Is Emergency Medicine genuinely that saturated, and should that still be my long-term goal?

[Frazier]

Yep. Maybe it's not that obscure, but it's not really in the EM wheelhouse. My self-proclaimed junkie (with horrible metastatic badness FWIW) has now decided she feels so good she wants off her dilaudid PCA. Oy.

Heh, yeah I'd say it is pretty obscure. The only folks that know about that usage is likely HPM and pain. That said a few months ago I informally polled our palliative faculty and maybe 10% if that had ever prescribed it.

We just had a person on our inpatient service make a similar pathway of adjuvants over course of their stay (hydromorphone PCA, ketamine, lidocaine, mexiletine).

Was this an exit strategy for lidocaine infusion? What dosage of mexiletine did you start at? Did you or do you plan to titrate up?

There is plenty of art to practice patterns in this field... especially for the more rarely used meds -- interested in how this pt's approach went leading to their success.

---

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[betamale]

Do internal med + fellowship. You can always do some EM after especially with a critical care fellowship, as well as, ED OBS, hospitalist, academics, clinic, telehealth/teleICU. Easier to transition to something else

 

[dchristismi]

I'm at a freestanding GIP hospice house and my pharmacy won't give me lido drips. I've done push dose lido a couple of times which has been impressive in the right patient. I also have a very supportive director and figured I had nothing to lose. I'll get lido drips eventually, I'm sure.

Went digging into the literature for a lady with really horrible tenesmus from rectal ca a few months ago - she would spend hours in the bathroom and was just miserable. Found a single paper from Japan ([Rectal tenesmus due to tumor invasion into the pelvic cavity responding favorably to antiarrhythmic drug therapy] - PubMed) with an N of 5, all with significant relief within 48 hours and gave it a go. Worked like a charm with no significant side effects. My staff got to learn all about it (The Word for today is TENESMUS).

When this particular patient sort of described the same, albeit in more crude terms, I figured it'd be worth a try and again, relief within 48h. 150mg TID. I called pharmacy and just guessed. I think it either works or it doesn't, and since I can't use a lido drip, I figure I'd try it 48 hours and either continue or stop. She was already on the dilaudid gtts, methadone and a bunch of other stuff, GIPed and not going anywhere. I sort of feel like Hermione Granger, just flinging meds at her to see what works. (Her med list is ridiculous.) It's the ketamine (push dose at the moment) and the methadone that's making her feel a lot better. She's probably only got a couple of weeks though... enough to work through some of her psychosocial trauma but not much more.

 

[Frazier]

I'm at a freestanding GIP hospice house and my pharmacy won't give me lido drips. I've done push dose lido a couple of times which has been impressive in the right patient. I also have a very supportive director and figured I had nothing to lose. I'll get lido drips eventually, I'm sure.

Went digging into the literature for a lady with really horrible tenesmus from rectal ca a few months ago - she would spend hours in the bathroom and was just miserable. Found a single paper from Japan ([Rectal tenesmus due to tumor invasion into the pelvic cavity responding favorably to antiarrhythmic drug therapy] - PubMed) with an N of 5, all with significant relief within 48 hours and gave it a go. Worked like a charm with no significant side effects. My staff got to learn all about it (The Word for today is TENESMUS).

When this particular patient sort of described the same, albeit in more crude terms, I figured it'd be worth a try and again, relief within 48h. 150mg TID. I called pharmacy and just guessed. I think it either works or it doesn't, and since I can't use a lido drip, I figure I'd try it 48 hours and either continue or stop. She was already on the dilaudid gtts, methadone and a bunch of other stuff, GIPed and not going anywhere. I sort of feel like Hermione Granger, just flinging meds at her to see what works. (Her med list is ridiculous.) It's the ketamine (push dose at the moment) and the methadone that's making her feel a lot better. She's probably only got a couple of weeks though... enough to work through some of her psychosocial trauma but not much more.

Phenomenal. Thanks for the pt course summary and literature source. I write down and keep pearls in an evernote account... and now I have a few more to add from this post.

 

[Doc Doc Doc Goose]

If that didn't exist anymore for me, I'd focus on controlling the part I can control, which is this part: Choosing a specialty where you can work regular hours, no nights, no weekends, no holidays and no call. Choose one of those and either find a job with some loan forgiveness program (rare, I know) or accept that you're going to have an extra house/car payment for the next 30 years. Because the other choice, which is to pick a specialty that makes you miserable for extra money, if a fool's errand. Many will still do it, though. The burnout rate in Medicine is high, for this among other reasons.

