Are you happy in EM??

[filhodeinferno]

Anesthesia (vs EM)

Some important caveats before I start:
-Since you asked why choose gas over EM, I'll focus on propping up anesthesia against EM. But it's also possible to ask why choose EM over gas, and then focus on propping up EM over anesthesia.
-I'll still try to be very objective though.
-Some of the pros/cons could fit in the opposite category, depending on your personal preferences.
-Ultimately it's all just my opinion, nothing more.

Similarities between anesthesia and EM
-Both involve a lot of variety in patient population and disease (EM is more like being an acute GP or FM, whereas anesthesia you see all types of patients and ages needing all types of surgeries)
-Both allow for shiftwork
-Both have acute care to some degree (though anesthesia is basically all acute care)
-Both get to do procedures (though EM does more procedures meant for treatment than anesthesia)
-Both get to play with fun toys (e.g., ultrasound, laryngoscopes) (though anesthesia has more cool gadgets obviously like the anesthesia machine and workstation)
-Both currently average pay >$300K
-Both don't bring patients to the hospital like cardiologists or surgeons do
-Both are more at the mercy of hospital administrators, AMCs, etc.
-Both can involve high legal liability for malpractice (fairly or unfairly)
-Both don't require a lot of overhead
-Both are mobile, meaning you can pick up and move if you really want
-Both are (mostly) hospital-based specialties
-Both don't require building a referral base, etc., before starting to earn good money
-Both allow for medical missions
-Both face some midlevel threats (though anesthesia seems worse)

Pros
-Acute care (if that's what you like) vs EM where it's a mixture of acute care and other things you find in PCP
-No need to deal with difficult patients, or not for long
-No need to do some of the uglier things in medicine (e.g., rectal exams, drain pus from infected body parts)
-In other words you will face less overall BS than in EM (though anesthesia has its own BS, see "Cons")
-You are an expert in physiology and pharmacology (though EM is expert in quickly working up and managing the undifferentiated patient, the emergent patient, etc.)
-Generally more regular hours than EM (but see "Cons" about hours too)
-Don't regularly have to work nights, weekends, holidays (though sometimes you might, depending on your group)
-Cases are usually more planned than EM (excluding for example emergency ORs or add-ons) where anyone and anything could walk through the door
-Higher pay potential than EM
-Not in the "fish bowl" that is the ED
-Generally busy at the beginning and end of cases, but in the middle there is some down time (depending on the case, and obviously you're still very vigilant throughout the case)
-If you are doing your own cases, it's nice to be able to focus on a single patient at a time, and not always have to "move the meat" (though in private practice, you are facilitating surgeries for surgeons and hospitals, so you are trying to rush every case along)

Cons
-You always have to deal with surgeons, many of whom can be (shall we say) less than pleasant people
-You have to be ok with not being the "captain of the ship" (e.g., "Hey, anesthesia! Tilt the bed!")
-No or not very much diagnosing and working up patients
-Longer hours than EM overall
-Early mornings
-Not all cases will necessarily end when you expect them to end
-Currently a worse job market than EM
-CRNAs (AANA) argue they are as good as anesthesiologists, and they have a growing influence in the healthcare system and market
-The ACT model is the future (and it's already about 50% of all practices) -- i.e., having to supervise 1:1 to 1:4+ CRNAs
-Less likelihood of always being able to do your own cases, which may mean you're not doing a lot of (routine) procedures, but running from room to room "putting out fires"
-Tied to the OR
-Either bored stiff or scared stiff (99% sheer boredom, 1% sheer terror) such as when a patient crashes, and you won't necessarily have a team including other attendings to help like in EM (sometimes you will, but often not)
-EM is a more team oriented specialty than anesthesia, where you are more "on your own" (though there are other anesthesiologists in other ORs, they are either doing their own cases or supervising CRNAs or AAs)

Just some of my thoughts. I'm sure there's a lot more that can be added.

