So what is EM really like?

[NotTheArmyDoctor]

Hi all EM attendings and residents,

I'm a final year medical student in INDIA planning on an EM residency in the US in a couple of years.

I have been reading online about all the specialities and EM has piqued my interest the most. Upon further research on forums and websites I've come across a lot of negatives about the field too and I had a few concerns.

I have never been in an actual ER because in India we don't really have ERs, just trauma centres and undergrads don't really get any exposure to it. So I'd appreciate if you keep that in mind while helping me with my queries.

Here are some of my concerns-

1- Do ER docs mostly just do triage, make loose diagnosis and decide whether to admit the patient or not, and then just call upon the specialist. Is that so?

2- Will cases of MI, DKA, Acute Asthma, etc come to me or go straight to IM? And if they come to me how much role will I get in their treatment? Will I feel like a doctor?

3- Is EM looked down upon by other specialists? Will I be yelled at and ordered around by the IM people (or other specialists)?

4- I love trauma, I think. But most of it would come under the domain of the surgeons, I'm assuming. As EM docs how much role do we play in trauma cases? Flail chest, pneumothorax, cardiac tamponade, etc do EM docs manage all this?

Thanks in advance for helping me out. Apologies if the post is a long read.

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[TheSingularity]

You are waitstaff at a restaurant. Only you have 2x the tables one should normally have.

Some customers walk out on the bill. Some pay half what they owe.

25% of the tables don't have forks. It's your job to explain why management didn't get them forks.

One customer wants a pork chop. You have to explain that pork chops are only available Monday to Friday 8am to 5pm and since they are here at 4pm on a Saturday they can't have it. This will reflect poorly on your customer satisfaction rating.

You have a wine expert, a steak expert and a pastry expert that you can ask questions to. But the wine guy isn't answering his phone even though the customer really wants wine. The steak guy is a bit salty and refuses to help you even though the customer's filet is totally messed up. Management likes him though cause steaks make a lot of money for the restaurant.

Some of the customers drink too much at dinner...or snort cocaine...and like to punch things.

Oh and the restaurant is on fire.

 

[DocEspana]

What is it really like?

It's mostly people who need to go home demanding you keep them for hours or days so they can justify their self-assessed illness. At the same time those who are peri-mortem attempt to AMA about a third of the time.

Also everyone wants dilaudid but no one can pronounce it.

 

[DocEspana]

You are waitstaff at a restaurant. Only you have 2x the tables one should normally have.

Some customers walk out on the bill. Some pay half what they owe.

25% of the tables don't have forks. It's your job to explain why management didn't get them forks.

One customer wants a pork chop. You have to explain that pork chops are only available Monday to Friday 8am to 5pm and since they are here at 4pm on a Saturday they can't have it. This will reflect poorly on your customer satisfaction rating.

You have a wine expert, a steak expert and a pastry expert that you can ask questions to. But the wine guy isn't answering his phone even though the customer really wants wine. The steak guy is a bit salty and refuses to help you even though the customer's filet is totally messed up. Management likes him though cause steaks make a lot of money for the restaurant.

Some of the customers drink too much at dinner...or snort cocaine...and like to punch things.

Oh and the restaurant is on fire.

A pastry guy seems like a cool dude. He must be on ophthalmology. He probably never comes in to bring any pastries, he just asked you to tell the customer to go to his bakery in the morning.

 

[Franzd'Epinay]

Hi all EM attendings and residents,

I'm a final year medical student in INDIA planning on an EM residency in the US in a couple of years.

I have been reading online about all the specialities and EM has piqued my interest the most. Upon further research on forums and websites I've come across a lot of negatives about the field too and I had a few concerns.

I have never been in an actual ER because in India we don't really have ERs, just trauma centres and undergrads don't really get any exposure to it. So I'd appreciate if you keep that in mind while helping me with my queries.

Here are some of my concerns-

1- Do ER docs mostly just do triage, make loose diagnosis and decide whether to admit the patient or not, and then just call upon the specialist. Is that so?

2- Will cases of MI, DKA, Acute Asthma, etc come to me or go straight to IM? And if they come to me how much role will I get in their treatment? Will I feel like a doctor?