I was lucky to get out with $150,000 in debt. That was 20 years ago and I'm still paying on it. But I'm okay with it, because after a hard road of detours, I finally landed in a specialty that's relatively low stress and sustainable. It would obviously have been easier if I had rich parents that paid for my med school, but I didn't, and neither do most people.

How come it’s taken so long to pay back your debt? Is that by choice?

 

[OTCAwesome]

Thanks guys but I’ve already matched and I know I’ll be fine. I was referring to awesome hours AND the whole part about not going into more debt than 6 months of salary. Nothing makes $800k and has no call and bankers hours.

My buddy since high school that lives down the street is ortho spine in the midwest, will me making >1.2M once he's partner with relatively speaking bankers hours.

 

[Ho0v-man]

My buddy since high school that lives down the street is ortho spine in the midwest, will me making >1.2M once he's partner with relatively speaking bankers hours.

That’s crazy awesome. But the vast majority of us can’t accomplish that. But $400k of debt is rapidly becoming the new standard.

If you know of any gigs in rads like this let me know

 

[Mad Jack]

You wrote this in response to @Birdstrike 's recommendation of: Any specialty where you can work regular hours, no nights, no weekends, no holidays and no call, can be good. That's as long as you don't put yourself >6 mos salary in debt during your training.

@Ho0v-man , while you're partially correct you're (possibly) also way off base.

You're spot-on that med school debts continue to grow and grow with each year. It sucks balls.

But you're potentially waayyy off base if you're convinced that you can't get into a specialty working regular hours, no nights, no weekend, no holiday and no call...and still pay off your loans. But I honestly can't tell from how your post is phrased. You may not be saying this in which case, my bad. But if you are...well dude you absolutely can.

And you don't have to be a super genius to do it. I tell med students to at least consider what have become the stealth "lowlies"-- Psych, IM and FM (lets call them PIF for brevity). Despite increasing awareness about how awesome PIF can be from a lifestyle and $ perspective, they still get crapped on all day long by ivory tower folks and subspecialists so med students stay primed to also look down on them. But I'm telling every med student who reads this...take a look at the trillions of job postings for outpatient jobs in these areas. No matter how desirable the city/location, there are always postings for 4d/wk no nights/weekends/holiday jobs in these fields paying in at least the mid 200s...yes that includes Denver, Austin (and other places EM folks who kill to work in). Many of these gigs offer loan repayment too. Many employed PIF docs make well into the 300s (and sometimes into the 400s). PIFs who start their own practice can make much more. PIF also offers a gigantic amount of varied work options to meet your life/financial needs and keep things fresh and reinvent your career (if you want that) over time. They also allow the lowest priced entry into a cash-only practice where patients don't get raked over the coals and docs get paid fairly and have total control.

And this is just for arguably 3 of the least competitive fields in medicine.

Will step off my soap-box now...but just because EM is imploding doesn't mean all of medicine is totally horrible. Within the overall sea of $hit medicine is currently resembling, there are still several bright spots if you look for them.

Ultimately with REPAYE you're effectively looking at a 10% salary reduction regardless of debt load so it isn't that bad even for higher levels of debt. If you invest the difference between a standard 10 year repayment plan and the REPAYE payment, you can get the debt paid down rather quickly (or make yourself a nice nest egg while you repay it slowly).

 

[Birdstrike]

How come it’s taken so long to pay back your debt? Is that by choice?

It actually is by choice. I was lucky enough to consolidate my loans (which were federal subsidized, prior to Obama changing the student loan laws) at a fixed 2%, about 20 years ago. Because the rate is so low, I've chosen to put any extra cash into retirement savings, 529 savings for my kids' college, and paying off other higher interest debt like cars, and now my house. I don't owe a ton on it and I keep saying that I'm just one good work bonus away from paying it off in once chunk. But as of yet, I haven't done that due to the rate being so low.

 

[Birdstrike]

My buddy since high school that lives down the street is ortho spine in the midwest, will me making >1.2M once he's partner with relatively speaking bankers hours.

