Fastest pace specialties

[vancoremed]

What specialties would be best for someone who enjoys a fast pace work environment? I know emergency med and critical care may be some but are there any others you'd recommend looking into?

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[Natremia]

Critical care really isn’t. Rounding on vented patients isn’t fast pace

sure when something acute arises it’s fast paced but I’d argue cc medicine is at baseline pretty moderate to slow work pace

EM sometimes you can’t even take a piss because you’re so go go go

 

[M&L]

Only M2 here, but OB comes to mind if you are on labor and delivery .

 

[Kaputt]

Only M2 here, but OB comes to mind if you are on labor and delivery .

Labor and delivery is the most excruciatingly long, drawn out process in human existence. So much boredom for 10 hours for 10 seconds of "thrills" at the end. I say that having been on the delivery side and father side

Correct answer is diagnostic radiology. Cranking through cases serves those of us who like to quickly move on to the next thing very well. I get to see over a hundred patients a day from the comfort of my reading room

 

[Lem0nz]

Trauma. But it sucks.

Edit: At an ubran level 1 trauma center.

 

[Redpancreas]

What specialties would be best for someone who enjoys a fast pace work environment? I know emergency med and critical care may be some but are there any others you'd recommend looking into?

As you can see by the answers, it depends. I second dispelling the notion that critical care/ICU is fast paced. It's not. I do think EM is pretty fast because of the established work flow. You see a patient, get a history, triage, place a few basic orders, present, +/- few additional orders and move on, disposition (floor, DC). Trauma surgery, believe it or not, is not as fast paced as movies make it out to be. Believe it or not primary care and dermatology clinic can be pretty fast paced with the amount of time you're given to do your task. Regardless, I don't think a "fast pace work environment" is something to actively look for when choosing a field regardless of what you may think now. I think you'll find fast paced elements of any field. I would start the decision-making process with medicine vs. surgery vs. elements of both. Good luck!

 

[Lem0nz]

Disagree. Trauma at an urban trauma center is incredibly fast paced when its happening. However I will concede that the downtime waiting between activations you can be doing nothing. But the operations are hectic and fast paced, the trauma bay is fast paced, and everything needs to be done *right now*. EM is the only other field that would have that sort of pace and chaos/unpredictability element. I don't think you can compare family or derm to EM/trauma. Maybe like, in volume of work. But I don't consider that to be fast paced, its just lots of work.

 

[Redpancreas]

Disagree. Trauma at an urban trauma center is incredibly fast paced when its happening. However I will concede that the downtime waiting between activations you can be doing nothing. But the operations are hectic and fast paced, the trauma bay is fast paced, and everything needs to be done *right now*. EM is the only other field that would have that sort of pace and chaos/unpredictability element. I don't think you can compare family or derm to EM/trauma. Maybe like, in volume of work. But I don't consider that to be fast paced, its just lots of work.

Admittedly, my experience with trauma surgery was limited to one center over two months (albeit a level-1 in a city with a high crime rate) and what I see out of the SICU at my current center but I'm assuming you may have more. I agree patients are more acute and that they are more stressful, but in terms of management and outcomes there a few (but critical) evidence based things that need to be done to improve outcomes and there were plenty of breaks. All fast-paced is, is amount of work divided by time so if the work volume's the same and the time is limited in two scenarios they are equally paced. It may seem like semantics but it's what OP asked. If they had asked what field deals with the most acute patients that trigger the most visceral responses in most humans, trauma surgery would be up there and Dermatology clinic would be near the bottom.

I think the point about pacing not being a major determining factor in a field you choose at least initially stands.

 

[Lem0nz]

Yes, we're arguing over semantics. I interpreted his post and asking about fast paced jobs to mean those that are a little more high octane, adrenaline inducing, higher acuity, and more importantly, high stakes. And often requiring multitasking and addressing multiple problems simultaneously. Since he specifically picked ICU and EM, that was what I read between the lines and that's what I envision when I think fast paced. But at face value you're right - huge difference of what fast paced means in my head than work pacing. Trauma is on and off but when its on its "omg on", when its off its "time for two hour llluuunnnnccchhhh and talk about game of thrones!" and the specialties you mentioned (and DR from Kaputt) would never stop moving but would be more equally spaced.

