I'm considering ER as my specialty, but am a little concerned about the rumors of a high burnout rate.

Anyone have any theories? Is it true?

My understanding is that burn-out pre-dated the specialization of emergency medicine. In essence, people dissatisfied with their own specialties or in search of additional funds often staffed emergency rooms (GPs, internists) either full-time or through moonlighting. Now that the specialty is a true career option, rather than a medical cast-off, people are generally happier. This is at least the theory as I know it, whether or not it is true is another story...

Mindy

Reasons frequently cited for burnout include:

- stress/high liability. The # of days off and lack of call, attracts some people, but 12 hr+ shifts in busy ER's is very hard work. In addition, some practioners I knew have worked 20-25 days/month of 12 hour shifts for the income. I can only imagine how fried you'd get doing that for any length of time. The potential for every visit to be a missed diagnosis (with the associated liability) is another reason I've heard cited.

- frustration with their role. I have talked to some mid career attendings who feel like they are "the world's largest FP clinic". The diffulculty in finding accepting physicians and subspecialty consultants in some areas can also be a source of angst and is an increasing problem even in some metropolitan areas I understand.

- Job insecurity. In large parts of the country, the relationship b/w the ER physicians & the hospitals is somewhat mercenary, with frequent turnover of staffing physician groups for contractual reasons. One of my fellow residents has a friend who trained @ Emory (a great ER program BTW) who ended up moving b/w 3 different hospital systems in South Florida in 12 months for this type of situation. The job situation in this respect can vary greatly however, with some groups having stable long-term relationships (it varies dramatically by region my friend in ER say)

- I've also heard complaints that ER physicians feel expendable or less important to hospital administrations than staff physicians & even nurses in some situations.

I understand there are some papers that show that more recently trained ER physicians may have less of the burn-out that was well known in the past, but I can't imagine that there is a whole lot of long-term follow up on these yet as most training programs are fairly young. At least during their training, my cohorts have seemed pretty happy where I'm doing my training with fairly short work weeks and hours (they are expected to moonlight, and many make $65-80k/year during training which is pretty good coin). Whether they feel the same way after they're out of the safety net of a 24/7 staffed tertiary center, we'll have to see.

I am currently an ER intern and I can tell you that you had better like doing community medicine. Even though I am in a busy Level 1 trauma center in Chicago, a very large percentage of the patients really belong in a community health clinic rather than an ER.

Also, keep in mind that at many ERs, the traumas are totally handled by a trauma team, not the ER staff. So if you fancy yourself managing MVAs or gunshot wounds you should seriously consider a trauma fellowship after a surgery residency.

That said, we do see true emergencies about 40% of the time and that is cool. I personally hate community indigent medicine and bread and butter family medicine (sore throat, OM, fevers) and for that reason alone I have trouble tolerating EM.

If you have never done a rotation at an inner city community clinic you should do one as this is the population you will treat a large percentage of the time at any urban/suburban ER.

Also I notice that the average time an attending spends directly interacting with a ER patient seem to be less than five minutes. I personally went into a specialty where I can spend tons of time with my patients: PM&R.

But, if you like the above stuff and want some action thrown in with true emergecies EM may be for you. Do a rotation.

I really respect ER docs, so no offense intended.

regards.

I seriously considered ER as a specialty until recently. Some of the reasons why I ruled it out are also reasons why it has high burnout.

Yes, it is nice to be either on or off duty. But often ER docs work rotating shifts (a period of time on morning shift, then to afternoon for a while then weeks on night shift. Then rotate again)

As one of our faculty recently said, ER is the only speicalty where the physcian is mandated by federal law to see all patients that show up. No other specialty is required to do this. There are a large number of patients out there that can tax the patience of the most patient person. They will show up at 3am on a Sat night for things like lice, and complain LOUDLY that they have to wait while you deal with true emergencies. The ER doc can only try to be nice, smile and apologize for the wait, and try to make friendly. The ER doc also has to see patients who are blatantly noncompliant with their baseline therapy, and try to fix them up and find someone to admit if necessary, even after the patient has pissed off every MD in town (patients must assume some responsibility for their own care, and many refuse to do so. These patients can be dismissed from the practice of any other specialty than ER)

Like a previous poster said, less than half of what an ER doc sees is truly an emergency. Most of the patients have problems that are more appropriately handled by a primarcy care doc (and many of these do NOT have access or insurance problems, many are on medicaid and have an entitlement mentality) In addition, ER docs are often looked down upon by all other specialties, and take flak from the admitting docs on other speicalties when the ER doc thinks a paient needs to be admitted. The ER doc is also an employee of the hospital, at the mercy of the hospital administration. If "too many" patients go to the administration to complain about the ER doc, s/he can be fired. ("Too many" could be even just 1 a month...someone with a minor complaint upset about waiting, and you didn't coddle them enough)

I decided that I could not put up with the drawbacks of ER. Having said all that, if I had to do ER I would probably do peds ER at a children's hospital. Though parents can be demanding, you don't see as much of the self inflicted, and frankly, stupid things that you do with adults.