Bankers hours as an ortho-spine guy? Hmm...You sure? The ortho spine guys I know are all with general ortho groups and share ortho and ER call. If he's got bankers hours as an ortho spine guy, and a salary of 1.2M, he has an incredibly rare unicorn job. Plus, bankers work Saturdays. I know many docs that have better than bankers hours at 4.5 days per week. But none of them are ortho. They're either Derm, Pain (like myself), family medicine, IM or other IM subspecialties that have very few emergencies.

That being said, you're not going to make the highest salary in town, at 4.5 days per week. I don't. I know Pain guys that make 3 times what I do. But they work 3 times as hard, run their practice, work out of multiple offices and surgery centers, or bill or practice in ways that I don't agree with.

 

[namethatsmell]

That’s crazy awesome. But the vast majority of us can’t accomplish that. But $400k of debt is rapidly becoming the new standard.

If you know of any gigs in rads like this let me know

You're going into rads and worried about paying off your loans? MGMA median and mean is in the 5s and rads job market from what my hide-in-the-dark buddies tell me has become very solid. South, Midwest and IR pay more as you no doubt know. If these numbers don't work for you, you need a budget not more $.

 

[Doc Doc Doc Goose]

It actually is by choice. I was lucky enough to consolidate my loans (which were federal subsidized, prior to Obama changing the student loan laws) at a fixed 2%, about 20 years ago. Because the rate is so low, I've chosen to put any extra cash into retirement savings, 529 savings for my kids' college, and paying off other higher interest debt like cars, and now my house. I don't owe a ton on it and I keep saying that I'm just one good work bonus away from paying it off in once chunk. But as of yet, I haven't done that due to the rate being so low.

Makes sense. Thanks for the intel and education.

 

[Ho0v-man]

You're going into rads and worried about paying off your loans? MGMA median and mean is in the 5s and rads job market from what my hide-in-the-dark buddies tell me has become very solid. South, Midwest and IR pay more as you no doubt know. If these numbers don't work for you, you need a budget not more $.

Oh yeah. No doubt I’m very fortunate on this front. But I’m simply stating that for the majority of people graduating today, making the total of your loans in 6 months while also working cush hours isn’t possible because debt is way too high.

 

[Franzd'Epinay]

I recently started a side gig as "the EP in the room of FM", and that notion seems to be holding true for me as well.

What does this mean? Are you seeing the walk-ins at a family medicine clinic?

 

[Birdstrike]

making the total of your loans in 6 months

What are you even talking about with, "making the total of your loans in 6 months"? I'm not sure what that even means. But if you mean "pay off your loans in 6 months," that's not what I said, above. I was referring to owing an amount of money not worth more than 6 months of salary. For a radiologist expected to make $500,000, that would equal graduating from medical school owing no more than $250,000. For a PCP expected to earn $250,000, don't let yourself end up more than $125,000 in debt.

That's an entirely different thing than paying off the total of your loans in 6 months. That's not reasonable to expect for the majority of indebted physicians. Hell, I'm still paying after 20 years. I don't expect anyone to pay off in 6 months, the amount people are having to borrow, today.

That being said, people that are ending up $500,000 in debt and sign up for a field of medicine where they'll only make $195,000, have only themselves to blame for the financial consequences.

 

[Ho0v-man]

What are you even talking about with, "making the total of your loans in 6 months"? I'm not sure what that even means. But if you mean "pay off your loans in 6 months," that's not what I said, above. I was referring to owing an amount of money not worth more than 6 months of salary. For a radiologist expected to make $500,000, that would equal graduating from medical school owing no more than $250,000. For a PCP expected to earn $250,000, don't let yourself end up more than $125,000 in debt.

That's an entirely different thing than paying off the total of your loans in 6 months. That's not reasonable to expect for the majority of indebted physicians. Hell, I'm still paying after 20 years. I don't expect anyone to pay off in 6 months, the amount people are having to borrow, today.

That being said, people that are ending up $500,000 in debt and sign up for a field of medicine where they'll only make $195,000, have only themselves to blame for the financial consequences.

We’re saying the same thing. I’m not saying making enough to pay it off in 6 months. I’m saying most students will not have a 6 month salary equal to their student loan burden in any field while working the hours you describe.

 

[RustedFox]

What does this mean? Are you seeing the walk-ins at a family medicine clinic?

No.
I took a side gig, and I'm the only EM trained person doing it that I've met thus far. They're all FM, some IM subspecialties.
I'm far faster at doing the work than so many of the FM/IM folks that have been doing this for [years].
My EM training is applicable here, and has given me a stat boost to the "move your ass" category.

