Does any field in medicine have better hours than EM?

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nitemagi said:
The factual issues relate to lifestyle and intellectual rigor, not to reputation. I actually agree with many factors leading to the poor reputation, including overmedication and medicalization by many. I don't take issue with that. The issue is that med students have a limited period of exposure to psych, and typically rely on their inpt experience and the opinions of those that didn't go into it (and thus have an equally limited amount of time exposure) to judge the reasons for going/not going into it. Like the poster above who thinks "For women psych is great because it requires so little intellectual effort you can go online shopping for designer clothes during rounds." It just perpetuates misinformation and reductionism.
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I feel your pain. I went into IM. You don't hear more trash talked about any specialty outside of of IM on SDN (IMHO) with the endless rounding and the hate on anything primary care.
 
Shinken said:
In the end, there's no perfect specialty for everyone. The only perfect specialty is the specialty that fits you the best. If EM is it, then great.
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Well said.

I would also like to point out that hours in EM vary dramatically from hospital to hospital. In the ED at the private hospital I currently work at, for example, doctors can work anywhere from 4-16 shifts per month, and these shifts vary in duration and overlap (ex: 7am-3pm,10am-4pm,3-10pm, etc.). Compare this to the previous ED I volunteered at (academic level 1 trauma center), where all the docs work 12-hour shifts for greater CoC. So *can* you work very few hours in EM? Yep. Do you have to? Of course not.

There's also a "myth" on this forum that all hospitalists work 7 days on, 7 days off. This is not true. Again, it depends on the specific hospital.

You can *probably* generalize that EM has "less traditional" hours than most other branches of medicine, but to argue anything further seems a bit silly...
 
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gman33 said:
Just saying you could work part-time in EM and make a similar living.
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Yup. And this is a particularly appealing option as you get older. Or if you want to split your time between EM and another field. Definitely worth considering.
 
EM, for the most part, does require less hours than other primary/secondary fields...though the hours spent working are overall much more intense as a whole (there is no down time...or rest for wicked!).
 
Law2Doc said:
Yeah I think premeds get too carried away with the total hours and forget that when you are really not enjoying what you are doing a 50 hour week is going to feel like 80, whereas if you are actually enjoying what you are doing a 70 hour week will feel like 40. Most of us further down the road would pick the latter over the former every time for this very reason. Sure we are kicking ourselves for not actually liking something with cushier hours, but wouldn't endure another one of those deadly hour if you paid us double.
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👍 This is exactly how I feel. I did all those AAMC Careers in Medicine surveys asking me how much I value my free time and how much lifestyle will factor into my decision. Of course I want good hours and to not be on call, but I'm more concerned that I won't be happy in my specialty. I'm going to be spending a lot of time working no matter what I choose, so I better love whatever I'm doing. Just have to figure that part out...
 
what about ophtho? no one seems to mention it in these discussions
 
Psychiatry is not only unsexy but intellectually insolvent.

Up until the 1980s, the field was beholden to Sigmund Freud. Enough said.

There is no convincing evidence that depression is biologically caused, as opposed to unhappiness due to life circumstance, in the context of poor coping skills.

There is no convincing evidence that schizophrenia is a real disease as opposed to some conglomerate of being stupid (neg sx) and being weird (pos sx).

Antidepressants are no better than placebo for mild depression, and are only better than placebo for severe depression because placebo stops working for severe depression.

The field is beholden to the pharmaceutical industry (ie, prescribing the brand name enantionmerically pure form of an SSRI (Lexapro) for 10x markup instead of the generic (Celexa) -- with no evidence the former is more efficacious).

The only thing that really works in the entire field is ECT, which if you have ever seen performed against a patient's will is one of the most barbaric acts in modern medicine. Plus not a single psychiatrist can tell you with confidence why it works.

Those are the main reasons to not go into psychiatry. It's just my opinion, don't take it personally.
 
Asp said:
Psychiatry is not only unsexy but intellectually insolvent.

Up until the 1980s, the field was beholden to Sigmund Freud. Enough said.

There is no convincing evidence that depression is biologically caused, as opposed to unhappiness due to life circumstance, in the context of poor coping skills.

