Damn this is tough!!!

[tjmDO]

Well here I sit, a new fourth year student who at the moment is 100% dead locked between Surgery and Emergency medicine. I was a paramedic for 5 years prior to medical school and therefore love EM, but during my surgery rotations I have fallen in love again with as much passion. How do I make a choice? How do you choose between your wife and your girlfriend if you love them both the same? So here is what I have dug up. EM spends on average about 40hrs/wk in pt care, surgery 60/wk. Ave salary for EM is roughly 220-250K, surgery is approx 250K. Ok lets not get into a pissing match about money. They both make a ****-load!! I have a wife and an 8mth old. Family is a big deal for me. No physician wants to really give you the detailed information about lifestyle or the real average salaries in medicine. They all just tell you do what you like and thats probably what most will tell me here. And by the way that line is a crock of crap because there are more than a few people who are hung up on choosing between more than one specialty. So I am looking to you surgeons out there to help me out with some much needed information, honest info!! Can I have a life outside of surgery to spend time on vacation with my wife and son while still making $250,000+/year? That is the dinger!! And don't forget I love both specialties the same!! Kind of like having to kids, you love them both equally.

Thanks

tjmdo

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[Seaglass]

How do you choose between your wife and your girlfriend if you love them both the same?

You already married your wife.

 

[GiJoe]

Well here I sit, a new fourth year student who at the moment is 100% dead locked between Surgery and Emergency medicine. I was a paramedic for 5 years prior to medical school and therefore love EM, but during my surgery rotations I have fallen in love again with as much passion. How do I make a choice? How do you choose between your wife and your girlfriend if you love them both the same? So here is what I have dug up. EM spends on average about 40hrs/wk in pt care, surgery 60/wk. Ave salary for EM is roughly 220-250K, surgery is approx 250K. Ok lets not get into a pissing match about money. They both make a ****-load!! I have a wife and an 8mth old. Family is a big deal for me. No physician wants to really give you the detailed information about lifestyle or the real average salaries in medicine. They all just tell you do what you like and thats probably what most will tell me here. And by the way that line is a crock of crap because there are more than a few people who are hung up on choosing between more than one specialty. So I am looking to you surgeons out there to help me out with some much needed information, honest info!! Can I have a life outside of surgery to spend time on vacation with my wife and son while still making $250,000+/year? That is the dinger!! And don't forget I love both specialties the same!! Kind of like having to kids, you love them both equally.

Thanks

tjmdo

Based on the surgeons I have worked with, I think surgeons tend to have a more stable and less taxing schedule after residency. And if you practice in a pretty developed group, call is almost never a problem ER docs on the other hand rotate a lot through days and nights during residency and afterwards...so there may be many times you may not be there on Christmas, thanksgiving, easter, or for your kid's soft ball game.

its a tough decision, but it sounds like to me you might lean towards surgery

Plus, the gen surg. that i've worked with make well over 250K

 

[Coach]

How do you choose between your wife and your girlfriend if you love them both the same?

Find a different girl that is hotter than either of them

 

[FoughtFyr]

And if you practice in a pretty developed group, call is almost never a problem ER docs on the other hand rotate a lot through days and nights during residency and afterwards...so there may be many times you may not be there on Christmas, thanksgiving, easter, or for your kid's soft ball game.

What are you smoking and why aren't you sharing!?! Call not a problem for surgeons? Who do you think we call to fix these SBOs or pull the hot appendixes in the middle of the night? To maintain OR rights in a hospital almost all surgeons MUST take call. The difference to me is that my shift is 8 hours long, so other than the "kid's soft ball game", I am around at least part of the day for every event you listed above. The surgeon, yeah, not so much. If the case comes in, it comes in. If it takes 12+ hours or if you get called in more than once... oh well. But hey GiJoe, you head off for surgery... we'll miss you!

And how do you get less taxing than 12 12-hour shifts a month for 300K a year plus benefits? That is the contract one of our seniors just signed in a 50K visit community ED with a democratic group, full partner in five years. Great payer mix in an affluent area. Life simply doesn't get better than that!

