Which Specialites Offer the Highest Quality of Life?

[prominence]

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With consideration to this question, the criteria should include full-time specialties with an average workload of 40-50 hours/week, minimal or no calls, and minimal or free weekends. Please disregard salaries in making any comparison between different specialties.

I look forward to seeing the opinions of fellow SDN posters.

 

[ckent]

Hmm. Actually, if you disregard salary, you can pretty much do whatever you want as a physician if you are willing to take the pay cut for it. I have a cousin who works as a pediatrician, she works 2 days per week but only makes ~30,000. In terms of a full time setting though, I suppose that the classic 9-5 doctor jobs would be things like psychiatry, allergy, rheumatology, rehab, and dermatology. But like I said, anything is possible as long as you aren't too hung up with salary conerns.

 

[VentdependenT]

How about occupational medicine?

 

[DrQuinn]

Dont' forget Emergency Medicine. Yeah, so you might work a few nights or weekends, but absolutely no pager, high pay, you can work 5 days in a row to get 4 days off, etc. One common thread you'll find in EM specialists is that we work hard and play hard. I know several attendings who will work 8-10 shifts in a row to get a few weeks off (and still make their requisite bling bling).

Q, DO

 

[Ligament]

If you are disregarding salary:
1. Derm-Easy clinical, sweet hours. no call.
2. PM&R-Moderate clinical (if you do inpatient rehab). Sweet hours, little to no call.
3. Occupational Med-Gotta deal w/ suits all day. Sweet hours.
4. Rad Onc-Too much to know, but nice after you learn it. Sweet hours. Big money.
5. Psych

 

[doc_strange2001]

Anesthesiology

If you dont mind waking up early. My cousin lives in NY and works with a plastic surgery group. Gets in at 6 am off by noon on most days. Does pretty much easy procedures/monitoring and pulls down 350k a year. If you really want to work or do say pain management you could bring down 800k or more a year. All this and your not REALLY busting your ass like say an OB/GYN and you get to see your familiy, have a life and acutally enjoy your money. If you are an anverage student i suggest getting in now b/c the secert is getting out.

 

[peptidoglycan]

What exactly is occupational medicine?

 

[cancer_doc]

Originally posted by Dr. Cuts
Telerads. Take your pick -- any city, any country. M-F, 9-5, 7 days on, 7 days off. 350K + bonuses right out of residency.

I hear that's only if you do loco tenum (or per diem) work- which means you're a gun for hire, w/ no health benefits etc (but do you really need it if you earn that much money?).

I hear most practices require you to pull some night call, though generally light. Is that accurate?

 

[DrMom]

Originally posted by peptidoglycan
What exactly is occupational medicine?

Basically, they treat workplace injuries & address workplace safety issues. They also may do pre-employment health and drug screening.

Sometimes they are employed by companies to be on site, others work in clinics. I've also known some that staff minor emergency centers.

I used to be an administrator for my state's Occ Med professional organization. Most of them made around what primary care docs make, but they worked fewer hours and were unlikely to have call. Depended on the individual situation, though, because some worked longer hrs & some made big $$.

 

[cancer_doc]

BTW: Rad Onc - Great clinical and procedural opportunities, without the call, without the long hours, and with your weekends off. It's also a whole lot more fulfilling than spending your days sitting in a dark room, or writing acne prescriptions.

 

[peptidoglycan]

What residency do you do? IM? Family Med?

Thanks

 

[Goober]

Originally posted by Dr. Cuts
Telerads. Take your pick -- any city, any country. M-F, 9-5, 7 days on, 7 days off. 350K + bonuses right out of residency.

Lol! have you ever looked for a telerads job? Almost all of them are nighthawk positions so unless you mean 9pm to 5 am as your hours you are a little off 😛 If you are on the mainland US it is very difficult to get a daytime full time telerads job. I am sure there are some out there, but I have seen are very few advertised. Most of them are specialized such as MSK MRI.