There is no convincing evidence that schizophrenia is a real disease as opposed to some conglomerate of being stupid (neg sx) and being weird (pos sx).

Antidepressants are no better than placebo for mild depression, and are only better than placebo for severe depression because placebo stops working for severe depression.

The field is beholden to the pharmaceutical industry (ie, prescribing the brand name enantionmerically pure form of an SSRI (Lexapro) for 10x markup instead of the generic (Celexa) -- with no evidence the former is more efficacious).

The only thing that really works in the entire field is ECT, which if you have ever seen performed against a patient's will is one of the most barbaric acts in modern medicine. Plus not a single psychiatrist can tell you with confidence why it works.

Those are the main reasons to not go into psychiatry. It's just my opinion, don't take it personally.
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Anyone that thinks schizophrenia is just stupidity and oddness is either a scientologist or astoundingly talented at denial. You are of course entitled to your opinion, as are people who say global warming isn't real or the earth is a few thousand years old. I can't take seriously those opinions because there's so much science to refute them. Your post is frankly just balls-out idiotic.
 
Global warming probably isn't real in the Al Gore alarmist sense.

The earth is more than a thousand years old, don't be silly.
 
Asp said:
Also my position is held by many in the literature, ie

http://admin.iop.kcl.ac.uk/maudsley-publications/maudsley-discussion-papers/mdp12.pdf
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While the maudsley debates are great, they actually don't support your opinion that schizophrenia is stupidity and oddness. They criticize the heterogeneity of the syndrome, which is a fair critique, and one recognized by everyone in the field. As has been said many a times, we've gotten the reliability down (fairly) well, but we're working on diagnostic validity. Still better than nothing. Schizophrenia isn't 1 disease, it's probably 100 different diseases. If you've really never seen someone truly psychotic then your medical school has truly failed to educate you.

It's a little sad though that you refute the Thousands of articles and research support with your "many in the literature" citation of an Opinion piece from a debate series at the Institute of Psychiatry intended to be controversial. Perhaps you yourself are trying to stir up debate through being excessively idiotic, dismissive, and provocative? N'est pas?
 
nitemagi said:
While the maudsley debates are great, they actually don't support your opinion that schizophrenia is stupidity and oddness. They criticize the heterogeneity of the syndrome, which is a fair critique, and one recognized by everyone in the field. As has been said many a times, we've gotten the reliability down (fairly) well, but we're working on diagnostic validity. Still better than nothing. Schizophrenia isn't 1 disease, it's probably 100 different diseases. If you've really never seen someone truly psychotic then your medical school has truly failed to educate you.

It's a little sad though that you refute the Thousands of articles and research support with your "many in the literature" citation of an Opinion piece from a debate series at the Institute of Psychiatry intended to be controversial. Perhaps you yourself are trying to stir up debate through being excessively idiotic, dismissive, and provocative? N'est pas?
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So yesterday schizophrenia was a disease. Today it is a 100 different diseases. Tomorrow it won't be a disease at all. Call me prescient.

When you guys find a reliable clinical test for schizophrenia (like troponins for ACS), page me. Otherwise schizophrenia just remains a term psychiatrists use to label odd people, based on rather arbitrary criteria that were established by committee, which have no consistent and reproducible neurological correlates.
 
Asp said:
So yesterday schizophrenia was a disease. Today it is a 100 different diseases. Tomorrow it won't be a disease at all. Call me prescient.

When you guys find a reliable clinical test for schizophrenia (like troponins for ACS), page me. Otherwise schizophrenia just remains a term psychiatrists use to label odd people, based on rather arbitrary criteria that were established by committee, which have no consistent and reproducible neurological correlates.
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Jeez, might as well get solipsistic while you're at it.

