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

  • q-school q-school 
    Status: Physician
    Posts: 2629
    Joined: 05/07/2017

    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.

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    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.

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    i’m not sure i agree with your assessment of hospitalist work, but as long as you are happy.

    i actually think hospitalist is a better fit, depending on how you prioritize the sleep situation.  you can be virtually guaranteed of not working nights in many hospitalist programs.   in addition there are many that are true week on/week off which has pros/cons, and there are many with open scheduling.  likely even more geographic flexibility than emergency med programs.  and if you pick the right place, acuity can be high.  in private practice, sometimes the ED starts the workup, determines they need admission, but final diagnosis occurs in the hospital.  ymmv.


    #236168 Reply
    Avatar Anne 
    Status: Physician
    Posts: 1159
    Joined: 11/07/2017

    It’s really difficult (impossible?) to know based on basically one year of clinical rotations what specialty you will be most satisfied with the rest of your life. I really hate that our medical education system is set up so that you have to decide so prematurely.

    My attitude towards getting to know my patients has changed over the years and yours might too. Right now working up the acute abdomen seems interesting because you haven’t done it so much and it’s new and exciting. The 1000th acute abdomen you see might not be so intriguing. You might start to actually be interested in knowing some of the more personal details of people’s lives because that can keep it interesting. Or maybe not.

    I think you are underestimating the amount of acuity and clinical problem solving that hospitalists encounter and overestimating the depth of the workup in the ER. People get transferred to the floor from the ER all the time without the ultimate question of what is going on answered–the question has been answered that this issue is acute enough to warrant further investigation. In the ER you will see a wide range of acuity, and seeing the non-acute stuff that doesn’t belong there but shows up there anyway can also be quite frustrating, especially at 3 AM. If you are at a decent academic center you can be shielded from that reality during your clinical rotations and think the ER is nonstop excitement.

    Good luck. That time of deciding what specialty to go into is one of the most stressful times because you feel like you have to get it right and you have such limited experience to inform your choice. People do switch down the road (I did).

    Avatar oysterblues 
    Status: Student
    Posts: 5
    Joined: 08/09/2018
    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.

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    Gamma knives – What do you think of the rad onc job market? Is this something to be worried about?

    #236213 Reply
    CordMcNally CordMcNally 
    Status: Physician
    Posts: 2806
    Joined: 01/03/2017

    but to me the fun is working up the abdominal pain in the first place.

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    That luster will wear off fairly quickly once you realized that many patients won’t get a firm diagnosis for their pain and they’ll all think you’re an idiot. The gap between what the true function of an ED is and what the public thinks the function is couldn’t be wider.

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

    #236215 Reply
    Avatar Gamma Knives 
    Status: Physician
    Posts: 169
    Joined: 06/25/2017

    Gamma knives – What do you think of the rad onc job market? Is this something to be worried about?

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    I cannot claim to have great insight into the job market as I am very happy with my job. I know that there has been concern due to the increase in number of residency spots. Many jobs in rad onc are never advertised so it is hard to know the market. Most of the interviews I did were either from cold calls(emails) or connections.

    My impression is that job market is very regional. Major metro areas are extremely competitive. Without contacts it is going to be difficult to get a job in a desirable city. We are also a small specialty so the job market can vary significantly year to year. Even a mid sized city may only have ~2-4 practices; any given year they may or may not be looking to hire. I have kept up with my home program and (to the best of my knowledge) all the graduates have found jobs consistent with their goals upon graduation. Not everyone got their dream jobs but I don’t think anyone was disappointed.

    My advice for medical students considering radiation oncology is that you should plan on being location flexible and if you have a strong preference of location try to develop contacts within the area.

    #236230 Reply
    Avatar Panscan 
    Status: Resident
    Posts: 1079
    Joined: 03/18/2017

    For every 1 real acute abdomen there’s like 20 negative/ bs like mesenteric panniculitis or etc

    #236237 Reply

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