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If you had to choose between 2 career specialities, which one would you choose?
I am a 19-year-old EMT with over a year of experience as well as NICU/PICU experience. When I receive my bachelor's and enter medical school, I'm going to have to decide between two specialities: Emergency and NICU/PICU. Both take on brutal tasks in a 12 or 24-hour shift,t and I'd like to know others' opinions on it. Do you think I would genuinely be happier if I worked in the ER or NICU? I love my job and working with adults and geriatrics, but I also love working with paediatrics.
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Dr’s Answer
Hey Antonio, First of all lemme just boost down my massive respect for you bud. you’re out here at 19 with EMT experience and NICU/PICU exposure, while half of us at 19 were just trying to figure out how to microwave mac and cheese without setting off the fire alarm. Now lemme go onto your actual question: ER vs NICU/PICU.
If you pick Emergency, you’re basically signing up for organized chaos 24/7 — it’s adrenaline, it’s unpredictability, it’s "I don't know what’s about to come through that door but bring it on" energy. You’ll be juggling adults, kids, drunk people, trauma cases, and just occasional weird dudes or grandmas. I had just tell you this route would be fast, it’s messy, and it’s addictive if you love action and quick decisions.
NICU/PICU, though — that's where you become the ninja of medicine. Tiny humans, delicate situations, life hanging by a thread... and somehow you have to stay calm, focused, and tender, even when the emotions hit like a freight train. It’s not about chaos, it’s about precision, long-term battles, tiny victories, and deep bonds with families.
Basically I have watched and shadowed my mom in ER and also in NICU so its really dependent. You said you love working with adults and geriatrics but you also love peds — so honestly, you already have the heart for either. The real question is: Do you want your chaos loud and fast (ER), or quiet and intense (NICU/PICU)?
If you find yourself thriving on the unpredictable "what next??" feeling, ER might be your soulmate. If you find meaning in slow, steady, emotional work where every ounce of patience matters, NICU/PICU might be calling your name. Neither path is wrong — it’s just about what brand of emotional battery you want your career to charge from.
So if you are still unsure I will just drop some cons and pros which I hope helps you.
Emergency Medicine .... I wanna say that You have to love the ugly parts of medicine, not just the exciting parts, or it will burn you out fast in this route.
Ups:
Fast-paced: Every shift is different. You never get bored.
Lots of skills: You treat everything — from heart attacks to broken arms — and you get really good at thinking fast.
Clear schedule: Shifts are set. When you're done, you're done. No late-night phone calls about patients.
Instant results: You often see the impact of your work right away.
Downs:
Burnout risk: The pace and stress can wear you out if you don’t take care of yourself.
Tough patients: Some people are angry, drunk, scared — you’ll need thick skin.
No long-term follow-up: If you like building relationships with patients, ER won’t give you much of that.
Odd hours: Nights, weekends, holidays — they’re all part of the deal.
NICU/PICU remember this, You don't just treat patients — you carry pieces of their stories with you for life. You have to be okay living with a heart that's always a little cracked... but somehow stronger because of it.
Ups:
Meaningful work: You’re caring for the sickest newborns and children. It’s emotional, but powerful.
Tight teamwork: The teams are usually small and close. Everyone relies on each other.
Precision: You’ll become incredibly sharp with small details and critical care skills.
Deep connections: Families never forget the care you give their children.
Downs:
Emotional weight: Losing a baby or seeing families struggle is very hard.
Slow progress: Some patients stay in the NICU/PICU for months. It’s a marathon, not a sprint.
Heavy responsibility: Tiny mistakes can have big consequences.
Family stress: Parents are scared, emotional, and sometimes difficult to handle.
Either way, Antonio, sounds like you're already the kind of person medicine desperately needs: someone who cares about the work and actually thinks about where they'll be happiest, not just what sounds impressive on paper.
You’re gonna crush it — whichever path you run toward. Remember, Both paths will make you a strong doctor — it just depends on what kind of work you want to live with day after day. All the best out there bud.
ER: Nobody tells you how lonely it can feel even when you’re surrounded by chaos. You’re making life-or-death decisions in seconds, and sometimes... nobody claps for you. No one comes back to say thanks. You patch people up, save lives, and they vanish. It can make you wonder if it mattered — even when it absolutely did. You have to be the kind of person who doesn't need outside validation to know you made a difference.
NICU/PICU: Nobody tells you how much sitting and waiting there is. It's not all intense action — a lot of your day might be monitoring tiny changes, adjusting tiny numbers on machines, and watching. Sometimes you can feel powerless because, no matter how hard you work, nature has its own clock. Also, NICU/PICU docs sometimes carry emotional scars for life — and they rarely talk about it because the expectation is to stay “strong for the families.”
