EM or OB

[medmom]

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Help!! I need to decide what specialty to go into! I am having a very difficult time deciding between OB/GYN and EM. When I came into med school and really up until last month (EM) I thought for sure I would do OB. I hadn't found anything else that I loved and missed when my rotation was over. Now I am stuck deciding. So here are my likes/dislikes about each:

EM likes: a lot of primary care but has some procedures and true emergencies mixed in, the ultimate physical diagnosis challenge (I feel like it is trivial pursuit in every room), a lot of variety each day, shift work, no follow-ups, no managing med lists, more time with my family

OB Likes: I really love women's health, I like delivering babies, I am innately good at OB/GYN,

EM dislikes: possibly monotonous, high burn out, the drugs seekers, child abusers and sexual assault, no continuity (good/bad?), little interaction with colleagues

OB dislike: 18 year statute of limitations, not sure I love GYN enough to go gyn only but also don't want to be up delivering babies all night at 60, schedule sucks, malpractice is $$, dead babies suck, the worry about dead babies every day, my back KILLS me after about 2 hours standing still in surgery (can I physically do it for 40 years?), will I ever see my kids?

So guys let me hear to good the bad and the ugly about each of these fields. Keep in mind that I am a married female and mother of three school aged children.

Medmom

 

[J-Rad]

Moving to Osteo.

 

[medmom]

I put it in the residency board because other students don't have experience being a physician.

 

[J-Rad]

There are plenty of residents who post in the Osteo board. Gen Res is geared towards those in residency discussing residency related issues.

 

[Colbert]

You need to decide for yourself what's more important to you, your life in medicine or your life outside of medicine. It sounds like you like OBGYN more than EM but you don't like the lifestyle of OBGYN. They are both hard to do if you don't love them, and as much as dead babies suck so does telling a 30-year old newlywed that their spouse died in a car accident (or any other of the million of crappy scenarios that happen every day).

 

[DrMom]

I've only known one person torn between these 2 specialties and she did EM. I'm an EP in a 3 hospital community ED group. I mostly work in a semi-rural critical access hospital.

EM likes: a lot of primary care but has some procedures and true emergencies mixed in, the ultimate physical diagnosis challenge (I feel like it is trivial pursuit in every room), a lot of variety each day, shift work, no follow-ups, no managing med lists, more time with my family

Much of EM is routine stuff (cough, earaches, dental pain, vaginal bleeding, abdominal pain, chest pain, fever, vomiting, back pain, UTI) and you'll see this stuff in most EDs every shift. If you're not at a big urban ED they're likely to be most of what you see every shift. Most of what I see is not an "ultimate physical diagnosis challenge." That said, we do start with completely new, undifferentiated patients (frequent fliers aside) throughout our shifts.

I still have to deal with med lists (thanks Joint Commission and the med reconciliation form) and I do see follow ups to some extent (abscess rechecks, frequent fliers who don't have a PCP).

Shift work can be a pro and a con. The irregular and constantly changing schedule is tough on "normal" life and family activities. It is true, though, that when you're off you're off and that is good. EM is also one of the rarer specialties where many docs work < 40/week.

EM dislikes: possibly monotonous, high burn out, the drugs seekers, child abusers and sexual assault, no continuity (good/bad?), little interaction with colleagues

Even though much of the job is routine, I don't usually feel like there is monotony. Don't get me wrong, I was very tired of seeing adults and kids with cc of "fever" for the 2 month peak of the flu season, but there's always a mix of CCs, personalities, etc that keep me more interested.

If you get a system with the drug seekers they become easier to deal with (I'm pretty hard lined about not refilling narcs and my state has a Rx lookup system. I just always make sure I get a good H & P done and then tell them I don't do narc refills. If they don't leave, then security can escort them out). Sure, they're still annoying much of the time, but I don't waste a bunch of time arguing with them.

You may or may not deal with rape cases. In my county there is a central location for all rape exams, so I avoid that unless they're medically injured enough to need stabilization first. I do occasionally get a kid brought in for suspected child abuse, but there's also a local system for those cases.

I'm not sure why you think there's little interaction with colleagues. I talk with other physicians many times every shift (and I'm single coverage for almost my entire shift). For a few hours I have an ED colleague in the same location with me, but I also talk with hospitalists, surgeons, primary care physicians, radiologists, and other specialists every shift.

I'm fine with no continuity. I don't want to keep taking care of the same people. I do try to get follow up on some of my sicker patients, though, so that I can know what they end up being diagnosed as and learn the good and bad of how I took care of them in the ED.

Burnout has a lot to do with whether you like what you're doing and there is burnout in every specialty. It also can be more than specialty choice. There's an ER group not far from me that I chose not to interview with because I knew I'd burn out quickly in their poorly run system.


Hope that helps some. 🙂