If you are willing to go to live in Europe or Asia, yeah you can do a daytime telerads job, but how many of us are willing to do that long term?

 

[RADRULES]

Not completely true. I used to telerad moonlight from home last year for a group in Minnesota (I live very far from there). I would work 8-5pm on Sat/Sun from home and get paid $1600 per day. This was as a board eligible radiologist, not board certified. The best part is that I could read the films from any computer, so I would read them sometimes from another hospital where I would be working babysitting contrast reactions. I made crazy bank that year.

As for NightHawk, that is not a bad deal either. You can live part of the year in a very nice city overseas and make a lot of money. There is also partnership in most nighthawk groups.

 

[Goober]

Originally posted by RADRULES
Not completely true. I used to telerad moonlight from home last year for a group in Minnesota (I live very far from there). I would work 8-5pm on Sat/Sun from home and get paid $1600 per day. This was as a board eligible radiologist, not board certified. The best part is that I could read the films from any computer, so I would read them sometimes from another hospital where I would be working babysitting contrast reactions. I made crazy bank that year.

As for NightHawk, that is not a bad deal either. You can live part of the year in a very nice city overseas and make a lot of money. There is also partnership in most nighthawk groups.

Reread my post. I don't consider Sunday and Saturday a full time job. If they did offer this 5 days a week, I would like to know the name of this group so I can contact them. There was one group that worked out of Minnesota that I contacted but they allowed only daytime weekend work and nighthawk work during the week.

 

[Weil-Felix]

Pathology:

Hours: 8-5
Call: Always from home😎
Atmosphere: Generally very relaxed and laid back
Salary: Very competitive
Misc.: Very common to find a "niche" area to specialize in. The residency was just shortened to be four years instead of five. You can sit down for a good portion of the workday (as you are reading slides, etc.) What other fields besides path and rads (maybe anesthesia?) let you sit down all day?

Yeah baby! Path rocks!

 

[RADRULES]

Hey dude, PM me the name of that group. Maybe I will reconsider my fellowship. I would love to live in Hawaii.

 

[Goober]

Originally posted by Dr. Cuts
Sure to nighthawk you would have to live in another part of the world for the hours to work out like I mentioned they would... but who wouldn't want to live in Honolulu, Hong Kong, Israel (places where they already have people)... or Paris, London, Zurich, Rome, The Swiss Alps, Budapest, Bora Bora, Tokyo, Rio de Janeiro (places Cuts' is considering 😉?

Well I wouldn't . Once you have kids and are settled it is not an easy thing to pull them out of school to move to another country. Not to mention my wife has her own career which she isn't willing to give up.

I have been talking to a lot of different telerad groups because I am keen on the idea of working from home. However I am not working the night shift since that pretty much defeats the whole point of working from home in the first place. Those overseas telerad jobs are good for short time gigs, but if you plan on settling in the US it is hard for me to see how that would work out long term.

Hawaii doesn't even work out that well because depending on time of year the time difference is only 5-6 hours east coast and 2-3 hours west coast. But if your group limits just to east coast you could probably get to bed by 1-2 am which I guess isn't too bad.

 

[beyond all hope]

In my humble opinion, the only specialty where you can have a lifestyle and be a real doctor.

I know I'm going to get flamed for this but I have to say it anyway. I am prejudiced. In my mind, anyone who does not see patients, make diagnoses and perform treatments is not a real physician. Real doctors carry stethoscopes. And use them.

That's not to say that Rads, Gas, Path, or Psych are in any way inferior, but to my simple mind, they don't fit the criteria of being 'real doctors', like the ones we imagine when we close our eyes and think of what a doctor is.

Many people have their own criteria for what real doctors are. I know a plastic surgeon who thinks internists are not real doctors because they don't stitch. I know a radiologist who thinks all primary care specialties are not real docs because they don't have a 'niche', they are just Jacks of all trades.

I know a cardiologist who thinks EM docs are not real doctors because we don't have our own patients...🙂

Have fun with that...

