Do I know what I am getting myself into? Is my indecision a sign that EM is not a good fit?

Doctor_Strange

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Mar 28, 2015
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I'm a USDO good board scores, low 240s Step 1, high 230s Step 2. No red flags.

Before medical school, I was a scribe at a community ED. I enjoyed it a lot. When I got to medical school, I told myself to keep an open mind, but EM was really my top choice. Starting clerkships, I never really hated or loved any one rotation outside maybe surgery. Anyways, I did an EM rotation at a community, non-residency site at a level III ED and walked away feeling that maybe I had found my specialty (18 busy shifts). The nights were tough, and I of course was not a huge fan of staying up until 4am to get ready for three nights in a row, but I thought it was tolerable. As an aside, other than EM, I had always considered PCCM. However, due to COVID my entire ICU exposure was only 1 week before getting pulled off rotations. Otherwise, I did an inpatient medicine rotation at the beginning of my clerkship that was mostly hands-off / shadowing. I walked away from the rotation enjoying it somewhat but I was not crazy about the workflow, but I chalked that up to not being terribly involved in the patient care.

I did my sub-i in EM at a county/community hospital. The residents said they see and do so much trauma that their PD was actually a bit worried they were not seeing enough bread and butter cases. So, I felt this place was representative of EM. At the end of the rotation, I said to myself I had enjoyed it (I certainly was not turned off to it) and said I would move forward pursuing the specialty. Even the PD said residents enjoyed working with me and that he said not to worry about matching. I ended up doing a sub-specialty rotation in ultrasound afterwards and I have a Peds EM rotation coming up too. So of my current SLOEs, all them are apparently strong which to me is an indication that I could succeed in EM.

Despite all this, I recently have been wondering if I have been getting a sanitized view of the specialty. I don't deal with consults directly. I mostly do H&P and discuss workups with my attendings sprinkled in with a few procedures and I have yet to really have a godawful terrible/rude/why-even-bother-doing-medicine type of patient interaction. I certainly don't get exposed to metrics or Press-Ganey BS.

All that being said, I still have some FOMO and will be applying to EM and IM programs since I think I have not been properly exposed to IM. Clearly, the one specialty I have had the most interaction with throughout my clinical years so far has been EM bar none. So, looking at my app you would think EM is a no brainer for me, but despite all this -- and especially with the doom & gloom of the field that seems to be many factors worse than in IM (or their respective sub-specialties) -- I feel like I never seriously exposed myself to the sub-specialties that were out there, like Cardiology, Heme-Onc, GI, or even PCCM with only 1 week really of seeing it. I plan on getting a MICU or Cardiology rotation after my Peds EM rotation.

Anyways, I know it's a long post and possibly a bit rambling, so thank you for reading this far. I don't really have any peers in a similar position so I appreciate any advice or thoughts coming my way. I think my worst case scenario is being like 37 years old and finding out EM was not the right fit for me when I decided as a 27 year old single guy at that time.

Edit: I am not sure if this will change anyone's response but I am extremely fortunate that I will be graduating with zero debt. So, I have the luxury of not thinking exclusively of the monetary goals.
 
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GatorCHOMPions

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You are doing good by yourself for having these second thoughts prior to training. Most in your position ride their naive and narrow student viewpoint all the way through and are then shocked to find themselves being burned out early on in training or one’s career. I am guilty of not realizing that life, not EM, changes a lot from age 25 to 35 and fortunately have found an exit but it wasn’t easy. If you can see yourself doing IM, I would go for that honestly. EM is not a lifestyle specialty and you really need to love it to last for the long haul of a 30 year career.

Here’s a few reasons one should choose EM assuming you’re not 100% all-in: If your goal is to just achieve FIRE after 10 years and then scale back to part time (if that’s even an option in 10 years?). If you plan to be single and want to travel a week per month around the world. If you’re business-minded and want to have an active side gig at the same time as being a full time MD, most specialties can’t compare. Problem is, I thought to myself I would be happy doing at least one of those things but again life changes a whole lot from 25 to 35 and I wanted different things that EM doesn’t accommodate very well with.

An analogous phrase about EM you often hear as a student regarding surgery is, “don’t go into surgery (EM) unless you must be in the OR (ED)”.
 
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turkeyjerky

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Okay, I am completely flummoxed as to how a student could feel as though they have had an inadequate exposure to IM. Either your school has failed you or you really F'd up in scheduling your rotations (is this a DO thing or something?). This notion of 'well, I worked in an ER before med school, so EM is my destiny' is just about the stupidest thing I've ever heard. Every medical student, at the white coat ceremony (do they still do that ridiculousness?) should be given a directive that their previous experience is irrelevant to their future.

Keep in mind you have seen the absolute best of EM and the absolute worst of IM. Hospitalists don't spend their time shadowing or presenting to superiors on rounds, and emergency physicians do have to deal with patient satisfactions surveys, metrics, and spend an inordinate amount of time w/ BS patients. Also, keep in mind that, if you pursue EM, you're unlikely to get a good job in an area you want to live. The old refrain of 'pick 2 of 3--pay, location, lifestyle' is soon to be 'you'll be lucky to get 1/3".
 
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Rekt

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Okay, I am completely flummoxed as to how a student could feel as though they have had an inadequate exposure to IM. Either your school has failed you or you really F'd up in scheduling your rotations (is this a DO thing or something?). This notion of 'well, I worked in an ER before med school, so EM is my destiny' is just about the stupidest thing I've ever heard. Every medical student, at the white coat ceremony (do they still do that ridiculousness?) should be given a directive that their previous experience is irrelevant to their future.