3- Is EM looked down upon by other specialists? Will I be yelled at and ordered around by the IM people (or other specialists)?

4- I love trauma, I think. But most of it would come under the domain of the surgeons, I'm assuming. As EM docs how much role do we play in trauma cases? Flail chest, pneumothorax, cardiac tamponade, etc do EM docs manage all this?

Thanks in advance for helping me out. Apologies if the post is a long read.

1) There's a lot of triaging, a lot of diagnosing (whether it's "loose" depends on your skills), and some calling of specialists if needed.

2) They'll come to you as undifferentiated patients. Once you've stabilized them, you'll decide what to do with them. You are their doctor while they're in the ED.

3) Some look down on it because they don't understand it. Some will yell at you.

4) You should be able to stabilize and manage all those things.

 

[deleted836128]

It’s like playing whack-a-mole all day long.

 

[TooMuchResearch]

That restaurant analogy was pretty good. I still find it surprising how much terrible advice consultants will give me over the phone to try to get out of coming in to do the right thing.

But OP, we manage many things, but the nature of US medicine means there are many parties managing many parts of these things, but we often get to be the first party to the party, so to speak.

 

[NotTheArmyDoctor]

Really appreciate the responses.

I was also considering other procedure based lines.
What makes EM better than the other procedure based specialties like anesthesia, pulmonology, hepatobiliary gastro, interventional radiology, etc. for you guys?

 

[deuist]

What makes EM better than the other procedure based specialties like anesthesia, pulmonology, hepatobiliary gastro, interventional radiology, etc. for you guys?

Gastro and pulm require an IM residency first, followed by 3 years of fellowship. Both specialties require clinic days and overnight call. You're the expert, so you get lots of consults that require your specific knowledge base. If you want procedures, going either route is a terrible idea.

Anesthesia is good for lots of procedures. I'll let the doom and gloom crowd on the gas fourms tell you more about why you should or should consider the field.

IR is the "do boy" of the hospital. You'll get calls for "do a paracentesis" and "do a thorocentesis." Until recently, you had to complete a radiology residency prior to an IR fellowship. Some groups still have their IR docs split time between reading in a dark room doing procedures. The hours can pretty good, but you still take call and may have to read films at night

 

[cyanide12345678]

Really appreciate the responses.

I was also considering other procedure based lines.
What makes EM better than the other procedure based specialties like anesthesia, pulmonology, hepatobiliary gastro, interventional radiology, etc. for you guys?

A lot of the specialties you are mentioning are very hard to get into if you're a true IMG aka no green card/US citizenship and having graduated from India without having done your clinicals in the US. Most Caribbean IMGs still get their students do clinicals in parts of the US.

And i make the comments above because I've lived in the subcontinent for 19 years, have plenty of high school friends from the subcontinent that are now residents in the US. EM is just not an easy specialty to get into if you haven't done clinicals here including SLOEs.

Also, the ER here is nothing like back in the subcontinent. Over there, the ER is run by the least trained docs, often straight out of medical school who quite literally triage most things. Here, you have a lot more resources. You get all your information like labs, imaging etc and then decide to admit/discharge/transfer. And while the patient is in the ER, you essentially do things to make them better, that can mean giving fluids and antibiotics to a septic patient, fixing a lac, discharging the dental pain with ibuprofen and a dental list, intubating the respiratory arrest, running a code and calling time of death, resuscitating the GI bleeder, pulling out an old tampon from a vagina, resuscitating the sick child, or sending home the kid with the snotty nose.

70-80 percent or so of your patients, you manage on your own. You don't need anyone.

The rest you either need to admit, which means talking to the hospitalist or the intensivist. A smaller number of patients need a specialist called - that AAA that's about to rupture, that appendix or gallbladder that needs to come out, that ovarian torsion or ectopic pregnancy.

