Specialties like EM?

[Maybedoc1]

What are some other specialties that are similar to EM? I'm going to be applying to med school soon and you could argue that EM is a huge reason why. I know it's early and I have lots of time to decide, but I like thinking about these things.

I read this forum pretty religiously and I see all the downsides that you guys talk about regarding EM. Everything from difficult patients, to administrators to mid-level encroachment, etc. I don't think these things are enough to turn me off from the field, but just in case the field burns a fiery death in the next couple years I'd like to know what other specialties have similarities to EM.

Who knows what will peak my interest in school, but as it stands right now EM is by far my number one interest. It just seems to fit me. I don't think I'd enjoy being a specialist seeing the same 4 things over and over again (I get bored easily). I don't like the idea of working long hours as Id rather work really hard and then chill. I love the idea of treating people who need to see a doctor right now for life threatening issues (although I know there's a lot of primary care stuff.) I even think I'd enjoy the sporadic schedule. So far at age 24 I've detested the M-F 9-5 schedule.

So which other specialties offer: wide variety of medicine, the comfort and knowledge to treat whatever walks through the door, emergency situations, being a jack of all trades, life saving procedures, undifferentiated sick patients, ample time off, and I guess good pay (less important for me)?

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[Tipsy McStagger]

It sounds like you want all the good things from EM without any of the drawbacks? If you find one let me know!

But seriously focus on getting into med school, then 3rd year you'll really find what floats your boat. Don't forget that you won't be 24 forever, and what seems fun now downright sucks later in life. (I'm looking at you sporadic sleep schedule).

 

[EMApplicant2016]

So which other specialties offer: wide variety of medicine, the comfort and knowledge to treat whatever walks through the door, emergency situations, being a jack of all trades, life saving procedures, undifferentiated sick patients, ample time off, and I guess good pay (less important for me)?

Surgery probably comes closest, if you're willing to sacrifice "ample time off".

 

[Birdstrike]

What are some other specialties that are similar to EM?

There is none. There absolutely is no specialty like EM. EM, hands down, is the hardest specialty in Medicine. By far. Don't doubt me on this.

 

[Brigade4Radiant]

There is none. There absolutely is no specialty like EM. EM, hands down, is the hardest specialty in Medicine. By far. Don't doubt me on this.

I would say general surgery.

 

[Siggy]

There is none. There absolutely is no specialty like EM. EM, hands down, is the hardest specialty in Medicine. By far. Don't doubt me on this.

How do you hide a $100 bill from a neurosurgeon?

Tape it to their kid.

 

[enalli]

There is none. There absolutely is no specialty like EM. EM, hands down, is the hardest specialty in Medicine. By far. Don't doubt me on this.

I think most people would agree surgeons have it worst. OBs rarely get brought up in these discussions, but I think a case could be made that they also have it worse.

 

[Hercules]

I think as with anything you have to define the terms of the discussion. Does hardest mean worst hours, worst work environment, worst training path, worst schedule for a parent with a spouse, worst schedule for a single person, etc? Different specialties can ring the bell for several of those examples so hardest has to be defined first.


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[Apollyon]

How do you hide a $100 bill from a neurosurgeon?

Tape it to their kid.

I heard it as "staple it to his kid's forehead".

 

[Hamhock]

Critical care medicine (MICU) is pretty similar in a lot of ways and has a lot fewer of the headaches (although CMGs may be coming someday soon).

HH

 

[GonnaBeADoc2222]

Honestly, I would advise you not to apply and run as far away from medicine as you can.

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[Brigade4Radiant]

Critical care medicine (MICU) is pretty similar in a lot of ways and has a lot fewer of the headaches (although CMGs may be coming someday soon).

HH

Yeah but you don't have the flexibility like ER has.

 

[Hamhock]

Yeah but you don't have the flexibility like ER has.

True, CCM doesn't usually have as much flexibility as EM.
CCM is not the same as EM. Rather, I was pointing out that CCM has many similarities to EM (as requested by the OP).
That said, the flexibility is pretty similar. Sometimes the blocks of CCM are longer, but when those blocks are worked is pretty flexible. And the opportunities to work days (avoid transitioning) are much more prevalent.
And, nowadays, the pay outside of academic centers is pretty similar...slightly more hours for very similar pay -- but many of those hours are spent joking with colleagues, eating meals in the lounge, reading the newspaper, etc.
HH

 

[TheComebacKid]

EM is a hard specialty but if you work it right you can have some semblance of a life.
Surgery is a hard specialty but no matter how you work it, your life will suck.