 

[Gator05]

Wow.

While I can see your perspective, I don't agree with it. But that's not the worst part. Psych and Gas BOTH fit your criteria of seeing patients, diagnosing them and treating their diagnosis. Gas, well, especially in Pain. Same for psych.

I'll also put forth my opinion that much of medicine in the primary care arena is actually social work.

 

[doc_strange2001]

Originally posted by beyond all hope

In my mind, anyone who does not see patients, make diagnoses and perform treatments is not a real physician. Real doctors carry stethoscopes. And use them.

Cant be a doctor without that all powerful stethoscope!!

And also there are many times when docs (esp EM docs) dont make the diagnosis AND perfrom treatments. Sometimes you need other doctors help..you know the ones without the stethoscopes ie Radiologists, Surgeons, Anesthesiologists for diagnosis and TX. In fact ive never called for more consults than on my EM rotation.

 

[Apollyon]

Originally posted by doc_strange2001
Cant be a doctor without that all powerful stethoscope!!

And also there are many times when docs (esp EM docs) dont make the diagnosis AND perfrom treatments. Sometimes you need other doctors help..you know the ones without the stethoscopes ie Radiologists, Surgeons, Anesthesiologists for diagnosis and TX. In fact ive never called for more consults than on my EM rotation.

Another EM basher...great.

However, I can tell that you are aiming for gas, because radiology and surgery are general, and accepted as not needing the 'scope, but, to say 1. anesthesia doesn't need or have scopes is IDIOTIC and 2. in 3 months as a student, 2 months as an intern and 6 months as an EM resident, I have NEVER consulted anesthesia in the ED for ANYTHING - EVER. Moreover, tell me something that affects patient care that is anesthesia-specific for diagnosis (ie, ASA class isn't relevant, nor is Mallampati classification - and Mallampati class just quantifies airways, which other specialties (EM, critical care) look at individually, since other specialties that intubate do not, very often, have the luxury of elective intubations).

 

[Whisker Barrel Cortex]

Originally posted by beyond all hope
In my humble opinion, the only specialty where you can have a lifestyle and be a real doctor.

I know I'm going to get flamed for this but I have to say it anyway. I am prejudiced. In my mind, anyone who does not see patients, make diagnoses and perform treatments is not a real physician. Real doctors carry stethoscopes. And use them.

That's not to say that Rads, Gas, Path, or Psych are in any way inferior, but to my simple mind, they don't fit the criteria of being 'real doctors', like the ones we imagine when we close our eyes and think of what a doctor is.

Many people have their own criteria for what real doctors are. I know a plastic surgeon who thinks internists are not real doctors because they don't stitch. I know a radiologist who thinks all primary care specialties are not real docs because they don't have a 'niche', they are just Jacks of all trades.

I know a cardiologist who thinks EM docs are not real doctors because we don't have our own patients...🙂

Have fun with that...

I don't really care about the whole "real doctor" thing, but I wanted to point out that radiologists do in fact:

Make diagnosis: easy one thats what we do the most of. Even if sometimes we have to hedge.

See patients: I saw about 5-10 patients a day on ultrasound (performing ultasounds to better see an abnormality, doing paracentesis/thoracentesis, liver biopsies, peritoneal mass biopsies, etc). I see 1-3 a day on neuro (flouro guided LPs, myelography), 5-10 a day on peds (doing VCUGs, upper GIs, etc), 10-15 on GI/GU (many procedures).

Perform treatments: Yeah, tell the guy I just drained 8 liters of fluid off of that I didn't do a treatment. How about the cancer patients that we do radiofrequency ablation or cryoablation on (this is not interventional, body imaging radiologists do this). Then of course all of the interventional procedures we all learn to do during residency (you can actually do interventional in private practice without a fellowship).

We get a little dose of patient contact without all the crap that ED docs and primary teams deal with. Plus a lot of cool procedures. All with very minimal use of a stethoscope (had a real hard time finding one when I needed it because a patient I was putting a dobhoff tube down was short of breath)

Man, I'm with Cuts. Soooo glad I chose radiology!

