EM vs Cards vs GI

[randommedstu]

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I'm having trouble deciding between EM vs IM. If i go into IM i would want to do a fellowship in Cards or GI. So i guess my real question is EM vs Cards vs GI.

in your opinion, which field of medicine has the better lifestyle? i know that Cards and GI pay better but i care more about lifestyle. Thanks!!

 

[Tiger26]

going through a medicine residency would be a vortex of suck that i just wouldn't be willing to do fwiw . . .

 

[Rendar5]

pick the field you an see yourself still being happy doign in 20 years. If the ED doesn't seem like home to you, then dont' bother with it.

 

[Apollyon]

And try not to post your question in multiple forums.

 

[deleted65604]

If you work hard for 20 years as an interventional cardiologist, you will be able to retire and buy a small island. ER...not so much. A small island would be a SWEET lifestyle. It is all relative. Rephrase your question to define your idea of "lifestyle".

 

[randommedstu]

If you work hard for 20 years as an interventional cardiologist, you will be able to retire and buy a small island. ER...not so much. A small island would be a SWEET lifestyle. It is all relative. Rephrase your question to define your idea of "lifestyle".

Lifestyle specialties are those that offer good pay with minimum work hours, low patient loads, above average working conditions, and typically low on-call time.

 

[gro2001]

Lifestyle specialties are those that offer good pay with minimum work hours, low patient loads, above average working conditions, and typically low on-call time.

-EM-
Pay +
Hours: varies, but you generally have a lot of choice
Patient loads: LOADS
Working conditions: depends if you like the ER. I love ED, I hate clinic, so for me its a +. For some, its a -.
Call: None.

-GI-
Pay ++
Hours: varies.
Patient loads: varies, tends to be a lot.
Working conditions: +
Call: varies.

-Cardio-
Pay +++ (if interventional)
Hours: varies.
Patient loads:varies.
Working conditions: +
Call: varies.

Both Cards and GI variable of hours, # of patients, and call time varies tremendously based on whom you are working for (huge center vs small hospital vs own practice vs physician group) and where in your career you are (junior docs tend to take lots of call to build up their patient base).

The nice thing about EM lifestyle is if you are cards/gi/almost anything else, and you have clinic on certain days of the week, there is usually nothing that could get you out of it since people signed up weeks in advance to see YOU. But in EM, a shift is a shift and can usually be swapped if you have your kid's baseball game to go to, or your favorite band is in town. Also, you generally know exactly when you are getting out of the hospital, and nothing short of a major disaster can get you back in. And no one calls you in the middle of the night because your patient is getting admitted.

 

[deleted65604]

low patient loads, above average working conditions

low patient loads? Have you ever seen an ER waiting room at 4 in the afternoon? Do you realize how it feels to walk into work with 20 in the waiting room and 10 waiting in rooms to be seen (or 70 in the waiting room if you work at one of those monstrously big ERs)? How about when four times the number of patients you can safely see in an hour all check into the ER at the same time? How hard is it to please somebody who just waited 6 hours, or 10 hours, or even 16 hours? How hard is it to please someone who spent the night in your ER waiting room to see you? There is not a worse specialty than ER for patient loads. On a busy shift, I will often forget to eat, or drink. I have often gone 13 hours without urinating. I get constipated for days on end after a string of busy shifts. Drugs seekers are working you on everyside, praying you screw up so they can strike it rich. Old weak and dizzies are laying in bed refusing to move until they are admitted. The whole world, whether young or old has chest pain and abdominal pain of unknown etiology that 75% of the time, you never find any reason for. Psychotics and Borderlines are threatening you physically and legally as they glory in the havoc they create. Drunk uncooperative head injuries are brought in by EMS with AIDS and your nurses plead with you to not make them risk their life by making them start IVs on flailing idiots for conscious sedation to rule out intra-cranial bleed. The working conditions of an ER are HORRENDOUS. They will tear you up spiritually and psychologically and spit you out in no time.

 

[Arcan57]

Lifestyle specialties are those that offer good pay with minimum work hours, low patient loads, above average working conditions, and typically low on-call time.

Jarabacoa overstates somewhat, but the only thing ED has in terms of your qualifiers is work hours and low on-call time. And the work hours isn't so attractive when you realize that your only weekend day "off" this month is you getting home from a Saturday 10p-8a and having to be back for a Monday 7a-5p. On-call time will vary depending on how much back-up is required. Obviously there is a much lower chance of being called in than cardiology, but still can't drink or travel.

