Underplaying the money is something I need to actually do for myself a lot. Paying attention to my elders has taught me that happiness >>>>>>money, but economics has taught me that money is still important. In that sense yes it's a factor, but more important is knowing where I'd be happiest.
Would you be able to elaborate more on what "burnout" really is? I don't know if it's a phrase that means EM physicians hate their jobs enough to quit or if it means after 3 poor shifts in a row they get stressed but that it eventually goes away. My attendings told me something similar to your statement that it varies a lot on practice type/setting. I've only been exposed to the well staffed, 1/4 of that number, near the water community ER and everyone I've worked with is very happy, but I think that contributes to my poorer understanding of "burnout". Thinking I might "burnout" of my profession after such a great investment into it does give me some hesitation and makes me really wonder, if burnout is in fact people qutting the profession, what I would end up doing if that scenario arose.
I agree that it's difficult as a med student to know if I'll love being in the ED. However, please let me answer your question as best as I can.
1: Rad Onc.....Through serendipity/happenstance/random chance I was fortunate enough to do research with a local radiation oncologist. I went into the cancer center with a naive view that it was a sad, depressed place to be and that the patients would be uncurable, chronic, miserable. It turned out that I was incredibly wrong and it was so much more of a positive environment filled with patients who got better, whose cancer was cured, and who greatly appreciated the efforts of their docs. Furthermore, I looked at the attending who I doing research for and saw that he has a very happy demeanor, incredibly happy life, etc. Being the nerd that I tend to be, I was also fascinated with the high tech equipment, with the use of radiation (which is always portrayed as harmful) in such a helpful way, and with the patient interactions that tie back into the happy vs sad aspect I just mentioned. It seemed great at the time, and that stuck with me throughout 2nd and 3rd year. However, I admittedly didnt have a full rotation. I did research in the cancer center which was mostly data pulling and analysis alongside paper writing and was able to see patients for a few hours with my PI here and there, but I didn't have the day in day out life of a radiation oncologist so a question mark remained. I also met with some other radiation oncologists who had more negative views than my PI, telling me the field was going to be cut by medicare heavily, that it was a poor time to go into it. I read some articles about how there are far too many rad onc residency spots as the need for radiation oncologists isn't so great per 100,000 population. On top of all of this, my stats aren't stellar and while I firmly believe I'd be able to match in this field, I needed to be 100% certain that this is the life and profession that I want.
2: Emergency medicine.....Third year rotations gave me one day/week in my local emergency department. I've done ~8 8hr shifts and 2 12hr shifts (one night 7-7, one day 7-7). What really stuck out for me initially was the variation. In room 1 there's a lac to repair, in room 2 there's a 90 year old with skin tears who fell, room 3 is an epidural bleed, room 4 is a pt who needs staples removed, room 5 is a pt with chest pain, then a stroke alert comes in. To me this really resonated as I felt I was seeing "real medicine". As I've been given more opportunity and responsibility by my attendings throughout my rotation, I've noticed the real happiness I get when my clinical diagnosis is confirmed by labs/tests/scans. I was worried about the pace going into it, but every doc I've been with has had enough time during his 11-12 hr shift to eat a 10-20 minute lunch, use the restroom, listen to music, read a quick article on espn, etc. Even with every bed full, 8-10 patients in the hallway, 2 stroke alerts coming in, and 15 in the waiting room....my attendings still got through it without really any visible stress and made the high pace of the department seem ok. Maybe though, it's just that I enjoy their pace so to me it feels ok. On top of this is a difficult to explain fact...but i'll try. I love doing procedures and thought early on that that meant I'd go into surgery, but surgeries were long and I found myself getting bored even as 1st assist. In the ER though, there are a lot of smaller, quick procedures to do and I've loved every opportunity to do them. I could go on for a while, but overall, emergency medicine just feels right to me. On top of that is one last thing. I've always looked at my attendings and wondered if I really see myself in their shoes; in their practice environment, with their lifestyle, etc. etc.. In no other field that I've rotated through have I identified as well with my attendings as I have in emergency medicine...........................However...A lot of my EM attendings are in their 30s which could explain why I identify so well with them. Also, only a few of them have kids but their kids are still 1-2 years old. So maybe they just dont have the "burnout" mindset yet, but it's coming? Add to this the ever-discussed "burnout" and EM to me has really seemed like this: I'm looking down this road and at the end is something amazing, but there are brightly lit road signs saying "Medical students think EM is great, but they're wrong" and "Burnout will kill you" among other things. I don't know if I should ignore those signs which seems a bit arrogant, or if I try to explain them and see if they're really right or not. These are really the questions for me with EM. Add also that while my step 1 is ok for EM, it's still a unique application process and I don't think I would get it without being 100% certain that this is the life and profession that I want.
I'm realizing this was a lot to type/read and I apologize for getting off my initial topic of money. Hopefully though, you can see my dilemma in picking. I lean a lot more towards EM, but I'm still trying to get as much info as I can before I make a final decision.
Again, thank you.
