Need help deciding!!

[sm2005]

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Hi, I'm a MSIII, and until recently, I was between ob-gyn and gen. surgery, but now I started to think about EM (some time ago I was also considering it). Do any of you were between these choices, how did you decided? Did you also like clinic (like me) but anyway decided on EM or all of the people that go into EM can't stand clinics?

 

[beyond all hope]

EM is very different from the surgical subs.

You don't have clinic (although a lot of ER patients are like clinic patients these days. Only about 5% of the people in the ER have true emergencies.)

Most people choose EM over surgical specialities because there is an opportunity to do procedures but you don't have to work 60-80 hours a week, and you don't take call. However, you see serious trauma in very few ERs around the country, so most of the procedures you do are related to airway or vascular access. Don't expect to be cracking chests or doing crikes every other week, even in the most hectic residencies.

EM people work hard and play hard (few hours, no call). EM docs have to be comfortable making decisions based on little or no information, and work on their instincts. You see a lot of patients, and a lot of them are smelly, disrespectful to downright hostile, don't care about their health, and many are simply in the ER for a bed or a meal. However, you have a chance to make a difference in a lot of people's lives.

Do a rotation as soon as possible if you are interested in EM. That's the best way to know for yourself.

 

[southerndoc]

Originally posted by beyond all hope
Do a rotation as soon as possible if you are interested in EM. That's the best way to know for yourself.

I think this is the best advice. You know what surgery and OB/gyn are like, so schedule EM as your first 4th year elective. That way you'll know quickly if it's right for you and if you should apply or not.

Like you, I was also considering surgery (never thought of doing OB though!). I just couldn't see myself working 80 hours a week and not having a family life. Plus, I liked a variety of patients and love pre-hospital medicine.

Do a rotation and see if it's what you want.

 

[sm2005]

Thanks for the advice 👍 !! I will try to rotate as soon as possible.

 

[DrQuinn]

Originally posted by sm2005
Thanks for the advice 👍 !! I will try to rotate as soon as possible.

Agreed. A rotation in the ED is the best way to see if its right for you. Heck, even spending a day or two in the ED while you're on an easy rotation month would give you a better idea. Remember that on all off-service rotations, your resident will HATE it when his/her pager goes off and it has the ED's number on it. It just means more work for that resident.

Down in the ED, its a very different story. In fact, the IM intern that's rotating down int he ED with me this month said "Man, Quinn, I don't know how you guys do it... everyone who's consulted hates coming down here... they just don't see it like "we" do!"

Q, DO

 

[Pegasus]

I totally agree with the above posts...do a rotation.
I for one LOVED Surgery and Ob...I mean LOVED them...BUT the hours for me was more that i am willing to commit for my life...I want a life..and neither of those specialties offer much time outside of work...

I LOVE EM b/c I can deliver babies and do procedures, and NEVER EVER carry a pager or be on call....Is there a better specialty...I am so glad I chose EM...

Good Luck

 

[Hercules]

I'm glad to hear that several others here thought about Ob before choosing EM and are happy now in EM. I spent the first 2 years of med school dead set on ob/gyn. I was an officer in our ob/gyn interest group and everything. So far surgery and ob/gyn were the only rotations where I've loved what I was doing. As third year has gone along, though, I've learned that I (as well as my spouse) don't do well with 80-100hr work weeks. I need more time off than that for my family and myself. As I spend more and more time looking into EM it just seems like it wold be a good fit for me.

Would you guys really advise doing an EM rotation as your first 4th year rotation? I was kind of planning on doing a medicine AI (review of everything) and some Anesthesiology (airway management) to tone up some skills before heading to my EM rotations. Would these two rotations be useful, or am I just wasting valuable time in the early 4th year?

 

[PimplePopperMD]

Originally posted by Hercules
Would you guys really advise doing an EM rotation as your first 4th year rotation? I was kind of planning on doing a medicine AI (review of everything) and some Anesthesiology (airway management) to tone up some skills before heading to my EM rotations. Would these two rotations be useful, or am I just wasting valuable time in the early 4th year?

Although they would obviously be useful, you should do your EM rotation as early as possible, and consider a scheduling a second one at a different program (in a place you'd like to have your residency), in case you actually want to choose EM... two EM rotations are better than one, generally, as letters from important people are IMPORTANT.