As someone married to a surgeon, can confirm she has it way "harder" than we do.

 

[Shufflin]

What are some other specialties that are similar to EM? I'm going to be applying to med school soon and you could argue that EM is a huge reason why. I know it's early and I have lots of time to decide, but I like thinking about these things.

I read this forum pretty religiously and I see all the downsides that you guys talk about regarding EM. Everything from difficult patients, to administrators to mid-level encroachment, etc. I don't think these things are enough to turn me off from the field, but just in case the field burns a fiery death in the next couple years I'd like to know what other specialties have similarities to EM.

Who knows what will peak my interest in school, but as it stands right now EM is by far my number one interest. It just seems to fit me. I don't think I'd enjoy being a specialist seeing the same 4 things over and over again (I get bored easily). I don't like the idea of working long hours as Id rather work really hard and then chill. I love the idea of treating people who need to see a doctor right now for life threatening issues (although I know there's a lot of primary care stuff.) I even think I'd enjoy the sporadic schedule. So far at age 24 I've detested the M-F 9-5 schedule.

So which other specialties offer: wide variety of medicine, the comfort and knowledge to treat whatever walks through the door, emergency situations, being a jack of all trades, life saving procedures, undifferentiated sick patients, ample time off, and I guess good pay (less important for me)?

A steamroller will squash you called medical school. The squashing process will push you in a direction you never anticipated. Get ready.

 

[RustedFox]

A steamroller will squash you called medical school. The squashing process will push you in a direction you never anticipated. Get ready.

So much this.
I went from FM to IM to Anesthesia to EM so fast.

But, really -
To the OP: Good on yah for trying to squirrel out as many details as you can so early in the game. Its not a behavior to be discouraged, even if its one that is easily mocked by the ones like myself and so many others on here that went thru it.

The logic that I went thru as a young medical student is so laughable as well.

I started out wanting to do FM because it was noble and I had a great FM mentor and I wanted to walk with my patients from cradle to grave.
Then, FM became "silly" and IM became flashy, with all of its sophistication and subspecialties and the amazing knowledge base that could be enjoyed.
Then, IM became "pointless" because "internal medicine is eternal medicine" and nothing happened for days and days and it was just academic wanking-off, and Anesthesia became "cool" because it was "tubes and lines and numbers and monitors and lots of dials". (Also, the IM folk I could never get along with for all of their wonkiness and general passivity.)
Then, Anesthesia became toxic because of the proximity to general surgeons, and EM became "cool" because I could do something, now - and generally see an impact.
Now, EM is lame because although you're the doctor, you have eight bosses [I have eight bosses, Bob.] and I want to get the hell out of the ER and go be a lumberjack.
Then, I wanted to be a lumberjack, and I realized that I am in no way a tough-man, and would probably get killed by a falling tree or something.
That last line just happened in like, 8 minutes or so.

In reality, I will always do EM. It "chose me". I often talk up a big game on here about leaving and rage-quitting and all that.
A lot of it is very true.
The number-one source of burnout for me is the patient. I say that on here so many times. Its so true. I hate modern dumb@ssery and whininess so much.

But you know what; I'll never leave this gig unless it becomes so toxic that I can't wake up to go to work anymore.

We just hired a guy at my shop. He's like 68 years old. No exaggeration. The guy is a local legend from other shops in the area. We've all heard about "Dr. GillyWater"
I heard the rumors about how this guy diagnosed his own NSTEMI on-shift, then finished his shift and then admitted himself to the hospitalist with a cardiology consult. Ordered his own Lovenox.

I asked him about it. Straight-up.

"Oh yeah. I had chest pain, but it quit after awhile. I ordered my own EKG and trops. Once I saw the Q-waves, I figured I was done with my infarct. I wasn't suprised when my TnI came back at like, 2 or 3 or whatever it was."

"Bull****, old man." I said. No joke, this was actually what I said. I risked offending him, but I didn't care at the time. 90% chance this guy took it in good stride, given what I could gather. It was a risk I was willing to take.

He pulled down his scrubs with one big meaty fist on each lapel to show me his CABG scar and said: "Say that again, kid." Then, he phucking cackled at me.

No other place in medicine is this looney tunes. If that's your game, then come play.

