Confused about ER residency

[Howard7]

Why do so many ER residents switch ou of ExR for Psychiatry. Are theses residents forced out do to bad performance, lazy residents looking for greeener pastures or is the lifestyle of ER physicians just plain rough. Any thoughts ir anecdotes from personal experience.

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[tkim]

You seem confused.

 

[Haemr Head]

In the programs I've been associated with, I've known of 3 residents to make this choice out of more than 300. Two switched to psychiatry during their internship because they quickly discovered they were struggling and not happy with the fast pace and multi-tasking of emergency medicine. One very talented fellow graduated from the EM residency, spent time as an academic ED attending, then went back and trainined in anesthesia, and then afterwards trained again in psychiatry reportedly because he had developed MS. Hardly run of the mill.

So this informal personal study suggests that the conversion rate from ED to psychiatry is roughly around 1%. I've seen equal rates of people leaving ED to move to radiology and anesthesia. The far more common pathway is from surgery and medicine into emergency medicine, which I would guess is easily >10% of EM residents.

With the exception of people who start EM and quickly discover their mistake, the vast majority of residency trained emergency physicians are very happy with their career choice. The veteran EM physicians I know would only switch to psych as a way to get cheap care for treating personal psychopathology. Like the delusion that it would be more fun to be a psychiatrist.

 

[Jeff698]

You seem confused.

Conflicted, perhaps?

Take care,
Jeff

 

[docB]

I've never heard of anyone switching out of EM for Psych. That doesn't mean it doesn't happen, it does mean it's very rare. I think your supposition that "so many" EM residents move to Psych is inaccurate.

 

[EctopicFetus]

I've never heard of anyone switching out of EM for Psych. That doesn't mean it doesn't happen, it does mean it's very rare. I think your supposition that "so many" EM residents move to Psych is inaccurate.

I actually know of someone who did this. He was a psych resident when I was an EM resident. I def wouldnt call it common. I know of a guy left EM to do Gas. We didnt have a single resident leave in the 3 years I was a resident and no one is leaving this yr either. Take that for what its worth.

 

[docB]

I actually know of someone who did this. He was a psych resident when I was an EM resident. I def wouldnt call it common. I know of a guy left EM to do Gas. We didnt have a single resident leave in the 3 years I was a resident and no one is leaving this yr either. Take that for what its worth.

Oh I know people leave EM for other things. I still think it's uncommon. It's more uncommon for EM residents to bail out than for many other specialties and I'd say it's a small minority across the board in all residencies let alone headed to psych. As for EM residents leaving for psych I noted that it does happen but it definitely doesn't represent a wave of people or "so many" as the OP suggested.

 

[docB]

On a different note that might be more helpful to the OP I could see someone who got into EM switching to psych once they realized how many ER patients have underlying psychopathology and that treating the medical end of things is only half the battle. I could see that driving someone who is interested in helping those patients into psych.

That said the personalities required for EM and psych are pretty different. Most people that could do psych don't even consider EM and most people who are in EM could never do psych (I sure couldn't) which probably explains the rarity of the aforementioned switches.

 

[enfuegoEP]

That said the personalities required for EM and psych are pretty different. Most people that could do psych don't even consider EM and most people who are in EM could never do psych (I sure couldn't) which probably explains the rarity of the aforementioned switches.

Agree 100%

 

[EctopicFetus]

Agree 100%

me too! Psych isnt for me.. EM is!

 

[Venko]

Interesting question, as I have not met anyone who left Emergency Medicine for Psychiatry, but I have a unique view in that I was formerly a Psychiatry resident and am now an Emergency Medicine resident.

I have been succesfull in both specialties, but made the switch into Emergency Medicine to be able to add variety to my practice, offer definitive care for some people, interface with many different specialties easily, and many other reasons. With this said, the skills that I possess from psychiatry have been extremely useful in the Emergency Department as well. Conflict management, trying to streamline a history to acquire the most salient features, working with a team of specialists to accomplish a single goal, etc (essentially, both fields are about communication).

Emergency medicine is the interface between so many specialties including to a large degree psychiatry.

 

[deleted109597]

..., trying to streamline a history to acquire the most salient features...

Not that you don't, but this is the biggest reason psych left a bad taste in my mouth from my medical school. You see, regardless of why they came, from full on schizophrenia to simple, uncomplicated substance abuse, we were required to perform a 30 minute interview, with each part of it having a defined time frame. So there were at least 2 occasions where I had to spend a half hour with someone who wouldn't respond to questions verbally or physically as they were catatonic, and others where you would ask one question only to have them speak for a half hour, ignoring any redirection.
I always hated that.

 

[Venko]

I cannot speak to the details of your medical student rotation, but in practice, the psychiatric interview is a very artful and trust me skillful thing when performed by leader in the field. It takes great talent extract an essential history from those who struggle to provide it...I can see how time expectations can leave a bad taste, but my point is that the skill acquired from performing a high quality, efficient, psychiatric interview makes interviewing a person for chest pain who wants to tell you everything very easy.

 

[Jeff698]

...I could see someone who got into EM switching to psych once they realized how many ER patients have underlying psychopathology ...

Hell, if this was enough reason to switch, I would have become a social worker since that seems to be what so many of my patients really need.

Take care,
Jeff

 

[enfuegoEP]

Not that you don't, but this is the biggest reason psych left a bad taste in my mouth from my medical school. You see, regardless of why they came, from full on schizophrenia to simple, uncomplicated substance abuse, we were required to perform a 30 minute interview, with each part of it having a defined time frame. So there were at least 2 occasions where I had to spend a half hour with someone who wouldn't respond to questions verbally or physically as they were catatonic, and others where you would ask one question only to have them speak for a half hour, ignoring any redirection.
I always hated that.

Can I get an AMEN...

 

[howelljolly]

Why do so many ER residents switch ou of ExR for Psychiatry. Are theses residents forced out do to bad performance, lazy residents looking for greeener pastures or is the lifestyle of ER physicians just plain rough. Any thoughts ir anecdotes from personal experience.

due to bad performance