Should I consider EM

[KanyeWes]

I wanted to bounce this idea off of random strangers without fear of repercussions.

I am burnt out. I don't want to get into the specifics as it can identify me. I will say that a large part of it is that I am in the bottom quartile in MS1/2 and am in the top 1/3 or 1/4 in MS3. I sadly am not competitive for a competitive specialty that I love, and am trying to find a specialty to match. This is really wearing me down.

My question is if EM should be an acceptable option for me. The way that I would practice EM would be moving meat (no offense, but I have seen multiple EP attendings use this term on SDN), deciding on whether or not to admit/dispo, and following algorithms with some critically thinking when deviating. I am fine with that. Plus, I have specialists to use when I am not sure what to do. I like that I don't have to completely fix/figure out the diagnosis and just move the patient upstairs. It becomes the internist's problem. I also like the rush, but am fully aware that it will wear away as the years pass. I like that there are procedures and that I am not just purely thinking. I am also perfectly fine with trauma coming in and calling the shots. I like that I am ultimately not the main doctor managing their chronic diseases. I want to let their PCP take care of that and all I am responsible is for stabilizing them. I have no qualms about dealing with drug seekers. If they make a big stink, I just get security. I like that when I am on, I am fully on and doing stuff with no down time. I feel so unproductive when I am just sitting there and would rather get all my work done early and leave. I want to work all nights if I go into EM as I am a night owl.

Things that I don't like are constant documenting and liability. But that isn't unique to EM. I like practicing defensive medicine to cover my a. I wouldn't like to work with PA/NP arguing with me about the assessment and plan.

Do you think given my description that EM would be an ok fit? Do you think that I am at an increased risk for burn out in EM, even if I framed EM as moving meat? I don't think that my burn out would worsen if I go in with this mindset. I think it might actually improve because I willingly accepted it.

I don't like IM b/c rounding forever is a huge turn off for me. I also get antsy just sitting on patients. I don't like FM due to the preventative care aspect of it. I don't like to nag people to stop smoking or putting down the cheesy poofs. No to peds. I like working with children, but it mid levels will cont. to tear up that field. And I am concerned about Watson taking over in peds. I don't mind psyche, but I def like the medicine aspects more than the psyche components. I cannot do pathology. I am TERRIBLE with neurology but at my ED we just consult the neurologists for strokes et al.

Any thoughts are welcomed and appreciated. Thanks.

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[deleted480308]

I change what I said earlier about intriguing trolling

 

[KanyeWes]

I change what I said earlier about intriguing trolling

Thanks. Any thoughts?

 

[SamtheWise]

Figure out why you're 'burnt out', fix it with therapy/lifestyle change/medication/whatever you need to do.

Also, rather than just describing what you theoretically like about EM, have you rotated in it? That is the best and probably only way to really decide.

 

[green lantern]

With the competitiveness of EM riding there are tons of applicants who want to do EM because they love it not because it is an "acceptable" field. If you have that mindset I can't see any program wanting you.

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[brabbit2222]

You seem like a person I would not want to be around. Hope you find another specialty.

 

[RustedFox]

Besides EM, what other fields of medicine have you considered as a "fit"?

I'm legit asking here, because you seem to be legit asking for help and opinions. I can be a real smart@ss on here, but this is not one of those times.

 

[clibby]

No, you should not decide on anything right now. You are already burnt out and EM will not help that. You need to re-discover a passion for something in medicine or you will be miserable no matter what you choose. Unhappy people make those around them miserable and that is no good for a group, an office, an OR, or a department.

There also isn't much in what you are saying that doesn't also apply to rads/IR or anesthesia. Everyone likes EM for different reasons, but nobody likes it because they think it is just algorithms and consults. The inconsistant hours will also get to you if you don't enjoy being there at least part of the time. EM is often for those who like the fun of figuring out a diagnosis in an undifferentiated patient, doing procedures, and managing the occasional critical patient.

 

[gman33]

Just drop out now.
Med school is really the easy part.
No way would I want to deal with you as a resident.

Find something else you enjoy and do that.

 

[pepperinyoureye]

horrible trolling attempt

 

[SpacemanSpifff]

I wanted to bounce this idea off of random strangers without fear of repercussions.

I am burnt out. I don't want to get into the specifics as it can identify me. I will say that a large part of it is that I am in the bottom quartile in MS1/2 and am in the top 1/3 or 1/4 in MS3. I sadly am not competitive for a competitive specialty that I love, and am trying to find a specialty to match. This is really wearing me down.

