why did you choose emergency medicine?

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BlueAvenue

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I want to know why you med students, residents, and attendings chose EM as a specialty. Not starting a specialty flame war! Im just very interested to see what you all have to say. thanks
 
BlueAvenue said:
I want to know why you med students, residents, and attendings chose EM as a specialty. Not starting a specialty flame war! Im just very interested to see what you all have to say. thanks
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there's a lot of good answers to this question that can be found by searching. also, if you're a pre-med, then should probably really try to make sure that you actually want to be a doctor first . . .
 
Yes I'm absolutely sure I want to be a doctor but being a premed my knowledge on specialties is limited to the brief answers my mom gives me ( shes an internist) and what I read on websites like this.
 
honestly, your best bet is to shadow and do clinical rotations to really get a feel for the different fields, because there are a lot of different reasons for wanting to go into each field.

I'm going into EM because the ED always felt like "home" to me from the first time I spent time in one, and it felt like it was the heart of medicine to me. Now that's all very subjective stuff and just knowing the pro's and cons of each field won't tell you what one is right for you.

But to answer your question with some more concrete concepts: I love the variety of being able to see everything that comes in through the doors. I like acute illness management more than chronic illness management. I like being the first person to see the patient in the hospital. I like that we deal with some really scary stuff occasionally, and are trained specifically to deal with those situations. I like shiftwork and the fact that you can have a lot of freedom in how you set up your schedule...eventually...i hope...🙂
 
Q: How many children with ADD does it take to change a lightbulb?
A: Wanna ride bikes?

This *HAS* to be amended somehow to read: "How many ED physicians does it take to change a lightbulb?" ... and the punchline somehow blatantly displays our innate ADD tendencies.

While I'm at it:

Q: How many psychiatrists does it take to change a lightbulb?
A: First, the lightbulb has to *want* to change.
 
I am just a first-year, but I am pretty well sold on EM. I reserve the right to change my mind, but I think it will be hard to pull me away. I am president of our EM interest group, and between working as an employee and a volunteer, I have about 4 years of EM experience.

When I quit at the hospital to move out here for med school, pretty much everyone assumed that I'd be going into EM. Everyone says I've got the personality for it, and the ADD. A lot of the nurses I used to work with, who I still keep in touch with, say they have a hard time picturing me in anything else. But then again, that's all they've seen me do, but EM folk really are my kind of people.

And then one of my professors says he can really see me going into anesthesiology. I don't know what he meant by this. I guess I'll take it as a compliment though since that is hard to get into, but he could also mean that I am boring or something.

But yeah, you should do some shadowing/volunteering. You'll know pretty quickly if it is the kind of thing that interests you.
 
TexasTriathlete said:
And then one of my professors says he can really see me going into anesthesiology. I don't know what he meant by this. I guess I'll take it as a compliment though since that is hard to get into, but he could also mean that I am boring or something.
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I'm not sure how this myth is perpetuated, but anesthesiology is dead average in competitiveness. Along with EM, I might add.
 
TexasTriathlete said:
I am just a first-year, but I am pretty well sold on EM. I reserve the right to change my mind, but I think it will be hard to pull me away. I am president of our EM interest group, and between working as an employee and a volunteer, I have about 4 years of EM experience.

When I quit at the hospital to move out here for med school, pretty much everyone assumed that I'd be going into EM. Everyone says I've got the personality for it, and the ADD. A lot of the nurses I used to work with, who I still keep in touch with, say they have a hard time picturing me in anything else. But then again, that's all they've seen me do, but EM folk really are my kind of people.

And then one of my professors says he can really see me going into anesthesiology. I don't know what he meant by this. I guess I'll take it as a compliment though since that is hard to get into, but he could also mean that I am boring or something.

But yeah, you should do some shadowing/volunteering. You'll know pretty quickly if it is the kind of thing that interests you.
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Grrrrrrrr.

👎thumbdown👎
 
well for me Emergency medicine is the best specialty ever .. emergency medicine is all waht i want to do and i am afraid its all what i can do.

