if after years of EM want to do something else?

Discussion in 'Emergency Medicine' started by lateness, Dec 16, 2005.

  1. lateness

    lateness Senior Member
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    i was just curious, if after years of doing EM one wanted to specialize or something like ICU or Resp Critical care, or some IM subspecialty, what credit would one get? would they be able to enter it directly? I ask b/c i know a doctor, whom was a surgeon for 10 or so years, then decided he was bored of it, and wanted to do something different, so he did a pulmonary critical care, but he didnt have to do IM residency at all, he just went straight into the subspecialty. I guess there are no absolute set criterias for changing specialties, or subspecializing, i guess it depends on the place? just thinking way ahead like 10 20 years, if i get burnt out, or bored. i doubt it though, just curious.
     
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  3. emedpa

    emedpa GlobalDoc
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  4. rh

    rh Member
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    What do you do if you are tired of ENT?
    What do you do if you are tired of Optho?
    What do you do if you are tired of Ortho?
    What do you do if you are tired of Neurology?
    What do you do if you are tired of OB/Gyn?
    What do you do if you are tired of Psychiatry?

    The list goes on and on. I don't see this question come up with other medical specialties. Why is this an issue with EM? First make sure that what you are going into is what you really want to do. If not it should become apparent during your residency and then get out of that specialty.

    We are all told in Med school about the high burnout rate in EM. I think this is a myth that developed when the majority of people practicing EM were rejects from some other specialty. This does not hold true with EM residency trained docs. Sure you may be more tired when you 50 than when you 30 but that will be the same with any specialty. You think that a 60 year old FP doc who has to see 30-40 patients a day 5 days a week does not feel burnt out at the end of the week?
     
  5. Apollyon

    Apollyon Screw the GST
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    I think that part of the earlier people in EM were the "rejects", thinking, "If any idiot can work in the ED, I could be that idiot", but, also, there were people who trained in other areas because there wasn't an EM residency spot they could get or was available - so, the heart was there, but the skills set wasn't as refined or specialized (as surgery with chest pain, or IM with trauma, or anesthesia with peds, or Ob/Gyn or psych with anything that isn't, well, Ob/Gyn or psych), and that is what, hammering against you, day after day, contributed to the burnout. The deciding factor is that I think that people weren't considering the ED when they started surgery or IM, but realized it later (our senior EP did FP for residency and was in private practice for 2 years until he punted that and decided EM was his way to go).

    I realized something funny a few days ago - a fellow EM resident and I were talking with a senior peds resident in the Peds ED, and I was saying how one downside of EM is working nights, weekends, and holidays, but I realized that, guess what - if you are in surgery, IM, Peds, or other specialties, you will ALSO be working nights, weekends, and holidays, chained to the pager for the rest of your working life - and then having to come into the office after being in all night on these weekends and holidays.

    No thanks.

    Oh, and, my nonspecific, nonscientific test for EM suitability - if you mention "burnout" in your first sentence, EM isn't for you.
     
  6. lateness

    lateness Senior Member
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    good point. i think its like you said, i kept hearing that it has high burn out rate, and that makes u think instinctively of the future.. etc.. you know. i agree, but im the type of person who would ask this question in any specialty, i think it applies to all specialties,. its better to ask why people switch any specialties after a year or many years of practice, when they pretty sure what they are going in the first place. but i think EM is a great long term career..
    cheers
     
  7. DropkickMurphy

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  8. beyond all hope

    beyond all hope Senior Member
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    There are a few EM folks who did Critical Care fellowships without IM who work part or full-time in the ICU. However, IM has decreed that we cannot do IM fellowships, so you'll have to fellowship under EM, Anes or surgery.

    Don't feel bad thinking about the future when you get tired of EM. It's the nature of the personality that goes into EM: lots of different interests.

    Many EM docs have gone lots of different directions: Admin, research, teaching, business, or something else entirely.
     
  9. paramed2premed

    paramed2premed Senior Member
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    What about "burnin?" What should I do then?
     
  10. DropkickMurphy

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    Here's a question: For those subspecialties what can one expect in the way of compensation?

    Hyperbaric and Undersea Medicine- ???
    Pediatric Emergency Medicine- ???
    Sports Medicine- ???
    Toxicology- I've heard $300K+ for this one
     
  11. southerndoc

    southerndoc life is good
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    Hey Praetorian, I think you misinterpreted my offer that I received. 300+ was for emergency medicine, not toxicology. Toxicologists often work at poison control centers and have academic positions, so usually $150-200 range.
     
  12. DropkickMurphy

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    Oops...thanks for the clarification. I'll be sending you a PM....I have another question.
     