Very good analysis, IMO. I was also choosing between Anesthesia and EM. Chose EM, but who knows if I got it right. Ultimately what tipped the scales for me were the two cons I felt uneasy about in anesthesia: working with surgeons and the job market. Looking back, worrying about the job market was probably overkill, but worrying about the surgeon one was spot on.

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[Angry Birds]

Very good analysis, IMO. I was also choosing between Anesthesia and EM. Chose EM, but who knows if I got it right. Ultimately what tipped the scales for me were the two cons I felt uneasy about in anesthesia: working with surgeons and the job market. Looking back, worrying about the job market was probably overkill, but worrying about the surgeon one was spot on.

F***in surgeons.

 

[TheBoneDoctah]

Anyone else?


Sent from my iPhone using SDN mobile app

 

[imapepper]

Residents and EM docs...are you happy working in
EM?
Still a baby, second year resident here, almost third (!) I'm SO happy in EM. I absolutely hate offservice rotations and honestly feel drained and kind of depressed when I'm on them- thankfully they're rare. Of course I have days when I am burned out, but overall, I leave work energetic and happy.

What was your reason for going into EM in the first place?
I love the patient population, procedures, acuity, variety, and ability to work hard while at work and then have lots of time off. I don't mind shift work, prefer it to monotony.

What's the best/worst part of your job?
Honestly, (call me Pollyanna) I still just love the patient population. I love the occasional psych patient, don't mind homeless, drunk, incarcerated, and drug seeking patients. I actually kind of love them. I view most of the patient population as sort of a mission field and have low expectations from most patients, so I'm pleasantly surprised when someone responds positively. I still love procedures, trauma, collaborating with the staff as a team during stressful times, and the adrenaline. Most of these things may fade as time goes on, who knows, but right now I'm happy.
The worst part is definitely the entitled patient who is pissed at the end of long workup bc I didn't find anything to explain their xyz. I lose my professionalism with them if I'm not careful. I also don't like that when I or my family members have a random symptom, I always immediately remember the worst case scenario I've seen and it takes me a while to shake that feeling.

Do you like your hours?
Yeah, I go to a program that works us while we are on shift, but doesn't require a lot of hours overall and has few offservice rotations. I love a rotating schedule bc it helps prevent monotony for me.

Do you feel like you have enough time with your family?
I do. I would like more, but compared to other residencies, I am grateful for the time I have off. As I am looking for a position for next year, I am prioritizing places
where I would contractually work fewer hours to prevent burnout and ensure time with my family.

Do you work in an academic center?
Yeah. Average residency program. Bw 70-100K.

Do you feel you are fairly compensated?
I am so broke. But I've got a family and a spouse that works from home, so it's by choice. I'm still naïve enough to be starryeyed about my prospective salary as an attending.

Would you choose EM again?
In a heartbeat.

If you HAD to choose a different specialty, what would it be?
I can't think of one that would make me happy. Not a single one.

Anything else you want to add?
I think perspective is so important. I know things are different because I'm still a resident, but I am so happy, even compared to other residents I know. Like I said, I went into EM for the population that makes people burn out, so maybe that's different, but I don't expect patients to take responsibility for their health, be reasonable, grateful, logical, or care about what they "do to themselves." I think this helps me because I occasionally encounter patients who I genuinely love interacting with, and I am rarely left frustrated by them. I cling to the encounters that make me cry, touch me, overwhelm me, etc. I am grateful to be able to encounter people and patient populations that I would otherwise probably never interact with. I think this benefits me as a person overall.
I also worked in health care prior to becoming a doctor, and I view the staff in the ED as part of the same team I'm on, like a work family. I treat them and consultants with respect and insist they do the same for me. I enjoy the camaraderie I feel with the nurses and techs I work with and I think it adds to my satisfaction at work.
I make sure I discuss frustrating or sad experiences with a close family member who helps me keep my perspective. I cry with patients when I feel like I need to, and I try not to talk about them in a way that dehumanizes (although it is easier in the moment) because I feel like it leads to burnout.
Just my experience. I've been in health care for ten years so I feel like it's working so far.

 

[Groove]

Residents and EM docs...are you happy working in
EM?