Anyway really think long and hard, there's a reason that every img from India/pakistan goes into IM usually. That's what's the easiest to get in. And even that's not easy to get in for imgs. My friends with double 260s in their usmles had like 7-8 interviews after applying to 130+ IM programs. Even getting into IM, the odds are heavily stacked against IMGs. Getting into now competitive specialties, is extremely usual for "true imgs"

 

[DocEspana]

A lot of the specialties you are mentioning are very hard to get into if you're a true IMG aka no green card/US citizenship and having graduated from India without having done your clinicals in the US. Most Caribbean IMGs still get their students do clinicals in parts of the US.

And i make the comments above because I've lived in the subcontinent for 19 years, have plenty of high school friends from the subcontinent that are now residents in the US. EM is just not an easy specialty to get into if you haven't done clinicals here including SLOEs.

Also, the ER here is nothing like back in the subcontinent. Over there, the ER is run by the least trained docs, often straight out of medical school who quite literally triage most things. Here, you have a lot more resources. You get all your information like labs, imaging etc and then decide to admit/discharge/transfer. And while the patient is in the ER, you essentially do things to make them better, that can mean giving fluids and antibiotics to a septic patient, fixing a lac, discharging the dental pain with ibuprofen and a dental list, intubating the respiratory arrest, running a code and calling time of death, resuscitating the GI bleeder, pulling out an old tampon from a vagina, resuscitating the sick child, or sending home the kid with the snotty nose.

70-80 percent or so of your patients, you manage on your own. You don't need anyone.

The rest you either need to admit, which means talking to the hospitalist or the intensivist. A smaller number of patients need a specialist called - that AAA that's about to rupture, that appendix or gallbladder that needs to come out, that ovarian torsion or ectopic pregnancy.

Anyway really think long and hard, there's a reason that every img from India/pakistan goes into IM usually. That's what's the easiest to get in. And even that's not easy to get in for imgs. My friends with double 260s in their usmles had like 7-8 interviews after applying to 130+ IM programs. Even getting into IM, the odds are heavily stacked against IMGs. Getting into now competitive specialties, is extremely usual for "true imgs"

So I am not sure how much stuff has changed in the last 4-6 years since I last looked into it - but EM is one of the least friendly fields to true img's in all of medicine. There are a few spots reserved specifically and solely for (iirc) Saudi graduates. Then there are like 12 programs in the whole US that will sponsor a visa. And I know at least one of them sponsors visa's solely for the saudi graudates and one sponsors is exclusively for canadians who may apply.

so youre dealing with roughly 10 spots that you can even apply (unless the influx of new and AOA programs suddenly changed that math. this is from an earlier ACGME only time) and those 10 spots are looking for 1-2 people max who are not americans.

 

[DocRPP]

1- Do ER docs mostly just do triage, make loose diagnosis and decide whether to admit the patient or not, and then just call upon the specialist. Is that so?

Not really. There is a lot of "treat them and street them". Most of what is happening in the ED is rote: nuts and bolts primary care. There is around 30% admission rate and for that you call in the artillery and the air force.

2- Will cases of MI, DKA, Acute Asthma, etc come to me or go straight to IM? And if they come to me how much role will I get in their treatment? Will I feel like a doctor?

These will all come to you and you will be the primary managing physician for all of them, as long as the patient and you are both in the ED. The moment you admit them or your shift is over, you are no longer their primary physician.

3- Is EM looked down upon by other specialists? Will I be yelled at and ordered around by the IM people (or other specialists)?

Some of them do. You won't believe the number of times IM physicians have told me to drop the idea of EM residency and try and pursue some "real specialty". As an EM attending, there probably won't be a lot of yelling or ordering around. But depending on your location of practice, specialists may disagree with you a lot.

4- I love trauma, I think. But most of it would come under the domain of the surgeons, I'm assuming. As EM docs how much role do we play in trauma cases? Flail chest, pneumothorax, cardiac tamponade, etc do EM docs manage all this?

I have seen both - EM physicians running trauma codes, and EM physicians just taking care of the airway and getting out of the way of the surgeons who are running the trauma. I would say this is practice dependent. However, there is going to be a fair bit of trauma in most EM residencies. What you do as an attending would be practice dependent.