No, I won't expound any further - because I have a plan. And if it works (and it just might), then I'm done with EM for keepsies, for all the reasons that we already all recite on here with regularity.

 

[Franzd'Epinay]

No.
I took a side gig, and I'm the only EM trained person doing it that I've met thus far. They're all FM, some IM subspecialties.
I'm far faster at doing the work than so many of the FM/IM folks that have been doing this for [years].
My EM training is applicable here, and has given me a stat boost to the "move your ass" category.

No, I won't expound any further - because I have a plan. And if it works (and it just might), then I'm done with EM for keepsies, for all the reasons that we already all recite on here with regularity.

If you're ever comfortable sharing, I'm sure everyone would love to have more options outside of the ED.

 

[RustedFox]

If you're ever comfortable sharing, I'm sure everyone would love to have more options outside of the ED.

Yep.
If I "make it", once I "make it", I'll post it all - in typical RF fashion; creative writing project and all.

 

[Birdstrike]

We’re saying the same thing. I’m not saying making enough to pay it off in 6 months. I’m saying most students will not have a 6 month salary equal to their student loan burden in any field while working the hours you describe.

Well, that's a big burden. And that's part of what perpetuates a lot of what is wrong with working in Medicine, today. The powers that be have a "take it or leave it" attitude because they know docs can't walk away due to their collective indebtedness. In short, they know they've got us by the gonads and that no matter how loud they squeal, most will do what they say. We don't have "f-you money." We have a servant's debt.

 

[GeneralVeers]

Congrats to RF. I hope your side project works out and you can educate us with a clever anecdote about how you got out of EM.

 

[nexus73]

I'd wholeheartedly recommend burnt out ED docs to transfer to pysch residency if you might find it interesting. If you've got federally consolidated student loans and get into residency at a typical university program or non profit hospital, your payments will qualify for PSLF. And you can moonlight as an ED doc or at urgent care through psych residency. There are a lot of potential jobs (outpatient, inpatient, consults, ED psych!, addictions, partial hospital, private practice where you can basically do whatever you want like see therapy patients for an hour each, work 4 days a week with basically no call, or churn thru 4 patients an hour and make good money, prison/jail, nursing homes, state hospital, forensics...the list goes on). We are in dire need of more psychiatrists too, so please come help!

 

[RustedFox]

Congrats to RF. I hope your side project works out and you can educate us with a clever anecdote about how you got out of EM.

Thanks.

I have to say this, though.
Its just a plan. Just one plan.

I may NOT make it. I might crash and burn. But it's a plan. I now know what Birdstrike felt like when he says things like: "It was a huge personal risk, but I took it." I might end up living in a van down by the river. Which, if you ask those who know me, I could make work just fine. Few material trappings really bother or comfort me. I really am one wily character.

Awhile ago, I promised the forum that when it was all over, that I would publish the tale of my first med-mal suit.
It's been a few years, and I have enough time and distance from it.

COMING SOON:

"FisherPrice: My First Lawsuit" - OR - "RustedFox vs. The Jackpot Jackass Attorney Gang".

I'm seriously banging this out in a separate Word file right now.

 

[ace_inhibitor111]

The market has improved. Practicealink jobs increased from 480 a few months ago to 580 now. Whether or not that will stay the same, well, there are an extra 200 EM physicians graduating next year so...

 

[jackinabox1]

Could you imagine the horror on this forum if the FM forum had a thread going, "Do FM and then a 1 year EM fellowship... and you'll be better and faster than a lot of EM docs out there."

I love how one of the top threads here was advocating booting out all the FM/IM people from EM, some of whom could be considered the pioneers that helped grow EM.

 

[Birdstrike]

I love how one of the top threads here was advocating booting out all the FM/IM people from EM, some of whom could be considered the pioneers that helped grow EM.

I'm in the camp that thinks the founding fathers of EM made a devastating mistake to close any and all pathways to EM physicians being employable outside of an EM. It was a devastating error, some would say, intentional. A huge portion of chronic, severe job dissatisfaction among EM physicians is because of the inability to leave the crematorium that is decades of shift work in EDs.

