Thursday, July 15, 2010

ER vs OR

So for a long time I always thought that if I ever became a doctor I'd work in emergency medicine*. It was dynamic and interesting, there were sphincter tightening moments and breezy presentations. Another bonus was that quirky personalities seemed drawn to that type of medicine. Hello, ABB finally fits in somewhere in healthcare.

I know I am going through the usual blush that medical students undergo with each specialty that trots in front of them during medical school. Yes, I was in a real anesthetist kick for the past year, but with more of a critical care/ED/pain specialty intention than an OR intention.

In the past week I've spent some time in the OR, shadowing a general surgeon and an orthopod. And holy mother of scalpels--I am in love.

Things I love about the OR/surgery:

-it's clean, sterile in fact!
-at the end of a 12h shift you don't feel the need to scrub yourself with lye and chlorhexidine in an attempt to get rid of the dirt that just wont wash off...
-patients are cooperative and unable to yell profanities at you/spit at you/bite you
-it is totally hands on, hello procedure-ville
-you get to look at imagining, see people in your office, consult in the ED
-nice variety (see above)
-you get to wear a mask and a cap (so really it doesn't matter what you look like at work)
-patients need to go through the medical systems sieve to get to you

Things I do not love about the OR/surgery:

-you could seriously eff someone up if you make a mistake (yes that can happen in the ED as well but somehow it seems much worse to botch a cholecystectomy and have a patient end up on the transplant list than to miss an occult fracture in emergency, or fail to intubate a difficult airway...)
-you have to stand still for hours on end and crick yourself into crazy positions to get the job done sometimes
-cautery smoke stinks
-apparently the hours stink too, though the surgeons here have *sweet* hours
-less patient interaction (though that means less of the nasty aspects of patient interaction)
-when you leave work there are still patients in the hospital under your care

The quest continues. Funny thing is my friends/colleagues seem very divided on the matter. I guess it is all part of the great med/surg divide. When I say that I am loving surgery, half the camp starts frothing at the mouth whilst going into a slow-motion dive toward me yelling 'noooooooooooooooo'
and the other half says, 'Yeah! Do it! You've totally got the personality for surgery and would be so good at it.'

Time will tell.

*I have been working in emerg for about 7 years now. Maybe it is the 7 year itch. 


NPO said...

You said you finished your first year of medical school, does there come a time when you have to decide surgery versus ER?

Sharp Incisions said...

As a med student who's currently loving emergency medicine, this is a very interesting read. I haven't seen surgery yet, but I'll be doing a few weeks of intensive exposure over the (southern hemisphere) summer, to which I'm really looking forward.
Have you considered acute/trauma surgery at all? That might be a nice compromise?

OMDG said...

From the people I've met who do EM, a lot of them chose it because they were really interested in Ob/Gyn or surgery, but didn't want the lifestyle associated with those fields. Anesthesia is a lot the same way.

Don't forget that you would have clinic as a surgeon. However, surg clinic is WAY different than med clinic. The surgeons I worked with were much better at talking to the patients than the medicine people I worked with, though maybe I just got lucky. Surgery is great because you say, You have X disease, and we will do X to fix it." That can be very satisfying.

As far as doing the anesthesia critical care route (you can also do surgery --> crit care if you decide you don't like the OR after all), the issue with this route I am told, is that most people aren't interested in doing a 2 year fellowship to take a 100K pay cut so they can spend time outside the OR doing crit care. That's why crit care is mostly done by med folks.

Anyway, keep an open mind. It's my experience that surgeons LOVE when chicks are interested in what they do, and take the time to pay extra special attention to them. Work that to your advantage! There are some assholes, but we both know that there are PLENTY of assholes in the other specialties as well.

Also think about ortho. You'll make more $$ that way than as a general surgeon, and some of the surgeries are very cool. You will get a great mix of trauma, onc, geriatrics, etc. Just don't turn in to an orthopod who turns his brain off.

Grumpy, M.D. said...

There's a field for everyone.

Lifestyle issues become bigger as we get older, as does the amount of time that would have to be spent in training.

But the bottom line is to do what makes you happy.

I know, that's trite, but true.

