I'm beginning to get super stressed out i've been having a constant headache for a couple weeks now. I'm an MS 3, and i just cannot figure out what I want to do. I've read countless threads after threads, and still have gotten no where. Here's my thought process, any insight/advice/help is greatly appreciated.
Anesthesia: My pros - I love the OR but don't want to be a surgeon, very laid back and fits my personality type very well, enjoyed the rotation, good lifestyle, great pay, good hours, i like being in an 'intensivist' position and love acute management and thinking on my feet and fast paced atmosphere. No rounding, no tons and tons of paperwork, no clinic, no continuity.
My cons - I was never really interested in physiology or pharm in MS, and haven't bothered to learn about it much. CRNA's might take over?
ER: My pros - I love studying about this stuff, i love knowing and being able to do almost anything even though i'm not specialized, i like the fast paced atmosphere, acute setting, no continuity, SHIFT WORK! you work and then you're done, lots of time off, good pay.
My cons - seems like it might be just one huge day of clinic, lots of bs problems to deal with, have to do really crappy and weird hours that can mess with your internal clock.
I think you just need to take the advice of some of the posters and spend time in both places then go with your gut instincts. You shouldn't have to use internal persuasive analysis to convince you of a certain specialty, it should almost be an internal instinct. Where do you enjoy being the most at the end of the day? If you thrive in chaos, don't like sitting still and enjoy constantly moving and having your brain functioning like an air traffic controller then go EM by all means, but I wouldn't say any of us really loved the OR at all. If you love the OR, that's got to mean something.
Look, I'm going to try and be as objective as possible, coming from an EM resident's point of view. Obviously, I'm biased, but just remember that no specialty is going to be perfect. Figure out the things you enjoy and try to focus on those because you're more than likely going to find things about each specialty that you end up hating. If you always focus on the aspects you love, it will make going to work easier every day. Yes, EM is great in that it's tons of varied pathology. I've never really bought into the whole jack of all trades masters of none, as I consider us to be "hopefully" masters at identifying, diagnosing, and managing virtually every pathology that has the potential to present with an acute or life threatening presentation, spanning all specialties. That's really what we are aiming to be good at. The rest of the stuff, I have no idea about. Fragile X, or treating Mycosis Fungoides, managing some of these weird metabolic disorders... forget about it. DKA, AG metabolic acidosis, Trauma, Anaphylaxis, Strokes, MI's, overdoses, toxic poisonings, splinting and reducing certain fractures, PE's, Aortic Dissections, etc.. these are things I should be very good at recognizing early or ruling out quickly and knowing how to best acutely manage these conditions. Sure, we're not experts in any particular specialty, but that's really not what emergency medicine is all about. Yes, 90% of what we see, a FM or any specialist could probably deal with just fine, and the ED is turning into one big outpatient clinic these days, but you're still going to see those 10% emergencies that an EM doc has got to be well trained to deal with.
I will say that most EM guys I know that I feel were meant for it, myself included, really just "knew" it after working in the ED. You either love it or you hate it. You're going to see a lot of social work nightmares, crack head drug seekers, crazies and you can either find humor and laugh about it or let it suck the life out of you. I haven't really met anybody that was on the fence about the ED, so follow your gut. Yes, we don't carry pagers, don't have to come back to the hospital, have tremendous amount of control over how much or how little we want to work, the pay/hrs worked ratio is great, but the schedule is very unpredictable. You'll always be working nights, days, weekends, holidays, and if you have a spouse that works the normal 9-5, off on weekends, it can be more difficult than you might expect for them to adjust to your erratic schedule. When I'm on nights, I literally see my wife in passing for days at a time. It was really hard for her at first but she's getting used to it. We don't have kids but I can imagine it being an even bigger issue. Yes, you might get to go on field trips with them, but daddy/mommy might not be home much that weekend to play if you are working nights during that time. Also, we don't have a tremendous amount of fellowship options to have much effect on drastically changing your work environment. It's pretty much high acuity ED, lower stress community settings, urgent care perhaps if you get older and want less stress, but not a lot of fellowships. Gas on the other hand.... Even if you hated the OR at the end of residency, you've got ICU, Pain, etc.. can work in a clinic, can be an intensivist, lots more options on customizing your work environment and I would say that with the lower stress level of an anesthesiologist (in general!), you could potentially work a much longer time.
I love the ED, but it's sometimes difficult for me to imagine working in a level 1 or 2 when I'm 65. I'll more than likely either be retired or in some smaller, low stress community ED, or even an urgent care center.
Just remember, no specialty is perfect. Figure out what you enjoy and try to stay focused on that. Listen to both sides and follow your instincts. Don't do it for the money as that is likely to change for all of us over the next decade.