 

[Siggy]

Then, I wanted to be a lumberjack, and I realized that I am in no way a tough-man, and would probably get killed by a falling tree or something.
That last line just happened in like, 8 minutes or so.

Don't worry, as long as you work all day, sleep all night, and wear high heels you'll make a fine lumberjack.

 

[solitarius]

Honestly, I would advise you not to apply and run as far away from medicine as you can.

I think it's very unfortunate that despite all the clinical experience that one tries to acquire in medical school, it is impossible to see the underbelly of clinical medicine until third year.

It's super easy to for young premeds to get seduced by the ED. I was in your shoes when I got into medical school. Like some other dude said, you'll probably end up picking something totally different.

I realized that EM is awful because:

• You are dealing with the worst patients on the daily.
• You will not reap any benefits from developing any rapport with them because they're not your patient, but you will catch hell if they don't like you.
• You will make split second decisions that will be picked apart by vulture colleagues a la Monday Morning Quarterbacking.
• You will be working for Corporate ER and their bull**** corporate metrics. You will feel like a cog.
• You will be sued because you didn't catch something despite the fact that you ran the chest pain workup.
• You won't be thinking critically because you'll just be applying algorithms anyway.
• You think you're saving lives but that's maybe the 2 Level 3 traumas that came on your shift because some old lady fell down; otherwise, it's just primary care on steroids.
• The consultants and specialists just need to be up to date on their turf. You have to keep up with everything else. Not worth it.

I was doing EM up until a week ago. Not looking back.

 

[TheComebacKid]

I think it's very unfortunate that despite all the clinical experience that one tries to acquire in medical school, it is impossible to see the underbelly of clinical medicine until third year.

It's super easy to for young premeds to get seduced by the ED. I was in your shoes when I got into medical school. Like some other dude said, you'll probably end up picking something totally different.

I realized that EM is awful because:

• You are dealing with the worst patients on the daily.
• You will not reap any benefits from developing any rapport with them because they're not your patient, but you will catch hell if they don't like you.
• You will make split second decisions that will be picked apart by vulture colleagues a la Monday Morning Quarterbacking.
• You will be working for Corporate ER and their bull**** corporate metrics. You will feel like a cog.
• You will be sued because you didn't catch something despite the fact that you ran the chest pain workup.
• You won't be thinking critically because you'll just be applying algorithms anyway.
• You think you're saving lives but that's maybe the 2 Level 3 traumas that came on your shift because some old lady fell down; otherwise, it's just primary care on steroids.
• The consultants and specialists just need to be up to date on their turf. You have to keep up with everything else. Not worth it.

I was doing EM up until a week ago. Not looking back.

Sorry, but you have very little understanding of the specialty, and I get the sense that you are really doing nothing but trolling. I have not been one to shy away from criticizing EM for its weaknesses. I'm happy to respond to each of your points individually even though you are nothing more than an utter troll and I probably shouldn't engage in this. But I'll bite.