Keep in mind you have seen the absolute best of EM and the absolute worst of IM. Hospitalists don't spend their time shadowing or presenting to superiors on rounds, and emergency physicians do have to deal with patient satisfactions surveys, metrics, and spend an inordinate amount of time w/ BS patients. Also, keep in mind that, if you pursue EM, you're unlikely to get a good job in an area you want to live. The old refrain of 'pick 2 of 3--pay, location, lifestyle' is soon to be 'you'll be lucky to get 1/3".

He's a DO. A lot of clerkships are essentially community hospitals without residents.

I'm very confused by how you said you felt you got a good view of EM by a heavy trauma EM rotation even with the PD worried about bread and butter. This will rustle some jimmies but trauma is a little, somewhat insignificant, portion of real EM life. You need medical diversity and medical volume. That will be a significant majority of your practice. So I'd say you didn't get a good view.

I think if you're not 100% sold then don't do it. Especially with zero debt. You have free to explore whatever you want from a subspecialty standpoint from IM. And I'm obviously probably the most vocal about the future market and how extremely poor the outlook is, but it's something you have to still consider even without debt.
 

sloh

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I'm very confused by how you said you felt you got a good view of EM by a heavy trauma EM rotation even with the PD worried about bread and butter. This will rustle some jimmies but trauma is a little, somewhat insignificant, portion of real EM life. You need medical diversity and medical volume. That will be a significant majority of your practice. So I'd say you didn't get a good view.

Thought that was a typo when I read the OP haha
 

Doctor_Strange

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Mar 28, 2015
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Okay, I am completely flummoxed as to how a student could feel as though they have had an inadequate exposure to IM. Either your school has failed you or you really F'd up in scheduling your rotations (is this a DO thing or something?). This notion of 'well, I worked in an ER before med school, so EM is my destiny' is just about the stupidest thing I've ever heard. Every medical student, at the white coat ceremony (do they still do that ridiculousness?) should be given a directive that their previous experience is irrelevant to their future.

Keep in mind you have seen the absolute best of EM and the absolute worst of IM. Hospitalists don't spend their time shadowing or presenting to superiors on rounds, and emergency physicians do have to deal with patient satisfactions surveys, metrics, and spend an inordinate amount of time w/ BS patients. Also, keep in mind that, if you pursue EM, you're unlikely to get a good job in an area you want to live. The old refrain of 'pick 2 of 3--pay, location, lifestyle' is soon to be 'you'll be lucky to get 1/3".

So most schools as I understand it did one of two things: a) once it was safe to return to rotations, students would finish those rotations that they missed or b) you did not have to finish them as long as you took the shelf exam and passed. My school did the latter of the two. It's not ideal at all, I agree.

Do you have any regret about pursuing EM?
 
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erdoc00

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Mar 31, 2013
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I did not read any of the original post or replies but the answer doesn't change: don't do EM.

Thank me in 10 years when youre still practicing medicine and not looking to change careers.
 
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Doctor_Strange

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He's a DO. A lot of clerkships are essentially community hospitals without residents.

I'm very confused by how you said you felt you got a good view of EM by a heavy trauma EM rotation even with the PD worried about bread and butter. This will rustle some jimmies but trauma is a little, somewhat insignificant, portion of real EM life. You need medical diversity and medical volume. That will be a significant majority of your practice. So I'd say you didn't get a good view.

I think if you're not 100% sold then don't do it. Especially with zero debt. You have free to explore whatever you want from a subspecialty standpoint from IM. And I'm obviously probably the most vocal about the future market and how extremely poor the outlook is, but it's something you have to still consider even without debt.

So yeah, that sub-i was heavy on trauma, but my two other EM rotations have been at a non-residency community level III ED. Those two rotations are more in line with your description -- I have seen maybe three STEMIs, three strokes, and a few random trauma-related injuries over the course of 27 shifts in total there. So in sum, I think my total EM exposure has been pretty realistic. I did not explain that clearly initially.

I mean, when you applied for EM were you 100% sold on it? Did you not have any doubt?
 

Doctor_Strange

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Mar 28, 2015
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You are doing good by yourself for having these second thoughts prior to training. Most in your position ride their naive and narrow student viewpoint all the way through and are then shocked to find themselves being burned out early on in training or one’s career. I am guilty of not realizing that life, not EM, changes a lot from age 25 to 35 and fortunately have found an exit but it wasn’t easy. If you can see yourself doing IM, I would go for that honestly. EM is not a lifestyle specialty and you really need to love it to last for the long haul of a 30 year career.

Here’s a few reasons one should choose EM assuming you’re not 100% all-in: If your goal is to just achieve FIRE after 10 years and then scale back to part time (if that’s even an option in 10 years?). If you plan to be single and want to travel a week per month around the world. If you’re business-minded and want to have an active side gig at the same time as being a full time MD, most specialties can’t compare. Problem is, I thought to myself I would be happy doing at least one of those things but again life changes a whole lot from 25 to 35 and I wanted different things that EM doesn’t accommodate very well with.

An analogous phrase about EM you often hear as a student regarding surgery is, “don’t go into surgery (EM) unless you must be in the OR (ED)”.

Thank you for the comment. I have a few friends applying EM that don't have a macro-level view of the specialty and anytime I bring up any big issues they tend to dismiss it.

Would you care to elaborate on your own exit from EM? I figured if I got an MBA after EM residency I could transition to more admin work. But yeah, of the points you listed -- I don't really meet any of time. I don't want to FIRE really, I am not business savy, and I plan on hopefully having a family in my mid to late 30s.
 

Tenk

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Work backwards. Figure out what kind of lifestyle you want and do whatever specialty matches that lifestyle that you hate the least.

Work is work. Life is better.
 
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