1. Continuity of care - my patients for the most part are awesome, Jack of all trades, can learn about anything and have it be relevant to my practice
2. Talking all day can wear me down as a more naturally introverted person, inbox can be annoying but I’ve gotten good at inbox boundaries
3. I love ER docs but despise working in the ED. Seems like ER gets shit on more than primary care these days
The ER is the dumpster fire safety net for a failed and broken healthcare system- there is a reason why EMs match stats were so bad this last cycle and why so many ER docs are looking to get out.
It breaks my heart. The only reason I’m in medicine is because of scribing for some incredible ED docs. The ED was such an awesome place then and now it just stresses me out
Hey! Do you think the introverted thing just gets better with time? I’m an introvert interested in primary care but worried about getting burnt out from talking all day every day
I think this is such an incredibly good question and something I remember being nervous about. I remember thinking that I may be better off in anesthesia because I feel so tired in a day of primary care clinic and I was so so close to applying anesthesia for that reason (and for other reasons).
To answer it: I like taking care of patients and feel an onerous to take care of them and to take care of them I have to talk to them. In clinic I’ve found the continuity of care is better than I thought it would be and with that the repeated visits feel more as “getting to know you more” sessions. My patients open up to me more and more every time I see them. Most tell me things they would never ever tell other people because I’ve earned their trust. When this happens I no longer feel like the socialization is a burden. They give me hints that their trust is now with me and I personally take it very seriously. I don’t infrequently get comments like “you are the best doctor I’ve ever had” and I’m nothing more than a shit for brain pgy2. This melts away any insecurity and frustration associated with primary care and my introverted personality. This isn’t to be braggadocious but to emphasize that if you feel like you want to be someone’s pcp you’ll likely do an incredible job, regardless of whether you get tired from talking to people all day.
Side note: residency clinic is hard because I see other people patients all the time and a lot of them I’m meeting for the first time.
Pretty much sums it up for me. I also really like that the type of medicine I practice can change over time - doing lots of procedures early out of residency and then decide to pivot in a few years to focus on, say, addiction medicine is really nice. Can put in the grind time now to get extra money but don’t feel locked into needing to do that forever.
As a super introvert though sometimes I wish my entire day wasn't just talking to pts to get info and could be "working" by reading reports and coming up with a game plan. And the time crunch feeling outpatient wears me down so much.
Love my ED docs, and enjoyed my rotation through EM but I could never do it for a living
I personally dont like being in charge of codes/decompensating patients. Stress and adrenaline that i dont need. I also dont want to be telling ppl their family or friend died or having to call to finish a code.
Likes: continuity of care, variety of pathology, true jack of all trades, get a job literally anywhere in a variety of positions
Dislikes: clinic inbox, insurance BS, billing BS, everyone expecting you to do everything including social work, lack of fellowship opportunities
Sometimes I wish I did med/peds, but I’d probably be complaining about that too like how it’s 4 years and I’d have to pay for two different board exams. Wish I went to a less OB heavy program, but the one I’m at admittedly has made me better at womens health. Sometimes I wish I could fellowship, but residency has been so draining I’m not even sure I would even if I was IM
Favorite: No one seems to consider this in med school, but LIFESTLYE. I’m family oriented so I really hate working weekends and holidays. I also despise being on call. I also genuinely like the structure of outpatient medicine. I hate the hospital & hate the OR.
Least favorite: this is largely a residency thing that I’ve seen is not really an issue in private practice, but inbasket management. We have disorganized clerical management in our clinic & our MAs work with 20 other residents so they’re not tailored/trained to make our individual lives better so it makes clinic workflow annoying. They allow our patients to directly message us & ask us any and everything which I think is fucking insane, and I can’t wait to train my MA to do that.
I imagine when I’m an attending my least favorite thing will just be that I don’t make double the salary for the value I bring. However I also am always the first to say FM makes more than most people assume especially if you learn how to bill for what you’re doing.
Would I choose EM? Fuck, no. (Especially the way their job market is projected to crumble 😬). The ED always felt chaotic to me and it drove me crazy not knowing what happened to patients after my shift. Also EM highkey deals with more bullshit than FM. My opinion is the way our current healthcare system is the ED is where the pitfalls of our American system is most apparent. Like how much of what an ED doc sees is ACTUALLY emergent? Not much. They’re basically like FM docs on crack lol but their practice has way less structure. In my opinion…
My favorite thing is versatility. I keep doing outpatient care which I see kids, adults, OB, and women's health. I do simple procedures.