 

[Gator05]

Whoa, easy on gas.

Anesthesiology does diagnose and treat pain patients. Also, as soon as your patient leaves the ER and heads to the ICU, anesthesia can and will assume care their as well. And I've seen plenty of cases where anesthesiology gets consulted by EM for intubations, usually a little late.

This is NOT to bash EM, but just to set the record straight.

 

[AlexanderJ]

Just thought I would give another side of a possible future of radiology. How is this for a teleradiology advertisement, "$30,000 (US dollars) per year for Indian trained teleradiologist, no benefits, must be named SanJay". Yes, outsourcing is a major threat to radiology in the future. With economics driving medicine these days, who wouldn't want to spend $30,000 a year for images outsourced to India rather than paying $500,000+ to US trained radiologists. Seems pretty logical to me. This, in some fashion, is already occurring today (MGH). Talk to some radiology residents (as I have). Many are very worried about this taking hold in the future. Others say this will never be a serious threat because of medicolegal issues. Who is right? I don't know, and anyone who thinks they can definitively predict the future is just plain trying to fool themselves. Rads could be very lucrative 10 years from now, or outsourcing could ruin the field. Teleradiology may be a blessing to the field, and yes you might be able to read images from your yahct, but if outsourcing takes hold you may just be flippin' burgers at McDonalds for minimum wage. I am not saying this will happen, I am saying this could happen.

Another thing I have noticed is the new generation of clinicians is also receiving training in interpreting radiological images. The department of orthopedic surgery at the place I am doing my TY year at is full of young orthopedic surgeons, all of whom received training on reading MRIs etc. in their residency. I am doing an outpatient ortho rotation right now, and none of the surgeons even read the radiologist report. The orthopods read the films, but just don't get paid for it. They have complained enough that starting January of 2005 all ortho images at my current institution will be interpreted by and billed out to orthopedic surgeons! Clinicians billing for images has always been a threat to rads, but now that certain specialty residency programs are including image interpretation in their training, I wonder if clinicians billing for images might become more widespread. Yes, some radiologists will say that medicolegal issues will prevent this, but any MD can legally bill for reading images. Who is to say that an orthopedic surgeon is not just as good (and perhaps better because they have all the clinical data as well) at interpreting an MRI of the knee as a radiologist? One could extrapolate this argument to other specialties as well

I don't mean to ruffle anyone's feathers (but I am sure that I have), and I am certainly not hoping the above scenarios will occur. However, no one knows the future. What is clear is that the field of radiology is vulnerable. For the record, I hope things stay the way they are, but medicine is all about money these days so anything can happen. And if you do decide to go into radiology, which is a great field, please worry about the above issues because worrying and being proactive may prevent these changes. It's the people in radiology that say the above scenarios could never happen that may ultimately be responsible for the destruction of the field. Good luck everyone in choosing the right field for you.

 

[ny skindoc]

Ten years ago I was advised that HMOs would shortly put Derms out of business by restricting access. Guess what?.. in reality just the opposite happened ..demand grew and most dermatologists are so busy now they can barely keep up with all their patients.There is such a shortage of radiologists and such an explosion in imaging technology that I see little chance of them being put out of business in the forseeable future.Of course no one can predict whats coming down the road(this applies to any career choice).So perhaps radiologists will not make 500k a year in the future... they may have to happy with somewhat less.

 

[VentdependenT]

Ridiculous. You guys consult real doctors after all your labs are in. 😛

Its all in good fun

 

[supercut]

Haven't seen this one offered yet...Compelete a sleep fellowship after a neurology residency. Neurology is relatively non competitive to match in, do well and get a sleep fellowhship. Then watch the bucks roll in from the sleep lab.

You have techs that hook the pts up and babysit them while they sleep. Then you arrive the next am, fresh as a daisy, read the EEGs and leave.