My question is if EM should be an acceptable option for me. The way that I would practice EM would be moving meat (no offense, but I have seen multiple EP attendings use this term on SDN), deciding on whether or not to admit/dispo, and following algorithms with some critically thinking when deviating. I am fine with that. Plus, I have specialists to use when I am not sure what to do. I like that I don't have to completely fix/figure out the diagnosis and just move the patient upstairs. It becomes the internist's problem. I also like the rush, but am fully aware that it will wear away as the years pass. I like that there are procedures and that I am not just purely thinking. I am also perfectly fine with trauma coming in and calling the shots. I like that I am ultimately not the main doctor managing their chronic diseases. I want to let their PCP take care of that and all I am responsible is for stabilizing them. I have no qualms about dealing with drug seekers. If they make a big stink, I just get security. I like that when I am on, I am fully on and doing stuff with no down time. I feel so unproductive when I am just sitting there and would rather get all my work done early and leave. I want to work all nights if I go into EM as I am a night owl.

Things that I don't like are constant documenting and liability. But that isn't unique to EM. I like practicing defensive medicine to cover my a. I wouldn't like to work with PA/NP arguing with me about the assessment and plan.

Do you think given my description that EM would be an ok fit? 1) Do you think that I am at an increased risk for burn out in EM, even if I framed EM as moving meat? I don't think that my burn out would worsen if I go in with this mindset. I think it might actually improve because I willingly accepted it.

I don't like IM b/c rounding forever is a huge turn off for me. I also get antsy just sitting on patients. I don't like FM due to the preventative care aspect of it. I don't like to nag people to stop smoking or putting down the cheesy poofs. No to peds. I like working with children, but it mid levels will cont. to tear up that field. And I am concerned about Watson taking over in peds. I don't mind psyche, but I def like the medicine aspects more than the psyche components. I cannot do pathology. I am TERRIBLE with neurology but at my ED we just consult the neurologists for strokes et al.

Any thoughts are welcomed and appreciated. Thanks.

2) Figure out why you're 'burnt out', fix it with therapy/lifestyle change/medication/whatever you need to do.

Also, rather than just describing what you theoretically like about EM, 3) have you rotated in it? That is the best and probably only way to really decide

1) Going into a field like EM you would likely be at increased risk for burnout, due to the relatively higher rate of burnout in the specialty. It's difficult to say whether adopting the above perspective would be protective against burnout. My initial thought is that this is unlikely to be helpful long term, because you attitudes about the specialty are highly likely to shift during your training. You like the idea of "treat 'em and street 'em" right now, but that is sort of an abstract concept that has little basis in a reality you have experienced.

2) For me, this is absolutely key. From anecdotal experience, it can be difficult to pinpoint a single cause for burnout. Developing protective practices that work for you is essential if you want to have a sustainable career in medicine. Developing these in medical school, before the demands of residency completely absorb you, would be ideal.

3) To me it seems like you're in the contemplative stage of changing paths, which is fine. You list a lot of good things about EM that I also found attractive when considering the specialty. If you haven't spent a solid amount of time in the ED, or have not had significant interactions with an EM doc, find a way to meet up with someone to shadow or have a frank conversation about the specialty. If you're truly interested in pursuing EM, and you're a rising MS4, you have to get a few things lined up quickly - primarily away rotations.

 

[Venko]

Life can be tough. With that said, medical school is much easier than a life of emergency medicine. You should strongly consider the fact that EM has a high burn out rate already. Regardless of how much you like or don't like it, it may not be good for your health to be in this specialty.


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[deleted109597]

Don't feed the trolls

 

[KanyeWes]

Besides EM, what other fields of medicine have you considered as a "fit"?

I'm legit asking here, because you seem to be legit asking for help and opinions. I can be a real smart@ss on here, but this is not one of those times.

It's another road specialty.

I guess I should have created a new account with a better screen name instead of reusing this old one. But I really didn't think it would have been such an issue since my posts are actually thoughtful if anyone actually reads through it.

I have a real predicament. I am not competitive for the specialty that I want. So I have to pick something else. This is not uncommon. It's life.

I have rotated through EM. It's ok. It's much tolerable than IM and FM by leaps and bound, which I absolutely cannot do. It is a mix of a little of everything and I would be both thinking and doing. Of all the residents that I asked, I got answers most similar to mine (they hate everything in medicine, they value time off, mix of everything, great demand and pay, it's a specialty that mediocre students can actually attain). Could be just my home institute though.

My mentors in EM, but they don't know how I feel due to concerns about repercussions. All faculty talk and I don't want it to get around that I am burnt out. Attendings and residents love me, but am still walking around with the dumb kid label despite doing well in clinicals. It is hard to shake first impressions, as I am clearly experiencing this right now on this forum.