So we both win and OP is clearly the one at fault. Clarify what you mean OP! 🤣

 

[Banco]

Trauma. EM. Maybe Acute care surgery? Transplant in a weird sense, due to the urgency/acuity, but day to day may not be so fast paced.

 

[Tenk]

ER and UC you don’t set who comes in through the doors. I’ve worked in ERs with 6 hour waits and also ERs where I waited 6 hours inbetween patients. UC can be similar but is usually faster in and out. Both can be fast paced or slower paced depending on the site.

You can have an insanely fast paced FM or peds or IM clinic. You just set yourself up to see a ton of patients each day.

Word of caution. This is not a good reason to pick a specialty as there are far more bad things associated with a fast pace environment (pissed off patients, missed diagnoses, stress, etc) than any positive I can think of.

 

[Redpancreas]

ER and UC you don’t set who comes in through the doors. I’ve worked in ERs with 6 hour waits and also ERs where I waited 6 hours inbetween patients. UC can be similar but is usually faster in and out. Both can be fast paced or slower paced depending on the site.

You can have an insanely fast paced FM or peds or IM clinic. You just set yourself up to see a ton of patients each day.

Word of caution. This is not a good reason to pick a specialty as there are far more bad things associated with a fast pace environment (pissed off patients, missed diagnoses, stress, etc) than any positive I can think of.

Right, I just hope OP is not thinking that they get bored easily so they want a fast pace by default. Instead, figure out why you're bored. You can add pace to anything, first find something you like.

 

[PhillyMed777]

High volume clinical Derm is fast paced

 

[Captain_Falcon]

High volume clinical Derm is fast paced

same for ophtho (i.e. retina clinic)

 

[Oligodinero]

People may laugh.....but family medicine can be pretty fast paced depending on your employer. It's become rather common for FM docs to be told they must see 4-5 patients per hour to meet their metric goals. Yeah, it's not super acute/critical life-and-death type stuff like in trauma/EM.....but it'll keep a person running all day long.

 

[Dr. Doctor MD]

I'll second Derm/Optho clinics as about as fast paced as I've seen. The number of patients per hour is staggering and just nonstop volume. I think ED and DR are also both very busy depending on the hospital/job, but also probably aren't running at a breakneck pace if you're working during non-peak hours/nights.

 

[WheezyBaby]

Agree with other. EM, anything high volume outpatient. Not ICU. I love resuscitation and resuscitation is absolutely fast paced but good ICU work from a clinical standpoint is largely micromanagement to maximize quality of care. FWIW I think most people ultimately find "fast pace" burn out inducing because it's a narrow line between "fast paced but still delivering good care, staying on top of notes" and "fast paced but oh no this came up and oh I guess I'll just try to find a way to punt this and I just need a minute and oh another thing"

 

[Tangerine123]

Want an Adrenaline rush?

Psych ER.

Somebody always hits the floor. Either you or the patient. I still wear my human-bite-scar with pride.

I remember reading an article in UpToDate about the need to create a human bond with your captor so they don't execute you. Where else would you find that?

 

[ewax]

interventional cardiology: door to balloon time <90m for STEMI

 

[radsisrad]

Diagnostic radiology. Derm. Pathology. IM if you do it right - whiz through a laundry list of complaints, physical exam takes 1-2 minutes if done efficiently, bring forward the note and complete it in five minutes, on to the next.

 

[Angus Avagadro]

Gas. Multiple cases, extremes of age, and acuity, OB, trauma, etc.

 

[longhaul3]

Everything is stat in neurosurgery

 

[Angus Avagadro]

Everything is stat in neurosurgery

Uh,...no. It's not.

 

[sevo00]

Everything is stat in neurosurgery

lol. Removal of tumor is not stat.

 

[longhaul3]

Uh,...no. It's not.