i just got done with what was suppose to be a 10 hour(ended up staying for 12 hours) shift at a level 1 trauma center in detroit. this is my 3rd straight month of working in this er. the first 2 months as 4th hear med student and this month as a first year resident. i strongly considered er as a career, but am really glad that i didn't. Ie, I AM ALREADY SICK OF IT. Of the 30 patients out team saw in our module (of which i saw like 10), 2 were a true emergency(surgical abdomens, which were promptly handled by SURGERY). the rest of the patients were people that would have normaly been seen by a fp had they any money. There were 3 gunshot wounds of which our er team was assigned 1, and guess what in that one we got to undress the patient, and once again stepped back so the TRAUMA SURGERY team could immediately take over. The amount of time doing paperwork and than dictating each chart is ridiculous.( the attending stayed 2 1/2 hours after his shift ended doing this.) of the 30 patients about 10 were already known to the er docs, as these were your chronic i don't have a doctor, i don't give a **** about myself, give me my narcotics, crowd. another 4 or 5 drunks, another 4 or 5 asthmatics, and throw in your 3 or 4 stds, and the rest who have so many vague complaints that you know your not going to find out what the hell is wrong with them, and you have the world's largest FAMILY PRACTICE CLINIC.
I haven't even gotten into the many problems the attending has, such as the patient who needs admission to save the the er doc's ass from liability, but whom he knows that no private attending will take, and the staff floor attendings are going to chew his ass out if he admits them to their service. this is in particular a problem if your a young attending, dealing with an older floor attending, because he's going to give you that look that's basically saying what cow dung medical school did you attend. Also these 10 hour shifts do not go by fast. i mean you are regardless of if your busy or not exausted at the end of the shift. i mean whether you've seen 1 or 30 patients the clock just moves so damn slowly. however we do get our 8 days off for the month and my attending who is a young guy does drive a jag. so there are ups, but it definately is not for everybody.

Truly excellent info., people! Thanks! You've all got me rethinking the whole enchilada.

I'm not really saying anything that hasn't been posted but from what I hear, a lot of the young burn out has to do with people entering the field thinking it's all trauma and emergency when in reality it's a great deal primary care oriented.

One of the posts mentioned moonlighting. I was wondering if this is still common and if so what specialties do it.

I think the amount of time actually spent on 'true emergencies' in this discipline is much much lower than the above estimates. I too considered this as a career choice, attracted by a seemingly good lifestyle (not), and opportunity to handle emergency. What I learned was that those ten hour shifts were more like 12+ and a life of permanent jetlag. Additionally, I learned that actually emergency exposure hovered somewhere around 10% or less. For me, ER represented an acute form of FP relocated into an emergency with much more rigid schedules, and much less personal flexibility.

YMMV

I think that this thread would be more useful (or at least more rounded) if we heard from those who chose EM as a specialty, rather than from those who have ruled it out.

To Ligament:
I was confused by one part of your post. First you said that you're an EM intern, and later, that you're doing PM&R. Are you doing an EM intern year before doing three years of PM&R residency? Which programs offer EM intern years?

To Dr. Oliver:
Where, pray tell, is this EM residency that has short hours and expects residents to moonlight and make ~$80k per year? I'd like to know so I can apply. Send me a PM! (I'd send you one, but my computer won't allow me - I keep getting an error message - or maybe I'm just computer illiterate).

To the others, incl Dr. Oliver and Ligament:
Thanks for your input!

Josh

Hornet...PMs aren't working until after the system is updated on Thursday.

Anyway...I currently work as a technician in a small city community hospital. The hospital is a private hospital in a very affluent area of this city with a fairly wealthy patient population in the surrounding towns.

Despite this, I would say a good 40% of the patients are the typical "give me drugs because I have no other place to go" crowd, another 40% are elderly with difficulty breathing or chest pain, and the rest are true ER cases.

I can see why the ER docs could get burned out. They are constantly seeing the same faces. They work in a high stress atmosphere...the lack of scheduling patients can lead to a large influx of patients in a short time...and when there is this large influx of patients, the lab and x-ray are backed up and this causes more delays.

Despite all of this, I still keep my interest in the work.

I like being a detective. I like different things...the same signs and symptoms can be very different things in 2 patients. I also like the camraderie among the ER staff. Everyone puts up with the same BS.

I agree with what other people said. Do a rotation in a busy ER.

Hey, can I present the other side? I want to do EM and I am currently doing my 4th year rotation at a very busy urban Level I trauma center with a huge indigent patient population. Why did I want to do EM? I paid close attention to what I liked about my 3rd year clinical rotations and everything pointed me this way.

On my surgery rotation, although I loved trauma surgery, I loved seeing the pt come in and the idea of doing the immediate stabalizing of the pt. When I was scrubbed in the OR and the trauma pager went off, I wished I could go down and see the new patient coming in and find out what happened to them. Trauma surgery is cool, but the coolest part happens in the ED when the EM and Surgery team work together to stabalize and evaluate the pateint, after that the surgeons are stuck standing in one spot for 10 hours sewing one person back together.

I actually LIKED my Family Practice rotation a lot b/c of the variety of complaints and that there was always that chance of a really interesting case being hidden amongst the routine problems. And I looked forward to my on-call days on Medicine, Peds, and OB/Gyn (certainly NOT b/c of the long hours of overnight call plus working the day preceeding and the day after call), but b/c I loved getting NEW patients and was bored as could be when I saw the same pt for 5 days straight watching the slow progress of their treatment.