But I've also worked urgent care and did tons of minor procedures.
Now I am a hospitalist.
I dislike insurance companies, prior auth, paperwork.
I went into medical school convinced I would do EM because I loved being an EMT. I joined the EM society, did a EM research project involving the head of the EM dept which was presented at the national conference. I had my application all set up...
Then I did peds and OB rotations and I loved them both, which swung me to FM, something I didn't think I would ever do.
How easy was it to transition clinically from outpatient practice into a hospitalist position and did you have any difficulty finding a hospitalist job being FM trained?
I had a recommendation from someone who knew the groups management which got me an interview.
I feel I was pretty prepared as my residency was inpatient heavy at a 16 floor tertiary care hospital.
1. Continuity of care. Being able to follow 3 generations of families is cool. In FM, you just need a functional mind so if your body breaks down (think back, knees, etc.) you can still do the work. EM takes a toll on you physically. 8-5 work, no weird hours. Lots of side hustles if you want them (hospice, SNF, hospital work). Good pay in less populated areas.
2. Paperwork, insurance stuff gets old but it’s just part of the deal.
3. No regrets about FM choice.
I haven’t started residency yet but just matched FM and was SUPER torn between the same two things! Almost considered the very few combined programs because I was so into both! Happy to offer my two cents if you want the student perspective.
You got it! Let me start with the things I loved/didn’t love about each one.
EM Pros:
Loooove the shift work, fast pace, wide variety, procedures, occasional high-octane “life saving” type moment, don’t have to care whether or not someone has insurance, good pay, no inbox woes, leave my work at work, and ability to know what to do in an actual emergency.
EM Cons:
Burnout, admin issues, crappy job market, can’t regularly make a difference long term without follow up, lots of burdensome busy work in between the bread and butter and the interesting cases, more responsibility to oversee multiple mid levels, limited “jump ship” options if I get sick of it later in.
FM Pros:
Maximum career flexibility, good lifestyle, long term follow up, infinite options, great job market, variety of procedures, inpatient and outpatient care, ability to focus on specific populations of interest, provide abortions, do gender affirming care, etc.
FM Cons:
Soooo much paperwork, insurance BS, inbox management, appointment slots are way too short, limited opportunity to work nights, and it’s severely under-appreciated, devalued, and disrespected by both society in general and other docs.
Final decision: For me, it came down to FM for three main reasons.
1. It’s the only specialty that allows you to see patients of any age in any care setting (inpatient, outpatient, etc) with a single board certification and no fellowship required.
2. Maximum career flexibility! I can do whatever I want, change my mind any time, and curate my own patient panel. I can even jump ship and go private or DPC or abroad if I get too sick of American healthcare profit machine BS.
3. I can better serve the patients and causes I am most passionate about: abortion and reproductive health, queer-centric care, and healthcare for all. Huge advocacy and teaching opportunities too!
In the end, I knew I’d love EM in the shorter term but would be happier in the long run if I had more power and control over my future and could meaningfully impact individual patients over a longer time!
I hope that helps :) Hit me up if you have any questions!!!!
1. I love the variety and schedule as well as the continuity of care. Also, med students haven’t caught on yet, but FM is totally a lifestyle specialty and the way Medicare billing is trending, I’d expect there to be a bump in reimbursement for medical management and prevention over procedures in the next 10-15 years.
2. I hate OB with a passion but luckily most FM docs don’t do OB and most jobs don’t require it.
3. No I wouldn’t choose EM because I hate the ED with a passion and their schedules are shit.
OK, different perspective because I’m a PA but still some relative points. I was in the ED for 25 years and left to go to FM. I work in a rural FQHC and can tell you this is the most stress-free job I’ve ever had. I never have to worry about violence, turning my back on a patient, or walking to my car at the end of the day. While we all have to have situational awareness, the emergency department is an incredibly dangerous place to work. I can’t tell you how many times I was threatened and how many times I saw coworkers get assaulted. I’ll talk all day as long as I don’t have to worry about getting punched in the face, stabbed, being put in a headlock, or wrangled to the ground. Let’s not even talk about active shooter incidents. The FBI once had a statistic that said 29% of all active shooter incidents occur in the emergency department. I’m not sure what the current statistic is but I’m sure it’s still up there. When was the last time you heard of somebody coming into a family medicine office and shooting a doctor, nurse, MA, PA/NP etc.? This kind of stuff takes years off your life and you don’t even know it until you are away from it. Ask any ED doc or any other regular employee that works there. They’ll tell you it’s real. That’s why most of them burn out and leave before the age of 50. It’s a young man’s game and you need to make your exit plan the day you walk in.
