Questions about specializing later in career (specifically E/CC)

[ShaWalla]

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Hi all! First 4 weeks of vet school done. Holy cow, it's a lot, but I am loving it so far.

Obviously I still have a ton to learn, and I'm not certain about wanting to specialize, but I am very interested in small animal emergency medicine.

I wanted to know if it would be unusual or very difficult to get a residency in emergency and critical care after being a general ER doctor for a few years? For reasons I won't share right now, I would probably wouldn't be able to do a residency right out of school, but I do plan on doing a rotating internship. If I did a rotating internship, then worked as an ER doc for a few years, would it be very hard to get a residency in E/CC?

 

[JaynaAli]

I don’t have enough experience in the ECC field to say how applying a few years after graduation might affect your chances, but I think that one of the biggest difficulties/adjustments in going back to training later is partly the mental shift back into a student/learning mindset but a big challenge is the financial changes. A resident is going to be making a fraction of the salary you will have become used to as a practicing ER veterinarian, and taking a sudden 75% salary cut back to resident wages (example percentage, ymmv) after your lifestyle has crept up over the past few years can be tough. It’s a bit easier to just do them sequentially and “live like a student” longer before your lifestyle creeps up and expenses rise.

 

[supershorty]

Tagging @cdo96 and @TheGirlWithTheFernTattoo and @MOOSEygoosey for ECC residency things

 

[battie]

As a non-internship and non-residency trained ER doc, I feel like it would be doable on the level of taking the right steps and networking. Job --> internship --> residency should be doable from the aspect of just getting it done. Depending on where you practice, your case load and acuity may be an adjustment (it would be for me).

However, the money cut is real. I make 85/hr, and I'm on the low end for my area. The internships in my area come out to *****20-25/hr***** when you factor in how many hours you work. Residency is likely ****25-30/hr*****. 75% was a good guess on Jayna's part. I wouldn't be able to do it, frankly. I have a House Husband and toddler. My husband would have to find a job at 50/hr with just a high school degree to make up the difference. And our family would have to take a more central role of daycare.

Lifestyle creep will absolutely be your greatest barrier here.

 

[TheGirlWithTheFernTattoo]

Hey,

I would say ECC is one of the programs where being in practice before applying is less likely to hurt you than most other specialties. 2 of my current resident-mates were out in practice (after doing rotatings) for several years before coming back to specialize. That being said, going back to being a trainee after the independence (and pay/QoL) of being an associate is not easy. The start of residency was very difficult for my one resident-mate and at least one resident before my time quit within a few months in the same situation. I have a huge amount of respect for my resident mate in that I don't think I personally would have had to grit to do everything that she did to get where she is now.

The biggest things are:
-Worse shift hours (overnights, switching shift types)
-More hours overall (no residencies will have you working less than 50 hours/week, most significantly more not counting studying/research outside of work)
-On call requirements
-Significantly less pay
-Significant studying requirements outside of work
-Research requirements outside of work
-Being a trainee again - someone always critiquing what you do and you having to conform to what your supervisor wants even if it is different from how you have practiced when on your own. This one is huge if you have been an independent doctor and have gotten used to calling the shots.

You are so early on in school that you have tons of time to change your mind and figure out what you want. If you ultimately want to specialize, I would personally recommend just grinding it out right away and being done with it. If you aren't sure, there is absolutely nothing wrong with going into practice (knowing that most people that do that do not go back). If specializing is on your radar I strongly strongly recommend a rotating internship out of school. Not only will it help you for ER practice, it will be very helpful/important if you do decide to specialize moving forwards.

 

[ShaWalla]

Hey,

I would say ECC is one of the programs where being in practice before applying is less likely to hurt you than most other specialties. 2 of my current resident-mates were out in practice (after doing rotatings) for several years before coming back to specialize. That being said, going back to being a trainee after the independence (and pay/QoL) of being an associate is not easy. The start of residency was very difficult for my one resident-mate and at least one resident before my time quit within a few months in the same situation. I have a huge amount of respect for my resident mate in that I don't think I personally would have had to grit to do everything that she did to get where she is now.