Now in the ED i'm still loving it - even the smelly patients oozing pus or blood I really enjoy taking care of b/c it just feels so rewarding to be able to provide medical care to people who need it most. I was a teacher before I went to med school, so maybe I'm more of a person who really gets a kick out of serving the community.

I agree, however, that EM is not for everyone, so if you are doing it just for the money or the days off or whatever, please do one of the many other specialites that affords these benefits (rads, anes, derm, pmr, optho, to name a few) b/c I'm trying to match this year and dont' need people competing with me in the match who will end up not wanting to work in an ED anyway. :)

Now let me stand up for the patients, whom many of you make sound like they are not even humans deserving of prompt medical care

I find that, yeah a few pts do complain about wait and act up, the great majority at our hospital are truly appreciative of the care they get, even if they wait many hours for it - maybe it's b/c they're not paying for it at the hospital I'm at.

As for non-compliance with meds - most pts dont' take them b/c they CAN'T AFFORD MEDICATIONS - not b/c they dont' want to take care of themselves. And many of these people DO WORK full time, sometimes several jobs, but in jobs where there is not medical coverage benefits. Not everyone's daddy was a doctor and has the opportuinty to go to college and make big money. The situation of health care, espeiclaly Rx drug plans and availabilty of primary care physicians to poor people needs some sort of major overhaul - if you want to hide from these problems in your private practice that accepts only insured patients, go for it. But please don't blame the pateints for choosing to pay rent or buy thier kids food over buying the $100 Rx you wrote them.

I think it's sad that they have to come to the ER and wait all day to see a doctor - but for many people that is their only option.

4thyear, very well said...this board is filled with too many people that cannot comprehend the fact that medication can be a luxury to some people, the fact that some actually have to choose between feeding their family, or filling out pescriptions... obiviously, most people on this board have never been in that situation, including myself, but as healthcare students/workers, the LEAST we can do is empathize with those less fortunate... and those people that are simply searching for medications b/c of addictions, are not making your life any more difficult, we chose to get into healthcare, so suck it up...deal with it, your job is to help people heal, mentally and physically...its not always about the glamorous truama cases, sometimes its just about educating patients about the importance of sticking to their medication...or helping them seek treatments for their addictions.

Thank you fourth year for your standing up for EM.

I am a first year med student... so my perspective may change in a few years. However, I have spent 3 years working as a PCT in a level 1 trauma center and have truly enjoyed it.

The one thing that I love about the ER is the camraderie. It is incredible. From the attending physicians down to the cleaning crew, we need everyone. If one person doesn't do there job, it affects the whole system. There is such a sense of pride there for everyone. If you are looking for a place to power trip and give orders, find somewhere else to hang out, people working in the ER will tell you where to stick it. All of us can be pretty cocky and no one is going to kiss your a**. However, if you like being part of a team, you will find yourself right at home in any ER. Just remember that you are merely one part of the whole team and you will get along great.

Another thing I love about the ER is that you are never lacking for a story. Everyday is entertaining. If you keep a positive attitude, you will find much of your work quite enjoyable and comical. My friends will often ask me to tell ER stories and I can go on and on. From comedy to horror to gruesome to fright to inspiration, you will find it all in the ER.

If I could give one drawback, it would be that you rarely see the happy ending. It is a continuous packaging and triaging and sending patients off to where they need to be. By the time you have one patient stable, there is another disaster for you to clean up. It is really your team that drives you to keep going. If you can deal without patient follow-up, the ER is not a bad place to be.

You see many people at the lowest points in their life...mentally, physically, spiritually, and psychologically. If you are the type to encourage and motivate others, you can be a great asset to Emergency Medicine.

ER is not for the fainthearted. It is not cut and dry. It is not for the complainer. Things don't always go your way in the ER. But if you like the challenge of fighting the system and helping those that most of society has turned their back on, step inside and enjoy the ride. It is a rush!

I too am only a first year med student, but, I have worked as an EMT in a relatively busy ER for the past three years. I have to agree 100% with "Go Broncos". EM is definately not for everyone. But, I think it is for me. I have the luxury of knowing that the majority of cases are mainly FP. But, I really enjoy dealing with the drunks that come in. I like the psych patients. I love the adrenaline rush that comes with a serious emergency. To me, that all outways the cons.

What's more, I believe there is a different mentality that is drawn to emergency medicine. Almost all the ER docs I know are simply a pleasure to be around (most of the time). And the nurses, especially on night shift, make working just a little more tolerable.

My mind may change a few times with each rotation that I enter. But, for now, I can't wait to be an ER doc.

People burn out in every profession and each reason is individual. Surgeons hate the malpractice. IM docs hate the call. FP hates the reimbursement. Psych hate their patients.

EM docs, if residency trained and board certified, have many many options of geographic location and hours. Though this all depends on years experience, the fact that I can work 40-50 hours a week and start off making >160,000 K is rather nice. And that estimate is rather conservative.

Burn out happens, but for those well prepared...it is preventable.

Yes, it seems that the greatest percentage of "burnout" is due to the fact that people watch the NBC show "ER" too much. Contrary to populary belief, 95% of your patients will not be blunt force trauma, etc.