The pay is usually quite good but I don't have a lot of my colleagues from other specialties lusting after my job.

 

[MadHat]

I shadowed an ER doctor on one of their shift, and I left the ED with a headache and nausea. The salary of an ED physicians can be in the millions and it still will not persuade me to go into EM.

Just curious, how many years have you physicians been an attending? DocB, Arcan57, and Jarabacoa.

 

[Groove]

When did EM become a new ROAD specialty? I can't even spell anything by adding E to ROAD...wait ADORE...which just sounds ******ed. ROAD works so much better...

Seriously though, to the OP, you seem a little all over the place, which is fine. You might be one of those med students who really has no idea anymore what they want to do, and perhaps doesn't even care, as long as you can bring home a nice paycheck and have plenty of time off. That's fine and dandy but I would caution anyone who pursues EM with no true love of the field or the work environment, because you will hate your life at some point. You'll have much more flexibility and psychological income by doing anything else in the long run. I love the ED, wouldn't work anywhere else in the hospital, didn't even apply to anything else, but then again... I'm probably more than a little crazy. Maybe I'll burn out someday, maybe not, but I would gladly perform a fecal disimpaction on the gomer in #E7 than suffer through a single morning of endless IM rounding and neurotic discussions about Mg, K levels.

 

[GoBuckeyes913]

I'm having trouble deciding between EM vs IM. If i go into IM i would want to do a fellowship in Cards or GI. So i guess my real question is EM vs Cards vs GI.

in your opinion, which field of medicine has the better lifestyle? i know that Cards and GI pay better but i care more about lifestyle. Thanks!!

Radiology

 

[deuist]

in your opinion, which field of medicine has the better lifestyle? i know that Cards and GI pay better but i care more about lifestyle. Thanks!!

Rads, anesthesia, PMR, derm, rheum, endocrine, pathology, and plastics are all great lifestyle specialties. There are even a few surgical subspecialties such as breast that are pretty nice, too. Cards is notoriously difficult because of the long hours and frequent call. GI is +/- based on the group. EM may in theory have good hours, but falls apart when you go through it.

To answer the other question about when EM became a ROAD specialty, students started hearing about a field of medicine where you work only 3 days a week, perform procedures, don't take call, and don't have clinic, and then decided that they had to go into it.

 

[J ROD]

Why is Psy never considered in lifestyle specialities?

 

[peppy]

Why is Psy never considered in lifestyle specialities?

I do feel that the lifestyle is pretty good but if you don't have any interest in or compassion for the mentally ill then being a psychiatrist is going to be a painful experience.
There's also the issue of people viewing psychiatrists as not "real doctors" of course.

 

[thethom]

And radiologists and dermatologists ARE real doctors?? Hehe JK.

The question to ask yourself is: do you like continuity or not? Cards and GI clearly involve LOTS of continuity and outpatient practice. In the ER, the continuity is looking back at how many previous visits the patient has had for the same pain complaint and dilaudid request. At least now we can tell them we can no longer prescribe Darvocet, 😛.

 

[Perrotfish]

Why is Psy never considered in lifestyle specialities?

Is Psy really a lifestyle specialty when you're actually utiizing your training? It seems like the people who work on the kind of actue inpatients that are at the heart of psychiatry work endless hours with few resources for poor pay.

 

[thethom]

I think as one matures, the goal in life becomes to move farther and farther away from the hospital and have more and more of an 8-5 outpatient practice, which is feasible early in a psychiatrist's career.

 

[MossPoh]

I think you just have to do your best to spend time in each environment and see which one you enjoy the most. It sucks to base an entire career off of limited exposure, but that is the way it works.

I feel that, in general, EM attracts different personalities than Cards and GI. Not just the doctors, but the support staff as well. I really enjoy time spent in the ED. It isn't always because of the patients, as much as it is because I've enjoyed the people working in there. We all know there are people that absolutely blow as well, but I'm talking big picture.

It also seems to depend on what KIND of flexibility you want. If you want to develop your practice around specific things and have set schedules, then EM obviously won't work. If you are looking for the type of flexibility where you can move or work hard and go off the grid for a bit, then maybe EM is a better fit.

Just like being in an OR, people either love or hate the ED. I've had friends talk about how it is such absolute chaos and they can't stand it and others that thrive in those conditions.