, EM is a commodity that many other specialists can't live without. If EM docs were so worthless, why would they be compensated roughly the same amount as a surgeon for working a fraction of the hours?

I was very much torn between surgery and EM as well. I remember as a third year medical student doing a cardiothoracic surgery rotation. The attending was about to cannulate the aorta and put the patient on pump when he just asked me casually what specialty I was interested in. I said EM was on my radar. His response was, "I see. So you want to be a triage nurse for the rest of your life? Whatever floats your boat"

I realize now in emergency medicine how far that was from the truth. First, many of the individuals (like this attending) who crap on EM are just horrible people to begin with. But secondly, as an EM resident I get to work closely with these other consulting services in the ED, and I see how clueless so many of them are. How dare a trauma surgeon question my skills as a physician, when their go to for literally everything in medicine is a pan scan? I watch surgeons freak out in traumas all the time because the truth is, they don't know how to feel comfortable anywhere outside of the OR. In the ED, this is my house, and I am in my zone here.

This is not to talk badly about your former colleagues, but I can't help but think of how bad some of our consultants are at things that we do well everyday. Many of them are amazing at what they do, but many of them are also horribly insecure as individuals which is why they feel the need to S*** on the ED.

As I have gone on in my training and gotten more comfortable with skills, it's more apparent to me how good we are. As an intern, these battles with surgery used to erode at my pride, but it's clear to me more and more that EM has a lot to offer.

 

[scummie]

I almost switched out the last second for a surgery spot that would be close to home. Looking back, thank God I didn't do it. Once I started residency, I was really happy. I was definitely that resident that would go hang out in the ED during other rotations just to be there. I have friends in surgical programs who are still residents and I gotta say, it feels good to be done. Only do surgery if you think there is nothing else in life that will make you happy or you will have regrets. For what it's worth, one of the surgery residents switched out into EM. The dark side is very nice.

When it's 5 AM, I am home, asleep, not rounding on patients, checking drains, asking them if they pooped. Instead, I'm at home, doing whatever I want to do on my time off, wondering what kind of weird crap I'll see during my next shift.