Currently a PGY2 EM resident in a 3 year Midwestern program. Decided last minute to bail out on Surgery for a career in EM halfway through the interview season as a 4th year med student. Now that I spend my the majority of time in the ER dealing with the worst of the worst patients (some with legitimate emergencies but most of them not), getting talked down to by my subspecialist colleagues ("You're consulting me for WHAT?!" "No, that's not a STEMI...I'm not taking your patient to the Cath Lab" "Do you even know how to read a CT? If so, read it before you consult me for an Appy"), not really being a trauma doctor since all I do is manage the head and the airway while the Trauma surgeons have all the fun with the open thoracotomies, chest tubes, etc., and worst of all - missing out on that appreciation from a patient that you actually did something for them or helped them (and the "thanks for the dilaudid doc - no my phantom abdominal pain is all gone and yes, I will be happy to go home now... you're the best doctor in town!" is not the appreciation I'm talking about).
I'm sure for many of you in EM, these are not uncommon occurrences or feelings. And moreover, I'm sure you all knew these things before going in to Emergency Medicine. But, did you ever think that the burn out would come this quickly? Sure we do shift work, don't have to take call, really don't put in that many hours each month, and still get paid decently. But is it worth it at the cost of not having that continuity with your patients to know if anything you did for them actually mattered, of not ever being taken seriously by your patients or colleagues because you're not a master of anything (but a jack of all trades), of feeling like in the end you're basically a triage doctor, and from a financial standpoint knowing that your earning potential is capped while your friends from med school who went into plastics, ortho, or vascular will eventually (albeit a long eventually) be making 5x's more than you do on a yearly basis?
Has it occurred to anyone that while you may enjoy running around the department seeing anything from a sprained ankle to a traumatic arrest, that one day you'll be 55 or 60 years old doing the same thing that you're doing now as a resident? Kind of a sobering thought. But I guess if you LOVE it, then it's not a big deal. However, let's be honest, many people (if not the majority) who decide to ditch their original aspirations of being a surgeon or cardiologist or whatever for Emergency Med did it not because they thought EM was their calling, but because it allowed them to have a "lifestyle" outside of work. It gave them limited time at work for a nice paycheck and the time to enjoy that paycheck. I agree, that sounds awesome.
What isn't awesome are those times when a STEMI or a gnarly dissection comes in and you're limited to getting an EKG or Chest X-Ray (and maybe you have the opportunity to actually auscultate the patient with your stethescope) and consulting cards or CT surgery, respectively, and then going off to do a pelvic exam and ultimately give her a shot of rocephin with a gram of azithromycin because she has cervical motion tenderness (woopdee****indoo)...all the while your buddies are doing cool **** in the cath lab literally saving this guy from his heart attack or scrubbed in and grafting his patient's aorta and literally saving his life. Sure you had your part in saving those patients' lives - i mean it was you consulted your colleagues... but in the end, who ultimately is the one saving their lives? You or your specialist colleagues? Who walks away with greater pride and satisfaction at the end of the day knowing that all their hard work actually mattered?
So, the point of this self-inflection rant is this question... do any of you (specifically those who ended up in EM secondarily to leaving your initial aspirations to be another type of doctor) have any regrets for selling out early and not going all the way? Do you ever feel that if you had just sacked up and decided to put in the extra few years in training that your status, freedom, and pay eventually as an attending would also be much higher, and thus making all that suffering worth it?
Consider this: had you pursued your aspirations to become a cardiologist or a surgeon, then the more you work along your career path, your status, pay, and autonomy also grow accordingly. For example, you do 5 years as a gen surg resident, then you're a plastics fellow for 3 years, then maybe a hand fellowship, and at the end you're taking call from home (if you even need to take call) only to tell the ER doc to suture or set what they can and have them follow up in the office tomorrow. You have your own practice and you get to operate a few days a week and you're pulling in close to a million a year (if not more). No nights, no weekends, no holidays. Life is sweet. Sure you're probably 55 years old. But at the same time, what's your 55 year old buddy from med school who went into EM doing? He's on his 4th night shift in a row looking forward to switching to days in 2 days dealing with the homeless druggies who are yelling at him because he's trying to be noble and not give them narcotics. He's doing the same crap he was doing as a resident. He doesn't have a PA or a resident that will go in for him to see ED consults or round on patients like you do. You're sleeping next to your beautiful wife in your beautiful home, while he's stressing out and probably having an NSTEMI himself while he's at work.
Sure, EM affords a great lifestyle and job early on when you're young in your career... i mean 3 years of residency and you're out... there's no delay in gratification. Who wouldn't want to take a bite out of that apple? But, take a moment to project long-term and then compare the two career paths... then you'll see my point. Again, this thread is only for those who didn't primarily choose EM because they love EM (these are the guys that I truly envy), but rather this is for those like me who had their hearts set on something else besides EM but somehow ended up choosing this career in the end...
