EM vs. Gas

[coop528]

I know this topic has been addressed before in previous threads, but I am interested to see what you guys think.

I am basically an undecided MS3 who likes....

1) Acute care with no continuity
2) Shift Work
3) Time outside of medicine

...which narrows the field down to mainly EM and Gas.

I'm interested in anyone out there that ultimately decided between these 2 specialties and what the determining factors were.

Any other thoughts are much appreciated. Thanks.

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[joshmir]

I took the same approach, and eventually decided gas b/c there is much more flexibility:

Lifestyle:
-can choose to get payed less and take no overnight call/weekends (not possible in ER without being a very senior partner)
-can choose whatever environment you want (high stress, complicated cases, easy cases)
-can choose to put yourself in a situation where you do a lot of chilling (academics where you are supervising residents) also with a pay cut
-less stress about malpractice

Subspecialty:
-outpatient pain
-ICU/critical care

also i have a bum back, and ER is heavy on the body (someone on sdn wore a pedometer for a shift and was suprised by how much ground he covered)

the camraderie in the er is magical, though. if we ever move to nationalized health care, er will be an awesome field to be in, although there will be fewer positions

I know this topic has been addressed before in previous threads, but I am interested to see what you guys think.

I am basically an undecided MS3 who likes....

1) Acute care with no continuity
2) Shift Work
3) Time outside of medicine

...which narrows the field down to mainly EM and Gas.

I'm interested in anyone out there that ultimately decided between these 2 specialties and what the determining factors were.

Any other thoughts are much appreciated. Thanks.

 

[BassDominator]

I considered EM for a while too. The ED can be exciting at times and working only 3 shifts a week is pretty cool, but those are long shifts and often overnight. That's fine when you're young and single, but it gets old and annoying when you have a wife and kids.

 

[DrQuinn]

I didn't really decide between Gas and EM, as I always knew I wanted EM... but besides the fact that I absolutely love EM as a specialty, regarding the topics that others have discussed...

The attendings at my program work ~32-34 hours a week and make 190k at an academic institution.

In the private world, you are never forced to work more than you want. If you only want to work two shifts a week and pull 100k a year, go do that. EM is the PERFECT specialty for someone who has outside interests in regards to finances. Many of my attendings are millionaires because they had lots of time (and capital) to open up other ventures.

Q

 

[gaseous]

Though the some aspects of the job (flexibility, acute care) are the same, the actual jobs are very different. I know for fact because I'm a tern currently in my ER rotation right now. I've found that ER is a lot of triage between people you send home vs. people to admit. As well, you see a lot of primary care for the poor and psych issues. I'd advise spending some time in the OR and the ER to see which you would prefer. As for "lifestyle" I don't think you can go wring with either. At the private hospital, the typical ER physican works between 8-14 shifts per month. Not bad.

 

[Creamfly]

I didn't really decide between Gas and EM, as I always knew I wanted EM... but besides the fact that I absolutely love EM as a specialty, regarding the topics that others have discussed...

The attendings at my program work ~32-34 hours a week and make 190k at an academic institution.

In the private world, you are never forced to work more than you want. If you only want to work two shifts a week and pull 100k a year, go do that. EM is the PERFECT specialty for someone who has outside interests in regards to finances. Many of my attendings are millionaires because they had lots of time (and capital) to open up other ventures.

Q

Are benefits included for the 2 shifts per week physicians, or do they have to find an outside source for health ins, life ins, 401K, etc....?

 

[DrQuinn]

Are benefits included for the 2 shifts per week physicians, or do they have to find an outside source for health ins, life ins, 401K, etc....?

It all depends... there are so many options.

Q

 

[coop528]

Great responses. Another thing is I am not sure I have the brain/personality for ER. What I mean is...my brain works better as a "knowing a lot about a little" instead of "knowing a little about a lot". Of course, I am an MS3, so right now I feel like I "know a little about a little".

Any other thoughts?

 

[Swaydaa]

Great responses. Another thing is I am not sure I have the brain/personality for ER. What I mean is...my brain works better as a "knowing a lot about a little" instead of "knowing a little about a lot". Of course, I am an MS3, so right now I feel like I "know a little about a little".

Any other thoughts?