BTW - nights works great for my wife and I. I get home from work at 7:15, kiss her good-bye on her way to work. She works all day while I sleep. I get up when she comes home, and we hang out until she goes to bed. Then I go to work. Rinse, lather, repeat. I see her a ton. When we have kids, it will work the same, only the kids will be in school while I'm sleeping. Big Deal. Plus, the pay differential for "nights only" in many community EM groups is HUGE!

- H

 

[GiJoe]

What are you smoking and why aren't you sharing!?! Call not a problem for surgeons? Who do you think we call to fix these SBOs or pull the hot appendixes in the middle of the night? To maintain OR rights in a hospital almost all surgeons MUST take call. The difference to me is that my shift is 8 hours long, so other than the "kid's soft ball game", I am around at least part of the day for every event you listed above. The surgeon, yeah, not so much. If the case comes in, it comes in. If it takes 12+ hours or if you get called in more than once... oh well. But hey GiJoe, you head off for surgery... we'll miss you!

And how do you get less taxing than 12 12-hour shifts a month for 300K a year plus benefits? That is the contract one of our seniors just signed in a 50K visit community ED with a democratic group, full partner in five years. Great payer mix in an affluent area. Life simply doesn't get better than that!

BTW - nights works great for my wife and I. I get home from work at 7:15, kiss her good-bye on her way to work. She works all day while I sleep. I get up when she comes home, and we hang out until she goes to bed. Then I go to work. Rinse, lather, repeat. I see her a ton. When we have kids, it will work the same, only the kids will be in school while I'm sleeping. Big Deal. Plus, the pay differential for "nights only" in many community EM groups is HUGE!

- H

Just in case you missed it , the first few words of my post, said "based on the surgeons I worked with". This was my experience in ONE group of docs.... If you would take the time to fully read my post, you would realize I never said surgeons dont take call. Of course they take call. The group of surgeons I worked with is larger than most other groups and therfore call is not Q4 or some other annoying number. I was just echoing what one of the surgeons I had worked with told me and what I experienced with him. On days he wasn't on call, he would sometimes be done by lunch time and be home to pick up his kids from school. Most days, i never saw him go past 6pm.

It would be a good idea if you didn't try to imply that I'm dogging EM. I'm gung ho EM all the way (more for the quality of the specialty rather than hours). My post was intended to give an unbiased view of a certain schedule from both specialties based on MY experience. Are there groups of surgeons that have a crappy lifestyle? Hell yea there are. But there are also some ER docs with crappy contracts as well. My advice to the OP would be to choose a specialty based on the type of MD he want's to be. Surgery and EM are very different specialties and they fit different personalities. If you choose a specialty just for lifestyle and end up hating your job.....You're gonna want to kill yourself every day at work for at least the next 30+ years.

 

[AzMichelle]

Well here I sit, a new fourth year student who at the moment is 100% dead locked between Surgery and Emergency medicine. I was a paramedic for 5 years prior to medical school and therefore love EM, but during my surgery rotations I have fallen in love again with as much passion. How do I make a choice? How do you choose between your wife and your girlfriend if you love them both the same? So here is what I have dug up. EM spends on average about 40hrs/wk in pt care, surgery 60/wk. Ave salary for EM is roughly 220-250K, surgery is approx 250K. Ok lets not get into a pissing match about money. They both make a ****-load!! I have a wife and an 8mth old. Family is a big deal for me. No physician wants to really give you the detailed information about lifestyle or the real average salaries in medicine. They all just tell you do what you like and thats probably what most will tell me here. And by the way that line is a crock of crap because there are more than a few people who are hung up on choosing between more than one specialty. So I am looking to you surgeons out there to help me out with some much needed information, honest info!! Can I have a life outside of surgery to spend time on vacation with my wife and son while still making $250,000+/year? That is the dinger!! And don't forget I love both specialties the same!! Kind of like having to kids, you love them both equally.

Thanks

tjmdo

What about a trauma surgeon?

 

[Sessamoid]

What about a trauma surgeon?

Trauma surgeons get the worst of both specialties when it comes to lifestyle. They have similar rotating schedules but also have to deal with inpatients. Good and interesting work if you're cut out for it. Not sure about the burnout rate.

I knew one trauma surgeon who'd been doing it for couple decades or so. Nice guy but got amazingly burned out. I knew him towards the end of his trauma career. Ended up so burned out, he's now doing a family medicine residency (in his 50's). Quinn knows who I'm talking about.

