EM or Radiology?

[EC3]

Alright, so i'm trying to make the big decision about which specialty i would like to pursue. I've always been a big EM nut and was pretty certain that this is what i've always wanted to do. Recently, though, i've had some increased exposure to radiology and i find that i'm really enjoying this as well. I'd like to list out some pro's and con's and get some feedback. Also, please keep an open mind and don't give the knee-jerk "if you have to ask..." because i think i have legitimate reasons for liking/disliking each specialty.

Emergency Medicine:

PROS
+Absolutely great set of clinical skills; a "renaissance man" of medicine
+Tons of procedures
+Great integrative, teamwork approach
+Lots of good fellowship options such as sports medicine, toxicology, wilderness med, cruise ship medicine,etc.
+Very good hourly wage
+Relatively short work week (~45 hours/week)
+Would be able to match in my top 3 (I'm moderate/competitive for EM)
+3 year residency

CONS
-Circadian shift work (not so much a problem when you're younger but i've heard from even EM-trained attendings that as you get older, it does start to 'take a toll' physically and mentally)
-Patient population can be taxing (drunks, drug seekers, histrionics, etc.)
-Trend toward "productivity-based" pay (i don't want EM to turn into family practice where you need to see 35 patients a day and make only $150K/year)
-Defensive medicine (the word "chest pain" gets MI r/o regardless of if the patient actually means abdomen)
-Trend toward more regulations and more "primary care" role (JCAHO isn't making things better)
-Consults not always appreciated (i already have patients whining, i don't need to hear it from MDs)

Radiology:

PROS:
+Reading films is interesting and fun
+Very analytical (Anything that has "physics boards" get my seal of approval)
+Integral part of almost every other specialty (lots of interactions with other docs)
+Some procedures (not as cool as EM, though)
+No patient contact (Some days I really don't feel like taking a history, especially when someone's meds consist of "that blue pill and that orange one")
+Excellent pay (about 1.5 times that of EM)


CONS:
-Sit in a dark room all day, talking to a computer (talk about depressing)
-No patient contact (it's very fun to deal with the compliant patients)
-5 year residency program
-Would likely end up at "lower"-tier residency programs, with a real possibility of not matching at all
-Trend towards cutting reimbursments as well as outsourcing film-readings
-Productivity-based pay
-longer work week (~56 hours/week)


Final thoughts: In terms of which i enjoy more, i'd say that EM wins out. I really like the knowledge and skill-set that EM training gives, and nothing is more fun than getting down and dirty with the pathology that presents to the ED. In terms of practice, though, I have reservations about being able to practice EM into my 60s, especially with having to work nights, weekends, and holidays. I really enjoy radiology and in terms of longevity, i think it's "easier" and less physically demanding; although, film-volume is increasing and it's not fun when you're forced to read x-amount of films per day. All in all, if I only was looking to practice for 10-15 years, EM would win hands down. However, this isn't the case and hence my difficulty choosing.

Any thoughts or advice from the EM crowd?

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[SolidGold]

Emergency Medicine:

+Would be able to match in my top 3 (I'm moderate/competitive for EM)

Radiology:

-Would likely end up at "lower"-tier residency programs, with a real possibility of not matching at all

Might want to check what happened this year with the match, even though radiology is traditionally more competitive, EM is becoming much more popular and thus more competitive than it has been in the past.

 

[EC3]

Might want to check what happened this year with the match, even though radiology is traditionally more competitive, EM is becoming much more popular and thus more competitive than it has been in the past.

i can agree about EM becoming more competitive. the thing is, though, my top program is my home program and i know the faculty, etc. and feel fairly confident that i would be able to match here.

i think, though, that this issue of where i match is somewhat less important in the grand scheme of trying to decide which specialty to choose.

 

[Sweet Tea]

i can agree about EM becoming more competitive. the thing is, though, my top program is my home program and i know the faculty, etc. and feel fairly confident that i would be able to match here.

i think, though, that this issue of where i match is somewhat less important in the grand scheme of trying to decide which specialty to choose.

Heh, yeah. I thought so too. My home program wasn't my top, but I thought "Oh I'm sure they'll rank me well...they know me and like me and they'll give me a spot." I'm doing a prelim year in surgery this year. Don't bet on your home program; they may rank you, but with the competitiveness of EM now they're not going to guarantee you a spot.

 

[SolidGold]

Heh, yeah. I thought so too. My home program wasn't my top, but I thought "Oh I'm sure they'll rank me well...they know me and like me and they'll give me a spot." I'm doing a prelim year in surgery this year. Don't bet on your home program; they may rank you, but with the competitiveness of EM now they're not going to guarantee you a spot.

