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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

  • CordMcNally CordMcNally 
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    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.

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    I would highly recommend doing a residency in EM if one wants practice in an emergency department. Some people may try to practice at lower acuity places but sometimes those are the places that receive the biggest train wrecks and you have the least amount of practice. I’m certainly not saying you aren’t a competent physician but one ED our group took over had FM docs staff it and looking back through the notes and various complaints and workups, I’m absolutely amazed they didn’t all get sued multiple times a year and have way more deaths.

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    #236037 Reply
    Avatar RocDoc 
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    I would highly recommend doing a residency in EM if one wants practice in an emergency department. Some people may try to practice at lower acuity places but sometimes those are the places that receive the biggest train wrecks and you have the least amount of practice. I’m certainly not saying you aren’t a competent physician but one ED our group took over had FM docs staff it and looking back through the notes and various complaints and workups, I’m absolutely amazed they didn’t all get sued multiple times a year and have way more deaths.

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    I agree with you Cord and docs currently in training should do an EM residency if they want to do EM. I’m an older doctor and at the time I started doing Emergency Medicine a quarter century ago, there were not many residency trained EM docs.

    #236047 Reply
    Avatar Brains428 
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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.

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    Nucs would actually be a great idea. I think a lot of the residencies phased out, but they’re now being re-introduced via a shortened DR pathway. Basically, 1 year intern, 3 years general rad, 1 year dedicated Nucs. You do a few months of nuclear medicine the first 3 years during diagnostic rad. You get double boarded. People thought that nuclear medicine would go the away with pneumoencephalograms, but PET/CT isn’t going away, and somehow clinicians keep ordering gastric emptying studies. The only thing that’s been lost is cardiac to the cardiologists (which is actually practice dependent… some radiologists still read them).

    An every day nucs job would start around 9:30 am (the radiotracer has to be injected and simmer a bit), and you can have the tech stop scanning by 3 pm to leave by 5 pm. The overnight stat VQs can be sent to telerad.

    Because of the lack of radiologists who are dedicated to nucs, there is a gaping hole in the private sector to fill.

    Oh, and if you must see a patient every once and a while, you can give them therapeutic iodine. It’s figuring out the dose then counseling the patient and giving them a pill.

    #236052 Reply
    Avatar SValleyMD 
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    i cant imagine trying to find a job in nuclear medicine in today’s day and age..

    #236053 Reply
    MPMD MPMD 
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    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. 

    Click to expand…

    I would highly recommend doing a residency in EM if one wants practice in an emergency department. Some people may try to practice at lower acuity places but sometimes those are the places that receive the biggest train wrecks and you have the least amount of practice. I’m certainly not saying you aren’t a competent physician but one ED our group took over had FM docs staff it and looking back through the notes and various complaints and workups, I’m absolutely amazed they didn’t all get sued multiple times a year and have way more deaths.

    Click to expand…

    This is my experience as well.

    I think it’s sort of remarkable that so many people think that can do EM without training in it. How ridiculous would it be for me to say that I was sick of EM so was going to do a little anesthesiology or ICU on the side?

    The thing is that that non-EPs who dabble in EM don’t know what they don’t know and in my experience are fairly oblivious to what is often a wake of troubles they leave behind them. I could tell your stories.

    #236055 Reply
    Avatar jacoavlu 
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    one way conversations aren’t much fun

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    #236057 Reply
    Avatar Panscan 
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    God I hate v/qs….

    But ya rads is good. I know of tons of people who switched into rads and extremely few who switched out.

    #236058 Reply
    q-school q-school 
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    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. 

    Click to expand…

    I would highly recommend doing a residency in EM if one wants practice in an emergency department. Some people may try to practice at lower acuity places but sometimes those are the places that receive the biggest train wrecks and you have the least amount of practice. I’m certainly not saying you aren’t a competent physician but one ED our group took over had FM docs staff it and looking back through the notes and various complaints and workups, I’m absolutely amazed they didn’t all get sued multiple times a year and have way more deaths.

    Click to expand…

    This is my experience as well.

    I think it’s sort of remarkable that so many people think that can do EM without training in it. How ridiculous would it be for me to say that I was sick of EM so was going to do a little anesthesiology or ICU on the side?

    The thing is that that non-EPs who dabble in EM don’t know what they don’t know and in my experience are fairly oblivious to what is often a wake of troubles they leave behind them. I could tell your stories.