 

[southerndoc]

It's a tough decision to make. I remember being torn between surgery and emergency medicine, but ultimately chose EM (and I'm glad I did).

What's funny is that a guy I know is now facing the same situation. It must be tough for him because everytime I joke about the other specialty he is interested in, he gets all pissed off and signs off AOL Instant Messenger. It's kind of funny. I think he identifies me as the typical emergency physician now, and he doesn't want to even consider my jokes or comments because it brings up his uncertainty with whatever career he is going to choose.

tjm, just go with whatever your heart tells you. If you make the wrong choice, you can always reapply after your internship. I have a feeling that you'll be happy with whatever you choose. Good luck!

 

[colforbinMD]

This one allways amazes me. Surgery or EM? Other then the procedural aspect I can't for the life of me see much similar about the specialties and even that is VERY different. It's like being in love with Maryanne and Ginger. (Sure that sounds fun but.....) In the end you have to realize that everyone is a Maryanne or a Ginger guy and you have to figure out which you are. Because a wise man once told me. No matter how hot she looks right now somebody, somewhere is sick of putting up with her crap. (Sorry ladies that my analogy doesn't apply to you)
This is where the old stand in advice just do what you like comes in. I know you think that advice is "a line of crap" but it's really not. You can like aspects of 2, or several, or many specialty BUT one will fit you best. That specialty is what you will do the majority of the remaining days of your life so don't sell this decision short. It takes some soul searching for many. I personally can't comprehend liking both surgery and EM with equal intensity, they are both too different. You love both your children but that's because you created them. When you babysit someone else's two kids it's easy to pick which one you like better. 3rd and 4th years you got to babysit alot of specialties. Now pick which one you wanna adopt. What bothers me is people who seem to say. I really LOVE surgery but the hours are too hard so I am picking EM. That's such a cop out and insulting to EM. There are plenty of people who want nothing but EM and we don't need the added competition for spots by people who will become disatisfied in a few years anyway. If you like surgery DO SURGERY the hours are not THAT big of a difference after residency (compared with the differences between the specialties) and that is when MOST of your life will take place AFTER residency. There are thousands of surgeons practicing today with wives and kids and they make it work because it's what they love. On the other hand.... if you really soul search and find you love EM then welcome to the club. Personally I would rather sleep with the captain and Gilligan then go into surgery. I love EM. If you switched the work patterns (hours and call) of the two specialties I would still have NO problem picking EM. Ask yourself if you switched the work patterns would you still even consider EM?

 

[RichL025]

Same boat as OP, and I agree, many people are perplexed that someone could be seriously considering _both_ fields.

I came to med school gung-ho for EM, but with a resolution to keep an open mind. During my GS clerkship, I definitely found something I could see myself doing for a living.

Maryanne or Ginger? Bullcrap - you could fall in love with either one. Or love them both - for different reasons. The things that attract me about EM are not all the same as GS - and I'm not even factoring in work hours and such - if I were going to pick a profession for work hours I woulda opted for path or derm <g> (and no offense to all those who picked one of those two because they loved it).

There are thinks I would miss if I picked either one of them - I love being in the OR, I love doing hands-on things, but I also love being somewhat of a jack-of-all trades, and managing the sick, undifferentiated patient as they come in through the door. Plus, in the military, EM would allow me to do some things that surgery wouldn't that are military-specific.

So I'm in the same boat. My official ER rotation is in September, that's when I'm going to have to make a decision.

 

[roja]

Do rotations. Its the only way to really figure it out. Also remember, since you already have a kid, residency is incredibly rough for general surgeons. and many are now specializing as well. So you have to consider if you are goign to do a fellowship as well. This puts your training at 7 years, minimum.

EM is 3 to 4 years min.

But in the end, you have to ask yourself what you want to be doing in 20 years. If you love the OR, love managing the patients post op, then surgery is for you. If you love EM- the diversity, the shift work, the pace then em is for you.