The biggest things are:
-Worse shift hours (overnights, switching shift types)
-More hours overall (no residencies will have you working less than 50 hours/week, most significantly more not counting studying/research outside of work)
-On call requirements
-Significantly less pay
-Significant studying requirements outside of work
-Research requirements outside of work
-Being a trainee again - someone always critiquing what you do and you having to conform to what your supervisor wants even if it is different from how you have practiced when on your own. This one is huge if you have been an independent doctor and have gotten used to calling the shots.

You are so early on in school that you have tons of time to change your mind and figure out what you want. If you ultimately want to specialize, I would personally recommend just grinding it out right away and being done with it. If you aren't sure, there is absolutely nothing wrong with going into practice (knowing that most people that do that do not go back). If specializing is on your radar I strongly strongly recommend a rotating internship out of school. Not only will it help you for ER practice, it will be very helpful/important if you do decide to specialize moving forwards.

Thank you so much for your reply!

You're right in that I still have a lot of time to figure out if specializing is right for me. And yes, I can't really predict if after I graduate I would want to do many more years of training. Like you and others mentioned, going back to training after practicing for many years is a huge adjustment as well. Right out of school though, I am planning on doing a rotating internship.

It does make me feel better to hear that ECC is more forgiving about residents who had been in practice previously. Without giving away a ton of personal info, my SO will certainly be the bread-winner between us (going to be an MD), so I could likely afford to take the pay cut at least. My SO's schedule for residency and certain service commitments is why it may be difficult for me to do a residency right out of school. Which I am fine with, our relationship is prioritized over specializing for me. Also, I believe I would be fulfilled with a career as a non-residency trained ER doc; but it's something I've thought about.

I can't predict the future, and we might be able to do our residencies at the same time, but I was just thinking about a future where I am practicing without specializing for awhile, then going back. It makes me feel better that the door would at least not be fully shut.

Thanks again for taking the time to share your perspective with me.

 

[cdo96]

Hey,

I would say ECC is one of the programs where being in practice before applying is less likely to hurt you than most other specialties. 2 of my current resident-mates were out in practice (after doing rotatings) for several years before coming back to specialize. That being said, going back to being a trainee after the independence (and pay/QoL) of being an associate is not easy. The start of residency was very difficult for my one resident-mate and at least one resident before my time quit within a few months in the same situation. I have a huge amount of respect for my resident mate in that I don't think I personally would have had to grit to do everything that she did to get where she is now.

The biggest things are:
-Worse shift hours (overnights, switching shift types)
-More hours overall (no residencies will have you working less than 50 hours/week, most significantly more not counting studying/research outside of work)
-On call requirements
-Significantly less pay
-Significant studying requirements outside of work
-Research requirements outside of work
-Being a trainee again - someone always critiquing what you do and you having to conform to what your supervisor wants even if it is different from how you have practiced when on your own. This one is huge if you have been an independent doctor and have gotten used to calling the shots.

You are so early on in school that you have tons of time to change your mind and figure out what you want. If you ultimately want to specialize, I would personally recommend just grinding it out right away and being done with it. If you aren't sure, there is absolutely nothing wrong with going into practice (knowing that most people that do that do not go back). If specializing is on your radar I strongly strongly recommend a rotating internship out of school. Not only will it help you for ER practice, it will be very helpful/important if you do decide to specialize moving forwards.

All of this plus wanting to add- going from internship straight to residency is generally easy because you have all your letters of rec basically from your internship (you’re going to need criticalists write you the majority of them).

Not saying that you won’t work with criticalists as an ER doctor- but depending on what hospital you work at and how it’s laid out, you may not have a criticalist on your half of the week, you might be on overnights and not working with them, etc. Lots of variables for sure.

But the shift in QOL is huuuuge. Of everyone who I’ve met (4) that took time off between internship and residency, 2 quit before their second year, 1 is in residency and hating it, and only 1 made it through.