    Click to expand…

    isn’t that what nurse practitioners and PA’s do?

    #236059 Reply
    Avatar Brains428 
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    one way conversations aren’t much fun

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    Didn’t someone propose that we close a thread if it makes it to page 3 without an OP response?

    #236060 Reply
    Dreamgiver Dreamgiver 
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    OP finally fell asleep!

    #236062 Reply
    Avatar Charlie Munger 
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    Hey folks, sorry for the slow reply.  I have been a little busy filling out ERAS and trying to get my letter writers in order on top of just starting my EM rotation, but I have been reading through the replies and I appreciate all of the thoughtful suggestions.  I want to clarify something from my original post by stating that I don’t altogether hate patient interaction, I just don’t find continuity so rewarding that it makes up for the some of the monotony of following patients with chronic medical problems and nothing particularly interesting/acute going on. I also think it’s possible that I may actually enjoy something like pathology, as I liked the 2nd year of medical school much more than 3rd, but I think a lot of that had to do with the limitations and unfortunate realities of being a 3rd year medical student in general (subjective evaluations, vague responsibilities, etc).  I’m fairly positive that I want something broad in scope, relatively practical, and as in demand in as many places as possible, which is why I’ve been oscillating between FM/IM/EM throughout medical school.  I also dislike the OR in general, which essentially eliminates anesthesia.

    It seems like the general consensus is that my concern of lifestyle incompatibility may be justified.  And although I’m sure it hasn’t helped, my sleep issues actually predate my enrollment in medical school.  The trouble is, as I expected, I’ve really enjoyed my EM shifts so far.  Now I’m just trying to figure out whether or not I should suck it up and do something I’m a little more excited about, or stick with the safe bet where there’s plenty of jobs that would fit my preferred schedule.  Even if it’s not an ideal endpoint, it’s nice to know there are things like urgent care to fall back on if I do end up pursuing EM. Sorry, I know this probably isn’t the most satisfying update.

    #236131 Reply
    Avatar Gamma Knives 
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    Rad onc was mentioned earlier and is a great field (IMO). The hours are consistent and while I do follow some patients long term that is not a major part of my practice. However, it does not match desire to be “broad in scope, relatively practical, and as in demand in as many places as possible.” Good luck with your decision.

     

    As far as replies of original posters, I think we should wait at least 72 hours before considering closing a thread.

    #236140 Reply
    SerrateAndDominate SerrateAndDominate 
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    I say you get into a path rotation ASAP before applications go out

    Earn everything.

    #236144 Reply
    CordMcNally CordMcNally 
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    I also dislike the OR in general, which essentially eliminates anesthesia.

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    Is there something in general about the OR you don’t like? It’s fairly different on each side of the drape.

     

    I will say re: EM schedule: it’s as much of a blessing as it is a curse. Sure, I may work evenings, nights, weekends, holidays, etc. but I can take a week long vacation every month if I want. Not too many specialties have that kind of control. Sometimes I’ll get my schedule and I’ll have 5 days off in a row in addition to all my other requests so we may decide to do a trip somewhere.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #236147 Reply
    Avatar Charlie Munger 
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    I also dislike the OR in general, which essentially eliminates anesthesia.

    Click to expand…

    Is there something in general about the OR you don’t like? It’s fairly different on each side of the drape.

     

    I will say re: EM schedule: it’s as much of a blessing as it is a curse. Sure, I may work evenings, nights, weekends, holidays, etc. but I can take a week long vacation every month if I want. Not too many specialties have that kind of control. Sometimes I’ll get my schedule and I’ll have 5 days off in a row in addition to all my other requests so we may decide to do a trip somewhere.

    Click to expand…

    I was mostly just bored in the OR.  I know an easy explanation for this is that as a student you’re not really active in the surgery outside of holding a retractor or closing up every so often, but seeing how excited some of my classmates were just being there makes me feel like there’s a more fundamental personality difference at play.  I’m much more interested in the “why” than the “how”.  I’m know there’s plenty of intricacy behind doing even a lap chole, but to me the fun is working up the abdominal pain in the first place.  Likewise, I don’t think I would enjoy managing all those patients and ensuring they don’t crash during their surgery either.

     

    I would agree that for most of the people I know going into EM the schedule is probably the biggest draw.  Apart from the true overnight shifts I can understand that point of view. I guess that is the price you pay for the acuity, as opposed to hospitalist medicine where many problems can wait until morning.

    #236163 Reply

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