 

[la gringa]

i myself never ever considered surgery. don't see the appeal and like drkp don't see how GS vs EM is really a debate... so so radically different. then again i'm a female and tjm is a male -- funny, i have not encountered a female who's struggling between GS and EM. maybe EM and medicine, peds, family, or anesthesia.

do you want to work in the OR or not? that's the first question one of our deans of student affairs asks students having difficulty deciding between specialties -- b/c if you aren't sure you want to work in the OR (or the ED for that matter!) then for gosh sakes don't do surgery. vice versa, if you can't imagine NOT being in the OR, then EM won't do it for ya. all the money and family time or whathave you won't make you happy if you aren't where you like to be most. which people do you like better?

ps you might want to have proofread your post before you copied the same message to the EP's as the surgeons, lol...

 

[Leukocyte]

GS is not just about the OR. The OR is only part of the deal. GS include other BS that an EM doctor does not need to deal with.

-Do you want to FOLLOW patients?
-Do you want to see patients in the CLINIC?
-Do you want to ROUND on your patients in the WARDS?

The typical day of a General Surgeon has 3 main parts:

-OR
-CLINIC
-ROUND on patients in the wards

This means long and unpredictable hours.

I do not know much about EM, but I guess your day is pretty much spent working in the ER with a predictable schedule.

Just my 2 cents

Good Luck

 

[dchristismi]

I'm a female, and I struggled between EM and GS. I shadowed surgeons, went to med school gung ho to be a surgeon, and loved my surgery rotations. (I even did an extra elective in plastics.) But I found that I loved the ED even more, especially as the "newness" of the OR wore off. (about the 15th lap chole.) I think it was the combination of procedures, working with my hands, thinking on your feet, and never quite knowing what would come in next (well, more than a day or so, it seemed) that attracted me to both.

Roja speaks wisely, as always. Do the rotations and decide what you love.
Good luck,
D

 

[Celiac Plexus]

I'm a female, and I struggled between EM and GS. I shadowed surgeons, went to med school gung ho to be a surgeon, and loved my surgery rotations. (I even did an extra elective in plastics.) But I found that I loved the ED even more, especially as the "newness" of the OR wore off. (about the 15th lap chole.) I think it was the combination of procedures, working with my hands, thinking on your feet, and never quite knowing what would come in next (well, more than a day or so, it seemed) that attracted me to both.

Roja speaks wisely, as always. Do the rotations and decide what you love.
Good luck,
D

other than lines, and chest tubes, what procedures are you referring to?

this is a serious question...

 

[roja]

suturing, intubation, foriegn body removal-from all kinds of places...., reductions.....
pericardiocentesis... on and on and on...

 

[mikecwru]

suturing, intubation, foriegn body removal-from all kinds of places...., reductions.....
pericardiocentesis... on and on and on...

From our log book:

anoscopy, art lines, athrocentesis, burr holes, pacing transcutaneous/transvenous, central lines, sedations, epistaxis packing, crich, culdocentesis, deliveries, intubations, forein bodies, reductions, I&Ds, LPs, pericardiocentesis, IOs, cutdowns, DPLs, ultrasound, resuscitations, slit lamp, splinting, suturing, swans, thoracentesis, chest tubes, thoracotomies, etc, etc, etc

I'm not insinuating I do surgical procedures, but we do enough hands on stuff.

mike

 

[Celiac Plexus]

From our log book:

anoscopy, art lines, athrocentesis, burr holes, pacing transcutaneous/transvenous, central lines, sedations, epistaxis packing, crich, culdocentesis, deliveries, intubations, forein bodies, reductions, I&Ds, LPs, pericardiocentesis, IOs, cutdowns, DPLs, ultrasound, resuscitations, slit lamp, splinting, suturing, swans, thoracentesis, chest tubes, thoracotomies, etc, etc, etc

I'm not insinuating I do surgical procedures, but we do enough hands on stuff.

mike

yeah, ok, i get it. i wouldn't call these procedures either ("epistaxis packing" = stuffing gauze in someone's nose), but i see your point about the hands on aspect i guess.

 

[colforbinMD]

yeah, ok, i get it. i wouldn't call these procedures either ("epistaxis packing" = stuffing gauze in someone's nose), but i see your point about the hands on aspect i guess.