I was also stuck between these two fields. I just could not stand that 70% of ER medicine is primary care....bottom line. And when you get an interesting patient you either send to IM or surgery and you move on to the next alcoholic with HTN. If you like critical care and airway management, anesthesia is the way to go. More of knowing a lot about little in my book!!

 

[SweetMD]

It's funny - I also had a hard time deciding between the two, and I ended up in EM. I agree with the above posts... The specialties have a lot in common = procedures, short term pt contact, critical care, good lifestyle as attending... but then the fields are so very different! You really have to (at least) rotate through both and ask yourself where you want to be!
For me one of the deciding factors was that EM is much more flexible as to what you can be doing in the future: as an anesthesiologist your job will be in the OR of a hospital or an office, whatever you subspecialize in (if you want to), with EM you can become an EMS director, a toxicologist, work with health organizations/international EM.... like another poster said... there are so many possibilities....!
All the mentioned downsides of EM are true as well, it's physically quite demanding, you don't get to ponder about these interesting cases, you do a ton of primary care. Yet, I'd do it again in a heartbeat!

 

[KungPOWChicken]

I agree that ER is way too much primary care. I never seen so many people who come in with a minor stomach ache who get huge workups for zip. I love walking into a patients room, and they're sitting back resting comfortably yet they have a "severe headache" or their back hurts like crazy. That's what I call a headache! I liked ER until I did an ER rotation. I love it when the trauma surg. team pushes the ER docs out of the room too.

 

[powermd]

I agree that ER is way too much primary care. I never seen so many people who come in with a minor stomach ache who get huge workups for zip. I love walking into a patients room, and they're sitting back resting comfortably yet they have a "severe headache" or their back hurts like crazy. That's what I call a headache! I liked ER until I did an ER rotation. I love it when the trauma surg. team pushes the ER docs out of the room too.

I agree. Aside from disliking the chaotic atmosphere in the ER, I felt like working in the ER is like being a bomb sniffing dog. You have to keep your clinical suspicion very high all the time, despite rarely seeing the problems you are most worried about. How many million dollar workups in the ED could be avoided if the patient simply had a regular doctor who knew him, and who he called when he got sick? I hate working up clearly non-emergent problems as though the patient were crashing in front of you. At least in anesthesia your patients are all pre-screened- they ALL have a problem serious enough to warrant taking them to the OR, and more likely than not what you do is definitely going to help them.

 

[KungPOWChicken]

Right On!!! That's what I love about ER. When I specialize in whatever, I will appreciate the ER doc who is capable of weeding out all the crap, so I don't have to deal with it, and I can sleep at night!!! Go ER!!!

 

[engineer]

hi kung pow. what are you going to specialize in?

 

[PiPhiDoc]

...after doing 3 years of a 4 year EM residency, I found that I was completely unhappy in the ER. Mainly because I could not stand dealing with social issues that nearly every patient brings to the ED, and I found that I felt like I rarely fixed a problem/made a diagnosis/made them feel better, often because they were in the ED for problems totally inappropriate for the ED.

On the flip side - after my CA-2 year, I am still LOVING anesthesia, and I feel like I make a difference in the lives of patients every day.

 

[Swaydaa]

You can also do many fellowships in anesthesia. Acute/chronic pain with many opportunities to do interventional pain...very exciting and very procedure based. You can do critical care, peds, CV, and neuroanesthesia fellowships. Many differnet options in anesthesia!!!!!!!!!!!

 

[CambieMD]

...after doing 3 years of a 4 year EM residency, I found that I was completely unhappy in the ER. Mainly because I could not stand dealing with social issues that nearly every patient brings to the ED, and I found that I felt like I rarely fixed a problem/made a diagnosis/made them feel better, often because they were in the ED for problems totally inappropriate for the ED.

On the flip side - after my CA-2 year, I am still LOVING anesthesia, and I feel like I make a difference in the lives of patients every day.

I consider EM as being primary care with greater liability. I can understand why some people find EM exciting, however.

CambieMD

 

[timtye78]

To me I met too many ER docs who were dismayed with their work. Watching many FP/IM and also docs who only completed an intern year perform the same (90%) work right next to some poor soul who actually worked hard to get the residency and complete it. Seeing PA-Cs flood the ER and basically doing the same thing. Everything is soooooooo acute, and you have to juggle all those pyscho-social/socioeconomic issues.