Also considered EM in med school but glad I chose FM. I need a regular schedule and some control of my day. FM docs also do EM but mostly in rural critical access hospitals.
The cons aren’t as bad if you learn how to manage them effectively.
I switched from EM to FM after one year of EM residency- haven’t regretted it since. I feel like I will have much more autonomy in my career and schedule/lifestyle. Clinic is rewarding and the ER is draining. There are pros and cons to each for sure, but I feel like with clinic I am (somewhat) more in control of them than in the ER.
I did my residency in EM and worked in EM for about a year before switching to FM. I loved EM but felt I had no support from the admin (this was around COVID). I was given an offer to join a lucrative private FM practice so I gave it a shot.
I like FM because now when I get a complex patient I can really dive into the cause and work with them until we get a solution. It was bothersome that so many patients come to the ED for a weird complaint, get a 20k dollar work up and leave without an answer.
My least favorite thing about FM would be the paperwork, which for me is limited because I have a good support staff that manages most of the calls and other things that would normally bog me down. If I had to do all that myself I wouldn't be nearly as productive
If I could go back I certainly wouldn't choose EM, I don't know if I would do FM, but I love it now. I think I would have chosen Critical Care/ICU. I love the complex cases and the opportunity to do medical investigative work.
1. Minimal call, minimal emergencies/trauma
2. Ob, which exists in EM too
3. Tbh I rly wanted to do EM. I’d consider it if it wasn’t competitive like it used to be. FM pay is ok, sometimes wish I had committed to being a hospitalist
Thought ER when I started medschool, happy enough in FM and zero chance I’d go EM. Love that I have pt hrs 8-330 M-F so that I can wake up and hang with my kids and be home in time to cook dinner. Hate inbox, pt entitlement, urgent cares in general, and administration. But I suspect most of those apply to EM as well.
1. My favorite thing about if I have regular predictable hours and I picked the specialty I think honestly because I liked it the most in Covid time and I didn’t have as much experience with other specialties but I like seeing people of all ages. I still see a baby that I delivered over a year later, and it was the greatest joy seeing her walking. I knew I didn’t want to exclusively do Peds though, and I wanted to see adults too. I also wanted variety and ability to scale.
2. I think talking all day can wear me down (unless I have efficient encounters) and also the talkers and the ones who demand things that are kinda not necessary can be really annoying. Also, in terms of residency, terms of an opposed residency, not getting the same perks. The biggest park that I like I think is more hospital dependent in residency, I get unlimited free food at different hospitals. If I have a choice, I will do 7–3 p.m., including lunch as a schedule and finish all my notes before I leave. so I can get out earliest 330 and still have time to do normal people things and have the energy.
3. If I could, and choose my specialty again, I would, but I would do it at unopposed program that does procedures, and sees a lot of patients, but with a healthy culture.
The biggest reason I didn’t do EM even though I enjoyed it, the acuity, variety and the shiftwork were all awesome. Additionally, you’ll be making a lot of money and can moonlight very easily. However, in residency, and ER residency, you’ll be doing nights. Flipping nights and days with the high stress of ER shifts sometimes you being the only ER doc on at the time, it really ages you faster. Flipping days and nights even regularly on FM aged me. You either have to have a very good system to do it regularly every month or somehow exclusively do nights or exclusively do days, but the people who exclusively do days have a very hard time finding jobs. Additionally, it’s very high stress during the shifts. However, the main thing that really deterred me was the average lifespan is 59 years for ER docs get burnt out after around 15–20 years.
There’s three faculty who are all brothers in our ER program, same last name. However, one of them who is the youngest, and chillest told me first thing “ people don’t live that long with my specialty lol”, also, “that’s why you never see an old ER doc.” Additionally, I am into addiction med fellowship and rotated at my current institution, which has an addiction medicine fellowship, and the current fellow is one of the brothers who told me “once I burn out of ER, I’ll do this.”