I agree, it happened to someone I know and their home program, which was ranked #1. You really can't bet on that with so much certainty.

 

[SolidGold]

BTW, I think there is a TON on information already on pros/cons of EM on this forum, just do a search. You seem to have a number of good pros/cons on there.

 

[kungfufishing]

The two are very different in terms of the work you will do, and this is the most important part. You like the work in one better than the other. Pick that one.

 

[MightyShorty]

The two are very different in terms of the work you will do, and this is the most important part. You like the work in one better than the other. Pick that one.

I agree. While it's true that the ability to switch circadian rhythm can affect career longevity in EM, it's ultimately doing what you love that will make the difference. If you pick a career that is not for you, it's not going to last no matter how easy it is on the body (or I guess you can still do it but just don't admit it).

 

[membsr-8890]

It seems like you might be able to mitigate at least some of your cons in each specialty by tweaking your practice environment. In Emergency Medicine, if your're not really into dealing with the drunks and the non-compliant patients and you're not into seeing a ton of patients per hour, find a cushy community position in a really snazzy area of town, or maybe a more rural job with low patient census. You'll still get SOME of the above mentioned patients but the number would be drasticlly cut from a busy county inner-city hospital.

For radiology, if it bothers you that you're not doing as many procedures or seeing many patients, do an interventional fellowship.

Overall, I think the most important thing to realize is that while there are specialties that are better fits for some than others, there's rarely one that the absolute perfect fit. There will be cons about which ever specialty that you ultimately choose, you just have to figure out which of them are the most liveable for you. For most, this comes down to the gut feel. If the specialty just makes you happy in general, you don't tend to mind the bothersome parts quite as much.

 

[EC3]

The two are very different in terms of the work you will do, and this is the most important part. You like the work in one better than the other. Pick that one.

i like both specialties a lot, though. I do like EM more but it's not like i dislike radiology, far from it.

 

[EC3]

It seems like you might be able to mitigate at least some of your cons in each specialty by tweaking your practice environment. In Emergency Medicine, if your're not really into dealing with the drunks and the non-compliant patients and you're not into seeing a ton of patients per hour, find a cushy community position in a really snazzy area of town, or maybe a more rural job with low patient census. You'll still get SOME of the above mentioned patients but the number would be drasticlly cut from a busy county inner-city hospital.

For radiology, if it bothers you that you're not doing as many procedures or seeing many patients, do an interventional fellowship.

Overall, I think the most important thing to realize is that while there are specialties that are better fits for some than others, there's rarely one that the absolute perfect fit. There will be cons about which ever specialty that you ultimately choose, you just have to figure out which of them are the most liveable for you. For most, this comes down to the gut feel. If the specialty just makes you happy in general, you don't tend to mind the bothersome parts quite as much.

how is the job availability of the more rural type EM practices? do these places still get lots of procedures? thx.

 

[da3dl3us]

Alright, so i'm trying to make the big decision about which specialty i would like to pursue. I've always been a big EM nut and was pretty certain that this is what i've always wanted to do. Recently, though, i've had some increased exposure to radiology and i find that i'm really enjoying this as well. I'd like to list out some pro's and con's and get some feedback. Also, please keep an open mind and don't give the knee-jerk "if you have to ask..." because i think i have legitimate reasons for liking/disliking each specialty.

Emergency Medicine:

PROS
+Absolutely great set of clinical skills; a "renaissance man" of medicine
+Tons of procedures
+Great integrative, teamwork approach
+Lots of good fellowship options such as sports medicine, toxicology, wilderness med, cruise ship medicine,etc.
+Very good hourly wage
+Relatively short work week (~45 hours/week)
+Would be able to match in my top 3 (I'm moderate/competitive for EM)
+3 year residency

CONS
-Circadian shift work (not so much a problem when you're younger but i've heard from even EM-trained attendings that as you get older, it does start to 'take a toll' physically and mentally)
-Patient population can be taxing (drunks, drug seekers, histrionics, etc.)
-Trend toward "productivity-based" pay (i don't want EM to turn into family practice where you need to see 35 patients a day and make only $150K/year)
-Defensive medicine (the word "chest pain" gets MI r/o regardless of if the patient actually means abdomen)
-Trend toward more regulations and more "primary care" role (JCAHO isn't making things better)
-Consults not always appreciated (i already have patients whining, i don't need to hear it from MDs)

Radiology:

PROS:
+Reading films is interesting and fun
+Very analytical (Anything that has "physics boards" get my seal of approval)
+Integral part of almost every other specialty (lots of interactions with other docs)
+Some procedures (not as cool as EM, though)
+No patient contact (Some days I really don't feel like taking a history, especially when someone's meds consist of "that blue pill and that orange one")
+Excellent pay (about 1.5 times that of EM)


