Wednesday, April 11, 2012

Why I didn't do Emergency Medicine

When you get to your fourth year of medicine, there are a lot of different paths you can take and each one probably would change your life entirely. This entry is about why I didn't do EM. If people like this entry, I can talk about other fields I was considering as well.

EM has a lot of awesome things about it, and in many ways would have been a perfect field for me. I really love procedures. I work quickly. The hours are very reasonable. The pay is great.

Here's why I didn't do EM:

1) For some reason, I really hate shift work. I like having a specific amount of work to do and know that I can leave when I finish it. Looking at a clock makes me physically ill.

2) I can't sleep when the sun's out. I'm like a reverse vampire. Or a human being. Anyway, those night shifts aren't going to work for me.

3) I actually like continuity of care a lot. I even like the annoying patients when I get to see them continuously and build a relationship.

4) If there's some new horrible killer virus out there, who's going to get exposed first? Certainly not the physiatrist.

5) Although I like the idea of knowing everything about everything, I realize that it's actually impossible. And that would eventually make me second guess myself to death and all the consultants would hate me.

6) Let's face it, too competitive. If you want to live where you want, you have to lower your expectations.

Also, what do you call an ER physician? An emergentologist? Emergentician? There's no well known name for it. Unlike physiatrist. Everyone knows what this is.

I guess that's all I could come up with. I guess it all came down to the fact that when I was on my ED shifts, I wanted to shoot myself in the head. That's how you know.

35 comments:

  1. Why not OB/gyn?

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  2. Yes please, more of these!

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  3. Physiatrist? That's someone with a degree in Physical Therapy, right? ;-)

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  4. This is a great idea for recurring posts!

    As a Pediatrician/ER doc, I think you accurately reviewed the key pros/cons of EM. Exactly why I chose the field - love shift work, have no problem shifting my circadian rhythm and day-sleeping, had trouble setting boundaries with patients in long relationships, etc....

    I will object to your last point. We get called "ER Doctor" and everyone from little kids to the lady who cuts my hair knows what that is. I assume you were tongue in cheek that "everyone knows" what a physiatrist is.

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  5. yes night shifts sound a bit tacky.. A person who works in ER department can be called an intensivist I guess.. And I really love the reasons you have mentioned..the cons specially. !! The first one to face a rare virus.. So true..

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  6. Great idea Fizzy! I feel the same way about shift work. I used to play a game with myself where I'd see how long I could go without looking at my watch. Not a good sign.

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  7. No, a physiatrist is a psychiatrist, I'm pretty sure :)

    I could do an ob/gyn entry, but it's not a field I was remotely considering, so it wouldn't really be a fair shake. I'd probably do fields like neurology and pediatrics and primary care, since those were the other fields I was strongly considering.

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  8. Number four is my favorite! And also the reason I'm backing away from infectious diseases...

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  9. Like! Both useful and funny. How about radiology?

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  10. Totally agree on the reverse vampire thing. I recently did a two-week stint of consecutive nights, and it made me wish for death. So glad I don't have to do that again for at least a few months.

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  11. Love this! You came so close to being an internist - why not IM?

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  12. These are awesome, more please. I'm still considering EM, but considering that I'm still an undergrad, that consideration could go on and on and not really impact the future until it gets here. But yes, please, pros/cons of the things you considered, pretty please Fizzy. :)

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  13. Like!! Do anesthesiology, derm, basically, anything else you can think of!! :D

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  14. What do you mean by too competitive? Competitive to get into a residency or competitive to be gainfully employed? Or both?

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  15. Most people who don't read this blog think a physiatrist is someone who builds atomic bombs!

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  16. I've always thought that a career in Radiation Oncology would be ideal. Regular hours, low insurance premiums, high pay, no emergency calls, plenty of opportunity for working with clinical trials, plenty of opportunity for doing original research.

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  17. I wrote a bunch of them and scheduled them over the next couple of months.

    Anon: By "competitive", I meant competitive to get a residency spot. EM isn't super competitive, but the area where I wanted to live was so desirable that even prelim spots were very competitive to get. A competitive residency in a competitive region requires top scores, whereas I just had good scores. So that eliminated several options for me.