- i love the rush of it, and sometimes its quitness.
- there is no routine what so ever.
- you can see patients from all kind. peads, adults, elderly.
- you can deal with all kinds of medical problems, no matter what..
- you can see patiens of all specilties medicine, peads, OB/GYN, surgery, ent, optha, all kinds really and that i love
- there is no limits in emergency medicine..
- in emergency medicine you can REALLY safe lives...
- in the ER you could laugh, cry, care, help all on the same shift..
- you can meet alot of ppl..

in short cut EM is the best... i love it more than anything and its all what i wanna do..

🙂
 
How many ED attendings does it take to change a lightbulb?

One. ED attendings actually get things done.
 
As for the OP's ?

I like EM because of the variety. I like to work higher intensity for shorter periods. I get bored with monotony like seeing HTN patients in a clinic. I like being (relatively) free from work when I'm off. I like the flexibility of shift work. I used to seem exciting and it is but that wears off as the years go by. At this point codes are boring and EMS protocol meetings are exciting (seriously).

On the lighter side:

How do you confuse an EP?

Ask him what the second dose is.
 
I work 14 days a month, 8 hrs per shift. I make over 400K a year (unusual but 300k common).
I can take 1 week vacation any time I want
I am never on call. Pts never call me
Variety is great even the drug seekers sometimes
Procedures
3 year residency
No need for any fellowship to be competative
Great to work with a bunch of different nurses, staff
ER allows a smooth transition to retirement. I could do Urgent care and care for colds at 120/hr. I could do a free standing ED doing mostly urgent care stuff for 180/hr.
Jobs are easy to come by. I get offers atleast 3 times a week unsolicited. I could find a job in any big city in Texas tomorrow if I wanted
No headaches with hiring staff, billings, supplies. No need to worry about the business end
I feel like I deal with the best part of the pts care. The diagnosis. After I diagnose DKA, or bowel obstruction the rest is cookbook.
I can go on and on but this fits me to a T
 
emergentmd said:
I work 14 days a month, 8 hrs per shift. I make over 400K a year (unusual but 300k common).
I can take 1 week vacation any time I want
I am never on call. Pts never call me
Variety is great even the drug seekers sometimes
Procedures
3 year residency
No need for any fellowship to be competative
Great to work with a bunch of different nurses, staff
ER allows a smooth transition to retirement. I could do Urgent care and care for colds at 120/hr. I could do a free standing ED doing mostly urgent care stuff for 180/hr.
Jobs are easy to come by. I get offers atleast 3 times a week unsolicited. I could find a job in any big city in Texas tomorrow if I wanted
No headaches with hiring staff, billings, supplies. No need to worry about the business end
I feel like I deal with the best part of the pts care. The diagnosis. After I diagnose DKA, or bowel obstruction the rest is cookbook.
I can go on and on but this fits me to a T
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I'll have what he's having.
 
-Variety
-Undifferentiated complaints
-Higher acuity = more interesting and better chance to make a positive impact
-Procedures
-Get to know a little about a lot (more appealing to me than the inverse)
-Personalities within the specialty (sense of humor, sarcasm, ADD-tendencies, etc.)
-Good relationships with nurses/staff
-Good pay
-Not being on call
-Weird, random, bizarre, funny stuff that just doesn't happen anywhere else

Ultimately, I like that it'll prepare you for anything. I'd hate to be a Dermatologist and be the only one around to answer the "Is there a doctor in the house?" call.
 
As for me, I do it first and foremost for the patients. I love being there for the community on each family's worst day potentially. I like being mentally able to address the most critical issues in every other physician's specialty. I love being an important link on the emergency response chain of care. These are all variations of the same thing...I want to help everyone with what they need the most, what they perceive to be an emergency.

I was in a different specialty before (briefly) and felt that in one year, I was able to learn 75% of all the evidence based practice of that specialty that was available...it was very unsatisfying. Where is the challenge in that? I want something that will always afford new challenges and new things to learn.

