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M4 debating specialty switch to EM, not sure I'm cut out for shift work

Home The Lounge M4 debating specialty switch to EM, not sure I'm cut out for shift work

  • Avatar trebizond 
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    As someone who went through the match this year, I just wanted to point out from above that Rad Onc is significantly less competitive now, with quite a few unfilled spots and unmatched programs this year (see SDN if you want a full discussion of reasons why).  I agree it can be a great field, but it seems like OP is pretty close to needing to decide with it being August of fourth year.

    I obviously can’t provide an attending perspective on specialty choice, but feel free to PM me if you have questions about the match.  I switched my specialty pretty late (not EM or IM), and I’m very happy I did.  After years of back and forth, I decided I needed to keep it simple and pick the field that I enjoyed most.

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    What’s the deal with rad onc? Why is it less competitive? I have read elsewhere that there is a perception of stagnancy and that heme onc has been taking off with the immunotherapy, but I have no idea why that would affect things, since it seems like they’re complementary modalities.

    #235741 Reply
    Avatar Outdoors 
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    As someone who went through the match this year, I just wanted to point out from above that Rad Onc is significantly less competitive now, with quite a few unfilled spots and unmatched programs this year (see SDN if you want a full discussion of reasons why).  I agree it can be a great field, but it seems like OP is pretty close to needing to decide with it being August of fourth year.

    I obviously can’t provide an attending perspective on specialty choice, but feel free to PM me if you have questions about the match.  I switched my specialty pretty late (not EM or IM), and I’m very happy I did.  After years of back and forth, I decided I needed to keep it simple and pick the field that I enjoyed most.

    Click to expand…

    What’s the deal with rad onc? Why is it less competitive? I have read elsewhere that there is a perception of stagnancy and that heme onc has been taking off with the immunotherapy, but I have no idea why that would affect things, since it seems like they’re complementary modalities.

    Click to expand…

    I think it’s mainly over a poor current job market and possibly too many new residency positions making it difficult to find attending jobs in big cities. I’m not in rad onc, so I can’t give a definitive opinion of my own.  I do think it’s a great specialty though.

    #235745 Reply
    q-school q-school 
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    A vote for rad onc if you’re smart enough. I was probably smart enough but didn’t realize it’s potential as a MS. Anesthesia will be tough if you don’t want to do nights/calls. I actually stopped both those 1.5 years ago but it came with a huge pay cut I couldn’t have handled if I were early career or weren’t an agressive saver the first decade. If you start out on that path in anesthesia, your career mobility and salary will be severely restricted. You would have a hard time as a fresh anesthesia resident finding a non-call Job and those that exist are 200k+ less than partners, especially in an environment shifting to CMGs and CRNAs.  ED likely some way.  Both anesthesia and ED are 24/7 shift work where new hires do a disproportionate share of nights/weekends/holidays.  Path is 100% diagnosis, 0% continuity, and can have great hours if that’s what you seek. I always was just staring at my eyelashes when looking in the microscope, but I have immense respect for pathologists and it would be on my short list if I could rewind time.

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    agree with you but in my experience, the job market for rad onc is least under your control in terms of geography.  as far as i can tell, job market is good historically speaking for rad onc.  anesthesia seems to have more geographic flexibility, even if you want to avoid call and night.   you may know more than me however.

     

    #235760 Reply
    Vagabond MD Vagabond MD 
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    Another vote for diagnostic radiology. There are plenty of jobs that do not require overnights, and a lot of jobs with no evening, too. And it’s all diagnosis.

    "Wealth is the slave of the wise man and the master of the fool.” -Seneca the Younger

    #235761 Reply
    SerrateAndDominate SerrateAndDominate 
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    Just wanted to add that “intern” year of path doesn’t suck, and it isn’t a hospitalist intern year 😉

    Earn everything.

    #235772 Reply
    Liked by Roentgen
    Avatar Brains428 
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    Downside to radiology is 6 years of training. Path is moving that direction with 2 fellowships. Both specialties are apparently in the cross hairs for AI and pigeons taking over.

    https://www.washingtonpost.com/news/speaking-of-science/wp/2015/11/18/can-mammogram-reading-pigeons-help-train-human-radiologists-an-animal-behaviorist-weighs-in/?utm_term=.327a47bd6734

    A chunk of radiology is shift work, but a large part of it isn’t. You can also work from home, if so desired. Mammo is pretty much 8-5 everywhere, and always a hot portion of the job market.

    Not to be a downer, but I would refrain from telling ANY residency that you have bad sleep patterns and it may influence your work.

    A big reason of not choosing EM for me was sifting through malingerers and psych patients would stress me.

    Good luck. Have fun 4th year. It’s a great time.