The real reason why I decided to respond here is that as a fellow medical graduate from India, I am going to request you to seriously reconsider pursuing EM. It is the road less traveled for a reason - the destination is almost always disappointing. I found that out the hard way. The only way for you to even have a shot at EM would be if you nail steps (250+ in both), have at least 2 SLOEs that are really good, and not require VISA. If you require VISA, then plan to have significant research to offset that requirement so that the larger university programs that do consider IMGs for EM considers you. It is doable - 10-15 FMGs who are not from SACM every year do it. But you will have to play a very unique game, and come out winning all the above mentioned rounds. Think carefully whether or not it is worth the significant amount of time, effort and stress that are going to be needed. Sometimes, IM->CC is a very doable, easy, and satisfying route.

Just food for thought.

 

[NotTheArmyDoctor]

So I am not sure how much stuff has changed in the last 4-6 years since I last looked into it - but EM is one of the least friendly fields to true img's in all of medicine. There are a few spots reserved specifically and solely for (iirc) Saudi graduates. Then there are like 12 programs in the whole US that will sponsor a visa. And I know at least one of them sponsors visa's solely for the saudi graudates and one sponsors is exclusively for canadians who may apply.

so youre dealing with roughly 10 spots that you can even apply (unless the influx of new and AOA programs suddenly changed that math. this is from an earlier ACGME only time) and those 10 spots are looking for 1-2 people max who are not americans.

Any idea which are these 10 residency programs?

 

[NotTheArmyDoctor]

Not really. There is a lot of "treat them and street them". Most of what is happening in the ED is rote: nuts and bolts primary care. There is around 30% admission rate and for that you call in the artillery and the air force.

These will all come to you and you will be the primary managing physician for all of them, as long as the patient and you are both in the ED. The moment you admit them or your shift is over, you are no longer their primary physician.

Some of them do. You won't believe the number of times IM physicians have told me to drop the idea of EM residency and try and pursue some "real specialty". As an EM attending, there probably won't be a lot of yelling or ordering around. But depending on your location of practice, specialists may disagree with you a lot.

I have seen both - EM physicians running trauma codes, and EM physicians just taking care of the airway and getting out of the way of the surgeons who are running the trauma. I would say this is practice dependent. However, there is going to be a fair bit of trauma in most EM residencies. What you do as an attending would be practice dependent.

The real reason why I decided to respond here is that as a fellow medical graduate from India, I am going to request you to seriously reconsider pursuing EM. It is the road less traveled for a reason - the destination is almost always disappointing. I found that out the hard way. The only way for you to even have a shot at EM would be if you nail steps (250+ in both), have at least 2 SLOEs that are really good, and not require VISA. If you require VISA, then plan to have significant research to offset that requirement so that the larger university programs that do consider IMGs for EM considers you. It is doable - 10-15 FMGs who are not from SACM every year do it. But you will have to play a very unique game, and come out winning all the above mentioned rounds. Think carefully whether or not it is worth the significant amount of time, effort and stress that are going to be needed. Sometimes, IM->CC is a very doable, easy, and satisfying route.

Just food for thought.

Thanks a lot for such a detailed reply it was really helpful. I really appreciate you putting in all that effort. Thanks a ton!!

I am aware of the fact that barely 20-30 non US IMGs get selected. It's an uphill battle.This is the reason I'm trying to get as much information about EM as possible.

IM is a lot easier to get into but I really don't like IM. I hope that's not a red flag for EM though.

As back ups, or even alternatives, I was thinking about anesthesia, interventional radiology (again, not easy to get), surgery (again vvv hard to get) or other procedure based lines of IM like pulmonology, CC, or hepatobiliary (will tolerate the 3 yr IM residency somehow)

thoughts, suggestions and advise in the context that I'm a non-US IMG are most welcome and very much appreciated, but let's keep the work and lifestyle of these fields (or others that you can suggest) I'm comparison to EM the main theme of the discussion, otherwise the thread title may get a bit misleading.