If you go into EM with the mindset that 75-80+% of your patients will be drunk, suicidal, FP-patients, etc., your chance of 'burnout' is much less. Being realistic always helps....

Best of luck.

Frank

so how much longer is it to get into a trauma surgery program?? EM is 3-4 years from what i can find, is the surgery part an extra year or 2??? Those have to be two of my three favorite things-- trauma and surgery!

Trauma surgery is a fellowship after a 5-7 year general surgery residency (otherwise known as hell to many people I know). I'm not sure how long the fellowship is, probably 2 years. You CANNOT do trauma surgery after an ER residency.

actualy, you can do a trauma/critical care fellowship as an emergency med physician. here is info on the 3 fellowships:
Trauma/Critical Care

Canada

Sunnybrook and Women's College Health Sciences Centre
University of Toronto
Michael J. Schull, MD
Emergency Department Fellowship Program
Sunnybrook and Women's College Health Sciences Centre
c/o Dr. Michael Schull, Fellowship Coordinator
G-147, 2075 Bayview Avenue
Toronto, Ontario, Canada M4N 3M5
Phone: (416) 480-4037 Fax: (416) 480-6048
Email: mjs@ices.on.ca
Categories available: Trauma, Research, EMS (air or land) Clinical Emergency Medicine Length: 1 Year
(maybe renewed up to three years if enrolled in research courses leading to post-graduate degree)
Salary: $55,000 (CDN) per annum plus benefits
No. of Positions: Variable (minimum one)
Start Date: July 1st of each year
Deadline: November 1st of year prior to start date (late applications may be considered; contact
coordinator).

Illinois

University of Illinois
Joseph P. Wood, MD, JD
University of Illinois, Chicago
Christ Hospital & Medical Center
Department of Emergency Medicine
4440 W. 95th Street
Oaklawn, Il 60453
Phone: (708) 346-5375 Fax: (708) 346-1028
Email: woodmdjd@prodigy.net
Length: 12 months
Salary: $65,0000
No. of Positions: 1
Deadline: January 31

Maryland

University of Maryland
Wade Gaasch, MD; Thomas Scalea, MD
R. Adams Cowley Shock Trauma Center
419 W. Redwood St., Ste 280
Baltimore, MD 21201
Phone: (410) 328-8025 Fax: (410) 328-8028
Email:
Length: 1-2 years
Salary: Negotiable
No. of Positions: 2
Deadline: Open

so i'm interested in EM and would love to hear what some of the current people in the forum thinks about the whole 'burnout' topic. i still hear that EM has a relatively high burnout rate. how do you all who DID choose EM stay positive day in and out and not get burned out? EM sure seems sweet (the work they do interests me, not just the $ or hours...although not being on call is a major plus). so yeah, whatever info you all could give would be much appreciated. :)

Perhaps re-read this thread? Your questions seem to haven't been answered in this year+ old thread, but do a search fo rit... the high "burn out" rate is an old-ish philosophy before the majority of EM attendings were EM trained...

Q, DO

trauma/critical care is a fellowship (2-3 years i think?) after 5 years of surgery. I agree with the previous poster who noted that in a program where the ED plays a role in traumas, we get to do all the glamourous stuff you see on TV then the surgeons take them upstairs, operate all night, then round on them for the next two weeks....meanwhile I"m working on the next chest tube, intubation, sore throat, and belly pain.

I love what I do and the fact that each patient i see is a new challenge. My favorite part of caring for urban patients that frequent our university county level one is that many of our patients have myriad untreated comorbidities and it ensures that no presentation is textbook and many end stage sick sick patients end up on my doorstep to be deciphered. I'm sure that by the end of residency there won't be much I don't know how to approach!

As for the original question,One of my attendings recently quoted a newer article about burnout looking at Residency Trained EM physicians...the newer numbers showed a lot of turnover was related to physicians not knowing what they were getting into and not knowing the right questions to ask when getting into their first job out of residency. This was leading to lots of turnover because people weren't happy with their ability to become partner in groups, how billing was done on their behalf etc. Things that noone had to worry aobut in residency. Again as the specialty ages, these things are being addressed and people are happier.

I never read this thread, since it was dead a year before I found these forums. I'm amazed at how many non-EM trained people chimed in. I don't go waltzing off to the IM forum and tell them how much their specialty sucks. I don't know why people feel the need to do that here. That said, we must be real miracle workers, because as this thread demonstrates we're able to raise the dead!

I'm only 2.5 years out of residency at this point, so I can't speak to any personal experience as to long-term burn out. I'm not feeling it if that's any relief. The money is good, the work is interesting, and we don't get shat upon nearly like some of our previous MEDICAL STUDENT posters have claimed. Those previous posters assumed that the situation at their particular institution must be how it works out here in the private world. Guess what? It's not.

As far as respect goes, there are always some older docs who aren't used to competant EM physicians who try to give us crap. Sometimes they have to be put in their place and realize that we are all colleagues. I've hung up the phone on rude consultants in the middle of phone conversations until they can be more civil. They also realize that if they're on the call schedule and they piss me off, I can document ANYTHING I WANT regarding our conversation about the patient. "Dr. X still refuses to evaluate patient after being explained nature of pt's problem." Doesn't look good in court. Generally, we all understand we're in the same boat. If it sinks, we all sink. After one conversation to clear the air, there generally aren't any further problems.