It's more of a mindset, everything needs to be done ASAP and the work is extremely fast paced. We do have a lot of truly stat clinical business though.

Obviously not all of it is stat. There's almost no such thing as a truly stat spine issue. Hell I just got a consult for (asymptomatic) degenerative lumbar spine findings on a CTAP done for hemoperitoneum in a patient with decompensated cirrhosis and hgb 4.

lol. Removal of tumor is not stat.

It's often not, but it certainly can be.

 

[paki20]

Interventional cardiology but you have to go through IM. Not many fields where a patient is coming on verge of death, you fix the issue within minutes and they walk out of the hospital in 48 hours.

 

[mrbreakfast]

Inpatient consult/emergency neurology. Neurology is generally the most consulted service and on a busier day will get multiple consults/hour through an entire shift, including plenty of urgent stuff like stroke alerts, bleeds, seizures, obtundation, etc, as well as following up on previous consults. Downsides are many "soft" consults and while there are many things you can fix, there are also many you can't.

For outpatient, neurology headache clinic can be very fast-paced - many patient encounters only take a few minutes.

The fastest-paced clinic I have ever seen was pediatric follow-up fracture clinic (peds ortho) which would see up to 10+ patients an hour.

 

[Angus Avagadro]

It's more of a mindset, everything needs to be done ASAP and the work is extremely fast paced. We do have a lot of truly stat clinical business though.

Obviously not all of it is stat. There's almost no such thing as a truly stat spine issue. Hell I just got a consult for (asymptomatic) degenerative lumbar spine findings on a CTAP done for hemoperitoneum in a patient with decompensated cirrhosis and hgb 4.


It's often not, but it certainly can be.

Sure some things are stat. I have seen the other side with friends and neighbors. We were having to shop neurosurgeons for cervical radicular symptoms. MRI not particularly helpful, which is not uncommon. Then do the pain clinic injection dance. I recognize 80 to 90 % of disc protrusions heal with conservative therapy. Once that fails, it's another 6 weeks to see the surgeon, who may not offer surgery. Then its another 6 weeks to see the next surgeon. So not stat or even reasonable. My neighbor had an MRI for the misdiagnosis of vertigo, he was falling down. My wife and I diagnosed a hemangioblastoma in his posterior Fossa on his outpatient mri. University neurosurgery office said it would be 6 weeks to see him in the office. Had them call back where they were again told they could not see him sooner. I told them to take their disc and go to the ER and tell them my husband has a brain tumor and is falling down. Neurosurgery won't see him for 6 weeks. They smiled, neurosurg showed up 20.min later, admitted him,on steroids and operated a few days later. Haven't seen much of the stat mindset around here. Of course YMMV.

 

[herbalife]

EM.

 

[painballer27]

Probably EM is what you’re looking for. Of course you could do derm and see 60 patients a day or rads and read studies one after another nonstop but I don’t think that’s what you mean

 

[Dr G Oogle]

Labor and delivery is the most excruciatingly long, drawn out process in human existence. So much boredom for 10 hours for 10 seconds of "thrills" at the end. I say that having been on the delivery side and father side

Correct answer is diagnostic radiology. Cranking through cases serves those of us who like to quickly move on to the next thing very well. I get to see over a hundred patients a day from the comfort of my reading room

Depends on what you define as fast paced. L & D at a tertiary care urban teaching hospital is a literal non stop 💩 show, rarely do you get a moment where you’re not putting out fires. But at the same time for sick patients you’re watching them and their fetuses like a hawk so it’s both draining and excruciatingly drawn out waiting for the kid to be born. Cranking through cases in rads can be seen as fast paced but often it’s like 90% normals or measuring 1mm differences in tumor size, and occasionally free air!