 

[KanyeWes]

Life can be tough. With that said, medical school is much easier than a life of emergency medicine. You should strongly consider the fact that EM has a high burn out rate already. Regardless of how much you like or don't like it, it may not be good for your health to be in this specialty.


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I understand attending life is much harder than med student life. But, I like patient care infinitely better than the basic sciences. I am better at problem solving than straight fact regurgitation. Hence the spike in my rank.

My burn out is multifactorial. I regret going to medical school since matching into my dream specialty is out of reach, but cannot leave as I have no means to pay my loans. I am constantly stressed about exams. Having exams so frequently wears me out as I fret about failing and having to go to my deans to have "the talk."

 

[deleted109597]

It's another road specialty.

Don't do it for this.

I guess I should have created a new account with a better screen name instead of reusing this old one. But I really didn't think it would have been such an issue since my posts are actually thoughtful if anyone actually reads through it.

Your original post isn't as thoughtful as you think.

I like that I don't have to completely fix/figure out the diagnosis and just move the patient upstairs. It becomes the internist's problem.

If a student ever said this to me their career in EM would be effectively over. This is so not even close to being true that it's been called trolling, for good reason.

 

[kjamess]

I like that I don't have to completely fix/figure out the diagnosis and just move the patient upstairs. It becomes the internist's problem.

ya, but no one in the hospital would respect you if you operated like this, including your colleagues in the ED

 

[da8s0859q]

No way would I want to deal with you as a resident.

If a student ever said this to me their career in EM would be effectively over. This is so not even close to being true that it's been called trolling, for good reason.

ya, but no one in the hospital would respect you if you operated like this, including your colleagues in the ED

Basically my thoughts as well, OP. It's as if you're thinking of wanting to be the kind of emergency physician that, well, doesn't make for a good emergency physician.

Yes, I like being able to hand off to the hospitalists when I'm "done." However, up to that point, a lot of thought and workup has gone into things, with a solid MDM on why I did / didn't do what I did / didn't do and where we are thus far.

It's another road specialty.

EM isn't a ROAD specialty. If anything, it's a quasi-lifestyle specialty at best.

 

[SpacemanSpifff]

It's another road specialty...

I have rotated through EM. It's ok. It's much tolerable than IM and FM by leaps and bound, which I absolutely cannot do. It is a mix of a little of everything and I would be both thinking and doing. Of all the residents that I asked, I got answers most similar to mine (they hate everything in medicine, they value time off, mix of everything, great demand and pay, it's a specialty that mediocre students can actually attain). Could be just my home institute though.

My burn out is multifactorial. I regret going to medical school since matching into my dream specialty is out of reach, but cannot leave as I have no means to pay my loans. I am constantly stressed about exams. Having exams so frequently wears me out as I fret about failing and having to go to my deans to have "the talk."

Hmmm... hates "everything in medicine", seeks a specialty which is "attainable for mediocre students", gets worn out by frequent exams.
The more information you provide, the more I am inclined to agree with the other posters: EM ain't for you buddy.

 

[shoal007]

you really should push for your dream speciality. You still have STEP 2. nothings done until you say it is. nsgy, ortho, ent, uro can all br accessed by sheer determination. it may be hard, require scarfices and time. One has to be happy. Good luck.

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[brabbit2222]

you really should push for your dream speciality. You still have STEP 2. nothings done until you say it is. nsgy, ortho, ent, uro can all br accessed by sheer determination. it may be hard, require scarfices and time. One has to be happy. Good luck.

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He wants to do derm, but based on what he's saying in this thread, I don't think he's doing it for the right reasons. He is certainly welcome to try, but if a derm mentor sees this kind of attitude lurking beneath the fake enthusiastic demeanor, even for a brief moment, his chances of matching derm would be effectively nil. They're already very, very small.

 

[gutonc]

He wants to do derm, but based on what he's saying in this thread, I don't think he's doing it for the right reasons. He is certainly welcome to try, but if a derm mentor sees this kind of attitude lurking beneath the fake enthusiastic demeanor, even for a brief moment, his chances of matching derm would be effectively nil. They're already very, very small.

Derm is one of the few specialties that will actually consider your M1/2 grades. Derm is an absolute non-starter. But so, apparently, is nearly every other specialty for the OP.

 

[enalli]

OP, I was starting to get burned out in medical school and went into EM with a positive attitude and mindset (I had drunk the kool-aid, so to speak). Despite that, I'm even more burned out now. I imagine it'll be much worse for you since it sounds like you don't fully understand, respect, or like the specialty for what it is. I don't think EM is right for you.