The vast majority of my consulting physicians and surgeons are quite pleasant, appropriately professional, and appreciative of the service we provide them (i.e. we allow them to go back to sleep in the middle of the night after a brief phone call). I'm on a first name basis with most of the physicians and surgeons who are usually on-call, and I don't think that's unusual.

Good point sessamoid -- I've never even entered the other forums b/c I don't have anything I could contribute regarding practicing im, surg, whatever. I almost feel that people who repeatedly put down emergency medicine must not be happy in their own fields. I'm happy with promoting emergency medicine to those considering it. I'm also glad that others love im/surg/psych/etc because like I've said on a different post, someone's gotta do it.

to answer a few things in the md03's post -- md03 mentionned that the schedule sucks. well, for a lot of us, the flexibility of shift work appeals to us. not everyone wants to work everyday and be on call every few nights.

in addition, the same poster mentionned that if patients are painful in the middle of the night and demanding, the ER doc has to make friendly. i work in an urban er and i can tell you that patients that are rude, obnoxious are put back into place. if they can't stop disturbing people, we can and do have security come and escort them out.

finally md03 says that the er doc is the employee of the hospital. not always the case. there are many different formats which i don't know too much about yet (being a resident) but i know not everyone is an employee of the hospital.

i think the wrong people to answer the question regarding burnout are people who did not choose this field (especially as demonstrated by md03 who got most of the facts wrong). it's good for everyone that for instance, md03, did not go into er because s/he would not be happy and i could possibly get stuck working with him/her.

unfortunately this thread is so old that i'm sure md03 is no longer following this thread and that the original poster probably has already been scared out of er. it's too bad if OP were interested. anyhow, hopefully for those reading this thread and considering er, they will see that those PRACTICING or TRAINING in the field love it.

Sessy and Jazz are right...

those that choose EM LOVE IT! Although I am butt a lowly EM intern (who has done one unit, one ward, and one Trauma Surgery month), I cannot wait to get back into the ED. Shift work, getting off when my shift is off, not working 36 hours straight, no writing on the same patient about hte same CBC or the same blood culture... *sigh*

I expect burnout will be MUCH MUCH lower (probably lower than most non-subspecialty pracitces) soon because most of the EM attendings are now EM trained, whereas twenty years ago it was FP/IM/OB/GYN etc who worked in the ED, and weren't formally trained in it, and did not initially WANT to be in EM (most people who are EM trained now knew they wanted it!).

Q, DO

Thanks guys,

This thread has been an awesome read :) I've been trying to follow up on the EM topic, including a post here and there for the past few months. Now as an MS I, I'm really beginning to appreciate all the input that's been provided and seeing how it relates to me while deciding where I will eventually end up. I have also worked in several ED's during my undergrad and I generally did not notice the "burn-out" that the other posters have complained about. There were some tense moments here and there, but generally, the ED staff really got along well and supported each other. For some time now, I've been considering EM and all of the advice posted has been helpful. Thanks again and keep up the good work :clap: :clap: :clap:

Good luck in your M1 year. Keep your options open, keep your head in the books, but keep your head above water (i.e. go out for a brewski or a Japanesey Massage every once in a while).

Q, DO

thanx for the responses everyone! i pulled this out (yes, having read it first, Q)....just to see what those of you who have written other posts i have read had to say about the subject...the thread was so old i didn't know anyone but didn't want to start a new one with the same question ;) so thanx. your answers were along the lines of what i was guessing.

Originally posted by fourthyear
But please don't blame the pateints for choosing to pay rent or buy thier kids food over buying the $100 Rx you wrote them.

Don't forget that they got to have their cigarettes and beer too!

Originally posted by spyderdoc
Don't forget that they got to have their cigarettes and beer too!

It is interesting to note that "fourthyear", the author of the original quote, is now a surgical resident...

Really, I just do boob jobs so I can afford to do the important reconstructive work that comes along!

My prediction - Michael J. Fox plays "fourthyear" in the movies. Wait, he already did! :p

- H

I am also in my first year of EM residency. And I absolutely LOVE it. I never considered EM in medical school. (I was set to do pediatric rhuematology) Even as premed, I never volunteered in an ER because I always said that I wasn't goign to be an ER doc.

Only at the end of my 3rd year when I didn't really know what I wanted to do and was bored on medicine, did I really even start thinking about it. I had enjoyed my 2 weeks of trauma surgery but new the surgical lifestyle wasn't for me. A fellow student wanted to do em and we started hanging out in the ER. He was very enthuisiastic and I started getting interested. I started talking to the ER attendings (some medicine trained, some surgical some ER) and really liked what I heard. So I did a rotation and absolutely loved it.

If you look at the burn out issues, those tend to be doctors trained in other areas working in ER's. since residency became the norm, the burn out rate is no higher. You do have to be careful and make sure you aren't working to many shifts a month (tempting because of all the per diem money)

But I love all of ER. Not knowing if your day is going to be 'clinic' day or 'trauma' day or some of both. Some day is Gyn day. What I love about the ER is the diversity. You will see it all. And yes, you see a lot of clinic type stuff. But it is up to you to decide if the patient needs to come in. This is huge. No one should be dismissed lightly! Er is very different from the rest of medicine where differentials are based on most common to least common. In ER the difference is the differential is based on 'what is going to kill this patient'.