 

[southerndoc]

Originally posted by Hercules
Would you guys really advise doing an EM rotation as your first 4th year rotation? I was kind of planning on doing a medicine AI (review of everything) and some Anesthesiology (airway management) to tone up some skills before heading to my EM rotations. Would these two rotations be useful, or am I just wasting valuable time in the early 4th year?

Anesthesiology would be a waste. EM attendings won't expect you to know how to be a master at intubation. Yes, you will probably have a chance to tube someone during your ED rotation (I tubed a couple during my core rotation, none during an away rotation). I think the anesthesiology rotation would give you a leg up for intubations, but I don't think it's necessary. You aren't expected to know that. Don't waste your time on it before your EM rotation because the earlier you do EM, the quicker you can decide if it's for you and the quicker you can get your LOR's. Doing anesthesiology after your core EM rotation might be a good thing.

 

[The White Coat Investor]

Originally posted by Hercules
Would these two rotations be useful, or am I just wasting valuable time in the early 4th year?

You'd be wasting valuable time.

You won't be good at intubating as a medical student, no matter what you do, and you will be by the end of your internship. No one cares how well you can intubate as a medical student. They only care about whether you can work hard, assemble a decent emergency differential (different than an IM differential,) and get along with the staff.

For what its worth, OB was my second pick and Gen Surg was my third (tied with Ortho) Now coming up on the end of my internship, and having done Surgery, Ortho, and OB as an intern, I'm positive I picked the right field.

 

[Homunculus]

i would recommend doing a rotation with a caveat-- make sure you do it in a quality ED. don't go to a community hospital or something. try to do it at a level I or II trauma center so you can get some exposure to something other than the "free clinic" type stuff.

 

[kungfufishing]

Ive never rotated with that type of Dr. before.

 

[sm2005]

Thanks for your responses!! I think that if I rotate in EM I would like it for the four weeks of the rotation, but it is hard for me to decide if I would like to be working in a ER for the rest of my life. I know, I know, I have to rotate first. I think that I would like it (the rotation) because when I was in my surgery rotation, what I enjoyed the most was when I was on call and we were in the ER and there was always something to do. But still, work in a ER forever, I don't know about that. The thing I like the most about Ob-gyn is the variety of settings (clinic, labor room, OR,ward). So, in conclusion, I'm just worried that after a rotation in EM, I would be in the same place I'm right now. But I know, I know, I have to rotate first. Thanks for listening 😉

 

[Homunculus]

Originally posted by kungfufishing
Ive never rotated with that type of Dr. before.

it helps to get accepted to a medical school first.

 

[kungfufishing]

so you consider yourself "accepted" at our school? whatever keeps you out of the arsenic, I guess...

 

[jazz]

to sm2005 and all others deciding

when i was a 2nd year med student, we had to shadow 2 hours in the ED. i hated it! when a friend told me he was doing EM, i thought "work in an er for the rest of my life? how much would that suck"

i fell in love with surgery during my ms3 year. then i did a subI in gen surg and there were so many cases and i actually got sick of going to the OR. plus, the 3rd lap chole wasn't as exciting to be scrubbed in on as the 1st.

i realized that i love procedures, enjoy being busy at work, and did an EM rotation at the end of my 3rd year. i loved it. everything i viewed as a negative is now a positive.

working in an ED allows you to have mobility if you need it. you don't have to worry about building up a patient base/practice.

you will never have call again after residency -- just think about how many times the medicine attendings are called each night they are on call for admissions.

you will be busy for the shifts you are there --- sometimes you don't really even stop moving. but when you're off, no pagers or any other bothers.

em is so varied -- you can see someone critically ill, septic, intubated, then see an ankle fracture, then see a pregnant and bleeding (get to do the u/s, confirm fht's, and never even have to involve ob), run a code. of course, there's bs in there too (chronic back pain) but hey, you can't have it all. when you get an exhausting (whiny, pain issues, noncomliant, manipulative) patient, just think ... "at least i'm not his/her primary...."

 

[Hercules]

Originally posted by Desperado
No one cares how well you can intubate as a medical student. They only care about whether you can work hard, assemble a decent emergency differential (different than an IM differential,) and get along with the staff.