Also, some ( not all )ER docs loose interest in solving problems definitively."Treat'em and street'em!" Everyone gets rocephin! Geeez. Spend your medical career ruling out MIs then sending them off to someone else once the cardiac enzymes are normal. Do you ever find out what was wrong with the patient? Did they even care? Who knows. Being a small town ER doc is worse. Same responsibility and problems, but infinitely less resources and specialists. People gripe about all the specialists, but it seems they are the ones who are able to stand up with the right answers most of the time.

Also, ER docs constantly jump to conclusions and misdiagnose people all the time, and it doesn't matter because now the cardiologist has things under control, or the IM doc points out it isn't DKA, because the only thing wrong is hyperglycemia. Who wants to have a reputation as a jack of all trades but master of none?

These guys don't even try to emphasize health screening measures from what I can see. "Get them out of me ER or get them to the specialist!" Or get your giggles from all the idiots that come through insulting your intelligence. Who goes through years and years of school/debt/training to be sitting in some dirty ER at 3 am with some crack ***** who stuck something in her butt?

Every ER doc I have ever met had one question in their mind
"How can I get this patient out of my ER?"

Now, before I get flamed, there are many ER docs who DO care, and who are great physicians, but these are the feelings that led me away from EM. Now as an intern going down to the ER every night, I am so glad I didn't go into that field! Yuck. All those poor souls who watch the TV show thinking that EM is the most exciting field. In my experience, being stuck in the ER(on rotation) was infinitely more boring than anesthesia.

 

[Lefty]

I wanted to do emergency medicine the first 2 years of medical school. By the time I had decided I wanted to do anesthesia I hadn't done an ER rotation yet. Right now I'm doing my ER rotation and I must admit that there have been times when I thought to myself, "Did I make the wrong choice? Would I be happier in the ER?" Now that I'm at the end of my rotation I am still enjoying it but I'm starting to see a lot of little things about the work that I could get really annoyed with over time. I did 2 months of anesthesia rotations and didn't see many things that would really bother me much or get old with time.

After just 1 month of ER its clear to me that I would hate many things about the ER. Here are a few: I hate seeing babies that have crusty, boogery noses brought in cuz mom says he's not sleeping and he has a cough-but he doesn't cough once in the ED, no fever, clear lungs, no accessory muscle use. One of those here and there isn't bad, but a couple a day makes me start to roll my eyes.

I HATE dealing with patients that come into the ER b/c they'd have to wait a few days/weeks to see their PCP. Instead, they're content to wait several hours to be seen in the ED, get treated for free, and get an excuse from work that day. Worst of all is when they come in with an attitude demanding care, or demanding better care than they've gotten in the past or complaining that the last ER doc didn't fix their problem.

I don't like pelvic exams (who likes them?), but I especially don't like doing them on an ER bed in a frog-leg position b/c the ER bed isn't equiped with stirrups.

My back was killing me the day after I had to suture some lacerations in the ER room that wasn't set up for procedures and the bed didn't adjust so I had to sit twisted over the patient to do the procedure. That could definately get old.

Labial and rectal abscess I&Ds, penile lac repairs--need I say more?

In all fairness I should admit that my ER rotation is at a county hospital.

I should also say about my personality that after seeing a handful of patient's like those mentioned above I find myself starting to dread seeing those kinds of patients. I am more annoyed with them, and have a lot less patience with them. I find myself turning into the grumpy, judgemental person that I always thought made a horrible doctor. I don't like dealing with those patients, and afterwards I don't like how I treated them and feel like I'm becoming the type of doctor I never wanted to be. That is a personal issue for me anyways.

On the other hand, there has been a lot about ER that I've enjoyed. I've really enjoyed the hands on procedures. I think that part of the reason I get excited about suturing, LPs, etc is b/c in the past my experience with them has been limited and I haven't been allowed to do them. I've certainly done more suturing in my ER rotation than during either surgery rotation. When I look at ER docs as a laceration comes in their immediate reaction is to look for a student--with a smile of relief if they find one I might add.

So, while I have enjoyed my month of ER I am confident that my decision to go with anesthesia was a good decision for me.