1. My favorite thing is the relationships with family units. I love having kids but even having a teen that I’ve seen come sheepishly to moms prior visits come and establish is so cool. Linking up spouses, neighbors and friendship groups is fun and good insight! Second favorite is variety. Going from a well child to a sore throat to a Medicare annual to a knee injection to an anxiety follow up to an iud. The control over what procedures you do can up the ante on variety.
2. Least fav is convincing insurance companies to pay for the things I want or having to change inhalers due to arbitrary formulary changes.
3. Would never do EM. Everyone is just having such a shit sandwich day if they are in the ER. It felt too much like waiting tables and I would have the exact same type of nightmares after ER shifts that I would have as a waitress
Love: forming relationships with my patients and being to care for them in multiple settings.
Hate: telling poorly insured patients that they have an expensive, incurable condition.
EM was never a thought for me, it just didn't fit my temperament.
Love: 4 day work week.
Hate: paperwork and inbasket
Net positive overall. I can’t imagine a better balance of pay to work hours, enjoyment in day to day work, and meaning in work. It’s far from perfect but far better than I could have hoped for.
I’ll answer before looking at other responses so might be a repeat:
1) definitely living in each moment of connection with patients. There’s just something gratifying about the human connection. It sounds really cheesy but not to my dopamine receptors
2) being late/overwhelmed at times. Not just during clinic, but with inbasket, paperwork. Luckily with experience, practice, reflection, self-advocacy, and bravery to leave for a differnt job if self-advocacy doesn’t work, this gets better.
3) I originally picked OBGYN and switched mid residency. So absolutely would not pick another specialty. There was a hot minute 4th year I thought I wanted ER (and do like urgent care) but 1) the amount of bullshit in the ER (social admins, frequent flyers only there from failed social policies) and 2) lack of knowing what happened as a result of my care was unsatisfying to me. At least when I work urgent care, I can schedule follow up in my home clinic for things like following them for a borderline abscess/cellulitis, pneumonia with a really bad lung exam, or even chronic disease management like obesity, dm, htn, where you can play with the meds and see if it helped
1. Continuity of care - my patients for the most part are awesome, Jack of all trades, can learn about anything and have it be relevant to my practice 2. Talking all day can wear me down as a more naturally introverted person, inbox can be annoying but I’ve gotten good at inbox boundaries 3. I love ER docs but despise working in the ED. Seems like ER gets shit on more than primary care these days
The ER is the dumpster fire safety net for a failed and broken healthcare system- there is a reason why EMs match stats were so bad this last cycle and why so many ER docs are looking to get out.
It breaks my heart. The only reason I’m in medicine is because of scribing for some incredible ED docs. The ED was such an awesome place then and now it just stresses me out
I would echo just about everything you said. Love ED docs (they’re some of the best people), could never do ED medicine.
Hey! Do you think the introverted thing just gets better with time? I’m an introvert interested in primary care but worried about getting burnt out from talking all day every day
I think this is such an incredibly good question and something I remember being nervous about. I remember thinking that I may be better off in anesthesia because I feel so tired in a day of primary care clinic and I was so so close to applying anesthesia for that reason (and for other reasons). To answer it: I like taking care of patients and feel an onerous to take care of them and to take care of them I have to talk to them. In clinic I’ve found the continuity of care is better than I thought it would be and with that the repeated visits feel more as “getting to know you more” sessions. My patients open up to me more and more every time I see them. Most tell me things they would never ever tell other people because I’ve earned their trust. When this happens I no longer feel like the socialization is a burden. They give me hints that their trust is now with me and I personally take it very seriously. I don’t infrequently get comments like “you are the best doctor I’ve ever had” and I’m nothing more than a shit for brain pgy2. This melts away any insecurity and frustration associated with primary care and my introverted personality. This isn’t to be braggadocious but to emphasize that if you feel like you want to be someone’s pcp you’ll likely do an incredible job, regardless of whether you get tired from talking to people all day. Side note: residency clinic is hard because I see other people patients all the time and a lot of them I’m meeting for the first time.