Thanks Desperado, PimplePopperMD, and Geek Medic. That was exactly what I wanted to hear. Can you guys think of any 4th year rotation that WOULD be helpful to do before an EM rotation? I ask b/c I can't schedule the EM rotation I want until August or September and I'm trying to find something to do with the month of July.

 

[southerndoc]

Originally posted by Hercules
Thanks Desperado, PimplePopperMD, and Geek Medic. That was exactly what I wanted to hear. Can you guys think of any 4th year rotation that WOULD be helpful to do before an EM rotation? I ask b/c I can't schedule the EM rotation I want until August or September and I'm trying to find something to do with the month of July.

Critical care might be a good rotation, but ONLY if they allow you to do things like starting central lines, managing many patients, etc. I saw an average of 5-8 patients every morning when I did surgical critical care. I put in 6 chest tubes, a couple trachs (percutaneous, not emergent surgical crics), a couple PEG's, did one needle chest decompression, numerous art lines, and I couldn't even tell you how many central lines I did (probably >50 -- I averaged more than 1 per day).

 

[The White Coat Investor]

Originally posted by Hercules
Can you guys think of any 4th year rotation that WOULD be helpful to do before an EM rotation? I ask b/c I can't schedule the EM rotation I want until August or September and I'm trying to find something to do with the month of July.

Oh they're all helpful, that's not the point. The point is don't feel like you have to do them before EM. Anesthesia, ICU, Medicine, Surgery, OB/GYN, Ortho, Rads, Plastics, another EM rotation at a community hospital so you can really shine at the University rotation etc. One thing a lot of EPs don't do that I'm glad I did was a 2 week senior rotation in Optho. It was nice to see so much eye path so I would know what I was ruling out with the slit lamp before calling something conjunctivitis.

Critical care might be a good rotation, but ONLY if they allow you to do things like starting central lines, managing many patients, etc. I saw an average of 5-8 patients every morning when I did surgical critical care. I put in 6 chest tubes, a couple trachs (percutaneous, not emergent surgical crics), a couple PEG's, did one needle chest decompression, numerous art lines, and I couldn't even tell you how many central lines I did (probably >50 -- I averaged more than 1 per day).

That sounds like a hellagreat rotation. I'd do that as a resident.

 

[Vincristine]

Crap -- now I'm waivering again. EM was the default in my mind as I started med school -- for most of reasons everyone has listed including proceedures, shift work, a life outside the hospital, etc. I highly disliked IM and knew I was never a primary care type. What I found most frustrating was that much of how the patients did was up to them, and so many of them didn't/couldn't take care of themselves....the patients who kept coming back in for a CHF exaserbation because they ate a pizza or lived on canned soup -- I could only take so much of that.

I got to surgery and thought I found my home. I LOVE finally working with my hands. I like the fact that so many of our patients come in with a problem (even if it's a simple hernia), and we actually help them, make a difference, and don't just try to keep a chronic problem from getting worse. I enjoyed the 3rd and 7th lap chole and I did the first. And, oh, how I loved trauma. At least at our Level I trauma center, trauma is handled by the trauma surgeon on call, not the ER staff. I started "ruling in" surgery. I'm starting to have second thoughts about the lifestyle, however.

My biggest problem is that I don't feel like I have the time to decide -- unlike everyone tells me I do. I have a surgical sub-I scheduled for the end of May/beginning of June. I have elective time July, August, and November. Sept and Oct is Psych. Anything after November is pretty much irrevalent. So I have 3 months for aways and to officially decide what I want to do. If I'm on the surgery path, I feel like I HAVE to do surgical aways at good programs in both July and August. If I take July to do an EM rotation, I feel like I'm be harming my chances of matching surgery.

I think the only reason EM is still in my mind is for the lifestyle. It's a big factor, but it's the ONLY thing at this point.

Thoughts?

 

[FoughtFyr]

Originally posted by keraven
Crap -- now I'm waivering again. EM was the default in my mind as I started med school -- for most of reasons everyone has listed including proceedures, shift work, a life outside the hospital, etc. I highly disliked IM and knew I was never a primary care type. What I found most frustrating was that much of how the patients did was up to them, and so many of them didn't/couldn't take care of themselves....the patients who kept coming back in for a CHF exaserbation because they ate a pizza or lived on canned soup -- I could only take so much of that.

