Career Planning, Match

Is the Grass Always Greener? Perspectives from EM Residents that Switched from Other Specialties

A small, but often overlooked group of EM applicants are trainees transitioning from other residency programs. Get unique insight into your chosen path from these 5 EM residents who came to emergency medicine with prior post-graduate training in another specialty.

Emergency medicine as a specialty has become more competitive over the past several application cycles.1 Applicants cite a variety of factors for selecting EM, with the most frequently listed reasons being a variety in clinical encounters, work/life balance, and perceived job satisfaction.2 Early exposure to EM, presence of an EM residency program associated with the applicant’s medical school, prior employment in the ED or as a prehospital provider, and completion of a 3rd year clerkship are associated with earlier interest EM by applicants, while interest in an another specialty and delayed initial exposure to EM were associated with later selection of EM.2  

A small, but often overlooked group of EM applicants are trainees transitioning from other residency programs. The number of residents who have transferred in to EM from other specialties is also on the rise, with 27 in 2013, 31 in 2014, 35 in 2015, 48 in 2016, and 53 in 2017.1 These non-traditional residents come to the specialty with unique experiences that inform their practice and contributions to their programs.

Get a unique insight into your chosen path from these 5 EM residents who came to emergency medicine with prior post-graduate training in another specialty.

What was your PGY year when you started EM, and what was your prior training?

Marc Cassone, DO: After PGY-1 from Internal Medicine, Geisinger Medical Center

Pierson Ebrom, DO: After PGY-3 from General Surgery, New York-Presbyterian/Queens

Matthew Fisher, DO: After PGY-3 from General Surgery, Geisinger Medical Center

Michael Howard, MD: After PGY-2 from General Surgery, Ohio State Medical Center

Hersh Mathur, MD: After completion of IM/Peds residency, Geisinger Medical Center

What attracted you to EM from your initial training program? Had you considered EM prior to your initial match?

Dr. Ebrom: EM doctors always seemed to be pretty happy. I think the lifestyle attracted me the most because they all said they enjoyed doing shift work. They all felt they had an excellent work-life balance which is something that is sorely absent from most fields of medicine, especially surgery.

Dr. Mathur: The most appealing part of EM, and the part that I still enjoy the most, has been taking care of the sub-population that I can treat and discharge from the ER. To see patients improve and return home over the course of just a few hours is not something that can be done in many other specialties.

Dr. Fisher: Looking at my surgery attendings, I saw that they seemed to be working similar, if not longer, hours. I missed quite a lot of “life events” such as weddings, funerals, and family time during my training and had little control over my schedule. I finally realized I did not want that for the rest of my career. I have always preferred the diagnosis and management of acute disease in a fast-paced setting, and EM provided me with that.

Dr. Cassone: I did my off-service EM month during July of that year and loved it. One of my EM mentors during that month told me, “You’re an ED doc, you just don’t realize it.” I think most of my friends and co-residents knew that already as well, and I guess I was just the last one to realize it.

Dr. Howard: Initially, I was attracted to the undifferentiated acuity of emergency medicine. During my clinical rotations in third and fourth year, I became attracted to general surgery because of my personal involvement in the hands-on delivery of definitive care as well as the mindset and discipline of the field. Although I was performing well in my surgical training, I found that my clinical interests are broader than the focused scope of practice found within the surgical specialties.

What has been the biggest surprise in EM training that you did not expect before starting? 

Dr. Ebrom: The sheer breadth and range of diagnoses that you encounter on a daily basis. It was also interesting to learn how challenging it can sometimes be to manage the undifferentiated patient. When a crashing patient arrives, knowing how to efficiently and accurately discover the underlying problem is almost an art form. 

Dr. Fisher: It was startling the amount of push-back and animosity that emergency physicians sometimes face from other providers and specialists. I was probably guilty of this during my surgery training as well… (EM has given me) thicker skin overall.

Dr. Mathur: On the surface, the EM schedule seems easy, but the mental and physical exhaustion after the completion of each shift was definitely unexpected.

Dr. Cassone: Shifts can seem like both a marathon and a sprint at the same time. Emergency physicians have an unique perspective on social determinants of health, risk-stratification, and community outreach that other specialties sometimes underestimate. I also didn’t realize how many different career avenues there are in EM.