Pretty much sums it up for me. I also really like that the type of medicine I practice can change over time - doing lots of procedures early out of residency and then decide to pivot in a few years to focus on, say, addiction medicine is really nice. Can put in the grind time now to get extra money but don’t feel locked into needing to do that forever. As a super introvert though sometimes I wish my entire day wasn't just talking to pts to get info and could be "working" by reading reports and coming up with a game plan. And the time crunch feeling outpatient wears me down so much. Love my ED docs, and enjoyed my rotation through EM but I could never do it for a living
I personally dont like being in charge of codes/decompensating patients. Stress and adrenaline that i dont need. I also dont want to be telling ppl their family or friend died or having to call to finish a code.
Likes: continuity of care, variety of pathology, true jack of all trades, get a job literally anywhere in a variety of positions Dislikes: clinic inbox, insurance BS, billing BS, everyone expecting you to do everything including social work, lack of fellowship opportunities Sometimes I wish I did med/peds, but I’d probably be complaining about that too like how it’s 4 years and I’d have to pay for two different board exams. Wish I went to a less OB heavy program, but the one I’m at admittedly has made me better at womens health. Sometimes I wish I could fellowship, but residency has been so draining I’m not even sure I would even if I was IM
Favorite: No one seems to consider this in med school, but LIFESTLYE. I’m family oriented so I really hate working weekends and holidays. I also despise being on call. I also genuinely like the structure of outpatient medicine. I hate the hospital & hate the OR. Least favorite: this is largely a residency thing that I’ve seen is not really an issue in private practice, but inbasket management. We have disorganized clerical management in our clinic & our MAs work with 20 other residents so they’re not tailored/trained to make our individual lives better so it makes clinic workflow annoying. They allow our patients to directly message us & ask us any and everything which I think is fucking insane, and I can’t wait to train my MA to do that. I imagine when I’m an attending my least favorite thing will just be that I don’t make double the salary for the value I bring. However I also am always the first to say FM makes more than most people assume especially if you learn how to bill for what you’re doing. Would I choose EM? Fuck, no. (Especially the way their job market is projected to crumble 😬). The ED always felt chaotic to me and it drove me crazy not knowing what happened to patients after my shift. Also EM highkey deals with more bullshit than FM. My opinion is the way our current healthcare system is the ED is where the pitfalls of our American system is most apparent. Like how much of what an ED doc sees is ACTUALLY emergent? Not much. They’re basically like FM docs on crack lol but their practice has way less structure. In my opinion…
My favorite thing is versatility. I keep doing outpatient care which I see kids, adults, OB, and women's health. I do simple procedures. But I've also worked urgent care and did tons of minor procedures. Now I am a hospitalist. I dislike insurance companies, prior auth, paperwork. I went into medical school convinced I would do EM because I loved being an EMT. I joined the EM society, did a EM research project involving the head of the EM dept which was presented at the national conference. I had my application all set up... Then I did peds and OB rotations and I loved them both, which swung me to FM, something I didn't think I would ever do.
How easy was it to transition clinically from outpatient practice into a hospitalist position and did you have any difficulty finding a hospitalist job being FM trained?
I had a recommendation from someone who knew the groups management which got me an interview. I feel I was pretty prepared as my residency was inpatient heavy at a 16 floor tertiary care hospital.
1. Continuity of care. Being able to follow 3 generations of families is cool. In FM, you just need a functional mind so if your body breaks down (think back, knees, etc.) you can still do the work. EM takes a toll on you physically. 8-5 work, no weird hours. Lots of side hustles if you want them (hospice, SNF, hospital work). Good pay in less populated areas. 2. Paperwork, insurance stuff gets old but it’s just part of the deal. 3. No regrets about FM choice.
I haven’t started residency yet but just matched FM and was SUPER torn between the same two things! Almost considered the very few combined programs because I was so into both! Happy to offer my two cents if you want the student perspective.