CONS:
-Sit in a dark room all day, talking to a computer (talk about depressing)
-No patient contact (it's very fun to deal with the compliant patients)
-5 year residency program
-Would likely end up at "lower"-tier residency programs, with a real possibility of not matching at all
-Trend towards cutting reimbursments as well as outsourcing film-readings
-Productivity-based pay
-longer work week (~56 hours/week)


Final thoughts: In terms of which i enjoy more, i'd say that EM wins out. I really like the knowledge and skill-set that EM training gives, and nothing is more fun than getting down and dirty with the pathology that presents to the ED. In terms of practice, though, I have reservations about being able to practice EM into my 60s, especially with having to work nights, weekends, and holidays. I really enjoy radiology and in terms of longevity, i think it's "easier" and less physically demanding; although, film-volume is increasing and it's not fun when you're forced to read x-amount of films per day. All in all, if I only was looking to practice for 10-15 years, EM would win hands down. However, this isn't the case and hence my difficulty choosing.

Any thoughts or advice from the EM crowd?

Dude, I'm going through exactly the same dilemma as you are. In fact, I came on here to do some soul searching about this myself. Honestly, I feel that the pros/cons you mentioned are spot on, and everyday, I find myself switching from one choice to the other and like you, I think I'm pretty competitive for EM, and not so much for Rads.


Right now, I'm on my EM mood swing. One of my life-goals is to volunteer extensively in free-clinics, thus the skill-set from EM would be extremely useful. If I were to go into Rads, I'd be afraid of losing my clinical skills. On the other hand, the power of radiology is amazing, in terms of helping people with technology.

Anyways, PM me if you want to revel in this topic more extensively.

 

[breaker1919]

Great thread. I'm impressed that no one has flamed away yet. Unfortunately, on many other specialty forums, members devour their own if they're insecure about their choice of specialty. I think questioning your decisions is an important part of choosing a specialty. Honestly, I'm still at about 85% EM. At the beginning of third year, I was at 10%. My biggest hang-up with EM was the fear of becoming one of those doctors who stereotypes everyone (drug seekers, fakers, etc.). I don't want to become bitter or jaded. I'm starting to learn that every specialty deals with this. It's a choice you have to make regardless of your specialty. Anyway, I'm always up for a good career discussion. EM isn't perfect; it's just better than all the others.

 

[deleted109597]

Maybe I can convince everyone in the class of 2008 to try rads, and I'll have an easier time next year.

FWIW, it was easier to scramble rads and rad/onc than it was EM this year.

 

[EC3]

Dude, I'm going through exactly the same dilemma as you are. In fact, I came on here to do some soul searching about this myself. Honestly, I feel that the pros/cons you mentioned are spot on, and everyday, I find myself switching from one choice to the other and like you, I think I'm pretty competitive for EM, and not so much for Rads.


Right now, I'm on my EM mood swing. One of my life-goals is to volunteer extensively in free-clinics, thus the skill-set from EM would be extremely useful. If I were to go into Rads, I'd be afraid of losing my clinical skills. On the other hand, the power of radiology is amazing, in terms of helping people with technology.

Anyways, PM me if you want to revel in this topic more extensively.

it's tough because the two fields seem really fun. it would be an easy decision if you could work only days after a certain point, but unfortunately that's not an option. and i'm not really into working urgent care.

can anyone give some ideas as to other options that are available to an EM-trained doc?

 

[EC3]

Great thread. I'm impressed that no one has flamed away yet. Unfortunately, on many other specialty forums, members devour their own if they're insecure about their choice of specialty. I think questioning your decisions is an important part of choosing a specialty. Honestly, I'm still at about 85% EM. At the beginning of third year, I was at 10%. My biggest hang-up with EM was the fear of becoming one of those doctors who stereotypes everyone (drug seekers, fakers, etc.). I don't want to become bitter or jaded. I'm starting to learn that every specialty deals with this. It's a choice you have to make regardless of your specialty. Anyway, I'm always up for a good career discussion. EM isn't perfect; it's just better than all the others.

I really don't mean any disrespect and I feel my motivations for liking each speciality aren't shallow. EM is my favorite specialty but i think there is some merit to worrying about longterm ability to practice; this issue even comes up in some of the EM journals and newsletters.

 

[EC3]

Maybe I can convince everyone in the class of 2008 to try rads, and I'll have an easier time next year.

FWIW, it was easier to scramble rads and rad/onc than it was EM this year.