The lack of blood tests for diagnoses is a common critique, but also what makes us actually have to use our skills of observation and critical thinking, rather than relying on labs and technology to do the work for us. An intelligent critical thinker can be an outstanding psychiatrist, but commonly contemporary psychiatric reductionism and purely symptom focus with pharmacology means many people can skate by as crappy psychiatrists. It's too bad you saw the poor side of the field. I don't feel a need to validate the field to you. If you actually read the science (rather than outright dismissing the field itself) you'd see that the research itself is moving the field forward. But maybe it's easier to continue living in the peanut gallery, pursuing a field like radiology, rather than working with those that might actually benefit from your care. Science is a process, and the brain is the most complex thing on the planet. You critique a field working to understand that which is hard to understand. You appear fairly concrete, only satisfied once science has completed something, rather than recognizing the steps along the way to that improvement. By that logic nothing is worth pursuing, since inherently it hasn't produced the desired outcome before it has. No science should be done if it won't lead to improvements, but the nature of science is that one doesn't know the outcome before the research is performed. You display a pessimism as if No progress has been made. If you think you can do better, then put up. Or shut up.
 
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nitemagi said:
The lack of blood tests for diagnoses is a common critique, but also what makes us actually have to use our skills of observation and critical thinking, rather than relying on labs and technology to do the work for us.
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Okay, strong work, carry on bro.

nitemagi said:
But maybe it's easier to continue living in the peanut gallery, pursuing a field like radiology, rather than working with those that might actually benefit from your care.
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Yeah I feel guilty about this every day. Maybe I'll feel better when I buy my first black German-made luxury car.
 
That was some pretty impressive derailing, but I'm more interested in the original topic being addressed further
 
nitemagi said:
Jeez, might as well get solipsistic while you're at it.

The lack of blood tests for diagnoses is a common critique, but also what makes us actually have to use our skills of observation and critical thinking, rather than relying on labs and technology to do the work for us. An intelligent critical thinker can be an outstanding psychiatrist, but commonly contemporary psychiatric reductionism and purely symptom focus with pharmacology means many people can skate by as crappy psychiatrists. It's too bad you saw the poor side of the field. I don't feel a need to validate the field to you. If you actually read the science (rather than outright dismissing the field itself) you'd see that the research itself is moving the field forward. But maybe it's easier to continue living in the peanut gallery, pursuing a field like radiology, rather than working with those that might actually benefit from your care. Science is a process, and the brain is the most complex thing on the planet. You critique a field working to understand that which is hard to understand. You appear fairly concrete, only satisfied once science has completed something, rather than recognizing the steps along the way to that improvement. By that logic nothing is worth pursuing, since inherently it hasn't produced the desired outcome before it has. No science should be done if it won't lead to improvements, but the nature of science is that one doesn't know the outcome before the research is performed. You display a pessimism as if No progress has been made. If you think you can do better, then put up. Or shut up.
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Lol at the implication that radiologists don't benefit patients. Don't know if that was serious or meant to be a joke but it made me laugh either way
 
I really didn't think med students still cared about prestige. I thought that was only a "childish" pre-med thought process.

Personally, I kinda see myself in a clinic as opposed to working in the ED or OR, etc. I feel it's a "better" fit for me. But some people hate the clinic and poke their eyeballs out. Like most people would say, it depends on what you can see yourself doing for the rest of your life. I was interested in EM before starting school, and now I realize I tend to be more of a "cerebral" person than a "procedural" person, evident by my dislike of OB/Surg and love of IM/Peds/Psych :O
 
Asp said:
There is no convincing evidence that schizophrenia is a real disease as opposed to some conglomerate of being stupid (neg sx) and being weird (pos sx).
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Wow, you're in med school? Are you sure?
 
Asp said:
So yesterday schizophrenia was a disease. Today it is a 100 different diseases. Tomorrow it won't be a disease at all. Call me prescient.

When you guys find a reliable clinical test for schizophrenia (like troponins for ACS), page me. Otherwise schizophrenia just remains a term psychiatrists use to label odd people, based on rather arbitrary criteria that were established by committee, which have no consistent and reproducible neurological correlates.
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lol, what? Seriously? You probably think there's a biochemical test for every disease. I'm terribly disappointed. I said goodbye!
 
Asp said:
Psych is out of the question for any red blooded American male. Looked down on, low prestige, okay if you're an IMG or just weird and don't mind the low status stigma.