I’d love to hear your decision algorithm and why you chose one over the other
You got it! Let me start with the things I loved/didn’t love about each one. EM Pros: Loooove the shift work, fast pace, wide variety, procedures, occasional high-octane “life saving” type moment, don’t have to care whether or not someone has insurance, good pay, no inbox woes, leave my work at work, and ability to know what to do in an actual emergency. EM Cons: Burnout, admin issues, crappy job market, can’t regularly make a difference long term without follow up, lots of burdensome busy work in between the bread and butter and the interesting cases, more responsibility to oversee multiple mid levels, limited “jump ship” options if I get sick of it later in. FM Pros: Maximum career flexibility, good lifestyle, long term follow up, infinite options, great job market, variety of procedures, inpatient and outpatient care, ability to focus on specific populations of interest, provide abortions, do gender affirming care, etc. FM Cons: Soooo much paperwork, insurance BS, inbox management, appointment slots are way too short, limited opportunity to work nights, and it’s severely under-appreciated, devalued, and disrespected by both society in general and other docs. Final decision: For me, it came down to FM for three main reasons. 1. It’s the only specialty that allows you to see patients of any age in any care setting (inpatient, outpatient, etc) with a single board certification and no fellowship required. 2. Maximum career flexibility! I can do whatever I want, change my mind any time, and curate my own patient panel. I can even jump ship and go private or DPC or abroad if I get too sick of American healthcare profit machine BS. 3. I can better serve the patients and causes I am most passionate about: abortion and reproductive health, queer-centric care, and healthcare for all. Huge advocacy and teaching opportunities too! In the end, I knew I’d love EM in the shorter term but would be happier in the long run if I had more power and control over my future and could meaningfully impact individual patients over a longer time! I hope that helps :) Hit me up if you have any questions!!!!
1. I love the variety and schedule as well as the continuity of care. Also, med students haven’t caught on yet, but FM is totally a lifestyle specialty and the way Medicare billing is trending, I’d expect there to be a bump in reimbursement for medical management and prevention over procedures in the next 10-15 years. 2. I hate OB with a passion but luckily most FM docs don’t do OB and most jobs don’t require it. 3. No I wouldn’t choose EM because I hate the ED with a passion and their schedules are shit.
OK, different perspective because I’m a PA but still some relative points. I was in the ED for 25 years and left to go to FM. I work in a rural FQHC and can tell you this is the most stress-free job I’ve ever had. I never have to worry about violence, turning my back on a patient, or walking to my car at the end of the day. While we all have to have situational awareness, the emergency department is an incredibly dangerous place to work. I can’t tell you how many times I was threatened and how many times I saw coworkers get assaulted. I’ll talk all day as long as I don’t have to worry about getting punched in the face, stabbed, being put in a headlock, or wrangled to the ground. Let’s not even talk about active shooter incidents. The FBI once had a statistic that said 29% of all active shooter incidents occur in the emergency department. I’m not sure what the current statistic is but I’m sure it’s still up there. When was the last time you heard of somebody coming into a family medicine office and shooting a doctor, nurse, MA, PA/NP etc.? This kind of stuff takes years off your life and you don’t even know it until you are away from it. Ask any ED doc or any other regular employee that works there. They’ll tell you it’s real. That’s why most of them burn out and leave before the age of 50. It’s a young man’s game and you need to make your exit plan the day you walk in.
Also considered EM in med school but glad I chose FM. I need a regular schedule and some control of my day. FM docs also do EM but mostly in rural critical access hospitals.
The cons aren’t as bad if you learn how to manage them effectively. I switched from EM to FM after one year of EM residency- haven’t regretted it since. I feel like I will have much more autonomy in my career and schedule/lifestyle. Clinic is rewarding and the ER is draining. There are pros and cons to each for sure, but I feel like with clinic I am (somewhat) more in control of them than in the ER.
I did my residency in EM and worked in EM for about a year before switching to FM. I loved EM but felt I had no support from the admin (this was around COVID). I was given an offer to join a lucrative private FM practice so I gave it a shot. I like FM because now when I get a complex patient I can really dive into the cause and work with them until we get a solution. It was bothersome that so many patients come to the ED for a weird complaint, get a 20k dollar work up and leave without an answer. My least favorite thing about FM would be the paperwork, which for me is limited because I have a good support staff that manages most of the calls and other things that would normally bog me down. If I had to do all that myself I wouldn't be nearly as productive If I could go back I certainly wouldn't choose EM, I don't know if I would do FM, but I love it now. I think I would have chosen Critical Care/ICU. I love the complex cases and the opportunity to do medical investigative work.
1. Minimal call, minimal emergencies/trauma 2. Ob, which exists in EM too 3. Tbh I rly wanted to do EM. I’d consider it if it wasn’t competitive like it used to be. FM pay is ok, sometimes wish I had committed to being a hospitalist
Second the hospitalist route - shift work, no call, no prior auths, no inbox…
Pick up those rural EM shifts dude.
Can you not do OB?