 

[cyanide12345678]

So I am not sure how much stuff has changed in the last 4-6 years since I last looked into it - but EM is one of the least friendly fields to true img's in all of medicine. There are a few spots reserved specifically and solely for (iirc) Saudi graduates. Then there are like 12 programs in the whole US that will sponsor a visa. And I know at least one of them sponsors visa's solely for the saudi graudates and one sponsors is exclusively for canadians who may apply.

so youre dealing with roughly 10 spots that you can even apply (unless the influx of new and AOA programs suddenly changed that math. this is from an earlier ACGME only time) and those 10 spots are looking for 1-2 people max who are not americans.

Agreed. But i guess both of our knowledge is a few years old. But true Imgs usually only have a shot in IM, peds, psych, gen surgery (tougher), family medicine (if graduated within 2 years), possibly neurology too.

But other fields are very rare to get into.

Also, as an Indian, you will be breaking your mom's dream of becoming a cardiologist if you went into EM

I know my parents were fairly crushed when i choose to be "just an ER doctor"

 

[jurassicpark]

2- Will cases of MI, DKA, Acute Asthma, etc come to me or go straight to IM? And if they come to me how much role will I get in their treatment? Will I feel like a doctor?

3- Is EM looked down upon by other specialists? Will I be yelled at and ordered around by the IM people (or other specialists)?

As an Internist, let me tackle these two.

2- ER doctors will get first crack at EVERYTHING. Their job is to work up and stabilize the patient before disposition.

3- The only time I've "yelled" at the ER, and not really yelled just strongly worded to a few jokers is over inappropriate workup and stabilization. Relationship between ER and other specialties are all individual-dependent. Sure, some IM people avoid the ER because much like Pavlov's dogs they get slapped with consults whenever they speak to ER and are conditioned to hate them. But I love working with most of them, we share the same potty/gallows humor and they love it when an Internist is willing to get their hands dirty and help them stabilize the patient.

 

[The Knife & Gun Club]

I know my parents were fairly crushed when i choose to be "just an ER doctor"

Number of times I’ve had family members say “but he has so much potential!” When I tell them I’m doing EM.

Such is life in a family of surgeons. you win some, you realize some are stupid battles not worth fighting.

 

[deleted859535]

As an EP:

Some people still think EM isn't a "real specialty." Patients occasionally still ask me what I plan on specializing in later. Some consultants are patronizing (rare where I am). Occasionally, patients are too, for that matter. That's okay. It is what it is. I'm not here for the jerks and don't spend a second longer than necessary with the ones who are unreasonable or abusive of staff or the system. Meet the standard of care and get them out. All specialties have their own kind of headaches.

That said, we work fewer hours than most, but more intense hours than some, and on the whole, do well for it. Consultants know more than us in their chosen specialty, but we know more about many other things than they do -- a fact they frequently forget when we call. And that's all okay. That's the point of our specialty versus their specialty. All on the same team in the end, though some people forget that.

Yes, you're a doctor. As above - you get first crack at things.

EM is a bit polarizing. They always told me when I was a med student that you do surgery if you can't fathom being anything but a surgeon, ever, or be an anesthesiologist if you can't fathom being anywhere but the OR but not a surgeon. With EM, best to do it only if you truly think you'll be happiest there and most okay with its bread and butter (and shortcomings). It's not a lifestyle specialty like people say occasionally. Half-lifestyle specialty at best, and a very certain kind of lifestyle you have to be okay with having.

 

[cyanide12345678]

To reiterate the above post.

EM is not a lifestyle specially. Psych derm radiation oncology pm&r optho and anesthesia are lifestyle specialties.

My life would be so relaxing if i had to see 1 patient an hour as the psych guys do.

 

[NotTheArmyDoctor]

After reading the responses here and on the other threads and websites, I've come to realise that EM would be really great for me.
I love the fact that we get to manage actual emergencies, even if they're 1 in 20 or so, and get the feeling of saving a life, and for me that's way more gratifying than treating or even curing a disease.
I also like how I don't have to be dependent on the patient's compliance, I get to be in control, and whatever intervention I make, the results would show in a matter of minutes.
EM is also the only field outside the OR where I can see myself dealing with trauma. **Am I right??**
I think I love the procedures I will get to do in EM the most; intubations, central lines, chest tubes, some suturing, etc actually that's how I got to EM in the first place.
Also love the fact that we get to order investigations and take a shot at making the diagnosis, kinda the best of both worlds.
The shift lifestyle, with all its challenges, I think would suit me very well, I love having my day/week organised, but I guess I can't know for sure.

