Difficulty choosing a specialty

[Jaspreed24]

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So it's towards the end of M3 year and I still cannot pick a career. It's gotten so bad that I'm posting on SDN -__-

But I currently think I'm between EM and Peds. EM because I like the procedures and being the first to start working up the patient (receiving sign-out from the ED felt like all the work had already been done). Peds because I enjoy working with children, and the endless comorbidities in adults because draining. I am finishing off a pediatric surgery rotation, and I really loved it because of the operation, and the fact that we find a problem, fix it, and see the result. However, while I love watching the surgeries, I can't honestly say I need to be the one DOING those surgeries--I got more of a rush from seeing the consults and mentally working through, "What does this kid have? What are we going to do to find out?" Also for surgery, I honestly just don't think I'm trying to work that hard.

So in terms of a career, I think my problem is the need to get a mix of everything, and the fear of not finding the "perfect" field. I also was the person that liked pretty much all my rotations (no love for neuro, unfortunately). Things I am looking for in a field: variety, complex medical problems, ability to see the effect of my work, diagnosis, meaningful patient interaction, some sense of work-life balance.

I love the ED because we see a bit of every specialty in there, and procedures happen, but I worry the pace might be a bit too much, and the medicine too superficial before handing the patient off. I am going to shadow Peds GI, since there is more of a procedural aspect, but I wanted to see if there is something I'm really just missing entirely. I considered the surgical subspecialties (ortho, ENT, urology), but I don't think the medicine is complex enough for the procedures alone to sustain me long-term (definitely not a diss to any specialty).

Any insight is appreciated!

 

[psychhopefull2016]

You can do pediatrics and then pediatric EM fellowship!

 

[Tenk]

I see about 20% peds in EM. It's enough for me.

EM can be incredibly in depth if you want it to be. It can also be very superficial and just be a disposition machine. It is whatever you want it to be. For me I take pride in my work and try to go above and beyond in both knowledge and care of my patients.

 

[takeurmeds02]

Yea peds EM sounds like what you might be describing.

But Like @Tenk said above, it would really be up to you in terms of how deep you want to delve into the actual medicine of each patient.

As far as seeing peds in non-specialized EM, it really depends on the hospital; some hospitals have separate wings for peds EM so some general EM docs never see kids.

Alternatively, you could also look into the path of peds critical care. You get your minor procedures + cerebral nature + working with kids *shrugs*

 

[bashwell]

Since you're also considering EM, and seem to like aspects of critical care too, you should consider anesthesia, then peds anesthesia.

-Complex cases
-Procedures
-Good pay
-Lifestyle not worse than EM in my opinion, though not as good as outpatient peds
-Anesthesia has a lot of overlap with critical care medicine
-5 years total, which is shorter than peds>peds EM which is 6 years, though obviously longer than EM (3 or 4 years) or general pediatrics (3 years)
-Anesthesia can be fast paced, but it's fast paced in a different way than EM where you have to juggle a bunch of different things at the same time in EM (good EM physicians are really talented here), though if you really want a more relaxed pace then outpatient peds wins
-Maybe a major downside for you is having to get through anesthesia first which involves mostly adults, but again since you're considering EM too that would also apply to EM

 

[bashwell]

1) Maybe another way to think about it is what do you want your base specialty to be (i.e., assume you don't or can't do a fellowship)? Would you feel more at home only taking care of kids (then it's peds) or would you feel more at home seeing and doing a bit of everything (then it's EM)?

2) Also, although money isn't everything, if you like two specialties equally, then you could use money as one possible factor to help you decide between the two specialties. In other words, all things equal, and if you like two specialties equally, then it makes sense to go for the higher paying specialty. My understanding is you'll be taking a sizeable salary cut if you do Peds EM vs. EM or EM then peds (e.g., in general I have heard there are lower reimbursements for kids in comparison to adults).

3) Consider work/life balance or "lifestyle" factors. Peds EM and EM both do shift work, but the positive of doing Peds EM is if you ever burnout on Peds EM, then you could move back to general peds (outpatient). In EM you would have to do a fellowship like toxicology etc. (Or I assume you could cut back on shifts in both).

4) Consider the time commitment:

Peds > Peds EM = 6 years
EM > peds = 5 years

It's only a year, but a year could still be at least $200K (possibly more). That's a lot of money, as much as attending many med schools.

However if you do only EM (no peds), then it's only 3 years (or sometimes 4). That's obviously a lot more money.

5) My understanding is you won't get as many procedures in peds EM as you would in EM. So that's another consideration if you like procedures.

6) If you love peds, and love complexity of patients, the intellectual aspects, research, etc then you could do neonatology. Although that's a very narrow field (neonates) which you either love or don't love I guess, there's a lot of complexity, intellectual stimulation. Similar with PICU.