I've heard that one can make in the order of millions while working M-F til noon. But even if you don't factor in the money, M-F working til noon reading EEGs allows for a lot of outside living.

 

[Whisker Barrel Cortex]

Although no one can predict the future, I do firmly believe that medicolegal issues will prevent tremendous outsourcing of radiology. One must have a medical licence in the US to practice medicine, and that includes interpreting images. Not many US trained and licensed physicians are willing to go to India and work for 30K per year. The current situation with Mass General and a company called Wipro will be corrected soon enough. These are non state licensed radiologists providing preliminary reports which are signed by a US radiologist. This will not withstand legal challenge in my opinion.

As for clinicians reading their own imaging. Yeah, it happens. Especially with subspecialists such as ortho. It is rare that they actually bill for interpretation, but that happens as well. One of my musculoskeletal attendings told me that this periodically comes up with some groups until they do get burned. The orthopods at one of the institutions he worked at would bill for plain film interpretation. Then a case of a young man who had just had a ACL repair took place. He had prolonged post op pain and the orthopod interpreted the expansile calcified lesion as heterotopic ossification. The kid came back 3 months later with multiple lung mets from osteosarcoma that any radiologist who saw the film would have questioned. They quickly backed off from billiing for their own films.

Most clinicians who order studies are not necessary subspecialists and they will always need the radiologist to interpret images. Also, most good subspecialist clinicians who have subspecialty radiologists available will consult them on difficult cases. Thus, they have to keep the bridges open by sending all imaging to the radiologist.

 

[beyond all hope]

As for myself, I am an EM intern and I read all my own films, CTs, MRIs, and ultrasounds. However, often for a tricky read I will ask the radiologist's opinion. Frankly, however, radiology is pretty weak at my hospital, so I usually trust an EM attending's read over a radiology resident.

The only things I'm still not good at reading are CTs to r/o PE and US to r/o appy.

 

[droliver]

Originally posted by Whisker Barrel Cortex
The current situation with Mass General and a company called Wipro will be corrected soon enough. These are non state licensed radiologists providing preliminary reports which are signed by a US radiologist. This will not withstand legal challenge in my opinion.

Why wouldn't this withstand a legal challenge? There still is a US liscenced physician sighing for them. It seems more of a liability issue that would need to be addressed to me (ie. will they find a malpractice carrier to cover this arrangement & the inevitable arguments that would arise in a lawsuit?).

As for the orthopedic surgery issue - billing for image interpretation is a large and (mostly) untapped source of revenue for them when their margins are shrinking from procedures. Of course its going to proliferate especially as more of them have MRI's in their office. I assume (and have talked to a member of the RRC about it) that this will be formalized in their training and be the subject of CME courses for people already in practice.

 

[Apollyon]

Originally posted by Gator05
Whoa, easy on gas.

Anesthesiology does diagnose and treat pain patients. Also, as soon as your patient leaves the ER and heads to the ICU, anesthesia can and will assume care their as well. And I've seen plenty of cases where anesthesiology gets consulted by EM for intubations, usually a little late.

This is NOT to bash EM, but just to set the record straight.

If I sounded like I was swinging the ball the other way, I'm sorry. However, what is different about anesthesia pain service, and neurology pain? Or critical care docs (in MICU's) vs. anesthesia critical care docs (in SICU's)? I've never seen (in 4 different hospital systems) anything but IM-pulmonary/critical care attendings in MICU's, and Gas only in SICU's (when surgical CC attendings weren't doing it).

 

[Whisker Barrel Cortex]

Originally posted by droliver
Why wouldn't this withstand a legal challenge? There still is a US liscenced physician sighing for them. It seems more of a liability issue that would need to be addressed to me (ie. will they find a malpractice carrier to cover this arrangement & the inevitable arguments that would arise in a lawsuit?).