    THT: A lot of people agree with you. That's why rad onc is one of the most competitive residencies to get into.

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    1. Awesome!! Looking forward to reading them!! I'm addicted to your blog!!

      Also, thanks for allowing anonymous comments. :)

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  18. Statements like #4 are why I have a girl crush on you.

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  19. 4) If there's some new horrible killer virus out there, who's going to get exposed first? Certainly not the physiatrist.

    Whaa?

    What is the Bayesian prior probability distribution, or in terms of Shakespearean literature, "What’s past is prologue," of physicians dying from newly emerging infectious disease epidemics? Isn't this kind of like not wanting to be a pilot because one is trying to minimize the risk of being killed by a meteorite?

    Secondly, if we're dealing with epidemics, then anyone who is dealing with strangers is going to be facing increased risk, so unless you practice as consultant and communicate solely by phone or computer, you're going to be facing risk of infection somewhere in your life just like the rest of the public.

    But it was funny.

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  20. let us compare - A practicing physician is being insulted by a dude named "whorefinder."

    I could go on, but I think the above set-up is more than sufficient to wrap up the argument and conclude that you need to start taking your meds again.

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  21. I'm Caucasian so if I'm an affirmative action case, they screwed up bigtime :)

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  22. I'm so looking forward to meeting people like THT when I start medical school. : /

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    1. Thank you for that compliment (unless I'm misreading you) but the side of me that you're seeing here you'd never see in my professional workplace for that would lead to career suicide in an ideological monoculture. The only time I'd ever feel comfortable exercising academic freedom is after being granted tenure and sitting on a number of research grants. The smallmindedness and ideological rigidity of academia at present is depressing to behold.

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  23. Also, Fizzy is right in the sense that in EM, you do a lot of procedures on people whose disease status you do not know, in a population that is probably more likely to have nasty diseases -- i.e. people without regular access to health care. So while perhaps Fizzy meant SARS, HIV and Hep C suck also.

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    1. -Ordinary people run a risk of catching a disease.
      -Physicians run a higher risk than ordinary people because they are generally around sick people, but they mitigate this risk by taking elementary precautions in the office - gloves, good hygiene and such that ordinary people don't usually follow.
      -EM run higher risks but they also take more precautions and work in an environment which is designed to mitigate the risks.

      The point is that when we see increased risk we also see measures designed to deal with that risk. I don't have data on hand which explicitly measures the effectiveness of the mitigation strategies with respect to the increased risk levels, but we can look at the instances of infection which do result from contact and that would probably be a better measure of the risk associated with treating infectious patients.

      I happen to think that it is best to focus on actual data of physicians contracting an infection from their workplace than it is to focus on the higher risk patient profile for the actual infection risk shows the end result of mitigation strategies which have failed.

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  24. Oh, you allow anonymous comments now? That's nice. I've wanted to comment, but not having any of the other accounts, wasn't able to.
    And I'm looking forward to more of these, please!
    ~Jasmine

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    1. I'm allowing them for now. If it gets abused, I'll have to disallow them again.

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  25. Could you do the same for Peds?? :D

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  26. Please do continue these! I'm just an MS1, but I've always been curious how people rule out other specialties. I feel like I'm going to have a really hard time deciding.

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  27. Yes, please do more! I'm about to start 3rd year, so any insights (besides hating my life on certain rotations) is appreciated.

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  28. Yay! finally i can comment!

    I love your blog, Fizzy. I find we share a lot of views of life as a med student/intern. it's nice to know other people share my views. also, am currently doing my ED rotation. Completely agree with you. as a student, i thought ED may be an option because i like doing minor procedures. but after doing just 3 weeks of it, i've had enough of the shift work. and yes, continuity of care is important to me. i find myself looking up a lot of pts i see through ED to see how they're doing, whether they were discharged, etc. can't wait for more of these entries!

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  29. Half your reasons are exactly why I want to go EM (though being pre-med that of course is very subject to change).
    I don't mind shifts, I function best in a fast pace environment, I'm bad at building good long term relationships, and I function the best at the ungodly hours of night time. Like right now its 2am and I'm wide awake. Always been nocturnal.

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  30. Im leaving it and im nearly at the end. It sucks and doesnt get better.

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