EM to Plastics?

[EMregrets]

Hey all, I could really use some advice. Trying to stay anonymous for obvious reasons.

As an MS3, I was originally set on applying to Integrated Plastics. Had away rotations scheduled, was working on research, etc. Then I had an EM rotation late in MS3 and really liked it. I waffled between the two but ultimately chose EM. Now that I'm near the end of PGY1 I'm convinced I made (possibly) the biggest mistake of my life.

I liked Plastics for several reasons: the diversity of cases and procedures, mostly open surgical techniques (didn't care for laparoscopic/robotic as much), great outcomes that you can easily see, and mostly grateful/healthier patients. I enjoyed the OR but was honestly scared of an intense 6 year residency. EM as a student was great because I had more autonomy on those rotations and got to do plenty of procedures so I think that biased my decision. I've given EM nearly an entire year and it seems that it just isn't a great fit for me. I find myself thinking more and more about what life would be like in an Integrated Plastics residency and as a Plastics attending.

I'm in good standing at my program with great clinical evaluations from faculty and the highest score in my class on the in-service. My EM program is in a community hospital without an Integrated Plastics residency and there's only one nearby Integrated Plastics residency that takes 1 resident/year. My Step 1/Step 2 scores are well above average for Plastics, 265 and 270 respectively. I received excellent clinical grades in medical school and was elected to AOA. I do have some research but most of it is not Plastics specific (I have 1 Plastics book chapter that I helped with). Unfortunately, my medical school does not have a home Integrated Plastics program either.

How could I go about switching to Integrated Plastics? It obviously doesn't help that Plastics is one of the most competitive residencies. I was thinking about using an elective this year to maybe do a rotation at another program to get a letter of recommendation. I would prefer not to switch to Gen Surg with the plan of doing fellowship as it seems that Plastics fellowships are being phased out as well as the possibility of not matching and being stuck in Gen Surg which I don't enjoy as much. Or y'all can tell me that I'm being stupid and switching would be impossible. Either way, appreciate it!

-EMregrets

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[doc05]

I liked Plastics for several reasons: the diversity of cases and procedures, mostly open surgical techniques (didn't care for laparoscopic/robotic as much), great outcomes that you can easily see, and mostly grateful/healthier patients.

As it turns out, "great outcomes" and grateful /healthy patients are the exception for plastics. You should see what my plastic surgery colleagues deal with on a day to day basis. It's not the least bit glamorous.


Don't make the switch. EM allows for a good income, no on-call, and more time off to see your family and have a life.

 

[deleted859535]

As it turns out, "great outcomes" and grateful /healthy patients are the exception for plastics. You should see what my plastic surgery colleagues deal with on a day to day basis. It's not the least bit glamorous.


Don't make the switch. EM allows for a good income, no on-call, and more time off to see your family and have a life.

Agree with the sense of caution here. End-intern year is notoriously a bad time to think about switches. You've seen enough firsthand as a resident to see some of what you don't like yet not enough of what you'll ultimately enjoy.

Clearly you did well as a student, but it sounds like what you saw as a student as far as plastics goes was itself maybe a bit skewed. Definitely mull this one over before you pursue a switch.

 

[ACSurgeon]

Hey all, I could really use some advice. Trying to stay anonymous for obvious reasons.

As an MS3, I was originally set on applying to Integrated Plastics. Had away rotations scheduled, was working on research, etc. Then I had an EM rotation late in MS3 and really liked it. I waffled between the two but ultimately chose EM. Now that I'm near the end of PGY1 I'm convinced I made (possibly) the biggest mistake of my life.

I liked Plastics for several reasons: the diversity of cases and procedures, mostly open surgical techniques (didn't care for laparoscopic/robotic as much), great outcomes that you can easily see, and mostly grateful/healthier patients. I enjoyed the OR but was honestly scared of an intense 6 year residency. EM as a student was great because I had more autonomy on those rotations and got to do plenty of procedures so I think that biased my decision. I've given EM nearly an entire year and it seems that it just isn't a great fit for me. I find myself thinking more and more about what life would be like in an Integrated Plastics residency and as a Plastics attending.