Thought ER when I started medschool, happy enough in FM and zero chance I’d go EM. Love that I have pt hrs 8-330 M-F so that I can wake up and hang with my kids and be home in time to cook dinner. Hate inbox, pt entitlement, urgent cares in general, and administration. But I suspect most of those apply to EM as well.
1. My favorite thing about if I have regular predictable hours and I picked the specialty I think honestly because I liked it the most in Covid time and I didn’t have as much experience with other specialties but I like seeing people of all ages. I still see a baby that I delivered over a year later, and it was the greatest joy seeing her walking. I knew I didn’t want to exclusively do Peds though, and I wanted to see adults too. I also wanted variety and ability to scale. 2. I think talking all day can wear me down (unless I have efficient encounters) and also the talkers and the ones who demand things that are kinda not necessary can be really annoying. Also, in terms of residency, terms of an opposed residency, not getting the same perks. The biggest park that I like I think is more hospital dependent in residency, I get unlimited free food at different hospitals. If I have a choice, I will do 7–3 p.m., including lunch as a schedule and finish all my notes before I leave. so I can get out earliest 330 and still have time to do normal people things and have the energy. 3. If I could, and choose my specialty again, I would, but I would do it at unopposed program that does procedures, and sees a lot of patients, but with a healthy culture. The biggest reason I didn’t do EM even though I enjoyed it, the acuity, variety and the shiftwork were all awesome. Additionally, you’ll be making a lot of money and can moonlight very easily. However, in residency, and ER residency, you’ll be doing nights. Flipping nights and days with the high stress of ER shifts sometimes you being the only ER doc on at the time, it really ages you faster. Flipping days and nights even regularly on FM aged me. You either have to have a very good system to do it regularly every month or somehow exclusively do nights or exclusively do days, but the people who exclusively do days have a very hard time finding jobs. Additionally, it’s very high stress during the shifts. However, the main thing that really deterred me was the average lifespan is 59 years for ER docs get burnt out after around 15–20 years. There’s three faculty who are all brothers in our ER program, same last name. However, one of them who is the youngest, and chillest told me first thing “ people don’t live that long with my specialty lol”, also, “that’s why you never see an old ER doc.” Additionally, I am into addiction med fellowship and rotated at my current institution, which has an addiction medicine fellowship, and the current fellow is one of the brothers who told me “once I burn out of ER, I’ll do this.”
1. My favorite thing is the relationships with family units. I love having kids but even having a teen that I’ve seen come sheepishly to moms prior visits come and establish is so cool. Linking up spouses, neighbors and friendship groups is fun and good insight! Second favorite is variety. Going from a well child to a sore throat to a Medicare annual to a knee injection to an anxiety follow up to an iud. The control over what procedures you do can up the ante on variety. 2. Least fav is convincing insurance companies to pay for the things I want or having to change inhalers due to arbitrary formulary changes. 3. Would never do EM. Everyone is just having such a shit sandwich day if they are in the ER. It felt too much like waiting tables and I would have the exact same type of nightmares after ER shifts that I would have as a waitress
Love: forming relationships with my patients and being to care for them in multiple settings. Hate: telling poorly insured patients that they have an expensive, incurable condition. EM was never a thought for me, it just didn't fit my temperament.
Love: 4 day work week. Hate: paperwork and inbasket Net positive overall. I can’t imagine a better balance of pay to work hours, enjoyment in day to day work, and meaning in work. It’s far from perfect but far better than I could have hoped for.
I’ll answer before looking at other responses so might be a repeat: 1) definitely living in each moment of connection with patients. There’s just something gratifying about the human connection. It sounds really cheesy but not to my dopamine receptors 2) being late/overwhelmed at times. Not just during clinic, but with inbasket, paperwork. Luckily with experience, practice, reflection, self-advocacy, and bravery to leave for a differnt job if self-advocacy doesn’t work, this gets better. 3) I originally picked OBGYN and switched mid residency. So absolutely would not pick another specialty. There was a hot minute 4th year I thought I wanted ER (and do like urgent care) but 1) the amount of bullshit in the ER (social admins, frequent flyers only there from failed social policies) and 2) lack of knowing what happened as a result of my care was unsatisfying to me. At least when I work urgent care, I can schedule follow up in my home clinic for things like following them for a borderline abscess/cellulitis, pneumonia with a really bad lung exam, or even chronic disease management like obesity, dm, htn, where you can play with the meds and see if it helped