 

[coop528]

I wanted to do emergency medicine the first 2 years of medical school. By the time I had decided I wanted to do anesthesia I hadn't done an ER rotation yet. Right now I'm doing my ER rotation and I must admit that there have been times when I thought to myself, "Did I make the wrong choice? Would I be happier in the ER?" Now that I'm at the end of my rotation I am still enjoying it but I'm starting to see a lot of little things about the work that I could get really annoyed with over time. I did 2 months of anesthesia rotations and didn't see many things that would really bother me much or get old with time.

After just 1 month of ER its clear to me that I would hate many things about the ER. Here are a few: I hate seeing babies that have crusty, boogery noses brought in cuz mom says he's not sleeping and he has a cough-but he doesn't cough once in the ED, no fever, clear lungs, no accessory muscle use. One of those here and there isn't bad, but a couple a day makes me start to roll my eyes.

I HATE dealing with patients that come into the ER b/c they'd have to wait a few days/weeks to see their PCP. Instead, they're content to wait several hours to be seen in the ED, get treated for free, and get an excuse from work that day. Worst of all is when they come in with an attitude demanding care, or demanding better care than they've gotten in the past or complaining that the last ER doc didn't fix their problem.

I don't like pelvic exams (who likes them?), but I especially don't like doing them on an ER bed in a frog-leg position b/c the ER bed isn't equiped with stirrups.

My back was killing me the day after I had to suture some lacerations in the ER room that wasn't set up for procedures and the bed didn't adjust so I had to sit twisted over the patient to do the procedure. That could definately get old.

Labial and rectal abscess I&Ds, penile lac repairs--need I say more?

In all fairness I should admit that my ER rotation is at a county hospital.

I should also say about my personality that after seeing a handful of patient's like those mentioned above I find myself starting to dread seeing those kinds of patients. I am more annoyed with them, and have a lot less patience with them. I find myself turning into the grumpy, judgemental person that I always thought made a horrible doctor. I don't like dealing with those patients, and afterwards I don't like how I treated them and feel like I'm becoming the type of doctor I never wanted to be. That is a personal issue for me anyways.

On the other hand, there has been a lot about ER that I've enjoyed. I've really enjoyed the hands on procedures. I think that part of the reason I get excited about suturing, LPs, etc is b/c in the past my experience with them has been limited and I haven't been allowed to do them. I've certainly done more suturing in my ER rotation than during either surgery rotation. When I look at ER docs as a laceration comes in their immediate reaction is to look for a student--with a smile of relief if they find one I might add.

So, while I have enjoyed my month of ER I am confident that my decision to go with anesthesia was a good decision for me.

Thanks for the extensive replies. It helps a lot to hear other people's dislikes of various fields. I should post a similar thread in the EM area to see if I get similar responses. Maybe later.

 

[DrQuinn]

I wanted to do emergency medicine the first 2 years of medical school. By the time I had decided I wanted to do anesthesia I hadn't done an ER rotation yet. Right now I'm doing my ER rotation and I must admit that there have been times when I thought to myself, "Did I make the wrong choice? Would I be happier in the ER?" Now that I'm at the end of my rotation I am still enjoying it but I'm starting to see a lot of little things about the work that I could get really annoyed with over time. I did 2 months of anesthesia rotations and didn't see many things that would really bother me much or get old with time.

After just 1 month of ER its clear to me that I would hate many things about the ER. Here are a few: I hate seeing babies that have crusty, boogery noses brought in cuz mom says he's not sleeping and he has a cough-but he doesn't cough once in the ED, no fever, clear lungs, no accessory muscle use. One of those here and there isn't bad, but a couple a day makes me start to roll my eyes.

I HATE dealing with patients that come into the ER b/c they'd have to wait a few days/weeks to see their PCP. Instead, they're content to wait several hours to be seen in the ED, get treated for free, and get an excuse from work that day. Worst of all is when they come in with an attitude demanding care, or demanding better care than they've gotten in the past or complaining that the last ER doc didn't fix their problem.

I don't like pelvic exams (who likes them?), but I especially don't like doing them on an ER bed in a frog-leg position b/c the ER bed isn't equiped with stirrups.

