Surgery or Emergency Medicine?

It's my goal to write about specialties medical students may find themselves between.  I personally, went through a phase where I was deciding between emergency medicine (EM) and surgery.

What do both surgery and emergency medicine have in common?
1. Acuity.  In the ER, you're the first person to see a patient with a problem.  You'll see more than surgical problems however.  EM does call surgery consults, and the surgery team will come down and work up a patient.

2.  Procedures.  Depending on the location of an injury, EM or a surgery member will come to irrigate and close a wound.  If it is penetrating neck trauma, ENT will come see the patient and take them to the OR (if it penetrates platysma, for example.  If it's a penetrating abdominal wound, general surgery will be called in.  ER doctors will not be taking patients to the OR.

I think those two are the major things EM and surgery have in common, although surgery does get to do more invasive things than EM.  EM does do their own intubations and rapid sequence induction, put lines in, and take care of abscesses and paracentesis for example, but generally is not as invasive as surgery.

I performed a paracentesis on my EM rotation, and not on my general surgery month.  I also closed a large hand wound on my EM rotation, not on a trauma surgery rotation or plastics rotation.  It was unbelievable.

I did hear from a friend that on his ER rotation, the ER doctors did a thoracotomy.  I hadn't heard of that before, and honestly would trust a surgeon more with my body if than an ER doctor.

How do surgery and EM differ?

1.  Lifestyle.  You'll see probably 1+ day off a week as an emergency medicine resident.  You will also work shifts.  Shift work can get very tiring very fast, for example:  You might work 7pm-7am on Sunday-Monday, then come back on 7pm Monday to work until 7am Tuesday.

2. The time crunch.  In the ER I think you are pulled in 18 different directions, with patients constantly asking you when they'll be home, when their prescription will be filled, and so on.  Constantly.

3.  The kinds of problems you see.  In the ER, expect to see a lot of patients who attempted suicide, patients who overdosed on alcohol/heroin/assorted drugs, vaginal bleeds at 3am, benign coughs, people who need medication refills, and vague abdominal pain.   Those on a pediatric surgery service will see unrelenting waves of gastrostomy tube consults, appendicitis, cholecystitis, less than trauma.  I say this after having done a rotation at a large county hospital.  Your experience might differ.

4.  The hierarchy, at least at one certain hospital I worked at.  In EM, there's more of a team spirit, in surgery, you basically move and speak when you're told to.  That's only because there's sharp objects or electrocautery inside a living human being and the stakes are high, even on routine surgery.

5.  Call.  This kind of falls under lifestyle.  Once you've signed out your patients, you're a free man.  No one can stop you from leaving the hospital.  You won't get paged in the middle of the night.  I had a brutal caffeine-fueled 48 hours of work on the orthopaedics service across 2 hospitals and 1 clinic.  I slept 4.5 hours and then went back to join my team in the morning.  Can you sustain that for 5+ years?  Good question to ask.