ER or...Neuro?

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prankster

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I'm a fourth year medical student and was set to apply Neurology.....however after spending a few weeks in the ER I feel that may be something I would want to pursue. I enjoy my time in the ER and like the variability. I don't know much about ER as I didn't really look into it much before this rotation. I should be applying for residency now and need to make a decision soon. I also enjoyed Neurology, but didn't find it as interesting. Anyone have any input on some of the advantages and drawbacks to ER? Is it tough to switch days to nights and vice versa? Is it really that stressful (I haven't seen many stressful situations in the ER, but this rotation is at a Level III center)? I don't really mind night shifts and stress right now, but I'm worried about say 25 years from now....
Also I know some places have physicians work three times or four times a week, but as an attending do you have to work a lot of weekends? Are there places where you can set a schedule and work those days (for example, Monday-Tues-Wed nights or something)? Does having to call other physicians for your patients ever become a problem? Sorry for all the questions but thanks in advance!
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I think requesting to only work monday tuesday and thursday or a similar request would indeed be hard to pull off. That would really be hard to schedule and the group and your boss would quickly grow to hate you. Trying to schedule ER shifts and not make people hate you would be hard enough without fixed requests like that. I'm not talking from personal experience as I don't do the schedules, but that is my feeling as I talk to those who have the infortunate job of putting together schedules.

Input from schedule makers, past or present?
 
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...that's an interesting dilemma; I for one can't think of two fields that are as unlike each other as ER and Neurology. The former is a fast paced generalist field that thrives on ruling out badness. The latter is a slow paced specialist field that has to take every neurological complaint that walks through the office door with equal seriousness. Unfortunately this includes no small number of drug seekers, fibromyalgia patients, and chronic pain patients who invariably get sent there after the PCP gets fed up enough to refer them on.
 
thanks for the responses...just thought i'd ask about the scheduling.
I know they're two very different fields, but I think part of the problem is is that I enjoy "a little bit of everything" but out of "everything" I really enjoy Neuro also.....if that makes sense. But yeah, Neuro is slow paced which is nice at times, but ER is more "fun"
 
I would do another rotation in EM before deciding its the specialty for you. Med students usually love their EM rotation because they get the most independence and actually get to act like a true doctor. You don't want to make a career decision based on a false sense of "fun".

On the other hand I love EM because it allows for a ton of flexibility when it comes to scheduling and it fits my short attention span for patients. I think continuity of care is great for the patient but I don't think I have the personality to provide that to my patients. That's why I "love" frequent flyers.
 
Capgras said:
I would do another rotation in EM before deciding its the specialty for you. Med students usually love their EM rotation because they get the most independence and actually get to act like a true doctor. You don't want to make a career decision based on a false sense of "fun".

On the other hand I love EM because it allows for a ton of flexibility when it comes to scheduling and it fits my short attention span for patients. I think continuity of care is great for the patient but I don't think I have the personality to provide that to my patients. That's why I "love" frequent flyers.
Click to expand...

Agreed, try to do another month. If you do try to focus on the "bread and butter" stuff (abdominal pain, vag bleeding, chest pain, vag bleeding, headaches, vag bleeding). Many EM clerkships push students into doing things that are relatively fun. I see alot of M4s closing lacs and whenever there is a trauma or resus everyone goes in to observe.

It's a cool field, just make sure you can handle the day to day activity aside from the "fun."
 
[F]ield that has to take every neurological complaint that walks through the office door with equal seriousness. Unfortunately this includes no small number of drug seekers, fibromyalgia patients, and chronic pain patients who invariably get sent there after the PCP gets fed up enough to refer them on."

Wait, are you talking about Neurology, or the ED?
 
just like other posters mentioned EM and Neuro are very different in their approaches. While Neuro is very thought, exam, and history intensive and there are interesting cases, it is less procedure oriented. EM is seeing not only cool neuro cases, but it's passing it off (once stable) after you see a massive head bleed, status epilepticus, etc. Most of us in EM are happy with not following the patient to the end. Would you be ok with it?

