Is Emergency Medicine right for me?

I always found this to be a very difficult question. It’s just like having to guess if being a physician is right for you. There’s really no way to know until you’re already a doctor, living the doctor’s life. And by this point… it’s too late! You can never really know until you’re living the EM life, but you stil have to make the choice. So…

…this is just the opinion of two EM doctors at Rush. Your results may vary. You may also want to look at:

  • Emergency Medicine Residents Association (EMRA). They have some great resources, including some incredible handbooks.
  • The “Emergency Medicine Clerkship Primer.” It’s a lot to read, but worth it.
  • Iserson’s Getting into a Residency: A Guide for Medical Students, Sixth Edition – it includes a good review and comparison of all specialties as well as advice on applications, interviews.. etc.

Let’s look at some of the commonly mentioned characteristics of EM, and then we will give our thoughts.

Variety. EM makes you a “jack of all trades, master of none.” Well, I wouldn’t say master of none. You’re a master of emergencies. With your training, you’ll be able to handle the emergent aspects of many disease processes. We may not handle long standing hypertension over years, but we can manage a hypertensive emergency.   As an emergency physician you must be prepared to deal with any person with any given complaint that walks in the door so if you variety there are few if any specialties that rival emergency medicine in this respect.

  • RP:  Personally, this is one aspect that draws me to the field. The downside is that there is a lot of stuff to know. You can never be on top of everything. I suspect that’s true of all disciplines.
  • PC:  For me the variety is one of the most exciting aspects of emergency medicine.  Not knowing what may come through the door next but knowing that regardless of what it is I am going to be able to deal with it is exciting.  Whether it is the critical unresponsive patient or the man that got a crack rock stuck in his ear (yes, it happened) emergency medicine training prepares you for the skills & innovation to deal with both.

Procedures. If you like to do procedures, we definitely have a lot under our jurisdiction.  Many emergency physicians enjoy being able to mix procedures with their clinical practice although one must be aware that the mundane procedures (e.g. laceration repairs, incision and drainage of abscesses) far outnumber the adventurous procedures (e.g. thoracostomy tubes, intubations).  Again, however, you must be competent in both as you never know which you may have to do next.

  • RP: There are plenty of procedures to be done. With this comes a lot of responsibility, though. There are plenty of ways for things to go wrong as well. You should know what you’re doing. Once you do, it’s kind of rewarding to do something with your hands as well as your head.
  • PC:  Doing procedures during your shift can be very rewarding.  Be wary of choosing emergency medicine for the procedures though as sometimes you may go several shifts without doing anything procedural and other days you may have to incise and drain in areas you hope to never see abscesses again.  These moments however are balanced by the satisfaction of a smooth intubation or thoracostomy tube placement.

Acuity. Everyday isn’t a crazy. Yes, there’s lots of sick patients, but there are way more people who have no access to health care and come in with run-of-the-mill primary care issues.   Only about 5-10% of our patients are critical enough to warrant ICU admission so you will see many more primary care problems than crashing patients.  That being said, those 5-10% of patients are more than you will see in the vast majority of other specialties.

  • RP:  Some days I love it. Some days I dread it. Ultimately, I’d rather take care of sick patients.
  • PC:  Most of us get into emergency medicine because we enjoy taking care of the unstable, ‘sick’ patients.  Those patients will often keep us coming back for more but you must be aware that most days you are more likely to feel like a primary care doctor for those with poor access to primary care physicians.

Lifestyle. I’m going to start right off the bat and tell you that the EM lifestyle is not easy. Yes, we work only a few days a week. And yes, when we’re off, we’re off. We don’t have to carry a pager. There is the possibility of going part time and flexibility in scheduling (very helpful when you have a family). You can also pick up and move somewhere else. You don’t have to build a practice base. However, it can be socially isolating. When your friends ask you out to a concert on Friday night, you reply “I have to work. Anyone free Tuesday night?” No one else ever is.

The biggest difficulty is cycling between days and nights. The older you get, the harder your body finds it to adjust to this changing schedule. The reason we don’t work that many days is because this constant changing is exhausting. There are ways to compensate for it, though.

  • RP: for me, one challenge is that I have to work a lot of weekends that most people have off. This prevents me from seeing family on Thanksgiving, Christmas and New Years. Also miss whatever is going on during the weekends. Usually I can get one of those days off, but not all. However, the EM schedule lets me have the flexibility to take my kids to school every day – though I end up working a lot of evenings and nights to compensate.
  • PC:  The shift schedule is both the best and worst thing about a life in emergency medicine.  I love having random weekdays off to do the things you enjoy doing but that often comes with having to work a weekend day when everyone else is doing the things you enjoy doing.  Overall you work less clinical hours that any other specialty in a month, however when you are at work it is often at a break-neck pace.

What’s the job market like?. Well, there is still lots of demand for EM trained, board certified EM physicians. Some areas are wide open (ie, most of Texas), while others are tough to crack (ie, Austin, TX… and Chicago… and Denver… but not impossible). The pay varies by region and whether one practices in private practice or academics.  When compared on a per hour basis with other specialties the pay for emergency medicine generally falls in the middle-upper echelon of salaries, though this should not be a reason for picking EM. You won’t last long, if you do.

Lack of Follow-up. Is this a plus or a minus? I don’t know. If you want to have relationship with your patient that spans years, you won’t get that in EM.

  • RP: While I miss that continuity, the many benefits of EM far overshadow that.
  • PC:  Emergency medicine sometimes offers continuity only with the patients with whom you would never want continuity.  Not having a longitudinal relationship with patients is a sacrifice of practicing emergency medicine so if you thrive on long term follow up with patients EM is probably not right for you.

Burnout. This used to be a problem when other physicians would staff emergency departments. The high acuity and different approach needed created dissatisfaction among these doctors who weren’t trained to handle this. EM physicians are specifically taught to handle these situations. Burnout is less of an issue.

  • RP: the day to day practice, I still find exciting and I can’t imagine when that won’t be the case. Working night shifts? Well, that’s getting harder as I’m getting older.
  • PC:  The burn out issue these days is primarily due to the rigors of shift work on one’s body and psyche.  This is a difficult thing to gauge when entering a specialty but I think provided you know this may be an issue down the line it should not be a deterrent if you know practicing emergency medicine is what you love.  I can’t imagine practicing any other specialty at this point but I know in 20 years that may not be the case.

Plagiarized works:

  • http://www.kcms.msu.edu/node/103 – great advice from David Overton, we only made it worse. Read the original if you want to know where it’s at.
  • Dr. Paul Casey’s brain – we left nothing behind
Is Emergency Medicine right for me?

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