• "You are dealing with the worst patients on the daily." My idea of the worst patients daily are probably different than most. If someone comes into the ED with what I perceive as functional abdominal pain, fibromyalgia etc, after I complete my workup and rule out life threats, they get discharged. They aren't happy that they didn't get opiates? That's ok. They still get discharged, either by themselves or by security. I can't imagine having to see that patient every single week in a GI clinic. Don't get me wrong, ED patients can be horrible human beings, they can be taxing to take care of, but I'm only taking care of them for part of my day.
• "You will not reap any benefits from developing any rapport with them because they're not your patient, but you will catch hell if they don't like you." I build rapport with patients in extremis, who I just met, within 1-2 minutes of talking to them. This is a different skill set than what an IM doc needs to build rapport. I find that I reap lots of benefits from my short interactions with them and gaining their confidence.
• "You will make split second decisions that will be picked apart by vulture colleagues a la Monday Morning Quarterbacking." Yeah, it's part of the job. This use to bother me quite a bit. I now realize the skills we provide are not found anywhere else in the hospital. EM training is unique and we are trained to make decisions with limited information. Often times we do the right thing, sometimes we don't. It's part of the job, but it's what makes it more challenging. I personally love to Monday morning quarterback all the other doctors (including surgeons) who manage their patients, discharge them from the hospital and then send them back to the ED in a few days because of some complication. Monday morning quarterbacking is pervasive throughout medicine. Have you heard how an IM doctor talks about a patients outpatient FP? If you don't have the cajones to make tough decisions and deal with the consequences, then you can't hang in our specialty.
• "You will be working for Corporate ER and their bull**** corporate metrics. You will feel like a cog." EM is definitely subjected to this, and I am adamant that this is a high cause of burnout in the specialty. But A) there are other options i.e. don't work for a CMG and B)have you not been in a hospital recently? Metrics/documentation etc is par for the course for ALL specialties. Do you know how many hospitalist groups are being bought up by TeamHealth?
• "You will be sued because you didn't catch something despite the fact that you ran the chest pain workup." Par for the course. EM is a high risk specialty, but there are others that are high risk as well.
• "You won't be thinking critically because you'll just be applying algorithms anyway." This one really irks me and shows that you really have zero concept of what the hell you are talking about. As a medical student (if that's truly what you are), you really lack any idea of the practice of medicine (or EM) for that matter. The patients that come to the ED are all undifferentiated. I make the diagnosis in 80-90% of patients before they are even admitted to the hospital. If I miss something and I send the patient, they may die or have a horrible outcome. The amount of "thinking" I do on a shift cannot be overstated. You can continue to use the common talking points that people use to criticize EM about it's algorithmic nature, or you can trust people who work it everyday. This is a challenging job and it requires very smart people to work in it.
• "You think you're saving lives but that's maybe the 2 Level 3 traumas that came on your shift because some old lady fell down; otherwise, it's just primary care on steroids." Again, very stupid comment on your part. I'm not saying that the old lady that fell is the most challenging resuscitation in the world, but we take care of lots of sick patients daily, not just old ones who fell. And the old lady's who fell are often times hiding badness that someone without experience such as yourself could not really comprehend. We save lives daily. I won't list to you all the times that I have saved a life and that I have been thanked by a patient and their families.
• "The consultants and specialists just need to be up to date on their turf. You have to keep up with everything else. Not worth it." I think it makes us better doctors for it. I can't manage an eye injury like an ophthalmologist can, but I can take care of a lot of the basic problems for every specialty. I find keeping up to date on things keeps me sharp and makes the job challenging.

Don't get me wrong, we have lots of downsides to our specialty, as do other specialties, but your complete lack of information on the specialty and idiotic trolling just needed to be called out.

On a personal note, I'm glad that you won't be joining our ranks and that I won't have to call you my colleague in the future. Good luck to you in your future endeavors.

 

[Zebra Hunter]

I think it's very unfortunate that despite all the clinical experience that one tries to acquire in medical school, it is impossible to see the underbelly of clinical medicine until third year.

It's super easy to for young premeds to get seduced by the ED. I was in your shoes when I got into medical school. Like some other dude said, you'll probably end up picking something totally different.

I realized that EM is awful because:

• You are dealing with the worst patients on the daily.
• You will not reap any benefits from developing any rapport with them because they're not your patient, but you will catch hell if they don't like you.
• You will make split second decisions that will be picked apart by vulture colleagues a la Monday Morning Quarterbacking.
• You will be working for Corporate ER and their bull**** corporate metrics. You will feel like a cog.
• You will be sued because you didn't catch something despite the fact that you ran the chest pain workup.
• You won't be thinking critically because you'll just be applying algorithms anyway.
• You think you're saving lives but that's maybe the 2 Level 3 traumas that came on your shift because some old lady fell down; otherwise, it's just primary care on steroids.
• The consultants and specialists just need to be up to date on their turf. You have to keep up with everything else. Not worth it.

I was doing EM up until a week ago. Not looking back.

There are certainly drawbacks to EM, but for myself, it is the best specialty in medicine. You claim that having to keep up to date on all specialties as a drawback, I see it as a plus. The amount of knowledge of medicine I’ve amassed sometimes astounds me. When **** hits the fan, we are the doctor you want, which is kind of awesome.

The “level 3” trauma patients are not the ones we are saving with relative frequency, it’s the sick medical patients. Hell, last night I did a successful pericardiocentesis for a patient with tamponade who was crashing. She is currently alive and well. Last week I resuscitated a GI bleed with a Hgb of 2, lactate of 25, and a pH of 6.6 and he walked out of the hospital yesterday. The week before that I convinced a family to make their loved one comfort care only allowing for a peaceful death in the ER rather than slamming tubes in and doing chest compressions. Even gave them enough time to call the immediate family members to come by to give one last goodbye. We get to acutely save lives more than most other specialties.