As for the orthopedic surgery issue - billing for image interpretation is a large and (mostly) untapped source of revenue for them when their margins are shrinking from procedures. Of course its going to proliferate especially as more of them have MRI's in their office. I assume (and have talked to a member of the RRC about it) that this will be formalized in their training and be the subject of CME courses for people already in practice.

The US radiologist is not reviewing these films himself, just signing them. Mistakes happen and the the first time something significant is missed and the US radiolgoist is sued, the first question will be, "How did you manage to review X number of overnight studies? Why did you not see X finding? " This will significantly limit this activity.

 

[droliver]

WBC,

I think you're saying the same thing as me...... it's a liability issue rather then something I think would be per se illeagle. Why is this arrangement any different then the one where radiology staff here sign out the overnite films @ teaching hospitals that junior radiology residents have been giving prelim reads on all night long?

 

[Whisker Barrel Cortex]

Its different because staff radiologists at teaching institutions review the imaging that was preliminarily read by the residents. Depending on the residency program, they may sit down and "staff out" all of the reads after dictating the cases the previous night or just write down their preliminary report and then the staff will read the case again and dictate in the morning and report any changes to the clinicians. Although I am not privy to the inner workings of out sourcing companies, if the volume is to be at a level so as to decrease radiology jobs in the US and be profitable for the US radiologist, there is no way they will be able to review all of these studies and then read studies during the day.

 

[RADRULES]

Ahhh yes... the impending doom of radiology. I for one do not see it that way, although I am VERY much against the WIPRO/MGH scam. That program to me is an isolated attempt by some people to become wealthy off the shortage of radiologists currently in the US.

However, keep in mind that NON-US board certified radiologists with Indian training and probably a couple years of "fellowship" at MGH (just long enough to qualify to get a state license) would be interpreting these studies.

Ignoring potential HIPAA violations such, the point is that these Indian rads would be giving their opinion on these studies as preliminary reports, which would later be signed off (and billed) by an US ABR rad. The idea is that these rads in India are like a human version of computer-aided diagnosis.

If I were an unscrupulous radiologist, I could potentially sign off in mass 50-100 studies from the night before and bill for them all every morning. Of couse, I would make a great deal of money, but would be also taking a LARGE amount of risk. Conceivably, if I were to protect my assests and live in a state with tort reform, it would not be such a bad idea in terms of risk vs. reward. Keep in mind, however, that NO insurance carrier would touch you, because they all ask how many studies you read per year, and if you are reading 250k, you will never get coverage.

As for reading MRIs.... well, clinicians have forever thought they can read films as well or better than radiologist. To me, this is really a non-issue because very few clinicians are willing to take on the legal risks associated with it. I hate to break it to you all, but reading high-end MRIs is not easy and nothing can substitute for experience and seeing a LOT of studies.

Radiology is on the cutting edge. For every imaging modality or procedure that we lose, another one is there to take its place. I for one would be VERY happy to have Ortho read all of their post-operative clinic films and Pulmonary to read all the ICU CXRs.... reading that **** is brainless and pure pain. The high-end stuff will always be the domain of radiologists.

As for the intern reading his/her own CTs and U/S... you are nuts.

 

[droliver]

Originally posted by Whisker Barrel Cortex
Its different because staff radiologists at teaching institutions review the imaging that was preliminarily read by the residents.

This is the same model proposed by the MGH program, no? How much attention they give to these studies on the "sign out" is another thing as there is no minimum amout of time you have to examine a study to bill for it (right ?). It just is a question of how much liability the stateside radiologist is willing to assume.