I'm in good standing at my program with great clinical evaluations from faculty and the highest score in my class on the in-service. My EM program is in a community hospital without an Integrated Plastics residency and there's only one nearby Integrated Plastics residency that takes 1 resident/year. My Step 1/Step 2 scores are well above average for Plastics, 265 and 270 respectively. I received excellent clinical grades in medical school and was elected to AOA. I do have some research but most of it is not Plastics specific (I have 1 Plastics book chapter that I helped with). Unfortunately, my medical school does not have a home Integrated Plastics program either.

How could I go about switching to Integrated Plastics? It obviously doesn't help that Plastics is one of the most competitive residencies. I was thinking about using an elective this year to maybe do a rotation at another program to get a letter of recommendation. I would prefer not to switch to Gen Surg with the plan of doing fellowship as it seems that Plastics fellowships are being phased out as well as the possibility of not matching and being stuck in Gen Surg which I don't enjoy as much. Or y'all can tell me that I'm being stupid and switching would be impossible. Either way, appreciate it!

-EMregrets

You can ruin your career by trying to switch and ultimately may never get to be a plastic surgeon.

My advice: finish your EM training and if you still think you want to become a plastic surgeon, apply to the match in your last year of training. Apply to plastics and prelim surgery if you’re determined to give integrated plastics a few years of your life in attempts. You can obviously the general surgery route but you already said you don’t want to. For anyone saying this is ridiculous, I refer you to the PGY12 pediatric surgery fellows. Some people value their career more than I can understand

Most of us would probably tell you to forget the fantasy and be glad you get the start enjoying life in 2 years. But I have a feeling you don’t want to hear that.

 

[TypeADissection]

Exactly what @ACSurgeon said. Can't agree with him more. Stay in EM, finish strong, get married, have big fat babies. Cheers.

 

[deleted547339]

Exactly what @ACSurgeon said. Can't agree with him more. Stay in EM, finish strong, get married, have big fat babies. Cheers.

Nothing worse than a skinny baby....


Anyways, to the OP, as others have said, the end of internship is rough. Also, there are good sub specialty options in EM that get you an “out of the ER” if that’s actually what you want.

I was torn between surgery and EM and ultimately picked EM. In times I’ve been down, I’ve definitely regretted it and considered changing, but I’m very happy I stuck it out. All specialties have their garbage and all grass is greener than wherever you’re standing at the end of internship.

 

[littleturtle10]

Hey all, I could really use some advice. Trying to stay anonymous for obvious reasons.

As an MS3, I was originally set on applying to Integrated Plastics. Had away rotations scheduled, was working on research, etc. Then I had an EM rotation late in MS3 and really liked it. I waffled between the two but ultimately chose EM. Now that I'm near the end of PGY1 I'm convinced I made (possibly) the biggest mistake of my life.

I liked Plastics for several reasons: the diversity of cases and procedures, mostly open surgical techniques (didn't care for laparoscopic/robotic as much), great outcomes that you can easily see, and mostly grateful/healthier patients. I enjoyed the OR but was honestly scared of an intense 6 year residency. EM as a student was great because I had more autonomy on those rotations and got to do plenty of procedures so I think that biased my decision. I've given EM nearly an entire year and it seems that it just isn't a great fit for me. I find myself thinking more and more about what life would be like in an Integrated Plastics residency and as a Plastics attending.

I'm in good standing at my program with great clinical evaluations from faculty and the highest score in my class on the in-service. My EM program is in a community hospital without an Integrated Plastics residency and there's only one nearby Integrated Plastics residency that takes 1 resident/year. My Step 1/Step 2 scores are well above average for Plastics, 265 and 270 respectively. I received excellent clinical grades in medical school and was elected to AOA. I do have some research but most of it is not Plastics specific (I have 1 Plastics book chapter that I helped with). Unfortunately, my medical school does not have a home Integrated Plastics program either.

How could I go about switching to Integrated Plastics? It obviously doesn't help that Plastics is one of the most competitive residencies. I was thinking about using an elective this year to maybe do a rotation at another program to get a letter of recommendation. I would prefer not to switch to Gen Surg with the plan of doing fellowship as it seems that Plastics fellowships are being phased out as well as the possibility of not matching and being stuck in Gen Surg which I don't enjoy as much. Or y'all can tell me that I'm being stupid and switching would be impossible. Either way, appreciate it!