I think critically every day on most every patient. Even the BS. Every misinformed med student and doc thinks the ER is all about algorithms, but it is expceptionally rare that I am ever consulting an algorithm to determine appropriate treatment or disposition. Things like uncomplicated UTIs, I’m looking at previous culture data, the hospitals antibiogram, the pts age and comorbidities and looking for potential drug-drug interactions. Even patients I decide to do no lab work on and provide no prescriptions frequently requires critical thinking.

As for Monday morning quarterbacking, I almost never see that at my current job. I also don’t work for a CMG and love my group.

The specific ER drawbacks for me are the irregular scheduling with frequent Day-Night switches. Anything else I could complain about is not really limited to the ER. Things like patient population, meeting metrics, patient complaints, unrealistic expectations, etc.

 

[Mad Jack]

A steamroller will squash you called medical school. The squashing process will push you in a direction you never anticipated. Get ready.

I went from critical care, hospitalist, anesthesia, or EM to psych or bust

 

[Lexdiamondz]

I think it's very unfortunate that despite all the clinical experience that one tries to acquire in medical school, it is impossible to see the underbelly of clinical medicine until third year.

It's super easy to for young premeds to get seduced by the ED. I was in your shoes when I got into medical school. Like some other dude said, you'll probably end up picking something totally different.

I realized that EM is awful because:

• You are dealing with the worst patients on the daily.
• You will not reap any benefits from developing any rapport with them because they're not your patient, but you will catch hell if they don't like you.
• You will make split second decisions that will be picked apart by vulture colleagues a la Monday Morning Quarterbacking.
• You will be working for Corporate ER and their bull**** corporate metrics. You will feel like a cog.
• You will be sued because you didn't catch something despite the fact that you ran the chest pain workup.
• You won't be thinking critically because you'll just be applying algorithms anyway.
• You think you're saving lives but that's maybe the 2 Level 3 traumas that came on your shift because some old lady fell down; otherwise, it's just primary care on steroids.
• The consultants and specialists just need to be up to date on their turf. You have to keep up with everything else. Not worth it.

I was doing EM up until a week ago. Not looking back.

You have a pretty poor understanding of emergency medicine.

 

[GonnaBeADoc2222]

I think it's very unfortunate that despite all the clinical experience that one tries to acquire in medical school, it is impossible to see the underbelly of clinical medicine until third year.

It's super easy to for young premeds to get seduced by the ED. I was in your shoes when I got into medical school. Like some other dude said, you'll probably end up picking something totally different.

I realized that EM is awful because:

• You are dealing with the worst patients on the daily.
• You will not reap any benefits from developing any rapport with them because they're not your patient, but you will catch hell if they don't like you.
• You will make split second decisions that will be picked apart by vulture colleagues a la Monday Morning Quarterbacking.
• You will be working for Corporate ER and their bull**** corporate metrics. You will feel like a cog.
• You will be sued because you didn't catch something despite the fact that you ran the chest pain workup.
• You won't be thinking critically because you'll just be applying algorithms anyway.
• You think you're saving lives but that's maybe the 2 Level 3 traumas that came on your shift because some old lady fell down; otherwise, it's just primary care on steroids.
• The consultants and specialists just need to be up to date on their turf. You have to keep up with everything else. Not worth it.

I was doing EM up until a week ago. Not looking back.

Yeah. I think you missed the point of my post. Medicine, with its ever changing environment and increasing pressures may not be a great choice of career for someone just entering college now. However, once making the commitment to medicine I don't think I could do any other specialty.

Your post does betray many misunderstandings about EM, as others have said. Yes, we are subject to corporate and hospital oversight and metrics, but what hospital based specialty isn't?

Contrary to popular opinion, EM is a medium (not high) medmal risk specialty, if you look at the data.

I think critically on every shift. If you aren't thinking critically in EM, you're doing it wrong. If I wanted to "just apply algorithms" I would be an NP.

Why wouldn't you want a wide breadth of knowledge?

I work just 10 to 12 days a month and make a boatload of cash.

It's pretty sweet.

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[Old_Mil]

I am going to second critical care medicine. If you are looking at a hospital based specialty, this is about as good as it gets. The entire facility is dedicated to making sure that most of what makes medicine bad actually doesn't make it to the door of your unit.

 

[Old_Mil]

I think it's very unfortunate that despite all the clinical experience that one tries to acquire in medical school, it is impossible to see the underbelly of clinical medicine until third year.