I very much understand that EM is becoming more competitive, but objectively Rads remains a tougher field to match. With this said, though, I think the EM and Rads residencies look for different things in their applicants. Rads tends to be very "numbers" driven while EM favors a more well-rounded applicant, valuing LORs and Rotation grades more-so than grades and step scores.

And as a disclaimer, just because a field is less "competitive" doesn't imply anything about the quality of the field. I mean, dermatology is the most difficult match; talk about

 

[deleted109597]

I very much understand that EM is becoming more competitive, but objectively Rads remains a tougher field to match.

Well, yeah, I was just saying from an absolute numbers standpoint.

 

[roja]

Emergency Medicine:

PROS
+Absolutely great set of clinical skills; a "renaissance man" of medicine

Ahem. "renaissance woman"

 

[CalypsoGP]

The best piece of advice I would have is do 4th year rotations in both and do them early. Even if you end up hating one of them you can't go wrong with a little extra training in radiology for EM and vice versa.

 

[da3dl3us]

The best piece of advice I would have is do 4th year rotations in both and do them early. Even if you end up hating one of them you can't go wrong with a little extra training in radiology for EM and vice versa.

Yup, that's pretty much the gameplan. I hitting up rads first, since it's slightly more competitive, so if I like it, I can get a headstart. But, in a couple weeks, gonna hang out with the EM physicians at my hospital for a day and get a taste of it.

 

[da3dl3us]

EDIT: Double Post

 

[SelflessAct]

it's tough because the two fields seem really fun. it would be an easy decision if you could work only days after a certain point, but unfortunately that's not an option. and i'm not really into working urgent care.

can anyone give some ideas as to other options that are available to an EM-trained doc?

Hey everyone,

I'm just an M1 here starting to really like the idea of EM from what I know about it so far (especially from reading this forum), but I wanted to ask a question about the above comment... Is it not very feasible to cut down your working hours after working in EM, say, 20 years? Are most docs of that age still expected to work those long and grueling shifts everywhere, or does it depend on the city/hospital you are at? I would think by then I might want to start working part time or days or something, but how realistic is that? Then again I might love it too much to ever cut down my hours too... Thanks, and congratulations to everyone who matched in EM! (and good luck to those trying again for next year. )

 

[deleted109597]

Is it not very feasible to cut down your working hours after working in EM, say, 20 years?

Most work less than half the days of each month.

Are most docs of that age still expected to work those long and grueling shifts everywhere, or does it depend on the city/hospital you are at? I would think by then I might want to start working part time or days or something, but how realistic is that?

How part time are we talking? Once a week? 16 shifts a week is fairly standard, compare that to most other fields. Yeah, if you get enough seniority, you might pull all days, but until then, it is shift work.

 

[Apollyon]

16 shifts a week is fairly standard

A week? Where you at??

Actually, I work 12, and the only people doing 16 are masochists that need the money. I know two guys doing 220 and 240 hours per month.

 

[deleted77919]

A week? Where you at??

I think he means for the whole department (maybe?), 16 shifts would split the difference between 12's (14 shifts/week) and 9's (about 19).

 

[Apollyon]

I think he means for the whole department (maybe?), 16 shifts would split the difference between 12's (14 shifts/week) and 9's (about 19).

(It was a joke - per week, which is a typo. You also fell into it - 14 shifts a week?)

 

[deleted77919]

(It was a joke - per week, which is a typo. You also fell into it - 14 shifts a week?)

I concede per month makes more sense.

I thought maybe he meant for the whole department per week (there would indeed be 14 shifts in one week for a department doing 12 hour shifts with single coverage for each shift), in which case the probability was small that you could work only days or work shorter shifts . . . sigh . . . I guess I've been studying too much physio which causes me to come up with such convoluted logic.

 

[salmonella]

I think the best way to test if you really like a specialty is to stay away from it for a short period of time. When you are on another rotation, do you you miss rads or ER more?

 

[roja]

I think the best way to test if you really like a specialty is to stay away from it for a short period of time. When you are on another rotation, do you you miss rads or ER more?

An outstanding piece of advice. One of the great (?) things about EM is people are rarely in the middle of the road about it. Most people know after thier first shift or so that it is the place for them or not. I have rarely met someone who didn't either love it or hate it. The pace, the variety, etc all either tend to make people love or hate it.

I knew on my first shift it was the place for me. I enjoyed almost all my other rotations but kept saying "I like this but not forever".

The pros and cons list can be decieving. Everything has these. it really comes down to what rotation do you miss bieng on the most? After my EM month, all I could think about was getting back into the ED. I just wanted to be there. Doing anything.

Best of luck deciding!