So, I don't know. I still love it. I get home sick for the ER when I am off service.

If you go in to ER thinking it is like the tv show, you will be sorely disappointed. I think if you are considering it, you should do a rotation. Most people I know are pretty certain about how they feel about it. They either love it or hate it.

the liability issue that dr oliver mentioned worries me--one of the professors at our school used to be a full time er attending who now works only about 6 shifts a month and spends most of his time teaching. most of what he teaches is evidence based medicine--he became kind of obsessed with it after he made some poor calls for tests, and now he's real unsure of what he's doing.

granted, this guy is kind of an exception--he's pretty scatterbrained and loses track of himself, but how much is liability an issue? and is going in the opposite direction a problem? (ie. just sticking straight to protocols to avoid getting in trouble, even when you might want to go a different direction)

also, one of the earlier posters mentioned that all they were able to was 'get the guy's clothes off' [sic] before the trauma team took over. this is a bit hard to swallow--am i just not good at catching sarcasm online? my only experience is at an academic center--are community hospitals run differently?

Good read. Thanks for the info :thumbup:

Solid 7 year old thread bump. Come on, you've been here 8 years, you should know better.

C'mon... it's not even six years old (since the last post)... and we get a blast from the past from DrQuinn "the lowly intern" :)

Solid 7 year old thread bump. Come on, you've been here 8 years, you should know better.

Yes, and 7 years ago I wasn't even pre-med. Your point?

Yes, and 7 years ago I wasn't even pre-med. Your point?

Then why were you registered here of all places?
He just said most people don't bump 7 year old threads. Although it is better than starting a new one. I suppose.

Then why were you registered here of all places?
He just said most people don't bump 7 year old threads. Although it is better than starting a new one. I suppose.

Nah, I registered out of interest back then, I wasn't a pre-med until about 6 years ago.

Didn't know there was a bump policy but if there is, someone please enlighten me. Dr.McNinja, Pontifex Maximus?

Considering recent posts, bumping a thread that's been dead for years or was started 15 minutes ago will both occasion comment. And here I was thinking that this thread was going to advance the theory that ED docs burn out quickly secondary to our consumption of flammable liquids.

Considering recent posts, bumping a thread that's been dead for years or was started 15 minutes ago will both occasion comment. And here I was thinking that this thread was going to advance the theory that ED docs burn out quickly secondary to our consumption of flammable liquids.

Well... considering those jalepenos I just ate and the 105 degree weather down here, we may be on to something.

Or it could just be the infestation of life-force-stealing-soul-sucking-fibromyalgia-chronic-pain-having-dementors-from-hell.

Tough call. Could go either way.

Take care,
Jeff

Eh, if you've gone back to like page 1 of the EM threads to read a post, you probably shouldn't bump if you're gonna add nothing to it.

105 degrees? Why am I even considering applying to Texas programs? good god.

It was in the mid-90's last week here, and one of our friends from residency was visiting from Houston. She commented several times how much cooler it felt in Memphis. Since I was dripping sweat after walking 100 feet, I didn't really appreciate the mild weather.

The light that shines the brightest burns out the quickest.

The light that shines the brightest burns out the quickest.

Are you saying we're all replicants?

http://www.filmwad.com/fw_images/2008/06/26/roy-batty.jpg

Take care,
Jeff

Are you saying we're all replicants?

http://www.filmwad.com/fw_images/2008/06/26/roy-batty.jpg

Take care,
Jeff

I think some of my co-workers are.

bump.

bump.
I can never figure out why people insist on bumping threads that have recent replies.

Bumping threads should happen if a specific question isn't answered after a week, not a few hours.

I can never figure out why people insist on bumping threads that have recent replies.

Bumping threads should happen if a specific question isn't answered after a week, not a few hours.

It's summer time..............the pre-meds and MS1s are out to bump :sleep:

I can never figure out why people insist on bumping threads that have recent replies.

Bumping threads should happen if a specific question isn't answered after a week, not a few hours.

I bumped after 6 years. Does that count?

I bumped after 6 years. Does that count?
Well, yes and no. You did search, instead of starting a new thread, so you did that right.
However, the risk of bumping a thread this old is that often, the people that were posting in it are no longer participating in this forum. I would say on average, most people post during med school/residency. There are some that post as attendings, but fewer. SERMO has peeled a few off. If you look back at my first intern class, there were quite a bit more postings, and people were completing the Rearview Mirror threads nearly monthly. Now it isn't as quick.
So if you bump an old thread to ask a new take on it, I think that might be ok. Depends on what you ask. If you bump it to ask the people in that thread a specific question, you're probably exercising in futility.

I bumped after 6 years. Does that count?
The most recent reply was 36 hours prior to your bump time, so no, a thread being that old doesn't count. If there wasn't a reply for 2-3 years, then yes, I could understand bumping it (but without just posting "bump" and instead asking a question that wasn't answered in the thread).

...If you look back at my first intern class, there were quite a bit more postings, and people were completing the Rearview Mirror threads nearly monthly. Now it isn't as quick...Hey - maybe we're working hard instead of goofing off on SDN! :laugh:

...There are some that post as attendings, but fewer...That is a shame. I wish ERMudPhuD would come back.

