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- Sep 17, 2011
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I'm currently a PEM attending a few years out considering trying to jump ship to PICU. The life style and financial sacrifice for 2-3 years of fellowship is obviously a big barrier but some days I think it would be worth it.
I went into PEM for the variety, acuity, and procedures. My favorite thing in medicine are the first few hours of stabilizing a patient when you're starting from scratch and not sure yet what is going on. I considered PICU but initially decided some of the negatives outweighed the positives: most patients already have a diagnosis, babysitting subspecialty patients, trapped for days/weeks with challenging family dynamics, rounding.
Over time, my perspective has shifted. A lot of PEM patients are transfers that come with a diagnosis too. A lot of PEM patients are just there to see their subspecialist with me contributing little to their care. The occasional challenging family dynamic seems countered by having more time to build a relationship with other families. Rounding and having time to actually think through a patient and their physiology now often seems more appealing than mostly heuristic decision making and primarily being concerned with efficiently getting out of a room and onto the next. Procedures seem relatively rare in both fields but definitely more common in the PICU. The schedule seems incrementally better than PEM in that there are generally no evening swing shifts and nights are blocked together. Generally, the relationship between PICU and other services seems more collegial than between those services and PEM.
I think in summary, the appeal of PICU is higher acuity with most patients having clear, objective pathology and a clear role for me to play in their care besides reassurance. My biggest concern is that the two specialties may prove to be similar enough where it's hard to justify the investment in time and income for an incremental gain in career satisfaction. It's not like I hate PEM or my job. What I find the most rewarding just seems to have changed over the past few years.
Mostly just posting as a sounding board and to organize my own thoughts but interested in any outside perspectives.
I went into PEM for the variety, acuity, and procedures. My favorite thing in medicine are the first few hours of stabilizing a patient when you're starting from scratch and not sure yet what is going on. I considered PICU but initially decided some of the negatives outweighed the positives: most patients already have a diagnosis, babysitting subspecialty patients, trapped for days/weeks with challenging family dynamics, rounding.
Over time, my perspective has shifted. A lot of PEM patients are transfers that come with a diagnosis too. A lot of PEM patients are just there to see their subspecialist with me contributing little to their care. The occasional challenging family dynamic seems countered by having more time to build a relationship with other families. Rounding and having time to actually think through a patient and their physiology now often seems more appealing than mostly heuristic decision making and primarily being concerned with efficiently getting out of a room and onto the next. Procedures seem relatively rare in both fields but definitely more common in the PICU. The schedule seems incrementally better than PEM in that there are generally no evening swing shifts and nights are blocked together. Generally, the relationship between PICU and other services seems more collegial than between those services and PEM.
I think in summary, the appeal of PICU is higher acuity with most patients having clear, objective pathology and a clear role for me to play in their care besides reassurance. My biggest concern is that the two specialties may prove to be similar enough where it's hard to justify the investment in time and income for an incremental gain in career satisfaction. It's not like I hate PEM or my job. What I find the most rewarding just seems to have changed over the past few years.
Mostly just posting as a sounding board and to organize my own thoughts but interested in any outside perspectives.