Sleep, sleep, sleep & part-time, choosing EM as a career?

[c_mor]

I am a 4th yr female medical student who enjoys many aspects of ER: team-work, population, problem-solving, multi-tasking, etc. I truly enjoy the field and am strongly considering ER as a career. HOWEVER, there are two points that make me hesitate.

1)SLEEP: I am extremely dysfunctional when I don't get enough sleep. I have passed out on multiple 24-hour-straight work days during 3rd year. The good news is that I can well recognize my pre-syncope prodrome & am now able to ward it off by putting my head between my knees. However, I am worried that I'll be constantly sleep-deprived during and after residency. Is this a realistic worry?

2)PART-TIME: Given I am a female who both hopes to have a family one day and has a deep-rooted interest in participating in international 3rd-world medicine - I am most likely looking at a medical career that involves part-time work.
Can I realistically do this in ER, and what sort of ballpark annual salary should I expect?

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[turtle md]

I am a 4th yr female medical student who enjoys many aspects of ER: team-work, population, problem-solving, multi-tasking, etc. I truly enjoy the field and am strongly considering ER as a career. HOWEVER, there are two points that make me hesitate.

1)SLEEP: I am extremely dysfunctional when I don't get enough sleep. I have passed out on multiple 24-hour-straight work days during 3rd year. The good news is that I can well recognize my pre-syncope prodrome & am now able to ward it off by putting my head between my knees. However, I am worried that I'll be constantly sleep-deprived during and after residency. Is this a realistic worry?

2)PART-TIME: Given I am a female who both hopes to have a family one day and has a deep-rooted interest in participating in international 3rd-world medicine - I am most likely looking at a medical career that involves part-time work.
Can I realistically do this in ER, and what sort of ballpark annual salary should I expect?

If you like the different aspects of EM, then I wouldn't let your concerns stop you. One nice aspect of EM is that there are no 24 hour shifts, so apart from a few off-service rotations during residency (which you will encounter in most specialties), you won't have to worry about this. There are different shifts, so the constant change from day to night may be a little difficult, but no long-hauls.. As far as part time goes, it should not be a problem. I, too, am interested in doing international work. I have met several EM attendings who work part time, and some who work only 1/2 the year in the US, and the rest in various other locals. So if this is what you feel your calling is, then go for it!

 

[roja]

You shouldn't ahve any problems. I haven't done a single 24 hour stint and I am about to start my 3rd year of residency. One of the great aspects of EM is the ability to do many things once residency is over.

International is very easy. We have several attendings who do this.

And family is easy as well. My kid is 4.5 years old.

 

[southerndoc]

The only problem you might have is during the residency itself when you do off-service rotations. When I did trauma, CCU, MICU, and medicine, I frequently was up all night long during the rotation and had to work for an additional 2-4 hours after my call ended (call was 6am-6am). Those were our only call months our first year of the rotation.

While in the ED itself, I haven't worked longer than a 12-hour shift. 24-hour shifts are unheard of in emergency medicine. 12-hour shifts are becoming rare as more programs and private EM groups are moving to 10- and 8-hour shifts.

All in all, my intern year hasn't been as rough as I had imagined.

I would suggest you go for what you like best. Even if you choose a more cush residency (radiology, dermatology), you will still need to do an internship year in general medicine. The majority of times, this will mean a year of taking call instead of the 4-6 months that are typical of most emergency medicine programs. Of course, EM programs require you to take call over multiple years. We have 3 months our first year (they dropped overnight call for medicine), 4 months second year, 1 month third year, and none our fourth year.

 

[beyond all hope]

Don't think of residency so much: think of your career after residency.

If you have real troubles with sleep deprivation, you may want to rethink EM. You will be working overnights for the rest of your life. Very few other doctors actually stay up all night after they finish residency.

Don't get lured into the idea that EM is easy because there are less hours and no call. In my experience working 40 hours a week in a busy urban ER is harder on my body and my life than 50-60 hours in medicine, peds or surgery.

EM can be a pretty cushy residency compared to medicine or surgery, but not always. I've done 6 ICU rotations in my 2 years, q3-4 for all, and rest has been mostly EM and med/surg floors. IM/Peds programs have lots of call in their floor/ICU months, but they also have cushy electives which we don't usually have.

It is a great specialty, but it's not easy.

There are many opportunities for part-time work and international medicine in EM (there is even an international fellowship). Many other specialities (rads, primary care) have a few opportunities as well.

 

[mumiitroll]

hey
1) can you tell anything about being a cruise ship dr as a career?
2) do locum-tenens ER people get paid as well as permanent physicians? and can they do like 1wk in california and the next in ny or they have to stick to their assignments? is there any way to avoid night shifts(say through a lower salary)?
3) regarding international work: can you get a license to practice in EU or Australia and work there for half the year, or it's unrealistic?
thanks

Don't think of residency so much: think of your career after residency.

If you have real troubles with sleep deprivation, you may want to rethink EM. You will be working overnights for the rest of your life. Very few other doctors actually stay up all night after they finish residency.

Don't get lured into the idea that EM is easy because there are less hours and no call. In my experience working 40 hours a week in a busy urban ER is harder on my body and my life than 50-60 hours in medicine, peds or surgery.

EM can be a pretty cushy residency compared to medicine or surgery, but not always. I've done 6 ICU rotations in my 2 years, q3-4 for all, and rest has been mostly EM and med/surg floors. IM/Peds programs have lots of call in their floor/ICU months, but they also have cushy electives which we don't usually have.

It is a great specialty, but it's not easy.

There are many opportunities for part-time work and international medicine in EM (there is even an international fellowship). Many other specialities (rads, primary care) have a few opportunities as well.

 

[southerndoc]

Regarding international work, Australia will grant you a license. However, I think they only recognize MD's for now. DO's are still trying to get through the hoops (they may have been successful by now).

 

[beyond all hope]

I just actually signed up to do 100% peds at my hospital. Conveniently, there are no peds night shifts (although the 6 pm-2am shift can be painful sometimes), and our peds shifts pay the same as the adult shifts. I moonlight at a trauma center, doing just adult trauma and critical care, also all days.

No more overnights! Spend every night in my bed! (or someone elses'...

Some places have no night shifts if they have enough night people. A friend of mine took a job in hawaii like that. My old job I only worked 2 8 hour overnights a month. That was really easy.

As for locums, if they need you badly they'll work you as much or as little as you want. I know a guy who lives half time in Spain, works a few months in NY and a few months in Texas.

The moral of the story is that if they need you bad enough they'll negotiate. EM is getting tighter because we graduate more EM docs every year, but it's still pretty wide open.

 

[DO2009]

To address your two issues:
1) Sleep - this will completely depend on what kind of group you join and where. Before medical school, I worked for a group of physicians that staffed multiple hospitals (one urban, one suburban, one rural). The schedules varied a great deal. At the rural hospital, the physicians worked 12 hr shifts with some physicians preferring nights (thus, they worked the majority). At the other 2 hospitals, they worked 8-9 hr shifts with most of them sharing the nights. However, some of the older docs paid the younger ones to work their night shifts. Also, a few of them worked only 4am shifts so they do not work nights.

2) Part-time - once again this depends on the group you join, but it is possible.

I agree with one of the PP....don't think about residency, but think about the rest of your career. Residency is 3-4 short years. They are just a stepping stones to get to where you want to go.