 

[Tenesma]

a few things:

beyond all hope: you are an EM intern with all of 6 months of clinical exposure and responsibility... you will get into very, very sticky situations if you read your own CTs/MRIs and Ultrasounds. I don't think a PGY3 radiology resident would say something like that with so much certainty. And I'd like to meet an EM attending who will disagree in court about a radiologists read?

apollyon: trust me - anesthesia-folk don't get much enjoyment from going down into the ER (primarily because of the desire to vomit at the sights and smells down there... but also because of the usual blatant misunderstanding and mismanagement of most critically ill patients - until we take over and transport or trauma/surg. takes over). I agree that from an EM perspective there is not much of a difference between neuro/anesthesia pain (except of course in the relatively stable patient with multiple/bilateral rib fractures with an EM request for a thoracic epidural - which pain service would you want doing that? anesthesia or neuro?), or critical care management - but we do get called down to the ED about 2-3 times per week to fix airway bungles.

radrules/droliver: while i agree with both of you that the liability/privacy issues are huge and will undo the situation... as somebody who works at MGH under the current rads system, I can only tell you how happy I am at the unbelievable speed of interpretation with the preliminary reads. And if anything ever looks fishy, any of the services can always find a radiologist to go over the film/preliminary read. I guess the only thing I can liken it to would be having a senior rads resident read an emergent film in the evening with the attending signing off the next day - and instead you have for the most part board-certified/eligible people doing the reading followed by the attending signing off. and as dr.cuts alluded to, there seems to be quite a push for tele-radiology, it won't be long before the only radiologists in-house are interventional.

 

[RADRULES]

Wait a minute.... I was under the impression having talked to several people affiliated with the MGH rads department that currently the only work being sent to India is 3-D CT reconstructions and other computer work. Supposedly no preliminary reads are being sent to India right now. Are you saying this is not true?

 

[Tenesma]

radrules:

i don't know which films are read by who - i just know that for the most part there is a preliminary read in the computer extremely quickly no matter what time of day or night.... so is it the resident? or is it somebody who is at home? i truly don't know...

 

[roja]

My vote would go to EM. But I love what I do. Very nice lifestyle, interesting patients, you interact with almost all specialties.

And I didn't even think about EM till the end of my third year (I was going to do pediatric rhuematology.. also a nice lifestyle).

I don't really have the interest or time to dredge through all the specialty bashing.

I am immediately suspicious of those that feel it necessary to discredit other specialities. It is often a sign of arrogance and insecurity.

I value all of the services I consult. Each area of medicine could not function well without the other. I am thankful that there are people that love to look at my CT spines and read them, because I don't really love it. And I am thankful that there are internal medicine people who want to work up my CHF patients once they are stable.

And I have many friends in other specialties who are thankful they don't have to work in teh ED.

Thankfully, we all don't want to be cardiologist or radiologists, or EP's.

In the end, you should just pick a specialty that you love. teh rest just works itself out.


/.02

 

[Apollyon]

Originally posted by Tenesma
but also because of the usual blatant misunderstanding and mismanagement of most critically ill patients - until we take over and transport or trauma/surg. takes over). I agree that from an EM perspective there is not much of a difference between neuro/anesthesia pain (except of course in the relatively stable patient with multiple/bilateral rib fractures with an EM request for a thoracic epidural - which pain service would you want doing that? anesthesia or neuro?), or critical care management - but we do get called down to the ED about 2-3 times per week to fix airway bungles.

Like Roja says, the other service bashing is lame. Is there an EM program at your hospital? If so, the "blatant misunderstanding and mismanagement of most critically ill patients" either a. isn't meeting the standard of care or b. doesn't happen the way you describe. Moreover, I individually have been in the ED once when gas was called (and we got the tube before they showed). 2-3 weeks is weak (and, once again, if there is an EM program, it's not up to snuff, or it's not 2-3 times a week). As far as an epidural for pain in the ED, haven't seen it. I would probably call Neuro just from inertia.

From your assessment of mismanagement and bungles, you bash EM. That's on you. Anesthesia does have specific jobs, and is pretty cushy, and I FREELY grant that - but I don't have to say, "EM is good, 'cause gas sucks". It's not zero-sum.

But I think that that is something that bugs people - no matter how much you bash EM, we don't care!

 

[Tenesma]

don't get me wrong - i still think that EM is a great career choice... both the lifestyle is wonderful, and the job can be very diverse and rewarding. And you have to be particularly good at multitasking...