My back was killing me the day after I had to suture some lacerations in the ER room that wasn't set up for procedures and the bed didn't adjust so I had to sit twisted over the patient to do the procedure. That could definately get old.

Labial and rectal abscess I&Ds, penile lac repairs--need I say more?

In all fairness I should admit that my ER rotation is at a county hospital.

I should also say about my personality that after seeing a handful of patient's like those mentioned above I find myself starting to dread seeing those kinds of patients. I am more annoyed with them, and have a lot less patience with them. I find myself turning into the grumpy, judgemental person that I always thought made a horrible doctor. I don't like dealing with those patients, and afterwards I don't like how I treated them and feel like I'm becoming the type of doctor I never wanted to be. That is a personal issue for me anyways.

On the other hand, there has been a lot about ER that I've enjoyed. I've really enjoyed the hands on procedures. I think that part of the reason I get excited about suturing, LPs, etc is b/c in the past my experience with them has been limited and I haven't been allowed to do them. I've certainly done more suturing in my ER rotation than during either surgery rotation. When I look at ER docs as a laceration comes in their immediate reaction is to look for a student--with a smile of relief if they find one I might add.

So, while I have enjoyed my month of ER I am confident that my decision to go with anesthesia was a good decision for me.

Its interesting to hear the other sides of the story.
I did an anesthesia rotation as a 3rd year med student, and I LOVED intubating... but that was about it. I absolutely hated sitting there putzing around with the gas and dials, abhorred writing the little arrows for the vital signs, etc. I spent a few days iwth the pain specialist/anesthesiologist and I thought I was going to kill myself... everyone had chronic back pain or sciatica... that was my personal hell.

I admit I liked the procedures and the medications were cool to learn... and responding to codes on the floor is always fun... but I couldn't stand anything else.

I love nearly all aspects of EM. Weird how somone's trash is another's treasure!

To whoever is on the fence of EM vs. Gas, best advice is to do a month rotaiton in each. You'll know after those two months which one you like better! Even though EM and Anesthesia are similar in some aspects... the two specialties are VERY different and require different philosophies.

Good luck!

Q

 

[CambieMD]

Its interesting to hear the other sides of the story.
I did an anesthesia rotation as a 3rd year med student, and I LOVED intubating... but that was about it. I absolutely hated sitting there putzing around with the gas and dials, abhorred writing the little arrows for the vital signs, etc. I spent a few days iwth the pain specialist/anesthesiologist and I thought I was going to kill myself... everyone had chronic back pain or sciatica... that was my personal hell.

I admit I liked the procedures and the medications were cool to learn... and responding to codes on the floor is always fun... but I couldn't stand anything else.

I love nearly all aspects of EM. Weird how somone's trash is another's treasure!
To whoever is on the fence of EM vs. Gas, best advice is to do a month rotaiton in each. You'll know after those two months which one you like better! Even though EM and Anesthesia are similar in some aspects... the two specialties are VERY different and require different philosophies.

Good luck!

Q

I think that Quinn is right on the money. Personal tastes will vary. Med students have to figure out what they are really interested in doing .
Lifestyle considerations aside, whatever someone decides to do should excite them at some point.

CambieMD

 

[PiPhiDoc]

Great post, Quinn, and an excellent point.

One thing I would caution people on is deciding on a specialty just based on "lifestyle". You can work a lot or a little in many, many different fields, depending on where you work, what the setting is (academic vs private practice), how much money you want to make, ect...and even if you have the best hours in the world, it is simply NOT worth it if you HATE what you do everyday. Also, we are PROFESSIONALS. Your career will (or should) always be an important part of who you are. If you don't like that, you probably should not have gone into medicine. People don't get sick at convenient times, and they don't care if you have a golf game/theater tickets/ect.
While there are extremes (Neurosurgery, ect) and I think you do have to figure out what your own personal balance in life should be, I think that the focus has went too far in the direction of lifestyle issues.
I personally do not want people in my program or my specialty who have chosen either because they just think that they'll have an easy job with lots of free time.

 

[CambieMD]

Great post, Quinn, and an excellent point.