Bostonian in NY said...

I can only echo Grumpy's sentiment: Do what makes you happy.

Dealing with everything under the sun that rolls into the ED, getting them definitive care/follow-up and going home at the end of my shift to actually live my life is pretty sweet. Surgery is a LOOONG road with a lot of personal sacrifices for the privilege of poking around inside of other folks innards providing that definitive care.

Robert said...

There is something seductive about having the power to put your patient under if you don't like them...

Albinoblackbear said...

NP--Well, being a Canadian studying in Ireland makes things a little more complicated. I basically have to decide by the end of next year what I want to go into.

The reason is, I need to use every spare day in years 3 and 4 traveling back to Canada and shadowing doctors in the field I'm interested in (and in the province I want to do residency in) to make connections that might help separate me from the zillions of other International Medical Graduates vying for Canadian residencies.

It's crazy but that is the way it is. So yea, it's not an ideal time line to figure this all out.

SI--HA! Well I hadn't really until OMDG mentioned it (over and over again! hahah) as something I'd probably like given my proclivities for trauma and emergency medicine (and my new LOVE for the OR).

Training and lifestyle considered, I don't know if it is ideal...
Though OMDG makes a compelling argument! :)

OMDG--The radiologist I've been working with this week said the same about ortho and said I was 'tough enough' for it. I've had a *great* reception by all the people I've been following the past couple week and the pimping has been not too severe (and no other students around to snicker when I totally drop the ball).

Grump--I'd love to have some more time to work with many different areas this summer and time to really pick the brains of the different specialists.

I am already old (comparatively speaking) and can seriously appreciate the lifestyle aspect of things as well. Hence my conundrum. I know that surgery, critical care, OB etc can really cramp ye olde social life...yet I am drawn to high acuity...but probably wont be when I am 50.

BINY--Indeed it is a long road, but as my mother continues to point out, I will get older no matter what I do. :) It's an interesting process, weighing all the pros and cons of all the different areas.

NXY--And putting them under even if you *do* like them! ;)

Unknown said...

The thing that really drove me nuts about surgery (and the OR in general) is the lack of control over your schedule. You are at the mercy of nursing shortages, ICU beds, anaesthesia schedules, etc. The surgeons I've worked with over the years (I'm an R1) seem to be frustrated by this stuff the most. They love operating, the the "real world" gets in the way.

I was in love with a few different specialties through med school (finally decided on rural family). The litmus test for me was - can I see myself doing this, day in and day out, for the next 40 years? Another good idea is to tag along with one of the residents in the program. As a med student, you see a lot of the cool stuff and little of the scut work. Someone once told me "If you think you're interested in something, have the resident call you every time their pager goes off".

You should also get a sense of what the workload is like in an academic centre. Surgeons in peripheral hospitals often have a really great work/life balance (if they want it) but that's not necessarily representative of the specialty as a whole.

That being said, ortho is super cool. Love the toys and the bionic joints they give to people.

Albinoblackbear said...

Colin--Good point.

I do realize that I am in a 'fairy tale land of surgery' here for a couple of reasons--first of all it is a very small center and the OR resources (ICU, anesthetists, nursing availability, etc.) are not so much of an issue. In fact the gen surg I am working with said "if my colleagues in Vancouver knew how much OR time I got a month they would lose their minds".

And yes, being a medical student is much different than the reality of residency and the job. I just get to jump on for the fun part of the ride. =)

The only thing I know for sure is that I want a rural practice, which gives me some nice options here in Canada (the 2 year family med plus one year fellowship programs in a variety of specialties).

I like the idea of having to trail a resident in a larger academic center. Perhaps a good idea of what the big bad world out there holds in store! hahahah

Beach Bum said...

Another thing to consider is rural Family Medicine. You can do ER, OB, minor procedures, assist in the OR (or do additional training to do some sugeries). In Canada you can do an extra year in almost anything. And it's not nearly as cut-throat, and the residency isn't nearly as long.

Albinoblackbear said...

BB--It has always been my plan to do a 2+1.

Seems I just can't decide on what that +1 is going to be! :)

(Happy very belated BTW!)