-EMregrets

I spent all of my 3rd year of med school deciding between EM, plastics, and gensurg. I like parts of all of them. Ended up double applying plastics and gensurg, got interviews in both, and ranked gensurg as the top of my rank list. I couldn't be happier as a gensurg resident. There are certainly days when I am getting crushed in the ICU, am still at the hospital, and think about that shift work life I gave up. But they are far outnumbered by the days I love being in surgery, or see the lack of followup in the ED and cringe. But I understand where youre coming from.

The best plastics residents don't want to do gensurg, but enjoy their gensurg months and work hard. If you like being in the ED more than being on a general surgery rotation, and would rather be in the ED than end up a general surgeon, my sense is that you won't like a career in plastic surgery enough to give up the lifestyle of EM. But, if you dislike EM so much and miss the OR enough that you are willing to do general surgery with a shot at a plastics fellowship, you might consider double applying. Maybe your scores will be enough to have a shot at an integrated spot. But I think if you're not willing to apply to both gensurg and integrated plastics, programs might think that the commitment isn't there.

 

[DarknightX]

I spent all of my 3rd year of med school deciding between EM, plastics, and gensurg. I like parts of all of them. Ended up double applying plastics and gensurg, got interviews in both, and ranked gensurg as the top of my rank list. I couldn't be happier as a gensurg resident. There are certainly days when I am getting crushed in the ICU, am still at the hospital, and think about that shift work life I gave up. But they are far outnumbered by the days I love being in surgery, or see the lack of followup in the ED and cringe. But I understand where youre coming from.

The best plastics residents don't want to do gensurg, but enjoy their gensurg months and work hard. If you like being in the ED more than being on a general surgery rotation, and would rather be in the ED than end up a general surgeon, my sense is that you won't like a career in plastic surgery enough to give up the lifestyle of EM. But, if you dislike EM so much and miss the OR enough that you are willing to do general surgery with a shot at a plastics fellowship, you might consider double applying. Maybe your scores will be enough to have a shot at an integrated spot. But I think if you're not willing to apply to both gensurg and integrated plastics, programs might think that the commitment isn't there.

Great post. I totally agree.

If couldn’t be a surgeon, I would quit medicine and find something else.

There is no amount of money that would make me do EM. I would be absolutely miserable. I would rather scrub into any case and be in the OR (even an Gyn case) then spend any time being in the ER and dealing with what ER docs have to do. If I hadn’t done a fellowship, I would have been just as happy doing General Surgery.

 

[EMregrets]

Thanks for all the responses! It's been busy with the new interns coming in and having more responsibility to keep the ED moving so I haven't had a chance to check back in here. In particular, thanks to @ACSurgeon, @TimesNewRoman, @littleturtle10 for your advice.

It's just hard to tell if I dislike being an EM resident or if I dislike EM as a specialty. This year has revealed many of the negatives of EM that I was shielded from (or willfully blind to) as a student. The sometimes difficult patient population, risk of burnout, being talked down to by specialists, feeling dumped on and disrespected by all the other services, some consultants automatically assuming I'm an idiot, being a generalist albeit with expertise in the undifferentiated/critical patient that nobody seems to care about, the many BS complaints, not having "my own" patients, etc. There are other aspects I really enjoy so it's not all bad. I'm also probably idealizing Plastics. I do miss the OR and I know it's not all cosmetic procedures on healthy, grateful patients. The reconstructive work interests me as well. But I didn't do any away rotations as a student so my perspective on the specialty is definitely limited. Maybe if I chose Plastics I'd be an unhappy PGY-2 working "80" hours per week dreaming of switching into EM.

I'll be on a lighter rotation soon so my plan is to try to shadow in the OR and see how I feel being back in the OR. Then, hopefully, I might be able arrange an away rotation at another institution for my elective in PGY-3. Either way, I'm not going to rock the boat at my program. I'll keep my head down and keep working hard in the ED. Integrated programs probably won't even look at me as an EM resident so all of this is probably for nothing anyway. Like some of you said, I maybe should give up the fantasy. It's just hard to accept that I might have made a terrible mistake as a student and that I will never be able to rectify the situation.

Sorry for the rambling.

 

[Pir8DeacDoc]

Maybe one day you can work in a smaller hospital where you can know your consultants..I consider my ER guys friends. We are all doing the best we can. The petulant behavior of academic medicine and ivory tower hospitals seems to disappear in the community.

Good luck
It's never easy