Yes.

What was your reason for going into EM in the first place?

Early mid-life crisis and ideological disillusionment with my previous career. I didn't feel like I was doing anything that ultimately mattered in the grand scheme of things and had put medicine on the back burner while I pursued other things. It continually tormented me until I finally made the jump.

What's the best/worst part of your job?

Best: Interesting and gratifying cases. Respect from colleagues and hospital staff.
Worst: Drug seekers, hospital bureaucracy and the stress.

Do you like your hours?

Yes and no. I can remember how soul sucking and monotonous the typical 8-5 weekly grind can be in corporate America. Compared to that, there's a refreshing component to having random and changing work days where you may work hard for 3-4 days and then have 2 off. On the flip side, I hate the circadian disruptions, working weekends and holidays and having friends/family/relationships say they "understand my schedule" when they really don't. Let's face it, nobody does unless they work it. Then again, I'm glad I don't take call and I knew a less than ideal schedule was going to be part of medicine. I don't think that part should be any shocker for physicians in general.

Do you feel like you have enough time with your family?

No.

Do you work in an academic center?

No.

Do you feel you are fairly compensated?

I'm reasonably satisfied but I don't think it's fair compensation when you realize how much is taken off your back by the hospital/group/corporation, etc..

Would you choose EM again?

Yes.

If you HAD to choose a different specialty, what would it be?

I suppose Anesthesiology or Neurology but like I said, I don't think I'd have a problem choosing EM again. It's difficult picturing myself doing anything else.

 

[Psai]

Anesthesia (vs EM)

Some important caveats before I start:
-Since you asked why choose gas over EM, I'll focus on propping up anesthesia against EM. But it's also possible to ask why choose EM over gas, and then focus on propping up EM over anesthesia.
-I'll still try to be very objective though.
-Some of the pros/cons could fit in the opposite category, depending on your personal preferences.
-Ultimately it's all just my opinion, nothing more.

Similarities between anesthesia and EM
-Both involve a lot of variety in patient population and disease (EM is more like being an acute GP or FM, whereas anesthesia you see all types of patients and ages needing all types of surgeries)
-Both allow for shiftwork
-Both have acute care to some degree (though anesthesia is basically all acute care)
-Both get to do procedures (though EM does more procedures meant for treatment than anesthesia)
-Both get to play with fun toys (e.g., ultrasound, laryngoscopes) (though anesthesia has more cool gadgets obviously like the anesthesia machine and workstation)
-Both currently average pay >$300K
-Both don't bring patients to the hospital like cardiologists or surgeons do
-Both are more at the mercy of hospital administrators, AMCs, etc.
-Both can involve high legal liability for malpractice (fairly or unfairly)
-Both don't require a lot of overhead
-Both are mobile, meaning you can pick up and move if you really want
-Both are (mostly) hospital-based specialties
-Both don't require building a referral base, etc., before starting to earn good money
-Both allow for medical missions
-Both face some midlevel threats (though anesthesia seems worse)

Pros
-Acute care (if that's what you like) vs EM where it's a mixture of acute care and other things you find in PCP
-No need to deal with difficult patients, or not for long
-No need to do some of the uglier things in medicine (e.g., rectal exams, drain pus from infected body parts)
-In other words you will face less overall BS than in EM (though anesthesia has its own BS, see "Cons")
-You are an expert in physiology and pharmacology (though EM is expert in quickly working up and managing the undifferentiated patient, the emergent patient, etc.)
-Generally more regular hours than EM (but see "Cons" about hours too)
-Don't regularly have to work nights, weekends, holidays (though sometimes you might, depending on your group)
-Cases are usually more planned than EM (excluding for example emergency ORs or add-ons) where anyone and anything could walk through the door
-Higher pay potential than EM
-Not in the "fish bowl" that is the ED
-Generally busy at the beginning and end of cases, but in the middle there is some down time (depending on the case, and obviously you're still very vigilant throughout the case)
-If you are doing your own cases, it's nice to be able to focus on a single patient at a time, and not always have to "move the meat" (though in private practice, you are facilitating surgeries for surgeons and hospitals, so you are trying to rush every case along)