For women psych is great because it requires so little intellectual effort you can go online shopping for designer clothes during rounds. A classmate of mine personally observed a psych resident presenting a new admit from memory while simultaneously buying a new pair of shoes on her laptop.. was impressive to say the least!
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This is one of the dumbest and sexist things I've ever read in my life. You also don't seem all that secure in your masculinity. Overcompensating for something, maybe?

Edit: And I just noticed your comments on schizophrenia. Good lord. The fact that people like you are allowed to be entrusted with peoples' lives is terrifying.
 
WarriorMed said:
Spoken like a true medical professional. As a long time resident of Detroit, I resent that statement. It's people like you who propogate the negative stereotype of Detroit and undermine all the hard work we put into grassroots movements to make it better,
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Of all things he said, you're most concerned with his opinion of Detroit?
 
What I have learned from this discussion:

1. There are three specialties that may not be bad-mouthed or face the butthurt on SDN a) psychiatry, b) emergency medicine, c) radiology (which we all know isn't even a "real" medical feidl, amirite?! lawl)

2. Detroit is a really, really, really nice place to live. No. Really. I mean when you get past the unemployment, crime, road-warrior ambiance, and mild winters it's really nice. What?
 
jdh71 said:
What I have learned from this discussion:

1. There are three specialties that may not be bad-mouthed or face the butthurt on SDN a) psychiatry, b) emergency medicine, c) radiology (which we all know isn't even a "real" medical feidl, amirite?! lawl)

2. Detroit is a really, really, really nice place to live. No. Really. I mean when you get past the unemployment, crime, road-warrior ambiance, and mild winters it's really nice. What?
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There's cheap housing...
 
nitemagi said:
Psych has less hours because it can be more emotionally intensive.
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I'm pretty sure no one looked at the "emotional intensity" of different specialties and then decided what kind of hours that each specialty is going to work.
 
Asp said:
There is no convincing evidence that schizophrenia is a real disease as opposed to some conglomerate of being stupid (neg sx) and being weird (pos sx).
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You can't be serious.

Have you actually seen someone with schizophrenia? I mean that seriously. There is no way you can interact with patients who have schizophrenia and learn about the disease and claim this.
 
Asp said:
The only thing that really works in the entire field is ECT, which if you have ever seen performed against a patient's will is one of the most barbaric acts in modern medicine.
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This statement makes it obvious that you've never actually seen ECT being done.
 
Asp said:
Psychiatry is not only unsexy but intellectually insolvent.

Up until the 1980s, the field was beholden to Sigmund Freud. Enough said.

There is no convincing evidence that depression is biologically caused, as opposed to unhappiness due to life circumstance, in the context of poor coping skills.

There is no convincing evidence that schizophrenia is a real disease as opposed to some conglomerate of being stupid (neg sx) and being weird (pos sx).

Antidepressants are no better than placebo for mild depression, and are only better than placebo for severe depression because placebo stops working for severe depression.

The field is beholden to the pharmaceutical industry (ie, prescribing the brand name enantionmerically pure form of an SSRI (Lexapro) for 10x markup instead of the generic (Celexa) -- with no evidence the former is more efficacious).

The only thing that really works in the entire field is ECT, which if you have ever seen performed against a patient's will is one of the most barbaric acts in modern medicine. Plus not a single psychiatrist can tell you with confidence why it works.

Those are the main reasons to not go into psychiatry. It's just my opinion, don't take it personally.
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16j3ke8.gif
 
Asp said:
...schizophrenia just remains a term psychiatrists use to label odd people, based on rather arbitrary criteria that were established by committee, which have no consistent and reproducible neurological correlates.
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Having grown up with a schizophrenic sister, I can say without a doubt that having a psychiatrist that does more than just medicate makes all the difference in the world. That being said, without medication, my sister is a paranoid wreck and at 30 is unable to function on her own without familial support. She's one of my main motivations for wanting to go into medicine myself.
 
silleme said:
Having grown up with a schizophrenic sister, I can say without a doubt that having a psychiatrist that does more than just medicate makes all the difference in the world. That being said, without medication, my sister is a paranoid wreck and at 30 is unable to function on her own without familial support. She's one of my main motivations for wanting to go into medicine myself.
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👍
 
lol at the psych derail

One thing I think thats hilarious is that a lot of arguments against psych are like "Psychiatry doesnt take intelligence because you can't order a test to prove someone has blank so you could just make something up". But this means that you actually have to use clinical skill and judgement as opposed to just reading a definitive lab value or pathology/radiology report.