It's super easy to for young premeds to get seduced by the ED. I was in your shoes when I got into medical school. Like some other dude said, you'll probably end up picking something totally different.

I realized that EM is awful because:

• You are dealing with the worst patients on the daily.
• You will not reap any benefits from developing any rapport with them because they're not your patient, but you will catch hell if they don't like you.
• You will make split second decisions that will be picked apart by vulture colleagues a la Monday Morning Quarterbacking.
• You will be working for Corporate ER and their bull**** corporate metrics. You will feel like a cog.
• You will be sued because you didn't catch something despite the fact that you ran the chest pain workup.
• You won't be thinking critically because you'll just be applying algorithms anyway.
• You think you're saving lives but that's maybe the 2 Level 3 traumas that came on your shift because some old lady fell down; otherwise, it's just primary care on steroids.
• The consultants and specialists just need to be up to date on their turf. You have to keep up with everything else. Not worth it.

I was doing EM up until a week ago. Not looking back.

You've done a decent job of summarizing the negatives surrounding EM. One thing I would say is it isn't that EM physicians aren't capable of thinking critically, its just that we are often put in positions we can't.

Two jobs ago I worked at a shop that got increasingly busy following Medicaid exoansion; a typical day shift involved picking up 4-5 charts an hour for the first half of the shift. It is bad enough to do that in a urgent care or FM clinic where acuity is expected to be next to nothing. It's an almost impossible in an EM setting. You have to rely on algos, decision rules, etc just to keep your head above water.

 

[TheComebacKid]

You've done a decent job of summarizing the negatives surrounding EM. One thing I would say is it isn't that EM physicians aren't capable of thinking critically, its just that we are often put in positions we can't.

Two jobs ago I worked at a shop that got increasingly busy following Medicaid exoansion; a typical day shift involved picking up 4-5 charts an hour for the first half of the shift. It is bad enough to do that in a urgent care or FM clinic where acuity is expected to be next to nothing. It's an almost impossible in an EM setting. You have to rely on algos, decision rules, etc just to keep your head above water.

I can't say I really agree with this.

Even in the moments when you are fighting to keep your head above water, you are still thinking critically on some level. You may not have the luxury of thinking AS critically as say, an intensivist. But you are still processing large quantities of information, assessing what is important from what isn't, making small micro calculations (without even realizing it) and task triaging.

I had to tell an NP last week who tried to sign out to me a patient with metastatic pancreatic cancer who was tachycardic and having chest pain that her ordering a d-dimer was arguable the stupidest thing she could do. She was not thinking critically, as the many midlevels do not have the training to do so. While it's easy to depend on an algorithm and say "cancer + chest pain + tachycardia" = PE workup, the patient ended being septic and having pneumonia.

While I don't think that was a terribly difficult diagnosis to make and I would argue that 99.9% of EM trained physicians will make that diagnosis without difficulty, it clearly requires "thinking outside of the box" and not depending on algorithms.

I have applied the HEART pathway to a handful of patients and by that criteria could have sent them home. But based on my clinical suspicion, something seemed off and I chose to admit for inpatient workup, only to find out the next day they are in the cath lab receiving intervention.

It takes a lot of critical thinking to realize that your "seizure" patient is in fact a TCA overdose. No amount of algorithmic thinking will help you with that if you don't have the training or the ability to think critically.

I think it's a huge misnomer that EM physicians don't think critically because we don't round for 4 hours on a single patient philosophizing about x, y and z ad nauseum. This seems to be something that other specialties use to disparage EM physicians, which quite frankly, is BS.

 

[Atlas Shrugged]

Part of me is sad I didn't go into EM for the reasons talked about in this thread, but there's no way I could handle the circadian rhythm disruption.

I don't think it would be a good fit for OP given he hates 9-5, but I will argue family medicine has many similarities to emergency medicine save for acuity at presentation. You are responsible for all of the patient's problems and should only be consulting people for things that you cannot do (ie surgery, ERCP, cath, etc).

If you (other medical students reading this thread) are interested in an undifferentiated patient with a cradle to grave patient population, and can be okay with less acuity and less immediate response with interventions, family medicine is a good specialty. Although there is that as well with crashing floor patients, or someone who shows up to clinic with melena and a hemoglobin of 4 who needs to be directly admitted; you just (ideally) won't be handling multiple crises at the same time as our emergency medicine counterparts are so comfortable with.