I don't think this is a troll post at all. I would venture to say his attitude toward and understanding of EM is the norm for people not in the field.

I'm not sure why people keep trying to claim EM is one of the "competitive" fields. No, not everyone who applies gets in. Yes, it is getting more difficult to get in each year. But you should know that when people talk about "competitive" fields, they actually mean near-unattainable residencies like neurosurgery and dermatology. EM is not in that category. So EM requires decent board scores, good clinical grades, and solid interviewing skills. Guess what? So does almost every other specialty. Repeating the mantra that EM is "competitive" will not elevate the cachet of our field.

 

[Venko]

OP, I was starting to get burned out in medical school and went into EM with a positive attitude and mindset (I had drunk the kool-aid, so to speak). Despite that, I'm even more burned out now. I imagine it'll be much worse for you since it sounds like you don't fully understand, respect, or like the specialty for what it is. I don't think EM is right for you.

I don't think this is a troll post at all. I would venture to say his attitude toward and understanding of EM is the norm for people not in the field.

I'm not sure why people keep trying to claim EM is one of the "competitive" fields. No, not everyone who applies gets in. Yes, it is getting more difficult to get in each year. But you should know that when people talk about "competitive" fields, they actually mean near-unattainable residencies like neurosurgery and dermatology. EM is not in that category. So EM requires decent board scores, good clinical grades, and solid interviewing skills. Guess what? So does almost every other specialty. Repeating the mantra that EM is "competitive" will not elevate the cachet of our field.

For what it's worth, competitive is a vantage point and that's why you're frustrated by the differing opinions.

To someone who is in the lower half of their class (remember half the graduates are), EM may be competitive as they do not have a very good chance of matching any more. To someone in the upper quartile (again 1/4th of the grads are) EM doesn't seem competitive but as you mentioned neurosurgery and dermatology may seem competitive.

There are large chunks of graduates who see the world quite differently on this issue. That doesn't make anyone wrong, just highlights that competitiveness is relative to your stance as the speaker.

I doubt people believe that if we say something enough times it will be true. I have been trying to say I'm six feet tall for decade and it hasn't done anything for me...

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[GonnaBeADoc2222]

Wow, lots of discouraging words for the OP...seems like a guy just trying to be happy, although maybe doesn't have the best perspective on EM...ya know, since he hasn't lived it yet. I wonder if this "burn-out" thing is a self-propagating phenomenon within our community, and medicine in general.

To the OP, I'd say this:

1) Maybe it's possible dream specialty isn't out of reach? Apply everywhere and have a backup. There were people in my med school class that on match day, we were all like "That person matched in that specialty?!...At that place?!"

2) I like EM. However, I don't think it was written in my DNA or the stars that I had to be an ER doc or that I wouldn't be equally happy in another field. Medicine is this weird thing where for some reason (in order to be competitive for most fields) we make student pick what they want to do before they've actually tried it. You don't have to be God's gift to EM or the most up-beat person ALL THE TIME to be a great ER doc.

3) Would very much caution the OP about the concept of being a ROAD specialty. TBH, I don't think that concept really exists much anymore as all of these "ROAD" fields have been feeling the heat of "more production, for same pay" pattern lately. For EM in particular, I think medical students have a skewed perception since we usually work far fewer clinical hours than the average physician. It is very true that there are not many jobs in America where you can work ~25-30 hrs/week and make $300+K/yr. HOWEVER, those hours are HARD, and you are EARNING that money. The medicine is seriously the easiest part - If I could practice in a vacuum where people did exactly what I wanted whenever I wanted I would have the most amazing job in the world. But this isn't the reality and the constant interruptions, "hey look at this EKG", "hey I have this person on the phone", "hey fill out this form", "hey we're gonna reject this admission have fun", "hey you saw 20 pts in 8 hours but you didn't do this one thing so you suck"...DOES mentally and emotionally wear on you.

Just things to keep in perspective...good luck!

 

[Venko]

Not sure if anyone else is unfamiliar with the term like me...

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[witzelsucht]

You could practice family medicine, ship everyone with hypertension to cards and 'beetus to endo, train your techs to do medicare annual wellness visits, and listen to old people ramble on while stoned or on benzos and collect your $200k without having to stay up all night on christmas eve if you just want to refer, do algorithms, and not be a doctor

 

[throckmortonDO]

Radiholiday
patholiday
optholiday
Sell out and be a doc for humana or something

or chock it up to being tired from med school. do IM and then figure out a subspecialty.

or drop out and be a dentist.