So thanks a lot to everyone who replied to this thread. It has helped me change my perspective just when I was getting a little sceptical.


But alas, just as I got surer and surer I wanted to pursue EM, I find out that I can't possible get into a residency program.

so youre dealing with roughly 10 spots that you can even apply (unless the influx of new and AOA programs suddenly changed that math. this is from an earlier ACGME only time) and those 10 spots are looking for 1-2 people max who are not americans.

What's mentioned above is absolutely true.

No matter how well I score on the steps. No matter how good or how many SLOEs I get. No matter how well I do on other electives, or volunteering, or research, or networking, or whatever you can think of, I've come to the conclusion that I can't do it.



Considering what I like in EM, which other specialty would you guys suggest for someone like me?

Also, I was looking into EM residencies in other countries. Does anyone have any idea about that? How's does FRCEM degree from the UK stand amongst ER Docs in the US. Is it any good? Should I consider it?
(Doing EM from India is a big no for me. So don't even think about suggesting that.)

 

[starbuck2]

As an EP:

Some people still think EM isn't a "real specialty." Patients occasionally still ask me what I plan on specializing in later. Some consultants are patronizing (rare where I am). Occasionally, patients are too, for that matter. That's okay. It is what it is. I'm not here for the jerks and don't spend a second longer than necessary with the ones who are unreasonable or abusive of staff or the system. Meet the standard of care and get them out. All specialties have their own kind of headaches.

That said, we work fewer hours than most, but more intense hours than some, and on the whole, do well for it. Consultants know more than us in their chosen specialty, but we know more about many other things than they do -- a fact they frequently forget when we call. And that's all okay. That's the point of our specialty versus their specialty. All on the same team in the end, though some people forget that.

Yes, you're a doctor. As above - you get first crack at things.

EM is a bit polarizing. They always told me when I was a med student that you do surgery if you can't fathom being anything but a surgeon, ever, or be an anesthesiologist if you can't fathom being anywhere but the OR but not a surgeon. With EM, best to do it only if you truly think you'll be happiest there and most okay with its bread and butter (and shortcomings). It's not a lifestyle specialty like people say occasionally. Half-lifestyle specialty at best, and a very certain kind of lifestyle you have to be okay with having.

Admitted student here.

I will be going to a private school and will have a mountain of debt. Should I be concerned about the future of EM in terms of earning potenial? There is a lot of doom and gloom in SDN regarding healthcare reform, market saturation, etc.

 

[Rekt]

Admitted student here.

I will be going to a private school and will have a mountain of debt. Should I be concerned about the future of EM in terms of earning potenial? There is a lot of doom and gloom in SDN regarding healthcare reform, market saturation, etc.

All of medicine in general is in a constant state of threat by people who have no idea how healthcare works. I don't think it'll be next term, but some form of Medicare for all is going to pass eventually and will gut medicine to the core. Most of these people pushing M4A also have stipulations of some sort to increase mid-level autonomy and scope, because again they're clueless about medicine.

As for EM itself, I personally recommend most people look elsewhere. There's too many residencies opening. Just within the past 1-5 years there's been a significant increase so we haven't felt the full effects yet. It'll be bad. The safest thing to do is surgical subspecialties and IR.

 

[deleted859535]

Admitted student here.

I will be going to a private school and will have a mountain of debt. Should I be concerned about the future of EM in terms of earning potenial? There is a lot of doom and gloom in SDN regarding healthcare reform, market saturation, etc.

Always will be. SDN errs towards being a bit critical and pessimistic. Probably will change. How much, nobody knows. I'd say that the bigger thing is choosing a specialty you can do for a career. Everything else will follow. If that's EM, great. I don't think we're going to be out to the boondocks.

 

[TheSingularity]

Admitted student here.

I will be going to a private school and will have a mountain of debt. Should I be concerned about the future of EM in terms of earning potenial? There is a lot of doom and gloom in SDN regarding healthcare reform, market saturation, etc.

