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GUEST POST: Why I went into Pediatric Emergency Medicine

Wednesday, May 25, 2011

When Dr. Todd Chang (pictured here) was asked, "why Pediatric Emergency Medicine?" he had several answers (!) and some appear below...

Here is the canned answer to why Pediatric Emergency Medicine: it is rewarding to treat acute illnesses and diseases; the variety of pathologies and diagnoses are vaster than any other pediatric subspecialty; and it's ripe for a myriad of procedures - lumbar punctures, fracture reductions, ultrasounds, and chest tubes.

The second answer is for those who know me a bit better. I despise waking up before 9am, I enjoy controlled chaos, and I have characteristics that would almost be diagnostic of ADHD that makes routines a bit tame.

The truth really lies somewhere in between. PEM is a very young subspecialty, having only earned Board certification status about a generation ago. The "Grandfathers and Grandmothers" of the discipline are still going strong, writing and teaching and practicing. PEM is making great strides as a discipline of medicine, but it incorporates elements of many other subspecialties. In fact, you can go into PEM via a pediatric residency then PEM fellowship (6 years), an emergency medicine residency then PEM fellowship (5-6 years), or 2 residencies in peds and EM consecutively.

There are even combined residencies offered in Maryland. Ultimately the path you take towards PEM depends on what you want to see in your career: do you want to see some adult patients? Do you want to be primarily academic or in a community setting? The more adult training you have, the more marketable you are in the future to many EDs throughout the US and Canada.

I decided on PEM during my second year in pediatrics residency when I found that although I enjoyed the families and patients in an outpatient clinic setting, the allure of the Emergency Department was far, far greater.

PEM is actually fairly exciting. Most PEM doctors work in the evenings, as that is the peak time for any ED, pediatric or not. About 90% of my shifts are after 3pm, for example. The good news is that although you work when most other physicians are wrapping up or asleep, as soon as your relief comes in and your shift work is wrapped up, you are home free. No patient phone calls, no hospital responsibilities, and a complete divorce from your work. When your next shift begins, you walk in ready and primed, and you are greeted by a plethora of patients ready to go. No waiting for your coffee to arrive, this is go time, my friend.

This type of scheduled chaos is very attractive, in my opinion. It keeps me excited about my work and able to rejoin my life when I'm off. Physicians with school-age kids are able to work overnight shifts, drop the kids off at school, crash in bed, and pick them up with plenty of energy and time to spend with them before tucking them to sleep and heading off to another shift. You cannot buy that level of work-life balance in most other subspecialties. A recent publication even put PEM with the highest satisfaction score out of all medical and surgical subspecialties. Evidence behind our happiness. You can’t beat that type of publicity.

The variety is actually something I will acknowledge as a very big plus. There is urgent care (the coughs, colds, viral items) which is still in general pediatrics territory. You may end up seeing quite a few of these, or if you work in a group with general pediatricians, your core group of patients will be the sicker kids, the rich and complex array of organ system pathologies, significant traumas, and resuscitations. From a purely scholastic point of view, getting first dibs on a difficult diagnosis or a Code Blue resuscitation from scratch, is quite rewarding, and tests your mettle as a physician. And once your shift is done and your relief is here, you’re all done.

Bottom line, if you thrive in a bit of controlled chaos, like significant variety in patient care, and are a bit of a night-owl and have some ADHD tendencies, PEM may be right for you.


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