I got to surgery and thought I found my home. I LOVE finally working with my hands. I like the fact that so many of our patients come in with a problem (even if it's a simple hernia), and we actually help them, make a difference, and don't just try to keep a chronic problem from getting worse. I enjoyed the 3rd and 7th lap chole and I did the first. And, oh, how I loved trauma. At least at our Level I trauma center, trauma is handled by the trauma surgeon on call, not the ER staff. I started "ruling in" surgery. I'm starting to have second thoughts about the lifestyle, however.

My biggest problem is that I don't feel like I have the time to decide -- unlike everyone tells me I do. I have a surgical sub-I scheduled for the end of May/beginning of June. I have elective time July, August, and November. Sept and Oct is Psych. Anything after November is pretty much irrevalent. So I have 3 months for aways and to officially decide what I want to do. If I'm on the surgery path, I feel like I HAVE to do surgical aways at good programs in both July and August. If I take July to do an EM rotation, I feel like I'm be harming my chances of matching surgery.

I think the only reason EM is still in my mind is for the lifestyle. It's a big factor, but it's the ONLY thing at this point.

Thoughts?

I would advise you look at at least one away EM rotation. Carle is not the last word on trauma, ED system design, or practice methodology. I'm not saying they are not good, what I am saying is that there are many ways to skin a cat...

Try to do an away at Hennepin. They have a great system of doing things and would provide a counter-point to Carle.

- H

 

[The White Coat Investor]

Originally posted by keraven
Crap -- now I'm waivering again. EM was the default in my mind as I started med school -- for most of reasons everyone has listed including proceedures, shift work, a life outside the hospital, etc. I highly disliked IM and knew I was never a primary care type. What I found most frustrating was that much of how the patients did was up to them, and so many of them didn't/couldn't take care of themselves....the patients who kept coming back in for a CHF exaserbation because they ate a pizza or lived on canned soup -- I could only take so much of that.

I got to surgery and thought I found my home. I LOVE finally working with my hands. I like the fact that so many of our patients come in with a problem (even if it's a simple hernia), and we actually help them, make a difference, and don't just try to keep a chronic problem from getting worse. I enjoyed the 3rd and 7th lap chole and I did the first. And, oh, how I loved trauma. At least at our Level I trauma center, trauma is handled by the trauma surgeon on call, not the ER staff. I started "ruling in" surgery. I'm starting to have second thoughts about the lifestyle, however.

My biggest problem is that I don't feel like I have the time to decide -- unlike everyone tells me I do. I have a surgical sub-I scheduled for the end of May/beginning of June. I have elective time July, August, and November. Sept and Oct is Psych. Anything after November is pretty much irrevalent. So I have 3 months for aways and to officially decide what I want to do. If I'm on the surgery path, I feel like I HAVE to do surgical aways at good programs in both July and August. If I take July to do an EM rotation, I feel like I'm be harming my chances of matching surgery.

I think the only reason EM is still in my mind is for the lifestyle. It's a big factor, but it's the ONLY thing at this point.

Thoughts?

Yea, don't go into EM ONLY for the lifestyle. You won't like it and we won't like you. That being said, you still do have plenty of time. Don't feel like you have to do 2 surgical aways to match at a good program. You've already done one surgery rotation. You're doing another this spring. You can do a third this summer. Do an EM month this summer. You may find you like more than the lifestyle, and it will help you a lot to prepare for Steps II and III and a surgical internship.

 

[Vincristine]

Thanks for all the advice. I'm still deciding on an EM rotation (of course, NOT at Carle), but I agree I shouldn't do EM based mostly on lifestyle. The panic episodes are less intense and less frequent, so I think I'll be sticking with sugery 🙂 Thanks again!

 

[funkless]

Thank you, everyone, for this thread!

I start MS-I at UTHSC in Memphis this year. I know better than to think that I won't change my mind a million times over the next 4 years, but EM sounds fascinating and I can't wait to get to the clinical years.

How soon is too soon to start shadowing? Do you think I could find an accomadating resident/attending who'll let a know-nothing incoming student tag along?


--Funkless