All of medicine in general is in a constant state of threat by people who have no idea how healthcare works. I don't think it'll be next term, but some form of Medicare for all is going to pass eventually and will gut medicine to the core. Most of these people pushing M4A also have stipulations of some sort to increase mid-level autonomy and scope, because again they're clueless about medicine.

As for EM itself, I personally recommend most people look elsewhere. There's too many residencies opening. Just within the past 1-5 years there's been a significant increase so we haven't felt the full effects yet. It'll be bad. The safest thing to do is surgical subspecialties and IR.

Nah the play here if you haven't matriculated yet is to NOT matriculate. Especiallyyyyy if you are going to go to a private school where you will graduate residency with 300K+ debt. It's not really an EM problem as much as a medicine problem. The debt, the sacrifice, the abuse...just not worth it.

 

[Zebra Hunter]

To reiterate the above post.

EM is not a lifestyle specially. Psych derm radiation oncology pm&r optho and anesthesia are lifestyle specialties.

My life would be so relaxing if i had to see 1 patient an hour as the psych guys do.

I'm not sure I am completely on board with the "not a lifestyle specialty" mantra that is so frequently stated here. Our hours are definitely stressful and odd; however, we are essentially the ideal specialty for FIRE followers (financially independent, retire early), given that we can work as much or as little as we want without significant issue. Even when we decide to retire, we can still work 20-40 hours a month, here and there, as needed. We are able to sculpt our schedule to make most important events and usually have enough colleagues that we can find people to pick up our shifts if needed last minute. We get paid the most per hour of nearly all specialties (as long as you are being paid fairly). We take no call. We don't have a clinic to worry about.

Sure the work is stressful, the patient population for the most part sucks, and we still have to frequently work nights, weekends, and holidays, but there really is a lot about EM that makes it an ideal lifestyle specialty for some.

 

[KeikoTanaka]

How does the lifestyle of EM compare to Hospitalist, another hospital-based, shift-working job? Is it also nice that you can work 1 week a month? I never hear about Hospitalists worried about the "night shift" dilemma like EM does. Is there a reason for that?

 

[cyanide12345678]

How does the lifestyle of EM compare to Hospitalist, another hospital-based, shift-working job? Is it also nice that you can work 1 week a month? I never hear about Hospitalists worried about the "night shift" dilemma like EM does. Is there a reason for that?

I would personally never be a hospitalist over EM.

Would only consider anesthesia, derm, optho, radiation oncology, psych if lifestyle is primary concern

 

[TheSingularity]

The entire house of medicine is burning to the ground. If you think it's any better in derm, rad onc, ophtho, anesthesia you are sorely mistaken. Go take a look at their message boards. We are all under attack. My best advice to any medical student would be to cut and run now before you start a residency. College students consider yourself lucky to not have dipped your foot into this toxic pit as of yet. Residents I feel bad for because their decision is a lot more complicated.

Sent from my Pixel 3 using SDN mobile

 

[RustedFox]

The entire house of medicine is burning to the ground. If you think it's any better in derm, rad onc, ophtho, anesthesia you are sorely mistaken. Go take a look at their message boards. We are all under attack. My best advice to any medical student would be to cut and run now before you start a residency. College students consider yourself lucky to not have dipped your foot into this toxic pit as of yet. Residents I feel bad for because their decision is a lot more complicated.

Sent from my Pixel 3 using SDN mobile

If I were an undergrad, and I knew what I know now... I'd get OUT of this game.

It seriously, literally... CAN'T get better. Even my wife (a muggle), was sharp enough today to point out during discussion that "the gimme gimme freebee crowd is only going to grow in number and in force, no matter what happens."

 

[cyanide12345678]

If I were an undergrad, and I knew what I know now... I'd get OUT of this game.

It seriously, literally... CAN'T get better. Even my wife (a muggle), was sharp enough today to point out during discussion that "the gimme gimme freebee crowd is only going to grow in number and in force, no matter what happens."

And the freebie crowd is the first one to look for any compensation in the event of a bad outcome.