I dont have any other ideas. EM doesn't sound like a good fit. you need to be very flexible and learn that things in EM are mostly out of your control. doesn't sound like you like that.

 

[GandalfTheWhite]

OP, it sounds like you just want to do the least amount of work possible and not really put an effort in by 'moving the meat' or making your patient 'the internists problem'. No specialty appreciates that mentality. But if that is your expectation, then specialties that are primarily solo based rather than teamwork oriented might be best suited for you such as pathology, radiology, or being a medical examiner. Your options are limited, but you can also be a consultant for companies, but that has more hours per week than you would seem to care for. You could also do IM as a hospitalist. No rounding. 7 days on 7 days off.
Your personality is also more suited towards the surgical profession since you dont want to focus on disease processes or preventative medicine and want to wash your hands of your patients by turfing them to IM. This attitude is more in line with surgery where you basically perform the surgery, and then ship the patients off to ICU. You do round, but its about 5 minutes per patient, if that.


To what the other posters said:
I would argue that EM IS a lifestyle specialty, based on your definition of lifestyle. If that means 9-5 everyday with all weekends and major holidays off, then no its obviously not.

But if you mean that you work 13-14 8-9 hour shifts per month with the remaining days off, that you can effectively take off 2 months because you feel like traveling, then come back and pick up where you left off, that if you want to work just 1700 hours the whole year, or if you feel like bouncing around making extra cash on locums, then it most definitely is. Sure you miss a few major holidays and outings with friends/family, the net gain of free time to spend the regular days with your family far outweigh the holiday time IMO.

 

[LilKangaroo]

OP, your story sounds a lot like mine, except I loved medicine and pediatrics. I also disagree with some of your assessment of the field - I personally don't believe in making the patient another person's problem, I want to consult as little as possible, and a lot of EDs are staffing APP's. I'm also concerned about your burnout at this point and the impact it could have on your future in the field.

I think you should consider radiology or anesthesia. I feel like these specialities have a reputation for being competitive, but right now they are pretty manageable. The only person from my school to not match into EM SOAPed into anesthesia at a reputable program. Radiology has a high average board score, but close inspection of the Charting Outcomes shows that nearly everyone who wants to matches at any board score. Both fields are fairly procedure heavy. If you haven't done rotations in these fields yet, keep in mind that these fields are very hard to simulate in the med school setting. Both have decent hours for medicine and really good pay. They seem to be some of the happiest people (as attendings) I've seen, which is extra important for you as you're already burnt out. If you're actually interested in resuscitation, anesthesia is the way to go. If you like being mentally challenged (and always busy), radiology is your bet.

I think you'd be a fine ER doc, but I'm not convinced you'd be happy in the field.

Also, you haven't mentioned surgery at all...?

 

[anonperson]

Hmmm.
Doesn't like medical care in general. Check
Wants to pass off work to others. Check
Make little to no meaningful contribution to patient care. Check

Wait. Are you one of the dozens of useless Vice presidents from my hospital? If not, I think you may fit in!

On a serious note. You just mentioned you liked psychiatry and pediatrics. Just go with one of those. The mid level creep is not going to stop you from getting a good job and is overblown . Psychiatry can be decent if you open up an outpatient clinic that is cash only which is not that hard due to the low overhead.

You have plenty of options within your reach.

Can always do FP or IM and work urgent care/locums/hospitalist.

And let's be real, no one loves dermatology that much (I think it was alluded that it was the dream specialty). It's a relatively chill residency with a great earning potential and no inpatient duties (which are all valid reasons to want to match in it). I'm sure if the pay was on par with peds or FP, med students would be saying "you know, I don't think I like skin that much."

But to go into medical school for the sole reason of one specialty is dumb. If you love it that much, drop out, become a PA and join a derm group. Problem solved.

 

[KanyeWes]

My dream specialty is actually ophtho. Unlike derm, there are no real ways to rematch even after doing a residency. I am very envious of "optimetric surgeons". My understanding was that ophthalmology would always be the ones doing eye surgeries....how things have changed recently. I did think about dropping out of med school and starting optometry school. But it would cost too much money, would have to do all of my prereqs again since they are only good for 7 years, get new letters, and have to deal with the stigma of being a med school drop out when applying. On advice of my deans, I stayed, which I of course regret.

Thank you for all of the advice. I will send applications to ophtho even though I am not competitive for those programs. I concede that I am not a good fit for EM, or medicine in general. I am merely trying to make lemonade out of lemons. With that being said, I cannot stand IM or FM. I guess this is my mess to figure out. Feel free to close the thread.