Also, this may be morbid, but I like being with people when they are dying. To me, decisions and life becomes clearer when you are in those moments frequently. Not just at the bedside but in my personal life...it affords great perspective.

With that said, if you dont want to work evenings and overnights and holidays this is generally not the right specialty for you. There are people who have worked out sweet deals in unique situations but on the whole you have to be prepared to devote a large number of evenings, overnights, weekends and holidays. Its just the nature of the business.

I highly recommend it to those who enjoy these things and want to learn everything about everything...
 
Can anyone tell me why you would ever prefer a 4 year residency to a 3 year and why there is even an option between the two? I've been looking into em a lot lately, and I feel like, I'd just not apply to 4 year em residencies. Why put off making a good paycheck for an additional year?
 
abolt18 said:
Can anyone tell me why you would ever prefer a 4 year residency to a 3 year and why there is even an option between the two? I've been looking into em a lot lately, and I feel like, I'd just not apply to 4 year em residencies. Why put off making a good paycheck for an additional year?
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Why do some people take five or six years in college? They want more variety of exposure? Want to have more time to accomplish specific goals like international experiences, subfellowships etc. There are people who prefer one to the other, but both will provide you exceptional training.
 
ThymeLess said:
Why do some people take five or six years in college? They want more variety of exposure? Want to have more time to accomplish specific goals like international experiences, subfellowships etc. There are people who prefer one to the other, but both will provide you exceptional training.
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Or they're DOs and do an AOA program.
 
There is really no reason to do this. Anyone who does 3 yrs + 1 yr attending would know more than a 4 year resident. The 1st Yr of attending is a steep learning curve.

When I applied to residency, all the 4 yrs were on my bottom.
 
abolt18 said:
Can anyone tell me why you would ever prefer a 4 year residency to a 3 year and why there is even an option between the two? I've been looking into em a lot lately, and I feel like, I'd just not apply to 4 year em residencies. Why put off making a good paycheck for an additional year?
Click to expand...

If I had the choice between three and four years, yes, I would probably want three. But seeing as I don't have that option (applying DO only, and would probably be more of a beggar than a chooser on the ACGME side, anyway), I do focus on the positives involved in having an extra year as a resident. In most cases, it seems that fourth years are functioning practically on the level of an attending, with lots of autonomy and often teaching interns or medical students, but still having an attending available if they need help. I see it as an extra year of training wheels. The main difference, really, is the pay, but really, who cares? You've got enough to live on, you can wait another year.
 
emergentmd said:
There is really no reason to do this. Anyone who does 3 yrs + 1 yr attending would know more than a 4 year resident. The 1st Yr of attending is a steep learning curve.

When I applied to residency, all the 4 yrs were on my bottom.
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I disagree to a point. I went to a 4 year program, did an away at the place I went and another 3 year program and interviewed at 13 I think it was...

I think the four year program polishes you out a tad bit more, more so than 'just working as an attending for a year'. I stepped directly into some admin position at my 'job' and have further increased my admin duties after being out just two years. I had a minimal to no 'learning curve' as a FT attending.

I also moonlit quite a bit, enough that I wrote a check for my student loans, plus saved more than enough for a down payment on our house.

I have financial freedom, and I LARGELY weigh that onto the fact that I went to a four year program with moonlighting opportunities. I also hold some admin positions that again I think I heavily stepped into those from the extra polish...

I hate seeing people/students write off a 4 year program 'just because'. I *almost* cancelled my away rotation because of 4 years and would not have went there had it not been for the value I saw on that rotation.

I do not disagree, three years will make you a competent emergency physician and you will be able to work anywhere; on the flip side I am VERY confident I would NOT be where I am financially or professionally had it not been for the extra year of training.