 

[honigbiene]

Have you considered family medicine, especially in a rural area?
I work at a hospital in a city where we are big enough to deliver babies and do general surgeries, but there are no specialists, so the FP docs do everything. All of the ER docs are FP residency trained. They also deliver all the babies, and the ones who did a 1yr OB fellowship post FP residency can perform csections.
So they get to take care of complex adult cases, do all the peds visits, cover the ER, and deliver babies.
Just a thought, I know you never mentioned FP but your statement about needing a mix of everything is a perfect fit for that.

 

[ortnakas]

Advice I've gotten is to pick your favorite bread and butter, not your favorite zebra (to mix some common medical metaphors).

You've described your favorite parts of both peds & EM, but which do you see yourself liking more on a day-to-day basis?

 

[WildEMDoc]

I was between pediatrics and EM too. Ultimately chose to apply EM because of the following:

1. I love kids, but at the end of the day it wasn't enough for me to only see children, being able to see the spectrum was important to me.
2. A uro resident once asked me to think of your "patient" which one gets you going/keeps you coming back. For me, I couldn't really answer that question because I liked not knowing what I was walking in to everyday and EM is just that.
3. The fellowship to PEM is still open to me by choosing EM, however at least at my home institution EM docs run the PED on night shifts with or without a fellow. In talking with some of them I realized that working in a academic PED was still not totally out of the question even without a fellowship
4. There are some reasons to choose EM over Peds to get to PED. The first is its shorter, the second is the procedural competence you have coming from an EM residency is a huge plus to PEM programs from what I've heard.

The only other thing to look into would be the combined programs. EM/Peds I think can be a good choice if you literally cannot choose between them and are okay with 5 years in residency.

Just some thoughts. Good luck with your decision! Do what makes you happy.

 

[Tenk]

Since you're also considering EM, and seem to like aspects of critical care too, you should consider anesthesia, then peds anesthesia.

-Complex cases
-Procedures
-Good pay
-Lifestyle not worse than EM in my opinion, though not as good as outpatient peds
-Anesthesia has a lot of overlap with critical care medicine
-5 years total, which is shorter than peds>peds EM which is 6 years, though obviously longer than EM (3 or 4 years) or general pediatrics (3 years)
-Anesthesia can be fast paced, but it's fast paced in a different way than EM where you have to juggle a bunch of different things at the same time in EM (good EM physicians are really talented here), though if you really want a more relaxed pace then outpatient peds wins
-Maybe a major downside for you is having to get through anesthesia first which involves mostly adults, but again since you're considering EM too that would also apply to EM

EM -> peds EM is only five years as compared to peds -> peds EM and gives you a far superior education if your end goal is peds EM. It is also waaaay easier to land the fellowship if you are EM. I always recommend this pathway if your end goal is peds EM.

 

[bashwell]

EM -> peds EM is only five years as compared to peds -> peds EM and gives you a far superior education if your end goal is peds EM. It is also waaaay easier to land the fellowship if you are EM. I always recommend this pathway if your end goal is peds EM.

That's another good option for OP.

 

[Tenk]

1) Maybe another way to think about it is what do you want your base specialty to be (i.e., assume you don't or can't do a fellowship)? Would you feel more at home only taking care of kids (then it's peds) or would you feel more at home seeing and doing a bit of everything (then it's EM)?

2) Also, although money isn't everything, if you like two specialties equally, then you could use money as one possible factor to help you decide between the two specialties. In other words, all things equal, and if you like two specialties equally, then it makes sense to go for the higher paying specialty. My understanding is you'll be taking a sizeable salary cut if you do Peds EM vs. EM or EM then peds (e.g., in general I have heard there are lower reimbursements for kids in comparison to adults).

3) Consider work/life balance or "lifestyle" factors. Peds EM and EM both do shift work, but the positive of doing Peds EM is if you ever burnout on Peds EM, then you could move back to general peds (outpatient). In EM you would have to do a fellowship like toxicology etc. (Or I assume you could cut back on shifts in both).

4) Consider the time commitment:

Peds > Peds EM = 6 years
EM > peds = 5 years

It's only a year, but a year could still be at least $200K (possibly more). That's a lot of money, as much as attending many med schools.

However if you do only EM (no peds), then it's only 3 years (or sometimes 4). That's obviously a lot more money.

5) My understanding is you won't get as many procedures in peds EM as you would in EM. So that's another consideration if you like procedures.

6) If you love peds, and love complexity of patients, the intellectual aspects, research, etc then you could do neonatology. Although that's a very narrow field (neonates) which you either love or don't love I guess, there's a lot of complexity, intellectual stimulation. Similar with PICU.

Didn't see this post. Agreed.

 

[IlDestriero]

Peds Anesthesia.


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Il Destriero

 

[J ROD]

Peds residency then ED fellowship. If you are more about the kids. Flip it if you want more adults and some kids.