The most recent reply was 36 hours prior to your bump time, so no, a thread being that old doesn't count. If there wasn't a reply for 2-3 years, then yes, I could understand bumping it (but without just posting "bump" and instead asking a question that wasn't answered in the thread).

http://imagecache2.allposters.com/images/pic/FIP/IO-00021-C~Lets-Have-a-Beer-Posters.jpg

:)

http://imagecache2.allposters.com/images/pic/FIP/IO-00021-C~Lets-Have-a-Beer-Posters.jpg

:)
Sure, I'll take a Beck's Dark. :D

i love how all the threads here turn to beer...but while were on the topic i'll have a yeungling please

i love how all the threads here turn to beer...but while were on the topic i'll have a yeungling please

I really miss Yeungling. I wish there were a way to get it out here.

I really miss Yeungling. I wish there were a way to get it out here.

No Yeungling out in Vegas? That is an outrage!!!!!!!

No Yeungling out in Vegas? That is an outrage!!!!!!!

I've never seen it anywhere but Philly and the surrounding region. It's like Coors used to be.

I grew up around Buffalo NY, and never saw it. Then, when I got to Duke, I did. Turns out they opened a brewery somewhere here in the south, which made it expand to here.

Personally, I wasn't totally impressed - not bad, by any means, but just isn't my beer. One of my colleagues, though - he drank it like water.

I really miss Yeungling. I wish there were a way to get it out here.This is like folks saying they "miss" Dunkin' Donuts "coffee." I just don't get it.

I've never seen it anywhere but Philly and the surrounding region. It's like Coors used to be.But now you compare Yeungling to Coors?! As one who spent much of his college years metabolizing one Coors product or another, I am offended. I demand satisfaction!

This is like folks saying they "miss" Dunkin' Donuts "coffee." I just don't get it.

There are a lot of these memes out there, and I can never understand it. My wife insists that McDonald's has the best ice cream out there. It drives me up the wall. I've heard people say the same thing about their coffee.

What's to understand? I really like Yuengling. I haven't found another beer that I like as much that every restaurant will have. I miss fried seafood from the gulf coast and the pastrami sandwiches from this one place in CA. Doesn't everyone have things that they miss that they can't get as frequently?:confused:

...Doesn't everyone have things that they miss that they can't get as frequently?:confused:...Oh, I understand completely. I can't find a decent mexican restraunt - and I've tried. Ditto for Thai. And I mentioned Mad Molly above. But this:
...I really like Yuengling...:d

Doesn't everyone have things that they miss that they can't get as frequently?:confused:

Sleep? Sex?

I bet if I moved farther away from saltwater I would miss seafood. But the places I came from (many) didn't have that many redeeming qualities. I mean, who misses Krystal burgers?
Mayfield milk ranks up there though. This crap down here is pretty awful. Sometimes I would rather pour water on my cereal.

Mayfield milk ranks up there though. This crap down here is pretty awful. Sometimes I would rather pour water on my cereal.

Happy Cow kicks Mayfield's ass up and down the field. And, for some inexplicable reason, Mayfield is more expensive than Happy Cow.

The story behind Happy Cow is interesting - the guy had his dairy, and was doing all the hormones and antibiotics. This guy's dairy was in trouble. One day, the cows broke through the fence and were grazing on the grasses. He let them. He got better returns from the cows. The milk goes through 40 feet of pipe TOTAL.

You have to shake up Happy Cow before you pour it, because it's not emulsified. Happy Cow chocolate milk is the best you'll ever find made from a cow's milk, bar none.

glad some others enjoy my taste for yeungling. and those nay sayers it is the oldest brewrey in the US you know ;) I have mostly lived in the NY/PA/NJ area so finding it has never been a problem for me. Oh and yeungling and coors are def not on the same level

glad some others enjoy my taste for yeungling. and those nay sayers it is the oldest brewrey in the US you know ;) I have mostly lived in the NY/PA/NJ area so finding it has never been a problem for me. Oh and yeungling and coors are def not on the same level
For the record I wasn't comparing Yuengling to Coors in terms of quality. I was noting that Coors used to ba a strictly regional beer and is now everywhere. Another example would be Sierra Nevada.

For the record I wasn't comparing Yuengling to Coors in terms of quality. I was noting that Coors used to ba a strictly regional beer and is now everywhere. Another example would be Sierra Nevada.
My father remembers making runs in college to Colorado (from western PA where he was in school) to fill up the car with coors and drive back, a la smokey and the bandit. Kind of a shame that coors is ubiquitous now.

Didn't know Coors started as a regional beer. sorry about that :P

glad some others enjoy my taste for yeungling. and those nay sayers it is the oldest brewrey in the US you know ;) I have mostly lived in the NY/PA/NJ area so finding it has never been a problem for me. Oh and yeungling and coors are def not on the same level

I never heard of "yuengling" till I went to Penn State. There is a brewery in Tampa too, so now I have it in Florida which makes me very happy.

Doesn't everyone have things that they miss that they can't get as frequently?:confused:

I grew up in East Texas. I thought I'd have a seizure if I ever saw another pine tree. Now, 23 years after graduation, I almost miss the things.

Almost.

Take care,
Jeff

BTW, if I moved from Texas, I'd have absolute fits without my Blue Bell ice cream.

