Breaking Radio Silence and Career Conjectures

Hello there, internet people. It’s been a while.

Second year has obviously been kicking my butt. In between trying to not fall too behind in school (harder than you might think) and spend as much time as I can with my long-suffering wife and our rapidly-developing eight month old son, life has been particularly hectic these past few months.

We just finished our first week back from winter break (which was excellent; albeit too short. One more week would have been awesome…), and school has started back up in full force. It didn’t help that a few lectures were reshuffled thanks to the wonderful Chicago weather (it has literally been colder than Mars as of late), which made for a couple of particularly busy days.

We’ve finished up with cardiac, pulmonary, and renal path before break and now are starting gastrointestinal pathology this week, with neuropath after that. In PCM, we’ve been learning EKG interpretation and just started chest x-ray stuff a little before break, which has been interesting.

I also registered for Step 1 last semester, which was a bit sobering. As of right now, I’ll be taking it in early June. I’m planning on taking five weeks to study for it – six seemed a little long (and it would be nice to have some more time off afterwards before third year starts) and four seemed a bit short for a test that plays a large role in determining your future. In terms of preparation/studying, I’ve been doing Pathoma throughout second year – before we start a block, I’ll watch the relevant videos so I get the “big picture” and an idea of what’s important. Then, as I go through the lectures, I’m making Anki cards out of the relevant Pathoma and First Aid sections, plus random material from lecture that isn’t in those sources but seems important. In my dedicated period, I’m planning on going through Pathoma and First Aid again along with the UWorld question bank, but that’s still somewhat fluid – I’ll update with more about that as the time gets closer.

Second year has been difficult. It’s not so much that the content is difficult or that I’m struggling grade-wise. It’s more that the sheer amount of constant effort required to stay afloat in the face of a constant barrage of new material (while also balancing school with family and life in general) can be draining after a while. I’ve still been trying to take weekends and evenings mostly off to spend time with my family, other than reviewing any Anki cards that come due and with the exception of the weekends right before tests, but that makes the weekdays pretty cram-packed. If you haven’t seen the “Pancakes Every Day” video put out a while back by the students at St. Louis University’s medical school, it’s worth a watch. It describes pretty well the volume of medical school – and how quickly you can get buried if you don’t keep up.

That said, I’m still enjoying medical school – the material itself is really satisfying and learning more clinically relevant things like exam maneuvers, EKGs, CXRs, etc., keeps things interesting. I’m also incredibly thankful to have my wife and son – they are both an incredible support system (though my son might not know it yet!) and I’m thankful for my wife’s patience and encouragement, particularly on those days that are rougher than others.

Since this blog doubles as a bit of a journal for me – it’s interesting even now to look back and read posts from a few years ago (including my somewhat cringe-inducing personal statement for medical school) – I wanted to mention that I’m still trying to decide what I want to be when I grow up. I came into medical school thinking that I would go in to Emergency Medicine, and to be honest that’s likely where I’ll end up. I have been trying to explore different specialties, but nothing really seems to fit quite as well as EM does. I’m looking forward to getting better exposure to some of the other specialties in third year.

One thing about Emergency Medicine that concerns me is the potential for burn out, which can stem from a variety of factors. I think people used to say that EM physicians burned out because, as a young specialty, those who were practicing it weren’t necessarily doing what they thought they would be doing – and to be successful in the specialty, you really do need to have a certain type of personality. And to some extent, that might have been true.

But it’s still happening. It’s still a concern for physicians today – residency-trained physicians who thought from the get-go that this is what they wanted. I think it is multifactorial – certainly, the shift-work aspect, which is often considered to be a benefit of the specialty (and can be, to be sure), can become a curse when you are 50-plus years old and still working on Christmas day or are unable to bounce back from night shifts as well as you used to. Obviously things vary from group-to-group in terms of how the practice structure is set up and how you progress through the ranks, but there are no guarantees. Also, something that’s somewhat unique to EM is the fact that, while some small groups or the rare larger corporation might provide some satisfaction in terms of how you can take part in influencing the group’s future or practice, all too often some physicians find themselves as cogs in a wheel for large corporations that care more about their bottom line, door-to-doctor times, patient satisfaction scores, and the like than they do about the physicians in their employ or even good patient care. That can understandably be frustrating for physicians.

There are a lot of great things about emergency medicine. It is appealing to me to be a jack-of-all trades and yet a master of acute medical care. The shift work, despite its negatives, is also nice – I’d rather work 3-4 busy shifts a week and go home than spend 80 hours in the hospital or be on call. The environment suits me well, and it pays pretty nicely to boot.

That said, I’m also considering a fellowship to give myself an “escape hatch” if needed, or at least to mix things up and hopefully keep things interesting. EM physicians recently became eligible to take part in a one-year pain medicine fellowship, which would allow them to work in an office-based settings (read: more predictable hours) in a stable group of physicians and use a variety of procedures and medications to, well, relieve pain. That sounds like a perfect yang to emergency medicine’s yin.

It can be difficult to get a fellowship spot as an EM physician and I’m not sure how the week-to-week practice of both specialties would play out (maybe 3 days/week of EM + 1 day part time in clinic? Perhaps locum tenens EM as desired + a couple of days in clinic? Who knows…), but it seems like it would provide a nice balance as well as a sustainable option that I could switch over to if I ever desire more predictability and more of an office-hour type job. We shall see.

Who knows what the future will look like? In the meantime, the week is over and the weekend is here. I’m looking forward to a bit of rest with my wife and son, and we’re all already looking forward to the next break!