If you pick Emergency, you’re basically signing up for organized chaos 24/7 — it’s adrenaline, it’s unpredictability, it’s "I don't know what’s about to come through that door but bring it on" energy. You’ll be juggling adults, kids, drunk people, trauma cases, and just occasional weird dudes or grandmas. I had just tell you this route would be fast, it’s messy, and it’s addictive if you love action and quick decisions.
NICU/PICU, though — that's where you become the ninja of medicine. Tiny humans, delicate situations, life hanging by a thread... and somehow you have to stay calm, focused, and tender, even when the emotions hit like a freight train. It’s not about chaos, it’s about precision, long-term battles, tiny victories, and deep bonds with families.
Basically I have watched and shadowed my mom in ER and also in NICU so its really dependent. You said you love working with adults and geriatrics but you also love peds — so honestly, you already have the heart for either. The real question is: Do you want your chaos loud and fast (ER), or quiet and intense (NICU/PICU)?
If you find yourself thriving on the unpredictable "what next??" feeling, ER might be your soulmate. If you find meaning in slow, steady, emotional work where every ounce of patience matters, NICU/PICU might be calling your name. Neither path is wrong — it’s just about what brand of emotional battery you want your career to charge from.
So if you are still unsure I will just drop some cons and pros which I hope helps you.
Emergency Medicine .... I wanna say that You have to love the ugly parts of medicine, not just the exciting parts, or it will burn you out fast in this route.
Ups:
Fast-paced: Every shift is different. You never get bored.
Lots of skills: You treat everything — from heart attacks to broken arms — and you get really good at thinking fast.
Clear schedule: Shifts are set. When you're done, you're done. No late-night phone calls about patients.
Instant results: You often see the impact of your work right away.
Downs:
Burnout risk: The pace and stress can wear you out if you don’t take care of yourself.
Tough patients: Some people are angry, drunk, scared — you’ll need thick skin.
No long-term follow-up: If you like building relationships with patients, ER won’t give you much of that.
Odd hours: Nights, weekends, holidays — they’re all part of the deal.
NICU/PICU remember this, You don't just treat patients — you carry pieces of their stories with you for life. You have to be okay living with a heart that's always a little cracked... but somehow stronger because of it.
Ups:
Meaningful work: You’re caring for the sickest newborns and children. It’s emotional, but powerful.
Tight teamwork: The teams are usually small and close. Everyone relies on each other.
Precision: You’ll become incredibly sharp with small details and critical care skills.
Deep connections: Families never forget the care you give their children.
Downs:
Emotional weight: Losing a baby or seeing families struggle is very hard.
Slow progress: Some patients stay in the NICU/PICU for months. It’s a marathon, not a sprint.
Heavy responsibility: Tiny mistakes can have big consequences.
Family stress: Parents are scared, emotional, and sometimes difficult to handle.
Either way, Antonio, sounds like you're already the kind of person medicine desperately needs: someone who cares about the work and actually thinks about where they'll be happiest, not just what sounds impressive on paper.
You’re gonna crush it — whichever path you run toward. Remember, Both paths will make you a strong doctor — it just depends on what kind of work you want to live with day after day. All the best out there bud.
Dr recommends the following next steps:
Thank you so much for this information! I've never really thought about how NICU patients can be in the hospital for multiple months or years, and the realisation that NICU is all about slow, progressive changes rather than invasive life-saving moves. It made me lean into emergency a bit more, and I honestly forgot to mention that specifically. I'd love to be a pediatric ER doc if I'm not ready or built for NICU.
Antonio
Thank you for your support Karin.
Dr H
Oh man, reading your words honestly lit up my whole day, You are most welcome Antonio. The way you’re thinking ahead with so much openness and maturity, man, this is exactly the kind of mindset that’s going to make you unstoppable in medicine and in life, honestly. And YES, you can totally change directions later if you want! Medicine isn’t a straight, rigid highway where one wrong turn traps you forever. It’s more like a huge, wild, slightly chaotic airport. There are tons of gates, and you can transfer flights if you realize the original destination isn’t quite right. Remember buddy, Residency and even early career years are the playground, not the final exam. You’ll learn, you’ll change, you’ll grow. And Know changing paths doesn’t mean you "failed," but it means you evolved.
Dr H
Since you mentioned.....So basically, If you dive into Emergency and later find that you miss building deep, emotional connections, you can pivot into Pediatric Critical Care, Peds ER, even Hospitalist roles.
And, If you start in NICU/PICU and realize you crave a faster pace or different age groups, you can train in ER, urgent care, or transport medicine. Some people even blend specialties, like doing Emergency plus Palliative Care, or Critical Care plus Pediatrics, so yea, there are combos out there.
You’re setting yourself up for a career that serves your soul, not just your resume.
So keep that flexible, fiery, humble heart wide open, Antonio. There’s no ceiling for someone like you, only sky.
And I'm seriously so excited to see the amazing doctor you will become.
Dr H