Once in medical school they
Then, I started having doubts. I met no one (even with all of this
So, I considered internal medicine. I guess I was stuck on this continuity of care issue, and thought that would make my practice worthwhile (you know, seeing the smiling faces of the patients I help, and eating the fresh baked muffins they'd bring with them to their office appointments to show their appreciation for my time and expertise). So, as a result of all the negative comments regarding primary care in general, I thought I would preserve my option of subspecializing (just in case the naysayers were right about primary care)...and internal medicine seemed better for that purpose than FP.
So, up until 4th year (FOURTH YEAR), I was all set to go into internal medicine. Then, in 4th year I did an elective anesthesia rotation. I thought about endless rounding that was internal medicine hospitalist care. I thought about the rushed office visits, and the lack of depth of knowledge (the "jack of all trades issue") and that kinda bothered me. What would I be doing all day as an internist? Rounding, taking call....clinic and referring? On the other hand...anesthesia pays well over $300,000 year, and you have only one patient at a time. There is no rounding, and the job is mostly low stress. And did I mention the over $300,000 yr salary??!!
I applied to BOTH internal medicine programs, AND anesthesia programs. I ranked anesthesia higher, and matched at my first choice spot. I did my prelim year in internal medicine...and off to anesthesia.
Well, I realized I hated anesthesia (at least my program sucked bigtime - which is no doubt detailed on this blog somewhere in another post). So now what do I do?
I didn't work this hard, for this long, and for this much debt to *hate* my job!!
I thought about my rotations as an intern. My ER rotation was the best. Not necessarily the most exciting specialty ever...but I just felt 'fulfilled' on that rotation. I felt healthier since I had time to get out in the sunshine on our days off. I felt disconnected (mentally and physically) with no beeper or hospital responsibilities on my time off...and the prospect of going back to work was exciting. Everyday I started with a clean plate. No inpatient ward 'rocks' or a patient that I was responsible for, yet someone else was just 'covering' for me. I enjoyed the 'we have a life' attitude of the ER residents. And I liked the fact that I could basically 'play doctor' with the patients until they became too complicated, or I became uninterested...then I could call someone else to take care of 'em.
So...I applied to EM programs (as a PGY2 anesthesia resident), AND internal medicine (in the case I didn't match in emergency medicine which was/is very competitive, I'd just finish up 2 more years in IM and be done). I guess you can say I decided on a EM career a bit late!! And even then, I *still* I wasn't completely sold...
I tell my story to demonstrate that choosing a speciality is very difficult indeed. With that said, I had a young woman send me a very thoughtful email:
I was telling my husband that I was really thinking about doing ER for the flexibility and the hours, because I'm really wanting to have kids...
...he responded by saying: I should do 'whatever I'm passionate about, no matter what the hours look like' because 'we didn't go through all of this to do something we're not passionate about'.
My Take -
Overall I think this is a very naive point of view. No, you don't wanna do something you hate. That wouldn't be fair...."after all of this time" you don't wanna go to a job everyday you *hate* (like me with anesthesia). But passion about a job.....??? I don't think that's a requirement at all, and if that's the *sole* determining factor in your specialty choice...you will be disappointed.
There is no way you'll *love*, say OB/Gyn if you cannot have your *dream life* because of it. Period. And, since being a 'part-time' OB is difficult....don't do it. It's kinda like buying a big house. Med students are basically telling themselves "you've worked hard...you deserve a mansion." So, you go buy a mansion....you're passionate about the house, and love the house....but after working 2-5 years around the clock, and never really having the opportunity to appreciate the home (or any other aspect of your life), you realize that you're just a slave to this house. Working to pay the mortgage....
...and you realize that you would be happier in a smaller house so you can work less and enjoy your life (and the small house) more. So, instead of finding joy swimming in your personal Olympic sized pool at your mansion (which you never had time to do anyway b/c you were working all the time)....you instead find joy swimming in the pool at the sports club you're a member of....and you actually have time to go and enjoy it.
Do you just absolutely LOVE your little house....??? Not necessarily. But, do you love your life...and the time this smaller home allows you to have free? Absolutely.
I don't like the lack of continuity with patients. I don't like not building relationships with families. I don't like the way it is in general...
My take -
I was very idealistic...."I wanna help people and build a relationship with them....". But, honestly, medicine isn't like that for most of us. Ask around...I think you'll find (I'm sure you'll find) that the *concept* of continuity of care is attractive, but the *practice* of continuity of care...sucks. You'll realize that, in your family medicine practice, you'll never see your "well patients" (the nice ones that do what you tell 'em to do...because they aren't sick frequently). And with all of your patients (in order to make a living) you can only spend 10-15 minutes with them (I get more time than that with my patients in the ER...and I actually probably get to know them better than their crazy-busy primary care doctor during their sometimes 6+ hr stay with me).
As a primary care doc you work long hours for little appreciation (and even less pay). And you realize that you'd rather have continuity of care with your own children, than with patients who don't listen to you, may actually sue you when they decide they have a bad outcome for not listening to you....and want it all for FREE!!
I say, continuity of care ideology is nice...but not the reality, and I wouldn't choose a specialty thinking that the continuity will be good thing.
I've never considered myself to be the type to gravitate toward "jack of all trades".
Emergency medicine is the best of all worlds. No matter what area of medicine you go into, you will not be the most specialized person in the field. And doing the same thing everyday sounds very boring, doesn't it? If you're not a 'jack of all trades' you'll be seeing the same stuff your entire career.
"I don't think I'm an ER doctor type."
Most of emergency is medicine is non-emergent stuff (so it's not like you'll be running around like on the TV show ER - of course depending on the hospital). In a given month (10-12 shifts) I may see 5 true emergencies. The rest is ruling out very unlikely things just to protect yourself (CYA), and urgent care/primary care things. I see these same people *way* more than I'd like - so there's the 'continuity of care' b/c they don't have access to primary doctors' offices.
Anyway, what is an 'ER type'? I think it's the type of person who values their time off...and realize that getting paid is important, and that life outside the hospital is more important to your health (sanity, and job satisfaction) than life inside the hospital. It's a person that realizes that having a dream life consists of balance, and that a job/career does not replace meaningful relationships (that require time and nurturing) with friends/family. That it is not necessary to become a martyr or forgo everything else to be a good doctor.
Now, what these ER types *do* with their time off...varies greatly (sometimes depending on gender).
Other pluses: you feel like a *real* doctor...not a technician or a pawn in a larger political game (at least not most of the time). And, you can always go work in a GP or walk-in clinic and see patients on an ongoing basis as a EM trained doctor.
Overall, it's important to remember (cuz lots of docs don't, and they are unhappy):
You don't have to LOVE (every aspect of) your job for it to be the PERFECT job.
*pictures from Life is Good Collection...it's an awesome collection. Check it out.