Only 30 years later, are we finally seeing cracks in that prison wall, with meaningful growth of EM fellowships that allow employment outside of an ED (Pain, HPM, sports). The powers that be know that if it was easy to leave EM and maintain your income, there would be a mass exodus of BC/BE EPs out of the ED and they would no longer have their controlling boot over your throat. The "mistake" was well planned. These are the same people, many of whom spent the later half of their careers taking cash in exchange for testimony that violated ethics and expert witness guidelines. Their names still sit on your textbooks. Some may very elderly chairs of your departments. But most are either dead of early coronary disease or enjoying a very comfortable early and long retirement. Not a single one will you see in the foxhole with you during your next ED shift.

 

[alpinism]

Dude the first EM training program started way back in 1970 over 50 years ago now.

The "original pioneers of the field" have long ago retired and no longer practice clinically.

 

[jackinabox1]

I am just an observer here. Not pointing fingers at anyone specifically, but I wanted to say that it's not fair to advocate pushing out IM/FM trained-docs from EM, while at the same time pushing for primary care options for EM. You can argue that EM-trained docs are better trained than IM/FM docs for the ED, but you'd have to acknowledge that IM/FM docs are better trained for primary care.

 

[Kryptocoin]

I'd wholeheartedly recommend burnt out ED docs to transfer to pysch residency if you might find it interesting. If you've got federally consolidated student loans and get into residency at a typical university program or non profit hospital, your payments will qualify for PSLF. And you can moonlight as an ED doc or at urgent care through psych residency. There are a lot of potential jobs (outpatient, inpatient, consults, ED psych!, addictions, partial hospital, private practice where you can basically do whatever you want like see therapy patients for an hour each, work 4 days a week with basically no call, or churn thru 4 patients an hour and make good money, prison/jail, nursing homes, state hospital, forensics...the list goes on). We are in dire need of more psychiatrists too, so please come help!

There are easier escape routes for burnt out ER docs than another 3-4 year residency. Very short fellowships like addiction medicine, obesity medicine, hospice seem more palatable than being a resident again. Unless you reallllly love psych.

To me the best rx for burnt out is doing something completely outside medicine. Or if you're gonna stay in medicine then maybe segue into something cash based. I'm currently working on the former.

 

[GassYous]

Dude the first EM training program started way back in 1970 over 50 years ago now.

The "original pioneers of the field" have long ago retired and no longer practice clinically.

Really? Isn't goldfrank still working

 

[Birdstrike]

You can argue that EM-trained docs are better trained than IM/FM docs for the ED, but you'd have to acknowledge that IM/FM docs are better trained for primary care.

Now do mid-levels

 

[Apollyon]

Dude the first EM training program started way back in 1970 over 50 years ago now.

The "original pioneers of the field" have long ago retired and no longer practice clinically.

Is that code for "are dead"?

 

[bravotwozero]

Is that code for "are dead"?

I mean, if you’re no longer working the EM pit, you might as well be dead to me!

 

[Apollyon]

I mean, if you’re no longer working the EM pit, you might as well be dead to me!

Then I'm dead to you.

 

[RustedFox]

No do mid-levels

Did you mean:

"Now, do mid-levels..."

 

[Birdstrike]

Did you mean:

"Now, do mid-levels..."

Yes. My bad. Thanks. I've gotten sloppy lately.

 

[Birdstrike]

I mean, if you’re no longer working the EM pit, you might as well be dead to me!

Then I'm dead to you.

Being dead, saved my life.

 

[jackinabox1]

Now do mid-levels

Again, there are a lot of mid-levels in EM too. I guess I should know better, since it is the EM echo chamber. Most of posts here are going to be self-serving to those in the field.

 

[RustedFox]

Again, there are a lot of mid-levels in EM too. I guess I should know better, since it is the EM echo chamber. Most of posts here are going to be self-serving to those in the field.

You missed his point, amigo.

 

[Birdstrike]

I guess I should know better, since it is the EM echo chamber. Most of posts here are going to be self-serving to those in the field.

Not from me. You must be new around here, because the vast majority of my posts on this forum over the past 10 years are indictments of EM.

 

[Apollyon]

Not from me. You must be new around here, because the vast majority of my posts on this forum over the past 10 years are indictments of EM.

When someone joined over 4 years ago, and has less than 20 posts, whenever they mention "echo chamber", I know that they have some agenda.

 

[miacomet]

45 applicants for a job in my area.
Yes, depends on how much you need to work. Even the jobs that remain are much, much worse.

 

[HeyDalaron]

Subspecialty surgery and radiology are the best ways to go.

 

[xaelia]

Do a bit and get your FACEM, then do locums in Australasia.