ER is fast paced moving from patient to patient but it’s a lot no you can’t have morphine with a Benadryl chaser for allergies and it’s just a UTI you can go home with intermittent intubations. Even a busy primary care practice seeing 20-30 patients per day can be seen as “fast paced” if you’re measure is how quickly you can move from room to room and how long you can hold your urine.

what’s exciting to you might not be exciting to someone else. I’m sure most people here would think keeping the elderly out of diapers is a real snooze fest but to me it’s the 🐝 knees

 

[longhaul3]

Sure some things are stat. I have seen the other side with friends and neighbors. We were having to shop neurosurgeons for cervical radicular symptoms. MRI not particularly helpful, which is not uncommon. Then do the pain clinic injection dance. I recognize 80 to 90 % of disc protrusions heal with conservative therapy. Once that fails, it's another 6 weeks to see the surgeon, who may not offer surgery. Then its another 6 weeks to see the next surgeon. So not stat or even reasonable. My neighbor had an MRI for the misdiagnosis of vertigo, he was falling down. My wife and I diagnosed a hemangioblastoma in his posterior Fossa on his outpatient mri. University neurosurgery office said it would be 6 weeks to see him in the office. Had them call back where they were again told they could not see him sooner. I told them to take their disc and go to the ER and tell them my husband has a brain tumor and is falling down. Neurosurgery won't see him for 6 weeks. They smiled, neurosurg showed up 20.min later, admitted him,on steroids and operated a few days later. Haven't seen much of the stat mindset around here. Of course YMMV.

Fair point. I don't spend much time on the outpatient/elective side. It must be frustrating.

Right now in my ICU I have 3 ruptured AVMs, an acute third nerve palsy from a rapidly enlarging aneurysm, an ICH with a blown pupil, and a cerebellar met causing acute hydrocephalus, plus the trauma side with the GSWs and acute subdurals. That stuff is more my speed.

 

[Frazier]

There is really nothing that compares to EM.
You have little to no control of the volume, flow, or, for that matter, your own time.

Here is a thought exercise:

Imagine being interrupted from an interruption of an interruption that occurred during the original task you just started.
...That is quintessential emergency medicine.

What might that look like in the real world?

A nurse stomps up to you requesting to B52 their patient as you glance at an EKG a tech just handed you to sign on another patient while you were on your way over to talk to EMS over the radio about a call from the field as it came through just when you were in the middle of trying to place orders on that code sepsis in the waiting room because they only have 8 more minutes before it becomes a "fall-out".

Welcome to multitasking on steroids.

 

[Redpancreas]

There is really nothing that compares to EM.
You have little to no control of the volume, flow, or, for that matter, your own time.

Here is a thought exercise:

Imagine being interrupted from an interruption of an interruption that occurred during the original task you just started.
...That is quintessential emergency medicine.

What might that look like in the real world?

A nurse stomps up to you requesting to B52 their patient as you glance at an EKG a tech just handed you to sign on another patient while you were on your way over to talk to EMS over the radio about a call from the field as it came through just when you were in the middle of trying to place orders on that code sepsis in the waiting room because they only have 8 more minutes before it becomes a "fall-out".

Welcome to multitasking on steroids.

EM is definitely a fast-paced field. I can totally see your EM experience, but will say it's not as stressful as many make it seem (I'm not saying this to make your field seem less bad-ass, but so that medical students aren't intimidated.)

1. At EM programs with residencies, the attending sits at a station while residents present patients to them (same with midlevels). Usually a few additional orders are placed and disposition is decided on. When there is ATLS, usually the attention immediately shifts to it and multiple attendings/residents/nurses shift to tag team the FAST, IV access, imaging, and Trauma Surgery is usually called down if something needs to be opened up. The highest trauma frequency I have seen in a shift at multiple level 1 trauma centers in heavy trauma areas are 4 ATLS per 8 hr shift so it's not like it's every other case but it was definitely challenging as someone was in the trauma bay doing stuff throughout the shift.

2. Sepsis is the #1 killer in hospitals. EM's role in management is highly protocolized though. There's prompt cultures, empiric abx, continuous fluids at 30cc/kg, 1st lactate, if not responsive NE and prompt ICU notification for transfer. The art lines, cardiac US, etc. can be done in the ED but it's often just better to ship them up because you don't have the level of nursing care to deal with that in the ED.

3. The first few ACLS episodes are stressful, but you are there with a team and the same general principles apply each time.