One of the best quotes I ever hear was "EM is a 3.5 year specialty"
 
Thanks for your perspective! It's nice to hear it from both sides. I'm only a 1st year so I've got plenty of time to formulate my opinions but it's good to hear why people feel one is better than the other.
 
abolt18 said:
Can anyone tell me why you would ever prefer a 4 year residency to a 3 year and why there is even an option between the two? I've been looking into em a lot lately, and I feel like, I'd just not apply to 4 year em residencies. Why put off making a good paycheck for an additional year?
Click to expand...

For me, it was because I am a DO, and went to a DO residency. However, I think one of the perks of the 4 year residencies, are they tend to be a little less intense schedule wise. Anecdotal certainly, but for instance, one of my friends went to a 3 year MD program, and was working 22 12's per month for 3 years (264 hours/month) and I've been working about 180 hours/month at my place, less now (160 hours/month) as a senior. Do I feel well trained. Sure! And I get all this extra time off to moonlight, which helps me develop a better sense of myself, which I think is only afforded by being out on your own. My income nearly doubles from this moonlighting, which allows me to live more comfortably, and allows my wife to not work, and stay at home with our kid.

I don't hate my job, or my residency, and I have adequate home time and monetary income to make things much easier. In short, it makes my quality of life much better.
 
I'm at a 3 year program, but I think the 4 year vs 3 year issue is overblown. Location and "fit" should dominate the decision with the caveat that "fit", in my experience, is inherently tied into the 4 vs 3 year decision.

The people who want to get in, come out as good clinicians, and then work their few shifts a month (maybe a few obligatory admin duties at most) are not the ones who are going to go to a 4 year program. Those with interests in research and leadership roles are going to be more inclined to look into the opportunities afforded by an extra year. Then the next batch of applicants comes through and those same personalities are going to be attracted to the 4 year program not just for the perceived benefits of the extra year but also because their personality and goals will be a better fit with the current residents which makes for a more pleasant residency experience and a more useful professional network.

Basically, with less rambling, people might choose a 4 year program because:
1) They concider the extra year a small price to pay for an ideal location or personality fit
2) More elective to explore interest and round out their formal education
3) More time to build some research or leadership experience (much easier to do a PGY4 in a system you're familiar and established in than as a new attending in a new place)
4) Some people probably do it solely for the reputation of the program. Many of the well established programs are 4 years.
5) The schedule may be a little more relaxed though not necessarily

Some people argue 3+fellowship, but that seems like apples to oranges as you lose most of the benefits above especially if you do fellowship in a different place and you run into the exact same argument if you compare 3+fellowship vs 4+fellowship.

There is also the 3 year + 1 year junior attending with fellowship credit model that is starting to pop up and seems to offer a lot of the benefits of both worlds.

At the end of the day, it's one extra year. It's asinine to discard a program with a good fit, good location, and a curriculum you like just to finish one year sooner. At the same time it's stupid to assume that 4 years is inherently better than 3 years.

Tangentially,I disagree that a 3 year resident with 1 year as an attending is inherently better than a 4 year resident especially once they both hit the 5 year mark. If we're going to go down the path of discounting formal education in comparison to work experience, we might as well just hand the specialty back to the generalists and moonlighters. The reality is it depends more on the individual resident than the program they went through...
 
DeadCactus said:
I'm at a 3 year program, but I think the 4 year vs 3 year issue is overblown. Location and "fit" should dominate the decision with the caveat that "fit", in my experience, is inherently tied into the 4 vs 3 year decision.
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👍👍👍

I know we harp on "fit" like it's the Holy Grail around here but everyone who has been on the site through the process gets to about second year and then says "Oh, I get it now. Yeah fit is what it's all about."

That said I did a 3 year program. I think I'd have liked an additional year. I firmly believe that I was adequately trained. However, EM, much more so than other specialties, being hospital based and institutionally unique, makes your first years very tough. No only do you have to learn to practice medicine standing alone but you have to learn to do it within the confines of the culture, norms and policies of your institution. That aspect is tough and no amount of additional training will give it to you. It has to be gleaned by OTJT. But any additional polish and confidence you have will help.
 
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