  13. BKN

    BKN Senior Member
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    I think you'll cut your income with any EM subspecialty. do it for love, not money.
     
  14. DropkickMurphy

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    I plan on doing something for the love of it (that's one of the reasons I am considering cardiology and I have an interest in the medical aspects of diving, but I am also interested in the economics of particular specialties. But thanks for your input. :thumbup:
     
  15. robh

    robh Senior Member
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    I'll be an MSI this coming fall, so I've a lot of time to figure this out, but if you all will indulge me a little, I have a question. I've always had this romantic notion of being a country doctor. I love rural settings, and I think I would enjoy being a part of a small community and involved with the lives of my patients. The reality is, I'll have a bunch of loans I have to pay off, and my wife is in OB/GYN and can't really afford to move to a rural location b/c of malpractice costs driving the need to have a very busy practice, not to mention her own loans. I'm not sure it is practical to start my career in a rural practice.

    For the last 2 years, I've been helping with clinical research in our local Level 1 academic hospital ED. This has been a very eye opening experience on many levels. My initial impression of EM was that I would not want to do it. There seems to be almost no continuity of care, and the physicians generally do not develop long term relationships with their patients. So I rejected EM initially.

    Since then I've realized that the patients that really interest me are the acute cases. So, I'm having a lot more thoughts about hospital based medicine, and EM in particular. It's almost never boring in the ED, and the EM docs get to do a lot of interesting procedures, especially if the trauma surgury service is having coffee. ;)

    But there is still my romantic notion hanging out there. Let's say I go into EM, and after 20 years doing EM, I decide to "retire" to my own clinical practice in some sleepy little backwater. I know as a physician, I can legally hang my own shingle, but can that sort of thing really be done by a doc boarded in EM and not FP or IM or some other primary care specialty? Without changing boards that is? There is so much what would be classified primary care medicine in emergency medicine, I can't imagine I would be incompetent. Any thoughts on any of this?
     
  16. BKN

    BKN Senior Member
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    There is a movement to create FM-EM residencies to train people to practice in rural em settings. so far it doesn't seem to me to be catching on.

    I'm almost 30 years into EM practice. I would be hesitant to turn myself into a PCP at this point. I believe I know all of the acute presentations, minor and major but:
    1. Don't know all of the screening and vaccination standards,
    2. Haven't delivered a baby since med school. (I have met a lot of cute new babies in the parking lot!)
    3. Don't know all of the antihypertensives, oral hypoglycemics nor the guidelines for treatment. (I live with Epocrates on my belt, it sure does help when I see patients on every kind of drug, that I didn't prescribe.)
    4. Not sure that any but the smallest hospitals would grant admitting privileges.

    I'm not saying you couldn't do it. I'm just suggesting that EM is about the acute side of primary care. Office practice is the opposite. You probably would require some kind of retraining.

    As I think about it. I'm not sure anyone can tell you. Medicine 20-30 years from now will probably be almost unrecognizable. Certainly genetic screening will become much cheaper. I suspect many people will have flash drives with much personal data incluidng records of important parts of their genomes. Care will be individualized, and I suspect communication with "your doctor" will be easier.

    If the 19th century was the dawn of the era of "scientific medicine" and the 20th century was the age of "pathophysiology and organ system medicine", I think the 21st will be the century of molecular medicine. I suspect the PCP will not go away, but will have to change his practice to include modification away from guidelines and more use of computers and genomics to treat each patient individually. I'm not sure how it will affect EM, but I'm sure it will be interesting.

    How about that, i just highjacked the thread from myself in mid-post. oops. never mind. :oops:
     
  17. EctopicFetus

    EctopicFetus Keeping it funky enough
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    IMO one of the biggest differences would be that EMD's arent really trained in all the preventive medicine. When a someone needs a colonoscopy, a mamogram etc. In FP you have to deal with OB schedules (tests etc.), Peds (vaccinations), the elderly (screening).

    there are a lot of differences, plus I cant imagine people showing up for med refills for 40% of your visits would appeal to EM docs, of course some EDs look like this too!
     
  18. robh

    robh Senior Member
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    Thank you for your thoughts on this. You too Ectopic. It seems to me that most of those things would be easy to get up to speed on. A good EMR(EHR) program would probably help too. The FP I shadowed was an early adopter of EMR. I think it improved patient care quite a bit. It takes way to much time to wade through an inch thick chart to see if a patient is due for a physical or a colonoscopy. Having the computer do it seems like a much better idea, because it will actually get done.

    I hadn't considered the admitting issue. Very few FP's in my area admit their own patients. I'm in a large urban area. I suspect that might be entirely different in a rural area. Well, my ignorance is now on display so I'll stop before I dig myself a hole! Thanks again!
     

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