Cons
-You always have to deal with surgeons, many of whom can be (shall we say) less than pleasant people
-You have to be ok with not being the "captain of the ship" (e.g., "Hey, anesthesia! Tilt the bed!")
-No or not very much diagnosing and working up patients
-Longer hours than EM overall
-Early mornings
-Not all cases will necessarily end when you expect them to end
-Currently a worse job market than EM
-CRNAs (AANA) argue they are as good as anesthesiologists, and they have a growing influence in the healthcare system and market
-The ACT model is the future (and it's already about 50% of all practices) -- i.e., having to supervise 1:1 to 1:4+ CRNAs
-Less likelihood of always being able to do your own cases, which may mean you're not doing a lot of (routine) procedures, but running from room to room "putting out fires"
-Tied to the OR
-Either bored stiff or scared stiff (99% sheer boredom, 1% sheer terror) such as when a patient crashes, and you won't necessarily have a team including other attendings to help like in EM (sometimes you will, but often not)
-EM is a more team oriented specialty than anesthesia, where you are more "on your own" (though there are other anesthesiologists in other ORs, they are either doing their own cases or supervising CRNAs or AAs)

Just some of my thoughts. I'm sure there's a lot more that can be added.

I think that em is nice because you can work in urgent care and be an owner. It's a field that teaches you many transferable skills so if you're not being treated fairly, you can move to basically anywhere in the country.
About the midlevel threat, the pas and nps seem to respect the em docs and some of them actually are thinking about going through the extra schooling to become a doctor. In anesthesia, the crnas think that they are better than the anesthesiologists and I haven't heard a single one of them say they want to do the extra schooling. And why bother when all of their programs indoctrinate them with the idea that they are better and give them free dnp degrees for nothing. I think EM is hot right now and it's a great choice for any medical student, especially since you can do the residency in 3 years. It seems pretty darn competitive now but I hear that these things go in cycles

 

[exsanguination]

I think that em is nice because you can work in urgent care and be an owner. It's a field that teaches you many transferable skills so if you're not being treated fairly, you can move to basically anywhere in the country.
About the midlevel threat, the pas and nps seem to respect the em docs and some of them actually are thinking about going through the extra schooling to become a doctor. In anesthesia, the crnas think that they are better than the anesthesiologists and I haven't heard a single one of them say they want to do the extra schooling. And why bother when all of their programs indoctrinate them with the idea that they are better and give them free dnp degrees for nothing. I think EM is hot right now and it's a great choice for any medical student, especially since you can do the residency in 3 years. It seems pretty darn competitive now but I hear that these things go in cycles

Incoming medical students can expect to be done with residency in T+7 (or 8) years. The field, practice environment, reimbursement, and job role may change quite a bit in that time.

I think that EM's stock is riding a current boom, and everybody is jumping on the train. But we all know about what happens to anybody who "buys high"

 

[Psai]

Incoming medical students can expect to be done with residency in T+7 (or 8) years. The field, practice environment, reimbursement, and job role may change quite a bit in that time.

I think that EM's stock is riding a current boom, and everybody is jumping on the train. But we all know about what happens to anybody who "buys high"

That's very true. I'm all about doing what you want to do which is why I'm going into anesthesia even though I believe that the job market will be less than ideal when I finish

 

[RPedigo]

Residents and EM docs...are you happy working in EM?

Absolutely.

What was your reason for going into EM in the first place?

Thought of being a "real" doctor at the time -- one who could take care of anything that walked through the door, continually learning new things, getting some hands-on procedures but also critical thinking.

What's the best/worst part of your job?

Best: The people -- getting to work with medical students and residents and grateful patients and excellent staff and colleagues
Worst: Drug-seeking, intoxicated/agitated patients

Do you like your hours?

