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May 23, 2012 1:12 PM   Subscribe

What type of doctor should my friend become? Emergency Medicine or Endocrinology? (Snowflake details inside)

My friend is a 3rd year med student and is trying to plan what residency (and elective rotations) to apply to. She likes emergency medicine (ER) because of the problem solving involved. She also enjoys being the first line in diagnosis and the satisfaction of often seeing immediate results from your treatment. The flexible work hours (which would allow more time for family) are also a plus.

On the other hand, she is drawn to endocrinology because it also offers a lot of diagnostic puzzles and problem solving. It would also allow her to practice part time in primary care, specifically for a diabetes clinic (for which there is a big need). Endocrinology has also been her favorite topic intellectually through school.

So health care professionals of Metafilter, what say you? Any advice?
posted by Wretch729 to Work & Money (8 answers total)
The flexible work hours (which would allow more time for family) are also a plus.

Is she sure about this one? My ex is a doctor and I do not think he would describe his time in the emergency room like this. See also this random article about scheduling family around ER work.
posted by jacalata at 1:25 PM on May 23, 2012 [1 favorite]

I'm not sure "flexible" means what you and your friend want to think it means. I only know two ex-doctors, they were both emergency med and aside from all the work-related stress and trauma, it was trying to raise kids while working odd shifts/days that eventually made it difficult to impossible to continue in that line of work.

When you work 3pm-3am or noon-midnight, you don't see your kids once they're school-aged.
posted by Lyn Never at 1:27 PM on May 23, 2012

The flexible work hours (which would allow more time for family) are also a plus.

Echoing what others have said: I recommend that your friend talk to some practicing ER doctors about that. My experience (as the child of an ER doctor) is that the hours are more unpredictable than flexible and do not fit particularly well with typical family schedules (i.e. normal work schedules and school schedules).

Another thing to remember: the ER does not close, ever. Somebody has to work on holidays, during bad weather, etc. Your friend may find herself working a lot of holidays and covering shifts for other doctors.

She also enjoys being the first line in diagnosis and the satisfaction of often seeing immediate results from your treatment.

Again, I would recommend talking to some practicing ER doctors about that. My understanding is that a lot of ER patients are people with chronic conditions (e.g. diabetes, asthma) that aren't really going to get better as a result of treatment in the ER (which, remember, is mainly about stabilization). Another major class of patient are those that, even if everything is done right, are going to have what most people would consider a bad outcome. Strokes, cardiac arrests, and the like typically have very bad outcomes even for people who survive (e.g. neurological damage, short survival time after leaving the hospital).

This is not to say that ER doctors don't do great work. They absolutely do, and they frequently make major differences in patients' lives—but medicine has its limits. Your friend might be overestimating how often they are able to turn a seriously sick patient into a completely well one. I don't know how much free time she has, but she might consider shadowing an ER doctor for a couple of shifts, if that's possible.
posted by jedicus at 1:43 PM on May 23, 2012

Great responses so far, keep them coming. To clarify but hopefully not threadsit:

It's worth noting that my friend has, at this point, spent ~3 months working in various ERs as a med student doing rotations (all in an urban setting), and so is pretty familiar with the day to day routine.

Re: the hours
I think she meant flexible hours more in a "relative to other specialties" sense. In the ER you work a shift, and it may be a long shift or a night shift but then you get to go home, vs. other specialties where you might be on call and have to drop everything and come in to do surgery or deliver a baby or whatever. (If this is contrary to others' experience it would be very helpful to know!)
posted by Wretch729 at 1:53 PM on May 23, 2012 [1 favorite]

Also a child of an ER doctor chiming in. Granted, my Dad was an ER chief for quite a few years but the idea of "regular" hours is laughable. Our family grew up being okay with celebrating birthdays and major holidays a day late because my dad was ALWAYS working. I don't ever remember him coming to any school-related activities. He was ALWAYS working.

He loved it, though. I grew up around a dinner table where we talked about foreign objects being inserted into body orifices. Decapitations. Mutilations. Gunshots. Endlessly. By the age of 10, I could tell you what the symptoms of a heart attack where. I had sympathy for the poor people who had nowhere else to turn and would come to the ER for simple care that often had them waiting for 12 hours just for antibiotics they could barely afford. I knew my Dad would often stick a $10 bill in someone's pocket and pretended not to notice when they walked out of the doors without paying.
posted by HeyAllie at 1:58 PM on May 23, 2012 [1 favorite]

Most ER docs that I know work three 12 hour shifts per week. The service is described as "An ocean of knowledge - one inch deep." They get to see a lot, but have to admit or discharge patients quickly in order to make room for new ones.
I don't know too much about endocrinology. I have heard a few strategies from indecisive med students. One is "choose the three specialties that you enjoy most, and then go with the one with the best lifestyle/pay" another is "Go into the specialty that seems to attract people with personalities similar to yours."
Metafilter and studentdoctor.net are probably not going to be as useful as real mentors within the fields.
posted by DaveZ at 2:01 PM on May 23, 2012 [1 favorite]

Your friend needs to decide if she wants to do three years of internal medicine training before she decides she wants to do a fellowship in endocrinology.

Also, having done my med school time in the ED and now watching friends go through their EM residencies, the shifts are longer than they seem. Yeah, you might take patients for twelve hours but the time after your shift spent tying up loose ends and signing out to the next guy can take a long time. And, if your shift times aren't stable, it's hard to avoid spending all of your off-time sleeping. Shift changes are super draining.
posted by honeybee413 at 2:07 PM on May 23, 2012

Wow, those two fields are about as opposite as can be. Endocrinology is the epitome of longitudinal care. Since the diseases they treat are rarely cured but only managed, you tend to take care of the same folks for as long as they are alive or you are practicing. ED the only longitudinal care you get is the frequent flyer homeless/mentally ill/alcoholic or the underinsured that call an ambulance every time they get the sniffles.

Almost everyone likes their ED rotation at first. You see different things, do some minor procedures, it's shift work. But the reality is that the ED attendings are like air traffic controllers. Evaluate the patient. They do stabilize life-threatening situations but they get passed off to specialists fairly quickly. If the problem is not life-threatening, identify the problem organ system and page the appropriate specialist. A lot of what they do is triage.

All due respect to the above posters, but most ED docs work 3 12 hour shifts a week. The last time I worked 36 hrs/ week I was in college. For what they get paid to hours worked, they are at the top of the pile. But they do have to juggle shifts and that can suck as you get older. More folks are working in urgent care centers which are not open 24 hrs/day and only take care of insured patients. It's a lot easier than working in a metro level I trauma center.

The challenge for any medical student is not to figure out what turns you on at age 24, it's to try and figure out what will still turn you on when you are 40. When I was an intern, I almost dropped my orthopaedic residency spot to become a transplant surgeon. It was thrilling, exciting stuff. I was on-call every night (this was in the olden days before any work hour restrictions) and putting my head down and wondering which one of my patients was going to try to die that night was exhilarating. It sounds morbid but it was true. But I'm old now and that would annoy the shit out of me. I'm still on call way too much for my liking but I don't have to go in all that often. But when I am up all night, functioning the next day is nowhere near as easy as when I was younger.

TL,DR She should find some attendings in both fields that she identifies with and try to spend some time with them one on one. She should ask about family and balance and job satisfaction, etc. If she can't find anyone that she can identify with in a certain field, that can be somewhat telling.
posted by karlos at 7:49 PM on May 23, 2012

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