Wow my mind is twice blown in one thread.
Have you ever had an anxious (terrified) pt. pouring blood from kiesselbach's (sp?) so fast you can't even visualize whether it's an anterior or post. bleed? It's flowing out the front and back into their throat at an alarming rate and they are gagging, spitting, and shouting a garbled help me (en espanol no less) all at once? You give them a little IV anxiolysis just so you can try and get near them and then spend the next hour suctioning and trying different sizes of nasal packings until FINALLY one seats properly and seems to tamponade the pt. Then the true joy of EM begins and you get to go beg the ENT guys to come see the guy before your thumb in the dam fails and the bleeding starts again (anxiolyis has worn off by then of course so let's just pretend NONE of the last hour even happened and start over) = stuffing gauze in someone's nose?

EDIT Yes if the bleeding is from kiesselbach's then you know if it's ant. or post. but when they are bleeding like that all you can do is guess secondary to mechanism

 

[colforbinMD]

Maryanne or Ginger? Bullcrap - you could fall in love with either one. Or love them both - for different reasons. The things that attract me about EM are not all the same as GS - and I'm not even factoring in work hours and such -

So your saying you want Maryanne AND Ginger. (So greedy! )As I said it sounds fun but A) It doesn't ever work out in the long run like we men would like to imagine and B) It's not an option in this analogy because you can't or let's say you wouldn't do EM AND GS both so you do have to pick one and in the end one will be a better fit and you will declare for the rest of your life I am a Maryanne or a Ginger guy. My initial post was to try and help the OP realize/see that A) they are SUCH different specialties that though you might like some things about both there has got to be a winner when you really soul search about what you want to do the rest of your life. B) Because the rest of your life is such a terribly long time I would recommend not weighing the difference in hours as heavily as the day to day practice aspects of each specialty.

 

[RichL025]

So your saying you want Maryanne AND Ginger. (So greedy! )As I said it sounds fun but A) It doesn't ever work out in the long run like we men would like to imagine and B) It's not an option in this analogy because you can't or let's say you wouldn't do EM AND GS both so you do have to pick one and in the end one will be a better fit and you will declare for the rest of your life I am a Maryanne or a Ginger guy. My initial post was to try and help the OP realize/see that A) they are SUCH different specialties that though you might like some things about both there has got to be a winner when you really soul search about what you want to do the rest of your life. B) Because the rest of your life is such a terribly long time I would recommend not weighing the difference in hours as heavily as the day to day practice aspects of each specialty.

Oh, sorry, I didn't mean to advocate polygamy. What I meant to say is that it is possible to love BOTH fields, but of course one would have to decide between the two of them. And forever give up the other, unrequited love... *sigh*.

Sorry, unmitigated silly back there. I'm in the same position as the OP. I love both fields - for different reasons of course. And I agree, the rest of your life is too long to be concerned about a 3 year difference in training times, or one or two hours per day.

 

[colforbinMD]

I love both fields - for different reasons of course. And I agree, the rest of your life is too long to be concerned about a 3 year difference in training times, or one or two hours per day.

That's really great news for both of you if you truly would be happy in both fields. This is a plus as many of us only have one option that we feel would truly make us happy and worse yet many more have no clue at all on ANY specialty that they want. The question I put to you now and I submit (again) that there is an answer here...... Which do you love MORE?

 

[RichL025]

The question I put to you now and I submit (again) that there is an answer here...... Which do you love MORE?

And THAT'S what I'm still working on.... I've got until October to decide.

 

[threepeas]

i work as a PA in a busy, fun surgery dept that covers both trauma and general and neuro. i am also a MS1. I ask every surgeon i run into would they go into surgery if they had the choice again. NOT ONE said they would go into surgery. despite their love for the pure art, the business side of it is extremely discouraging and draining. this effect spreads to the side of the job they love and infects it. i have never met a surgeon who i would consider "a family man" by my definition. the idea of surgery is very exciting but the reality is quite different. it is too bad it is that way, but medicine is changing from a vocation that makes a ton of money to a regular job. surgery residency is 5 years of being extremely busy. 5 years is a long time. in addition the pressure to do a fellowship is stronger than ever that adds more time. you first 5 years or so out of training is very busy getting a practice growing. people like to exclude these things (money, malpractice, work hours, respect) when considering a field and just focus on whether you love it or not, but the rewards are just not there any more to justify the abuse of training to be surgeon. the field needs to revamp their system to let people focus sooner in their training on a speciality so it doesnt have to be so long, etc. the choice is easy if you love one and hate the other. if you love both ER is the way to go for the pace, excitement, variety, challenges, work schedule and money and opportunity to spend time with the family (which is the most important thing we should be doing as human beings if our species is going to survive itself). its a no brainer. the bottom line-i havent met any surgeons who would do it again except for maybe 2 out of 20. when i worked in the ER almost all of them would do it again eventhough they thought another speciality "seemed" more interesting. in ER when you get close to retiring you can work part time and make some great $$$.