With that said, for those of you who have regrets (not necessarily of choosing medicine in general) but of leaving your dream of being a surgeon or whatever... would you consider going back and chasing that dream? Or have you found a way to accept your career and a way to enjoy EM? If you're like me and can't see yourself pulling full-time shifts in the ED 10, 15 years into your career... then what have you chosen as your alternative?
I've been known on this forum to be a grumpy goose on Emergency Medicine (and really, medicine in general). However, not only do I disagree with your post, I find it offensive, obnoxious, and horribly misguided. I even wonder if you really are an emergency physician or just some random troll who didn't get into EM. (I've seen weirder things on SDN.) But, even if we accept you for who you are, I suspect that you're an a**hole and as such, were more suited to Surgery.
To address your points:
1. "We treat the worst patients."
It depends on where you work. I work in the rural setting and 70% of my patients are absolutely fine. Another 30% suck, but many of these are in truth from a vulnerable segment of the population, and we therefore are providing a valuable safety net service for the community.
2. "Not really being a trauma doctor."
I trained at a Level 1 trauma center and we did plenty more than just the airway. We placed chest tubes, put lines in, and even cracked chests. But, in any case, I'm so glad I no longer work in the trauma setting any more.
3. "No appreciation from patients."
Yeah, I saved a patient from almost certain death (after coding her for two hours), and she came back several months later to hug me and give me a card, with a picture of the entire extended family holding a sign thanking me.
I save at least one person per day at work. How many people can say that?
4. "You're not a master of anything."
False. I'm a master of treating the undifferentiated patient in an emergency. I do that better than anyone else. In fact, PCP's routinely send me their patients to "figure out what the hell is wrong." I can handle anything, and tell them, "send em my way; I'll take care of it."
5. "You're a triage doctor."
This is where I really started to think that you're not a real EM doctor. No real EM doctor would think that this is what we do. It's in fact an accusation thrown against us by people who only see the 10-15% of people we admit to the hospital, not the overwhelming larger number that we treat and street.
Moreover, even those we admit, we diagnose, stabilize, and begin the treatment. To me, this is the hard part. The rest is maintenance. Yeah, you on the floor can go recheck the CBC and BMP every day, lol.
6. "Specialists make 5x more than you."
My hourly salary is higher than most (all?) other doctors. I just decide to limit how many hours I work.
7. "Most people choose EM due to lifestyle choice."
False. Only idiots do that. And you're one of them. EM is not a lifestyle choice, due to the large number of evenings, nights, weekends, and holidays. You're just an idiot who chose the field due to lifestyle, when we here on this forum would have told you long ago that this would be an idiotic decision.
8. "You do nothing in a STEMI or a dissection except consult your colleague."
I don't have anyone to consult. I interpret EKG's, and identify a STEMI when others would have missed it. Mattu is better at this than any cardiologist. So yeah, when I identify a STEMI on an EKG most would have called normal, yeah I have the right to feel good. And yeah, when I identify and treat a dissection, I feel good about that.
And when such patients and others crash and code, I then code them like a boss, better than anyone else. I got called to the OR for a code, and I pushed aside the clueless surgeon and anesthesiologist, and I ran that code like a boss.
Where you got this idea that I don't do anything, I don't know. I take care of sick and crashing patients from any number of disease processes, ranging from severe sepsis to heart failure to cardiac arrest.
For years after my residency, my heart would race when I was in the parking lot right before work... I'd feel super nervous because I know I'd be dealing with crazy sick patients. I've moved past this feeling, as I've explained in another thread. But, this feeling would not be there if "I didn't do anything" and "just consulted other services"--as you claim. EM is a super challenging job, and most other doctors (like you) could not hack it. The problem is that we don't give any true responsibilities to those non-EM residents (like you) who rotate in our ER. So, they see 1 non-sick patient every 2 hours and leave thinking EM is so easy.
9. "You're sleeping next to your beautiful wife in your beautiful home, while he's stressing out and probably having an NSTEMI himself while he's at work."
I thought we don't do anything -- now we're taking care of NSTEMIs?
10. "Again, this thread is only for those who didn't primarily choose EM because they love EM (these are the guys that I truly envy), but rather this is for those like me who had their hearts set on something else besides EM but somehow ended up choosing this career in the end..."
You crap all over my field, and then say this? Screw you.
You're an idiot for going into EM for lifestyle, and now you're crapping all over the speciality when in reality you should just be crapping over your own idiocy.
MS2. There's your answer right there.