Another thing, you prolly would have better work hours as neuro ofc doc (8-5, no wkends) if work hours are your thing. And I know you wouldn't write in your personal statement, but work flexibility/schedule should not be an overriding factor in your decision. If you hate it or indifferent, it won't make if you just work 12- 8 hr shifts a month, you are going to die inside. So think of what you seeing yourself doing for the next 30-40 years and the work hours will not matter (look at surgeons!)

good luck. oh and push comes to shove you can always apply to both and after interviews decide which you like and want to rank higher.
 
The point is you have 2 fields that seem to be exact polar opposites. In my opinion it is extremely hard to reconcile the two and you would be better off siding with what you know or trying to accumulate more information

Controlled Chaos vs. Anal Control
Fast paced vs. Slow and detailed
Random schedule vs. More regular schedule with some call
See um and street/admit um vs. You're stuck with um (chronic diseases)
Action/procedure based vs. intellectual based (except Neuro ICU & LPs)

Money is about the same.
 
WilcoWorld said:
[F]ield that has to take every neurological complaint that walks through the office door with equal seriousness. Unfortunately this includes no small number of drug seekers, fibromyalgia patients, and chronic pain patients who invariably get sent there after the PCP gets fed up enough to refer them on."

Wait, are you talking about Neurology, or the ED?
Click to expand...

Neurology...

Naturally, such people show up in the ED, but you're not stuck doing MRIs, EEGs, and refilling scripts for Amytriptiline long term...
 
Funny! I had it narrowed down to the same two fields when I started fourth year. Did neuro in July, loved it, interviewed for their residency (early) since it was and out of state rotation, came home, did ED in August, loved it more and applied for that. The neurologists understood.

I don't regret it for a second. You might want to do another ED rotation to make sure (I didn't). You can always submit apps for both until you make up your mind.

Remember with EM you are a generalist, but if you do academics people usually have their niche, so if you wanted yours to be acute stroke or something else related to neurology you can combine both interests.

Good luck!
 
Oof, I am torn between EM and Psych right now.
 
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I enjoyed Neuro a lot... especially because we also rotated through stroke team and the quickness and speed through which we ran the team was very reminiscent of ED pace to me. I thoroughly enjoyed Stroke Team neurology and would've loved to go into Neuro if I had not rotated in Neuro so late in my 4th year (Match month).

I also liked the fact that Interventional Neurology is picking up and I enjoyed shadowing our Interventional doc.... he was truly fantastic.
 
MY favorite part of neurology was um uh well it'll come to me.
 
OP- I'm in a similar position (MS4, EM vs Neuro) but coming from the other direction. I've always wanted to do EM and thought I would never like neuro, but did the two back to back at the beginning of 4th year and found out that neuro was not as bad as I had thought. Well, clinic was what I expected it to be, but I spent some of my ward time in the ICU and realized that neuroICU was something I could really do. It has my favorite parts of EM- sick patients and procedures. The plus/minus for me is that it's highly specialized, which is both a plus (knowing neurocritical care well) and a minus (no jack of all trades, take all comers mentality) for me. Research opportunities are also important to me but I've been pretty well convinced that a person could do well in either specialty.

EM was great... it has been the only rotation where I've been really interested in the lectures. Good luck with your decision making- I'll be making the same choice in a month or so.
 
OP and donesoon, I was in a similar position considering EM vs Neuro. I too really liked the idea of neurocritical care but really preferred EM overall. Then I discovered that EM trained physicians that do a neurocritical care fellowship can be neurocritical care boarded. Pretty cool. Do what ya like.
 
iridesingltrack said:
OP and donesoon, I was in a similar position considering EM vs Neuro. I too really liked the idea of neurocritical care but really preferred EM overall. Then I discovered that EM trained physicians that do a neurocritical care fellowship can be neurocritical care boarded. Pretty cool. Do what ya like.
Click to expand...

This is very interesting. Do you know who offers the training? Also, what exactly can a EP do with the fellowship. Do they become more like an intensivist in a inpt. setting or do they continue to do shifts but know how to manage Neuro issues better?
 