Dr. Howard: The pressure of managing a department with a full waiting room on a busy shift was hard to appreciate as a medical student and might be somewhat lost to residents in other specialties. The constant rotation of night/day shifts is also chronically challenging in its own way. 

How do you use/apply what you’ve learned in your prior training?

Dr. Fisher: The hands-on procedural experience from nearly 4 years of surgery training is irreplaceable.

Dr. Howard: I also appreciate some of the communication styles used by other specialties during acute/time limited situations.

Dr. Mathur: Spending the last several years in the children’s hospital, medical wards, and outpatient clinic settings has allowed me to have a good grasp on the patients who benefit most from coming in to the hospital and what conditions can reasonably be managed by a primary provider.

Any regrets about EM training after other training? What would you have done differently?

Dr. Ebrom: It was the best decision I ever made. I only wish I had gone straight into EM from the first place!

Dr. Mathur: I always make it a point to let others know that I didn’t switch into EM but added it to my previous training. I find the skill set gained in EM training is very different from other specialties and can be complementary.

Dr. Fisher: I am much happier where I am at right now and definitely made the right decision for me. It was hard to leave the residents in surgery whom I had worked with for so long. We had become a little family. While dysfunctional at times, we looked out for each other. It was hard leaving the surgery attendings who had invested so much time into my training. I did not want them to feel as if they wasted their time on me. Hopefully that is not the case.

How has your training in EM been different? Are there aspects of your training that EM does well? Could do better? 

Dr. Ebrom: On your days off you don’t feel completely exhausted, and you actually have the energy to not only take care of yourself but to also study.

Dr. Fisher: While I no longer work the long 24-28 hour shifts anymore, I feel that I work much harder during my shifts. I don’t think you can understand how hard seeing 20 or so patients in 9 hours, along with managing their care and documentation, is until you actually do it. In the long run though, those days make you a more efficient and effective doctor. 

Dr. Howard: I love how much direct attending interaction I receive as opposed to the resident team general surgery model, although there are trade-offs as well.

Dr. Cassone: The academic EM model provides a great way for residents to have increasing levels of responsibility through their training while always have an attending present for feedback. I think EM in general is ahead of the curve in terms of medical education with all the podcasts, simulation opportunities, blogs, FOAMed, etc. Excited to see how other specialties are catching on. 

What plans for the future do you have (ie, fellowship, observational medicine, urgent care, academic, etc)?

Dr. Mathur: I hope to split my practice between hospitalist and emergency medicine work and eventually create a niche in observation medicine.

Dr. Ebrom: I’m going to start working as an attending in a community hospital this summer.

Dr. Cassone: Working in the community and considering academic emergency medicine down the road.

Dr. Fisher: I would eventually like to work in some aspect of medical education.

Advice/tips for residents wanting to switch into EM?

Dr. Mathur: A big part of any residency training is learning the intricacies of the hospital system you function in. If I were to do it again, I would have given more consideration to training in a different system for the primary purpose of seeing how things are done differently in various systems.

Dr. Ebrom: EM is getting more and more competitive each year, so it’s important to build a strong resume…the process can be intimidating, but don’t be afraid to get the ball rolling and it’s a good idea to start by asking your program director for help.

Dr. Fisher: Do and be what makes you happy. Reach out to people in your program that you trust for advice. Your education and training are a large part of your life that should be putting you in a position to have a successful future so use that time wisely. It is never too late to reset or change course.

Dr. Cassone: Find an EM mentor. Join EMRA. For better or worse, you only go through residency once!

Dr. Howard: Use every last shred of every network and contact you have.


REFERENCES

  1. Nelson LS, Keim SM, Barren JM, Beeson MS, Carius ML, Chudnofsky CR, et al. American Board of Emergency Medicine Report on Residency and Fellowship Training Information (2017-2018). Ann Emerg Med. 2018;71(5: 636-648.
  2. Ray JC, Hopson LR, Peterson W, Santen SA, Khandelwal S, Gallahue FE, et al. Choosing emergency medicine: Influences on medical student’s choice of emergency medicine. PLoS ONE. 2018; 13(5): e0196639.

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