 

[Celiac Plexus]

Wow my mind is twice blown in one thread.
Have you ever had an anxious (terrified) pt. pouring blood from kiesselbach's (sp?) so fast you can't even visualize whether it's an anterior or post. bleed? It's flowing out the front and back into their throat at an alarming rate and they are gagging, spitting, and shouting a garbled help me (en espanol no less) all at once? You give them a little IV anxiolysis just so you can try and get near them and then spend the next hour suctioning and trying different sizes of nasal packings until FINALLY one seats properly and seems to tamponade the pt. Then the true joy of EM begins and you get to go beg the ENT guys to come see the guy before your thumb in the dam fails and the bleeding starts again (anxiolyis has worn off by then of course so let's just pretend NONE of the last hour even happened and start over) = stuffing gauze in someone's nose?

EDIT Yes if the bleeding is from kiesselbach's then you know if it's ant. or post. but when they are bleeding like that all you can do is guess secondary to mechanism

uh. yeah. i still call it packing a nose. i don't consider that a "procedure".

 

[mikecwru]

yeah, ok, i get it. i wouldn't call these procedures either ("epistaxis packing" = stuffing gauze in someone's nose), but i see your point about the hands on aspect i guess.

A bad nosebleed, hemodynamically unstable and an airway issue, can be pretty hard core. You can have your opinion, though.

 

[southerndoc]

A bad nosebleed, hemodynamically unstable and an airway issue, can be pretty hard core. You can have your opinion, though.

I agree. I've seen some serious nosebleeds. Get a good arterial or a bleed so significant that it compromises an airway, and you have the setup for a very interesting case.

 

[Celiac Plexus]

A bad nosebleed, hemodynamically unstable and an airway issue, can be pretty hard core. You can have your opinion, though.

you guys are missing the point. i was asking about procedures... in the stressful scenario above, what procedures were done? from what i can tell, some iv fluids were given, an intubation was performed, and a nose was packed.

 

[mikecwru]

you guys are missing the point. i was asking about procedures... in the stressful scenario above, what procedures were done? from what i can tell, some iv fluids were given, an intubation was performed, and a nose was packed.

Nevermind.

mike

 

[FoughtFyr]

you guys are missing the point. i was asking about procedures... in the stressful scenario above, what procedures were done? from what i can tell, some iv fluids were given, an intubation was performed, and a nose was packed.

All by the EM intern, while the surgery second year ran scut starting an H&P for the fourth year before figuring out that the EPs had it under control.

- H

 

[threepeas]

A bad nosebleed, hemodynamically unstable and an airway issue, can be pretty hard core. You can have your opinion, though.

if anyone was wondering what artery bleeds its the sphenopalatine artery which is one of the terminal branches of the maxillary artery.

 

[southerndoc]

if anyone was wondering what artery bleeds its the sphenopalatine artery which is one of the terminal branches of the maxillary artery.

Thanks.

 

[kungfufishing]

now I can sleep

 

[Willamette]

For the record: I'm a MaryAnne guy.


Willamette

 

[Leukocyte]

Dude, screw Maryanne and Ginger!

Arn't they old hags by now? Damn, they are like 30+ years older than us!!!!

Don't tell me Liz Taylor, and M Monrow give you a woody too!

I am a Sarah Silverman kind a guy.

 

[JudoKing01]

**** that. There's this weather girl on NBC10 in NJ/Philly named Amy Freeze. She is the hottest thing I have ever seen. I just realized she's hot and her name is freeze...and she's a weather girl...too much coincidences/irony...brain imploding...

 

[kungfufishing]

Dude, screw Maryanne and Ginger!

my kind of action!

 

[Willamette]

my kind of action!

That's right! He must not know that experience counts...


Willamette