This discussion is interesting to me because lately I'm thinking neuro too. Which is weird. In PA school I HATED neuro. Well, all that memorization and stuff; it was hard to conceptualize and I'm a conceptual learner. Problem: I never learned enough neuro and I've always felt it was a weak point of mine. I've practiced 8 years mostly in outpatient FP and a year and a half of that time in the ED. I don't like ACUTE neuro stuff that much (limb weakness e.g. ?is it CVA? TIA? what to do?) but I really like the chronic stuff, where taking the time to figure it out doesn't mean I'll kill somebody. I'm fascinated by neurology in the cerebral sense :laugh:
And some very interesting research is going on all the time, especially lately in how we think, how we learn. My husband's aunt is a professor at Boston College; her specialty is communications but she teaches it from a neurologic perspective. Interesting. I don't know enough but it's piqued my interest.
OK, enough "interesting" there.
So how does one get to be a neurologist? I assumed it was an IM residency then a neuro fellowship, but honestly I don't know.
I do know the ED is definitely NOT for me as I HATE not knowing what happens to people; I don't like the lack of continuity; and I hate trauma.
I like the variety and the fact that I'm never bored. I don't like feeling like I'm never expert at anything.
😉😳
 
iridesingltrack said:
OP and donesoon, I was in a similar position considering EM vs Neuro. I too really liked the idea of neurocritical care but really preferred EM overall. Then I discovered that EM trained physicians that do a neurocritical care fellowship can be neurocritical care boarded. Pretty cool. Do what ya like.
Click to expand...

I've looked a little bit into this. It's true that the EM physicians can sit for the neurocritical care exam given by the neurocritical care society. This exam is not (yet) ACGME-certified but is open to multiple specialties including neurology, neurosurg, anesth, IM, and EM. At this point I don't think either EM or neurology can sit for the "official" boards... So in theory, EM-trained neurointensivist should be equal to a neurology-trained one.

But how easy is it for an EM grad to get a fellowship? It seems that the only place that has trained and actively recruits EM neurocritical care fellows is at Cincinnati. A handful of other fellowship programs appear to accept EM candidates, but most are still looking for neuro/nsurg candidates. This is according to their website guidelines... it is true that neuroICU is still new and fellowship could be arranged individually.

My other question is, how will these EM-trained neuroICU people be viewed for jobs after fellowship, as compared to neuro-trained neuroICU people? The faculty I've spoken with (both EM and neuro) suggest that all things being equal, it would be easier to get a job through the neuro pathway than the EM pathway. You would likely be able to get a job at or near the place you do fellowship, but you may be more geographically limited if you wanted to go somewhere else.

After looking into it I've come to the conclusion that if one intends to practice neurocritical care alone, neurology is the better way to go. If you like EM and want to work both in the ED and NSICU, then EM+NCC fellowship is a viable option but you may find your fellowship and/or job opportunities to be more limited than if you had done neurology. If anyone has a different opinion, I'd like to hear it as these are major factors in my decision-making process for choosing EM vs neuro.
 
thanks for all the responses everyone, it's been helpful. what i've decided to do is apply to both EM and Neurology. I have one more question, though. I'm applying allopathic neuro and osteopathic ER. I know that I will have decided by the end of October on which specialty I want to do (I will have done one more Neuro rotation by then). Then I will either cancel my ER interviews or cancel my Neuro interviews, if I have any (I will not interview in both fields and rank both because osteopathic match happens before allopathic match and I don't want to take interview spots from people if I'm not going into the field). Is this a realistic plan? Will I be asked during interviews if I applied to other fields and is it going to hurt my chances if I say yes?
 