 

[bravotwozero]

Do a bit and get your FACEM, then do locums in Australasia.

Sure, if you want your house to be overrun with rats!

 

[Siggy]

I love how one of the top threads here was advocating booting out all the FM/IM people from EM, some of whom could be considered the pioneers that helped grow EM.

I'm going to give people the benefit of the doubt that there's a difference between the people who's careers pre-date EM as its own specialty and IM/FM people who graduated from residency last July.

 

[vm26]

That’s crazy awesome. But the vast majority of us can’t accomplish that. But $400k of debt is rapidly becoming the new standard.

If you know of any gigs in rads like this let me know

Last group I was with was around 800-850K w/most partners in the 17-18K RVU range. Weekday shifts were 8 hours, but only 8 weeks vacation. Weekend call could be soul-crushing but you do get acclimated/desensitized. About 20 miles outside of largest metro area in the country. Moved on for family reasons. Very solid democratic group where the leaders actually produced the most RVUs and would not ask anyone to do anything that they were already doing. Probably shouldn't have left!

 

[Ho0v-man]

Last group I was with was around 800-850K w/most partners in the 17-18K RVU range. Weekday shifts were 8 hours, but only 8 weeks vacation. Weekend call could be soul-crushing but you do get acclimated/desensitized. About 20 miles outside of largest metro area in the country. Moved on for family reasons. Very solid democratic group where the leaders actually produced the most RVUs and would not ask anyone to do anything that they were already doing. Probably shouldn't have left!

Well if this is just a good job and not a unicorn job, then I need to be apologize to the previous posters.

 

[vm26]

Well if this is just a good job and not a unicorn job, then I need to be apologize to the previous posters.

It's actually not when you look at the #s. One is reading almost twice as much as an average volume group (around 10K RVU) with less time off. So those 8 hour shifts are super -busy and it takes a certain type of rad (both from skill-set and temperament perspective) to tolerate this grind. While some places like the south and mid-west do have higher reimbursement, in my field I have yet to see high-income job without high volume reading. Maybe doable 20 yrs ago when groups could profit tremendously from tech fees from owning equipment but thats no longer the case.

 

[sloh]

It's actually not when you look at the #s. One is reading almost twice as much as an average volume group (around 10K RVU) with less time off. So those 8 hour shifts are super -busy and it takes a certain type of rad (both from skill-set and temperament perspective) to tolerate this grind. While some places like the south and mid-west do have higher reimbursement, in my field I have yet to see high-income job without high volume reading. Maybe doable 20 yrs ago when groups could profit tremendously from tech fees from owning equipment but thats no longer the case.

Reminds me of these responses:

What contributes to burnout in Radiology?

Genuinely curious - what are the big factors that contribute to Radiology burnout? Is it mostly because of high volume or are there other factors I don't understand as a non-radiologist? Thanks in advance.

forums.studentdoctor.net

"What I think non-radiologists don't understand about radiology is intensity-level that we perform at consistently (on-call). It's not uncommon to have a call shift where, other than getting up to pee and maybe answering phones calls, we're reading a huge stack of acute cases. 80-100 acute cross sectional cases where the radiologist's input directly drives patient care. Baseline that's like a 7-8 out of 10 on the stress scale.

I remember clinical medicine calls; in my opinion, people wildly underestimate just how much time they spend doing low-intensity activities: calling consults, walking to see a patient, putting in orders, writing notes, waiting for a trauma patient to arrive, doing the closure on a surgery, etc.... I would liken radiology to doing the most intensive part of a surgery, some sort of delicate anastamosis, for 8-10 straight hours. Or running 8 codes in 8 hours. That's gonna be mentally fatiguing."

"I am at a high-end academic medical center, and our IR residents and fellows compare their IR call to their general radiology call. IR call is busy without too much time downtime since there are few fellows covering a large health system; despite this, they almost always consider IR call a bit of a break when compared to general diagnostic radiology call. Some of the IR residents/fellows partake in ICU/SICU rotations, and DR work to them is relatively more intense, especially on a per unit of time metric.

My co-residents all felt more mentally tired working 50-60 hours a week in radiology compared to internal medicine or surgery intern year where many of us routinely worked 70-80+ hours/week. The closest analogy is focused non-stop driving for 10-12 hours, but this not an apt comparison since diagnostic radiology requires even more mental focus/intensity, or else miss rates go up."