I'm in the army, so civilian family medicine likely has differences that I am unable to comment on.

 

[Vandalia]

I think it's very unfortunate that despite all the clinical experience that one tries to acquire in medical school, it is impossible to see the underbelly of clinical medicine until third year.

It's super easy to for young premeds to get seduced by the ED. I was in your shoes when I got into medical school. Like some other dude said, you'll probably end up picking something totally different.

I realized that EM is awful because:

• You are dealing with the worst patients on the daily.
• You will not reap any benefits from developing any rapport with them because they're not your patient, but you will catch hell if they don't like you.
• You will make split second decisions that will be picked apart by vulture colleagues a la Monday Morning Quarterbacking.
• You will be working for Corporate ER and their bull**** corporate metrics. You will feel like a cog.
• You will be sued because you didn't catch something despite the fact that you ran the chest pain workup.
• You won't be thinking critically because you'll just be applying algorithms anyway.
• You think you're saving lives but that's maybe the 2 Level 3 traumas that came on your shift because some old lady fell down; otherwise, it's just primary care on steroids.
• The consultants and specialists just need to be up to date on their turf. You have to keep up with everything else. Not worth it.

I was doing EM up until a week ago. Not looking back.

Let me add a few things to @TheComebacKid 's excellent response:

1) I am not sure specifically what you mean by the "worst patients on the daily", but there is an element of self-selection here. I would much rather have the worst ED shift of the year every day than spend an "easy" day practicing dermatology, or psychiatry, or nephrology.

2) The bottom line is patients don't care about rapport. If someone comes in with significant dental pain and leaves with a block, they will be happy even if I forget their name and spend 2 seconds talking with them. On the other hand, I can be the most charming man in the world and if they don't get the opioids they want they will hate me. This is pretty much a results-oriented specialty.

3) Sure, they might second guess me. But guess where all their "mistakes" and complications end up? Right here in the ED. If they get a little too nitpicky about my management, I just have to remind them of the patient they saw in the office with "normal post-operative pain" who comes in at 2 am that night needing a return to the OR. They will never win that game - at least with me.

4) Yes, that might be true, but welcome to the 21st century. If you are a hippy artist, or maybe a plastic surgeon, you are immune from that but you will have to deal with this whatever else you chose. My dentist bought out the practice of her partner who retired. One day I was in the chair listening to her deal with an insurance company rep on the phone: Insurance: "We need an x-ray showing the #2 molar." Dentist:"That tooth was extracted 5 years ago." "We need an x-ray showing the work you did last week including that tooth." "It was extracted 5 years ago." "We need an x-ray..." "That is physically impossible!" "If you want paid we need an x-ray" "The one that doesn't exist?!?!" "We need an x-ray..."

5) So you are sued. A bunch of lawyers fight over something that doesn't directly effect you. It is only a big deal if you let it be a big deal.

6) Sure there are some algorithms that are relevant, but idiots who are brought to the ED will come up with something that no algorithm maker could ever imagine. The 18th Rule of the ED: Idiot's creativity far exceeds a physician's imagination. In fact there is a huge thread about that on this forum.

7) Yeah, but that "primary care on steroids" patient could be dead in 90 minutes, and you have no idea which one it will be when you enter the room.

8) Yes and no. I need to know a bit of emergency ophthalmology, and emergent complications of breast surgery, and a fair amount of psychiatry, but I don't know how to definitively treat and manage the vast majority of those specialties.

 

[deleted859535]

I don't think it would be a good fit for OP given he hates 9-5, but I will argue family medicine has many similarities to emergency medicine save for acuity at presentation. You are responsible for all of the patient's problems and should only be consulting people for things that you cannot do (ie surgery, ERCP, cath, etc).

If you (other medical students reading this thread) are interested in an undifferentiated patient with a cradle to grave patient population, and can be okay with less acuity and less immediate response with interventions, family medicine is a good specialty. Although there is that as well with crashing floor patients, or someone who shows up to clinic with melena and a hemoglobin of 4 who needs to be directly admitted; you just (ideally) won't be handling multiple crises at the same time as our emergency medicine counterparts are so comfortable with.

I'm in the army, so civilian family medicine likely has differences that I am unable to comment on.

To clarify this in case any med students misread:

Emergency medicine is not responsible for all of a patient's problems. Only the acute problems where standard of care dictates you evaluate for emergent versus urgent versus non-urgent as a reasonable peer in same or similar circumstances would do.