primadonna22274 said:
This discussion is interesting to me because lately I'm thinking neuro too. Which is weird. In PA school I HATED neuro. Well, all that memorization and stuff; it was hard to conceptualize and I'm a conceptual learner. Problem: I never learned enough neuro and I've always felt it was a weak point of mine. I've practiced 8 years mostly in outpatient FP and a year and a half of that time in the ED. I don't like ACUTE neuro stuff that much (limb weakness e.g. ?is it CVA? TIA? what to do?) but I really like the chronic stuff, where taking the time to figure it out doesn't mean I'll kill somebody. I'm fascinated by neurology in the cerebral sense :laugh:
And some very interesting research is going on all the time, especially lately in how we think, how we learn. My husband's aunt is a professor at Boston College; her specialty is communications but she teaches it from a neurologic perspective. Interesting. I don't know enough but it's piqued my interest.
OK, enough "interesting" there.
So how does one get to be a neurologist? I assumed it was an IM residency then a neuro fellowship, but honestly I don't know.
I do know the ED is definitely NOT for me as I HATE not knowing what happens to people; I don't like the lack of continuity; and I hate trauma.
I like the variety and the fact that I'm never bored. I don't like feeling like I'm never expert at anything.
😉😳
Click to expand...

Neurology is a residency. But it requires an Internal Med Internship (one year). When you apply, you would apply for Preliminary Internal Medicine positions, and a Neurology residencies simultaneously. You'd get accepted to one of each, and complete them one after the other.
 
Thank you, that's kinda what I thought.
🙂
L.

howelljolly said:
Neurology is a residency. But it requires an Internal Med Internship (one year). When you apply, you would apply for Preliminary Internal Medicine positions, and a Neurology residencies simultaneously. You'd get accepted to one of each, and complete them one after the other.
Click to expand...
 
Ugh, sounds nasty. I have empathetic nausea and a pounding HA just thinking about it. Can anyone say blood patch and glucocorticoids STAT?!
thanks for sharing E.
Thank goodness for CT & MRI! Hello technology!
Seriously though, the idea of ME being interested in neuro would be VERY amusing to my PA faculty. 🙄
L.

emedpa said:
my dad was a neurologist in the days before CT/MRI. fascinating stuff. made for some great dinner conversation.
do a search for pneumoencephalogram sometime. it was the tool used before CT existed. beastly test.
check it out:
http://en.wikipedia.org/wiki/Pneumoencephalogram
neuro guys used to do these routinely.
Click to expand...
 
Sorry that I haven't replied in a while I've been working a string of nights. I may be a little biased since I am a resident at Cincinnati, which is indeed where EM trained physicians are getting the most opportunity for NSICU fellowship training. However, in talking with the graduating fellows they are having no trouble finding work and in fact are being highly recruited. I don't think finding a job would be a challenge.

Aloha Kid, you were wondering about work life, and from what I can tell the fellows plan to split their time between the NSICU and the ED. But, I suppose you could still just practice in your preferred environment. Personal decision.
 
emedpa said:
my dad was a neurologist in the days before CT/MRI. fascinating stuff. made for some great dinner conversation.
do a search for pneumoencephalogram sometime. it was the tool used before CT existed. beastly test.
check it out:
http://en.wikipedia.org/wiki/Pneumoencephalogram
neuro guys used to do these routinely.
Click to expand...


Thats unreal. Psych still does ECT. When will they decide that ECT is beastly?
 
kiterunner said:
If you hate it or indifferent, it won't make if you just work 12- 8 hr shifts a month, you are going to die inside. So think of what you seeing yourself doing for the next 30-40 years and the work hours will not matter (look at surgeons!)
Click to expand...

look at all the divorced surgeons, lol. i just had to put that in there. seriously though, do what you love. you want to be able to look back in yur life on your deathbed and see what you've done with your life. were you miserable half the time. were you a chronic clock watcher who couldn't wait to get out? some people can live with that just fine. are you? can you?
 
Thats unreal. Psych still does ECT. When will they decide that ECT is beastly?
Click to expand...
What's so beastly about it? I've seen a few, the patient is totally sedated, doesn't feel a thing. No convulsions, no pain. If you didn't have an EEG on you'd have no idea they were having a seizure. They're are lots of people for whom ECT works very well.
 
I did my psych core at a place where they did ECT. It does work well.... But, not knowing the mechanism of action doesn't sit well with me. I'm really interested in neuro and psych as well. I realize that the mechanisms of many treatments remain unknown. For some reason, I'll accept that in other fields, but not in neuro and psych. Maybe its just overblown academic curiosity.
 
I've started to accept that much of medicine is just plain magic. Little bit of hand waving, little magic fairy dust, and those pesky lab values make perfect sense.
 
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