Thats not to say there aren't valid arguments against doing psych, just kind of hilarious that the argument related to intelligence essentially boils down to "the field is too hard because I have to make my own decisions"
 
Skinceutical said:
This statement makes it obvious that you've never actually seen ECT being done.
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I have. Patient was tied down, sedated against his will, and put under general anesthesia. Multiple seizures were induced. I even got to push the button a couple times. I guess that makes me an accessory.
 
Asp said:
I have. Patient was tied down, sedated against his will, and put under general anesthesia. Multiple seizures were induced. I even got to push the button a couple times. I guess that makes me an accessory.
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That's right, most ECT is done against the person's will. 🙄
 
Asp said:
I have. Patient was tied down, sedated against his will, and put under general anesthesia. Multiple seizures were induced. I even got to push the button a couple times. I guess that makes me an accessory.
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And how is restraining that patient any more "barbaric" than restraining delirious old people, or agitated people in various states of intoxication (all of which happen FAR more often than involuntary ECT, for which you would actually need to pursue legal proceedings if I'm not mistaken). As for the "multiple" seizures, the patient was already completed sedated, and had been given muscle relaxants, so their seizure likely consisted of some mild toe or finger twitching.

I saw plenty of ECT as a med student (it was a required part of our psych clerkship, in order to prevent precisely the kind of misconceptions you're propagating above). Honestly, I was far more traumatized watching the OB girls lopping the foreskins off of fully awake babies, who had also been strapped down in restraints and had only been given sugar water for pain control.
 
Skinceutical said:
Honestly, I was far more traumatized watching the OB girls lopping the foreskins off of fully awake babies, who had also been strapped down in restraints and had only been given sugar water for pain control.
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I agree, circumcision is barbaric when performed on non-consenting neonates.
 
nitemagi said:
That's right, most ECT is done against the person's will. 🙄
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Its rarity is irrelevant. If you read my original post, I have nothing against voluntary ECT.
 
Asp said:
And yeah, EM sucks donkey balls. Degenerates, drug seekers.. basically EM is to medicine as Detroit is to America. Don't get me wrong, I respect ER docs.. just not for me.
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Please continue to vocally support this viewpoint. After an initial reaction of, "Wow, I really disagree with this post-- allow me to retort!", I realized that the more people that believe this, the better chance I stand of matching to an excellent program in a few years. So I shall join you.

Getting dysentery on the Oregon Trail > Making accidental eye contact with a 40 year-old man as he's eating a banana > Pre-Allopathic Folder > Tebow > Emergency Medicine
 
DrDrummer said:
Please continue to vocally support this viewpoint. After an initial reaction of, "Wow, I really disagree with this post-- allow me to retort!", I realized that the more people that believe this, the better chance I stand of matching to an excellent program in a few years. So I shall join you.

Getting dysentery on the Oregon Trail > Making accidental eye contact with a 40 year-old man as he's eating a banana > Pre-Allopathic Folder > Tebow > Emergency Medicine
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Incredible.
 
...and a "grass-roots" effort to save Detroit. Amazing.
 
jdh71 said:
What I have learned from this discussion:

1. There are three specialties that may not be bad-mouthed or face the butthurt on SDN a) psychiatry, b) emergency medicine, c) radiology (which we all know isn't even a "real" medical feidl, amirite?! lawl)

2. Detroit is a really, really, really nice place to live. No. Really. I mean when you get past the unemployment, crime, road-warrior ambiance, and mild winters it's really nice. What?
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:laugh:
 
Forensic Pathology. You work just a few hours a day. Depending on your offices rotating schedule, you may only "cut" one week out of the month. You can leave around lunch everyday. Great benefits, lots of vacation time!
 
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