+1 for ER being a good way to see cool cases. You are the first person seeing all of the cases that often move on to a specialist. Every ER functions a little differently, but at the one I worked at (ER + specialty), the only thing I wasn't 'allowed' to do was surgery as we had on-call surgeons. Specialists deserve a ton of credit for the knowledge and skill they have (and the time it takes to get it), but ER docs are woefully underrated, underpaid, and underappreciated. ER vets often do the work of a board-certified criticalist without the credentials (and increased pay). You are stabilizing DKAs, admitting parvo puppies, tapping chests and abdomens, stabilizing fractures, managing heart failures, keeping back/neck dogs out of searing pain until the neurologist gets them into the OR, managing the criticalist's post-op septic abdomen overnight, etc. I could go on. Probably 90% of the cases that specialists saw at my hospital went through the ER first, and we had to make sure everything was set up and performed correctly so the specialist could take over the next day. It was never boring (grueling and exhausting? yes) and you touch on almost every single specialty every day. You have to have a breadth of knowledge of all specialties to do the job well, and often need to know each specialist you work with extremely well so you know how to set up their transfers.
An ER-only practice is even more challenging - you either do all of the above without a specialist there to take over at some point, or you refer.
You don't need to specialize/do a residency for ER work. I'd recommend at least a rotating internship before jumping into ER, but that's just one person's opinion.
You
can also do some specialty-level work without going through residencies/sitting for boards. There are a few internists, radiologists and surgeons I've come across that have their practice limited to that specialty, but either did not do a residency, or never ended up boarded for whatever reason (or still are trying to qualify for/pass boards, I suppose). Some get their experience through CE and/or internship training. You could debate about whether or not you should call yourself a 'specialist' (as in an internist, surgeon, radiologist, etc.) in this case, but nevertheless, some people definitely do this. When my vet school had no radiologist on staff (3 years of my education...), they hired on a vet who just was 'good at' ultrasounds. She never did a residency, but all she did was ultrasounds, even before being hired by the school. I don't remember if she referred to herself as a radiologist or not. The vet who did a TPLO on my childhood dog a few years ago? Not a boarded surgeon and did not do a residency, but owns an entire practice that is limited to surgery and definitely referred to himself as a surgeon. Semantics, but some people get very worked up about the use of a title and feel it has to be earned a certain way.
Zoo is another 'specialty' field that does not require a residency - I did a specialty internship, but will not be doing a residency. You do not need to do a residency to qualify for the board exam, either, which makes this field unique (although there are some people that absolutely want to change this...). I will say that zoo med is essentially GP/ER but with species that make your job really hard, and sometimes really scary (I was nearly killed last weekend....this field is nuts
). With that said, I don't refer to myself as a specialist in zoo med, or a specialist at all. (similar to above...can you call yourself a specialist if you haven't passed a board exam? a discussion that is not entirely relevant to this thread). The ACZM (zoo specialty board) has actually trademarked the phrase 'Board certified specialist in zoological medicine.' Not sure if other specialties have gone that far.
Anyway, TLDR: there are options to do 'cool' stuff with and without going through a traditional route to specialize (rotating internship -> specialty internship, sometimes multiple -> residency -> specialty board exam). In general, there is a big push for specializing and I noticed that right off the bat in my first year of school.
