Help!

[sirsam84]

I'm a 3rd-yr student at the end of his rope...I just can't decide on a specialty, and the clock, she is a-tickin'. The current flavors of the month are PM&R, and radiology is kinda in there, but I have been all over the place. I just recently started seriously thinking about ER...I have an Ortho relative who had always really talked down on it so I never much considered it before. (thought about Ortho, but decided against it after surgery rotation, plus the fact that I am a 7-footer and do not want to end up prematurely kyphotic) I want the broad base, but I don't like the FP thing...too much potential to evolve into 60-80 hr weeks. Anyone wanna help me out with some advice and/or their ideas of personality/character traits that would make a good ER doc (and enjoy it and not burn out)? That's all

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[Sessamoid]

For many of us, deciding on a specialty is more about "ruling out" what you don't like, as much as "ruling in" what you do.

The first thing to decide is how much patient contact you want. If the answer is "not much" or "not awake", then forget radiology, pathology, and probaby anesthesiology. It sounds like you've already ruled out the surgical specialties.

It also sounds like you want fairly sane hours, or at least limited hours. Reasonable schedules are doable in most of the medicine and primary care fields given the right practice environment, though obviously easier in others.

PM&R is a good choice for those who are low key, like being relatively independent, enjoy taking care of relatively defined problems with a defined end-point, and also like to work at a somewhat slower pace with clearly defined hours. It pays pretty well (from what I hear) and the lifestyle is very good. If your personality fits, and you enjoy the work, then it's hard to beat.

EM shares several of those characteristics, but tends to attract more active people. EM has virtually no continuity of care, doesn't necessarily involve definitive diagnoses (but then again PM&R isn't really much of a diagnostic specialty either), and always involves some night shifts. Those are the down-sides, as I see them. The people in EM tend to be very smart attention-deficit kids or at least have some tendencies in that direction. You'll find lots of adrenaline junkies in EM--at my residency, the favorite pasttimes were mountain biking, rock climbing, and snow skiing. One guy was really into ice climbing. More EM physicians tend to ride motorcycles or drive fast cars than other specialties in general (except maybe trauma surgeons, with whom we share many common traits). One of the guys I work with is also an active duty cop. He owns LOTS of insanely fast vehicles (he offered to sell me a couple old Ferraris), which he can (of course) drive very fast without fear of getting ticketed.

A good ER doc has to be able to laugh at life's vagaries, sometimes even when it hits you in the face (or vomits on your shoes, or tries crawling to the bathroom too drunk to walk). You have to be able to roll with the punches, and find them really amusing. One poster noted that EPs tend to view medicine as a job, not a calling, which I find to be true.

Me, I work about 35-40 hours a week on average, and don't really feel a driving desire to work any more than that. If I get a raise, I may cut back my hours further still. More time on the beach for me!

 

[DrQuinn]

Sessy gives good advice, as usual.

If you are not an "adrenaline junky" it doesn't mean you can't do EM. But that's just sort of what lends itself to EM. More like the stereotype of the "dumb jocks" doing ortho.

Do an elective in EM and see if its for you. Remember that the thought process of EM is entirely different from any other specialty in medicine (which is why I like it). You may not diagnose what's going on, but you need to find out if what the patient is presenting with is going to kill them. Some students/residents find it infuriatin to work that way and it just doesn't click for them.

Me, I can't stand figuring out the transtubular potassium gradient.

I am STILL so hung over.

Q, DO

 

[roja]

Good advice all around. We have very diverse group of people in our residency. Only one of them is a psuedo adreniline junky (although we have an attending or two).

I am personally not an adreneline junky, either. However, I do like to have several things going at once. I would much rather see patients all day, busy, than sit around on the floors waiting for labs/etc. You have to like to make decisions quickly, think quickly. You also have to be comfortable with certain concepts, emergency medicine is well emergencies (or that's what we assume until we realize you are there for a runny nose).

If you are nervous about putting in lines in someone who is coagulopathic because you don't want to cause a hematoma, despite the fact that the patient is crashing, EM may not be for you. And if you don't want to wait for anesthesia to intubate your patient that needs it, then EM is probably good.

The lifestyle is very good. There is research if you are interested (I am doing 5 research projects right now). Its no big deal if you don't.

You have to be good with people and be able to run interference with a number of consultants.

but quinn gives the best advice: do a rotation. if its for you, you will know it. (this is what I did and after my first shift as a fourth year, I knew it was for me.)

 

[Apollyon]

The points about PM&R are right on ("plenty of money and relaxation") - 9-5, no weekends, no call (a broken leg is a tech's job), EVERYTHING you bill gets paid, since, if it costs $1000/day to keep a patient in the hospital, and you do your thing for $850, insurance will eat up that savings they get, and, as a buddy of mine was saying he was told, "no self-respecting PM&R is in the office after 1pm on Friday".

If you want to be a businessman in medicine, PM&R is as close as you'll get (maybe preventive medicine or occ health can also be close to it). For the ultimate, have an orthopedic surgeon, a PM&R doc, a chiropractor, and PT/OT in the same group/building.

The downside? So damn boring! (a/k/a "regular", "no surprises", etc.)

EM is on the other end - I actually enjoy calling consults and seeing my colleagues from other departments, because the ED is a central meeting point (then again, having to page the cards attending 5 times (who was a fellow last week) without a response, and finally calling the CCU fellow to accept the patient is SO much a bummer). You also see some interesting interactions, like the guy I had yesterday with edema in one hand - tenosynovitis vs. gout. Plastics was covering hand that day, and I also called rheum. Plastics said gout vs. infection; rheum said infection vs. gout (it wasn't classic for either one). Each made really good points, and it was interesting to see it from one side and the other.

In the ED, if I need to, I can step outside for just a minute and get a real breath of fresh air. I have a defined end point, and get a chance to have the fun while it is to be had, without the chronicity of the follow up.

It works for me (and a bunch of others), but a like number CAN'T STAND IT. The best advice is that given above - give it a whirl with a rotation.