    #235814 Reply
    Avatar DCdoc 
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    Derm remains the one oasis in a desert of crap.

    #235851 Reply
    Avatar redsand 
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    Inpatient things like hospitalist (already said), maybe also neurohospitalist, inpatient psychiatry. Depending on the job, there might be outpatient diagnostic clinic positions for things like psychiatry (like a person who does intake but not follow up). I would wonder whether certain areas of neurology or cardiology would be more diagnosis focused. Also look into genetics; metabolic conditions require management (but acute crisis stuff is there since you said you find that interesting), but the majority of genetics is figuring things out. I would also think rheumatology would have room for someone who does a lot of diagnosis and less so management, for people who have musculoskeletal pain and other presenting complaints, for whom no one has figured out what they have.

    #235893 Reply
    Avatar redsand 
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    Also, just thought of this, primary care residency –> full- (or part-) time urgent care position. No need for continuity, you are still figuring things out, etc.

    #235895 Reply
    Liked by RocDoc
    Avatar RocDoc 
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    Also, just thought of this, primary care residency –> full- (or part-) time urgent care position. No need for continuity, you are still figuring things out, etc.

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    Here’s another vote for Urgent Care. I’m a family doc who did Emergency Medicine for most of my career but in the last few years after I turned early fifties I down shifted to mainly Urgent Care and work 13 shifts per month maximum, and get PTO days off, holidays off and work 9 AM to 9 PM. No nights. With bonus and 403-B match pay I’m over $300k annually and have a pretty easy schedule. Compared to how hard I worked in the ER, I feel like I am retired even though I’m full time with full benefits and health insurance. I know everyone says UC is being taken over by mid levels but our large hospital owned UC wants physicians because they want as few patients sent to the ER as possible. The directors say mid levels are helpful but send too many patients to the ER which causes the the hospital to lose  insurance contracts that they are vying for against other hospitals. Compensation was higher doing ER for all those years, but now that I’m old and FI, this UC is a nice way to wind down my career without having to quit.

    OP might do well working ER as a younger doc and consider transitioning to UC or part time ER once older and FI if this is the type of work you’d truly like to do. I still do some 1099 ER work as a side job but will only take day shifts at lower acuity shops at this stage of my career.

    Unfortunately, I agree with other posters that early in career, you will almost have to take some night shifts in order to make an income worth doing ER.

    #235919 Reply
    Liked by Anne, angeladiaz99
    Avatar PedsCCM 
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    I’ve got to agree with the folks who are advising you that EM may not fit well. I do a lot of shift work and it’s really not great for sleep hygiene. Agree with the others who advocate with Radiology, Pathology, Rad Onc. I also think hospitalist positions might fit what you want well, or even some of the IM specialties – especially ID. FWIW I use Ambien 1-2x per month to help reset after calls and I can frequently find an hour or two nap during my overnight shifts. Those short naps make a huge difference and are pretty rare/impossible for the EM docs I know.

    #235898 Reply
    Avatar Tim 
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    “Not to be a downer, but I would refrain from telling ANY residency that you have bad sleep patterns and it may influence your work.”

    Just saying. Anecdotally, the anxiety in your current career path isn’t unusual. Four hours tossing and turning is happening to a ton of classmates. It’s great to consider the long term, but with internship/residency/fellowship you will have the joy of every schedule imaginable.

    With so many options, just don’t lose sight of the type of medicine you will practice for many years. Good luck.

    #235944 Reply
    Avatar loeffy 
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    Inpatient can have issues too.  Inpatient consults/admissions can get redundant.  The true interesting cases/unicorns are few and far between, lots of bread and butter and pointless cases. If you’re not only doing admissions but are following inpatients then that gets old too, sometimes they just sit there, for reasons beyond your control.  Inpatient you have no choice over who you see and can often be the worst type of patient; frequent fliers, non-compliance, gross, unpleasant, weird, etc.  I imagine EM gets this a lot. IM still keeps a lot of options open, hospitalist, outpatient, subspecialty, locums, urgent care, EM (in some places), etc.  If you have a specific area you’d like to work, I’d also consider the job market. What specialties are in demand, the employers/groups available, etc.

    #235995 Reply
    Avatar Roentgen 
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    Another vote for diagnostic radiology (not interventional radiology.)  Also, Nuclear Medicine which is a residency that can be entered into from Internal Medicine OR Radiology, and is 18% diagnostic, and totally 9-5 job.  Rad Onc is a great suggestion too.

    #236002 Reply
    Liked by EndoRobert
    Avatar jhamaican 
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    Careful with IM. Many of your rotations you will be admitting overnight. There is also overnight call in the form of EM month and Neuro month rotations.

    #236029 Reply

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