Overall, yes. There are of course the cons of weekends and holidays and nights, but I don't (yet) seem to mind those very much. I moonlight a lot so I work probably a disproportionate amount of weekends because my weekdays are spent doing my academic duties when not in the ED. I probably work 60 hours per week many weeks, but only half of that is clinical...

Do you feel like you have enough time with your family?

Yes.

Do you work in an academic center?

Yes, my full-time faculty position is in an academic center, but I moonlight at two other hospitals so I can better teach residents how community practice works (since that's what most go into after graduation).

Do you feel you are fairly compensated?

I have a high student loan burden and Southern California has an absolutely crazy housing market and I do academics, but all those things considered yes I feel fairly compensated.

Would you choose EM again?

Absolutely; I might not choose anything else though (meaning I'd probably not go into medicine as a field if it were not for this specialty).

If you HAD to choose a different specialty, what would it be?

Probably anesthesiology.

 

[bashwell]

Absolutely.


Thought of being a "real" doctor at the time -- one who could take care of anything that walked through the door, continually learning new things, getting some hands-on procedures but also critical thinking.


Best: The people -- getting to work with medical students and residents and grateful patients and excellent staff and colleagues
Worst: Drug-seeking, intoxicated/agitated patients


Overall, yes. There are of course the cons of weekends and holidays and nights, but I don't (yet) seem to mind those very much. I moonlight a lot so I work probably a disproportionate amount of weekends because my weekdays are spent doing my academic duties when not in the ED. I probably work 60 hours per week many weeks, but only half of that is clinical...


Yes.


Yes, my full-time faculty position is in an academic center, but I moonlight at two other hospitals so I can better teach residents how community practice works (since that's what most go into after graduation).


I have a high student loan burden and Southern California has an absolutely crazy housing market and I do academics, but all those things considered yes I feel fairly compensated.


Absolutely; I might not choose anything else though (meaning I'd probably not go into medicine as a field if it were not for this specialty).


Probably anesthesiology.

By the way thanks for your book Crush Step 1! Amazing book.

 

[RPedigo]

By the way thanks for your book Crush Step 1! Amazing book.

Thank you so much! Glad that you liked it.

 

[The White Coat Investor]

I think the lack of Type A thing will change as EM continues to attract more competitive candidates... just a small prediction that I've already seen with the medical students that come by at my program to interview. Got to be careful with the 250/260 type candidates!

Why would you take a candidate like that when there are so many 220-240 people?

Actually, I know plenty of pretty fun people who just happen to be skilled at standardized tests. Just because you score in the 250-270 range doesn't mean you can't find your place in EM. I mean, even those of us with a 298 matched somewhere.

 

[gro2001]

Why would you take a candidate like that when there are so many 220-240 people?

Actually, I know plenty of pretty fun people who just happen to be skilled at standardized tests. Just because you score in the 250-270 range doesn't mean you can't find your place in EM. I mean, even those of us with a 298 matched somewhere.

There seems to be this persistent myth in EM circles that people with high Step scores are somehow less likely to be good clinically. Which I find somewhat ironic as it's basically nerd shaming. By slightly worse performing nerds.

My impression has been that the two are largely independent, with a small trend towards people with better scores also being more likely to be good clinically. And I say this as someone who did not have spectacular board scores.

 

[slurpy15]

Residents and EM docs...are you happy working in
EM?
-HATE it.

What was your reason for going into EM in the first place?
-Went to medschool late, loved surgery, decided it was too long and too intense, hated my IM rotation, which is unfortunate, because in retrospect I think I would have been happy in a subspecialty (ID or heme-onc)

What's the best/worst part of your job?
-The best is getting paid and where I live. The worst is the abusive employer.

Do you like your hours?
-No. Too many nights and weekends.

Do you feel like you have enough time with your family?
-No

Do you work in an academic center?
-No

Do you feel you are fairly compensated?
-That's a great question. I earn enough, but not for the amount of stress and the amount of nights/weekends/holidays.

Would you choose EM again?
-No
If you HAD to choose a different specialty, what would it be?
-rich spouse. ID, heme-onc, peds ID, general IM

Anything else you want to add?