 

[Birdstrike]

Emergency medicine is not responsible for all of a patient's problems. Only the acute problems where standard of care dictates you evaluate for emergent versus urgent versus non-urgent as a reasonable peer in same or similar circumstances would do.

This above, is an out of date job description. I believe this is a more accurate description: If a patient has the expectation that the Emergency Physician must be "responsible for all of their problems" for the patient to be satisfied with their care, and if the Emergency Physician in unable to change that expectation, then absolutely the Emergency Physician is "responsible for all of their problems." In the Patient Satisfaction Trumps All Era, such a failure to meet patient expectations is viewed by the doctor's employer, as a failure of job performance by the doctor.

 

[Atlas Shrugged]

Thank you for clarifying. Responsible for the emergencies of all organ systems is perhaps a better way of looking at it, wheres family medicine is responsible for ongoing care of all organ systems and coordination of care.

 

[bravotwozero]

This above, is an out of date job description. I believe this is a more accurate description: If a patient has the expectation that the Emergency Physician must be "responsible for all of their problems" for the patient to be satisfied with their care, and if the Emergency Physician in unable to change that expectation, then absolutely the Emergency Physician is "responsible for all of their problems." In the Patient Satisfaction Trumps All Era, such a failure to meet patient expectations is viewed by the doctor's employer, as a failure of job performance by the doctor.

Fortunately there are some EDs out there where they don't, or won't bother docs about their patient satisfaction scores too much. I happen to work in one.

 

[deleted859535]

Fortunately there are some EDs out there where they don't, or won't bother docs about their patient satisfaction scores too much. I happen to work in one.

As do I.

 

[Birdstrike]

Fortunately there are some EDs out there where they don't, or won't bother docs about their patient satisfaction scores too much. I happen to work in one.

As do I.

I'm glad to hear it and happy for you both.

 

[Redpancreas]

What are some other specialties that are similar to EM? I'm going to be applying to med school soon and you could argue that EM is a huge reason why. I know it's early and I have lots of time to decide, but I like thinking about these things.

I read this forum pretty religiously and I see all the downsides that you guys talk about regarding EM. Everything from difficult patients, to administrators to mid-level encroachment, etc. I don't think these things are enough to turn me off from the field, but just in case the field burns a fiery death in the next couple years I'd like to know what other specialties have similarities to EM.

Who knows what will peak my interest in school, but as it stands right now EM is by far my number one interest. It just seems to fit me. I don't think I'd enjoy being a specialist seeing the same 4 things over and over again (I get bored easily). I don't like the idea of working long hours as Id rather work really hard and then chill. I love the idea of treating people who need to see a doctor right now for life threatening issues (although I know there's a lot of primary care stuff.) I even think I'd enjoy the sporadic schedule. So far at age 24 I've detested the M-F 9-5 schedule.

So which other specialties offer: wide variety of medicine, the comfort and knowledge to treat whatever walks through the door, emergency situations, being a jack of all trades, life saving procedures, undifferentiated sick patients, ample time off, and I guess good pay (less important for me)?

I would guess that you're not really listing your desirable traits, you're just listing the positives of EM so its hard to give you any suggestions. If you disagree, maybe just do EM. If you're willing to sacrifice life saving procedures, a hospitalist job gives you similar benefits. If you're willing to take a few more years to train, doing Pulm/Crit will let you do all those things outside of seeing kids and will involve more conceptual thinking and a good clinic/in-patient balance with patient continuity if those are things you enjoy. Anesthesia will offer you a lot of life-saving interventions with decent hours (albeit less within your control) for slightly higher pay, but it's a very defined job. Psychiatry offers the lifestyle and pay of EM, but for a completely different personality.

 

[Redpancreas]

True, CCM doesn't usually have as much flexibility as EM.
CCM is not the same as EM. Rather, I was pointing out that CCM has many similarities to EM (as requested by the OP).
That said, the flexibility is pretty similar. Sometimes the blocks of CCM are longer, but when those blocks are worked is pretty flexible. And the opportunities to work days (avoid transitioning) are much more prevalent.
And, nowadays, the pay outside of academic centers is pretty similar...slightly more hours for very similar pay -- but many of those hours are spent joking with colleagues, eating meals in the lounge, reading the newspaper, etc.
HH

CCM/Pulm Crit and EM are both flexible. The biggest downside to CCM or Pulm/Crit is the additional training.