One thing I would caution people on is deciding on a specialty just based on "lifestyle". You can work a lot or a little in many, many different fields, depending on where you work, what the setting is (academic vs private practice), how much money you want to make, ect...and even if you have the best hours in the world, it is simply NOT worth it if you HATE what you do everyday. Also, we are PROFESSIONALS. Your career will (or should) always be an important part of who you are. If you don't like that, you probably should not have gone into medicine. People don't get sick at convenient times, and they don't care if you have a golf game/theater tickets/ect.
While there are extremes (Neurosurgery, ect) and I think you do have to figure out what your own personal balance in life should be, I think that the focus has went too far in the direction of lifestyle issues.
I personally do not want people in my program or my specialty who have chosen either because they just think that they'll have an easy job with lots of free time.

The whole topic of lifestyle hits a note with me because I choose FP years ago in part because I would be able "have a home life." I have been shouting from the mountain top, "do whatever turns you on." Forget about lifestyle considerations. I have wasted years trying to tolerate make myself like primary care. I have finally given up trying to make a square peg fit into a round hole. The one plus that I see in all of this is that I was able to step back and figure out what I really wanted to do.
Also do not believe that anesthesiologists spend their days supervising CRNAs and drinking coffee in the loungue. The guys that I followed worked pretty damn hard. Some days were long and hard. The guys who hated what they did were horrible to be around. Everything was a hastle for them.

Enough for now.

CambieMD

 

[timtye78]

I think these guys Cambie and Quinn etc are absolutely right. Like they said you can work as much as you want to in each specialty. It still is work.

Lifestyle is probably an overused, abused term. But there is still something to each specialty that can make it unique in wonderful ways or in terrible ways. Surgeons compared to anesthesiologists get floor consults and ER consults in addition to OR duties. Anesthesiologists don't need to work so many odd hours that ER docs work. ER docs don't need to find the diagnosis in all their patients, they run some tests, and once life-threatening problems are 'ruled-out' or after they 'eye-ball' diagnose pancreatitis they triage oops 'consult' to the specialist.

Each specialty can be nightmarishly busy if you want it to be that way. Otherwise some specialties are better suited to part-time work. Some people split medicine into inpatient medicine and outpatient medicine. I have heard many say "OMG, I can't stand working in a hospital." Or "Geez, I hate working in a clinic/office."

See where you feel intrigued, and drawn to. I remember reading somewhere that most people tend to go into specialties "that they know the least about."-as if that is the best criteria to use! Interesting.

 

[Lefty]

To whoever is on the fence of EM vs. Gas, best advice is to do a month rotaiton in each. You'll know after those two months which one you like better! Even though EM and Anesthesia are similar in some aspects... the two specialties are VERY different and require different philosophies.

I agree with this advice, but I would actually add that if you really are teetering between ER and Gas, or even if you are thinking about either one I would HIGHLY recommend doing 2 rotations in each field. 2 separate rotations at different institutions. Both can be very different at large university hospitals vs. county hospitals vs. small community hospitals. You may end up training at a large university hospital and then getting hired on at a small community hospital. It is wise to look at different settings within the specialty if you have any doubts.

2 more cents from me...

 

[GASDR]

Lifestyle aside, there are great things about both specialties.

I too was trying to narrow my decision between EM and Gas. I decided on anesthesia, however I just finished an EM rotation during my internship and mostly enjoyed it.

The major thing that annoyed me was all the psych issues you had to deal with. I would guess that approximately 60% or more of EM pt.'s have psych problems. How many people with CP have you seen that are actually very anxious and are having panic attacks? Too many! And then you still have to admit them to CYA. Also all the people who try to OD or the alchoholics, etc. Yikes. Maybe I got unlucky because I did not cherry pick charts from the rack, but it made me crazy.

Like the above patient with CP there is so much defensive medicine practiced in the ED that you wind up having to admit everyone with anything worse than a hangnail. I blame most of that on they lawyers we see so much on TV trolling for litigation, but in the ED it is a fact of life.

On the positive side, there is so much variety in the ED. You do some simple orthopedic stuff, minor surgical procedures, dabble in medicine, a little bit of OB, some critical care, peds, even some anesthesia.

I am glad I chose gas so I don't have to deal with all of the psych issues, unless I chose pain management. That is a tough call, because the procedures are cool but you still have to deal with the patients.

If you are into psych or are a psychiatrist, I apologize for my bias.