I see blue bell everywhere.....I grew up with it in Indiana.

Wow, this thread spans 7 years! When this thread was started, I was still pimply and awkward in high school. but thanks for the info guys! I'm trying to decide if I want to do EM or surgery, but I have a few years until I have to really decide.

Happy Cow kicks Mayfield's ass up and down the field. And, for some inexplicable reason, Mayfield is more expensive than Happy Cow.

The story behind Happy Cow is interesting - the guy had his dairy, and was doing all the hormones and antibiotics. This guy's dairy was in trouble. One day, the cows broke through the fence and were grazing on the grasses. He let them. He got better returns from the cows. The milk goes through 40 feet of pipe TOTAL.

You have to shake up Happy Cow before you pour it, because it's not emulsified. Happy Cow chocolate milk is the best you'll ever find made from a cow's milk, bar none.

Interesting stuff on their website (http://www.happycowcreamery.com/About.htm). I didn't realize that when something travels through a pipe it gets 'bruised' (by way of its 'molecules breaking down'). So if you drink NYC tap water that has traveled hundreds of miles from upstate, you're drinking broken down H2O. Bruised water. Good times.

Interesting stuff on their website (http://www.happycowcreamery.com/About.htm). I didn't realize that when something travels through a pipe it gets 'bruised' (by way of its 'molecules breaking down'). So if you drink NYC tap water that has traveled hundreds of miles from upstate, you're drinking broken down H2O. Bruised water. Good times.

Water is H2O - very simple. Milk is MUCH more complex. Recall you're a trained scientist, also - the Happy Cow Creamery isn't aiming for you, despite your sarcasm.

Elsewhere on SDN, years and years ago, I posted a thread entitled "Tasty Tap Water", and I mentioned the water in NYC, and also south of Buffalo where I grew up, and how it was great right out of the faucet.

Water is H2O - very simple. Milk is MUCH more complex. Recall you're a trained scientist, also - the Happy Cow Creamery isn't aiming for you, despite your sarcasm.

Elsewhere on SDN, years and years ago, I posted a thread entitled "Tasty Tap Water", and I mentioned the water in NYC, and also south of Buffalo where I grew up, and how it was great right out of the faucet.

I guess they're not aiming for people who have taken a college chemistry class, but it sounded like you bought into it as well (though I'm sure you simply wrote it to point out how simplified and local their processing is...). In terms of milk vs water, yes milk is more complex, but I still don't see how piping milk through long, large pipes is going to 'break it down'.

The reason I pointed it out is because it irks me when I see lay people using scientific terms to 'explain' something. E.g., the other day I had a discussion with a friend who tells me she has hypothyroidism and is on levo. Then she asks me if it's true you can cure hypothyroidism with a "white-cell cleanout". I understandably laughed it off, and she insisted and said that "it makes a lot of sense because if you fix the white cells bla bla bla". Of course she had no idea what a white cell actually does or how and what the thyroid does. Anyway, I don't think it's too much too expect that if a lay person is going to use a term like 'molecules breaking down' they should know what it means and use it correctly.

NYC tap water is consistently rated among the best tap waters around. And I've personally compared NYC taps with Upstate and Western NY taps and NYC is better IMHO. Regardless, the taste of the tap water has nothing to do with the molecules and their state after traveling miles and miles but with minerals and 'stuff' in the water that it picks up or drops off along the way.

I don't understand the ER doctors who are upset that it's not all emergencies. As if they didn't have any experience in an ER before picking that specialty. I've been volunteering in an ER for a little over half a year now and realized within the first day that the majority of people were in there because they just needed to see a doctor and didn't have money (or it was a weekend and their doctor wasn't open). Fyi, I want to be an ER doctor despite all that.

I don't understand the ER doctors who are upset that it's not all emergencies. As if they didn't have any experience in an ER before picking that specialty. I've been volunteering in an ER for a little over half a year now and realized within the first day that the majority of people were in there because they just needed to see a doctor and didn't have money (or it was a weekend and their doctor wasn't open). Fyi, I want to be an ER doctor despite all that.

Your comment is essentially hijacking the thread (from the bruised water discourse) but the bolded area of your text is exactly what we have a problem with.

People are using the EMERGENCY DEPARTMENT as a drive-thru window for all of their medical needs. I have no problem with the laceration, vomiting, or other URGENT medical problem coming in on Sunday. I do have a problem with the "my foot hurts for 4 years", or the "I have had a runny nose for 4 days", or "my doctor wants $75 to be seen" patients.

This is the problem with our medical system. Americans want all of their healthcare NOW and they want it FREE.

Americans want all of their healthcare NOW and they want it FREE.

"Everything, for nothing, immediately." Something has to give when that is what is wanted.

but it sounded like you bought into it as well (though I'm sure you simply wrote it to point out how simplified and local their processing is...).

Since the post on which you commented is almost 5 months old, it sounds like you were the only one who thought that way.

Speaking of the opposite of tasty tap water (NYC being definite quality), Clearwater FL is the most misnamed city in the US. The water was so nasty that even the fountain drinks were undrinkable. And this was after an all day roller hockey tournament. I was forced to resort to beer to rehydrate. For shame Clearwater, for shame.

My typical reply to this question stands...

If you can not be satisfied working a couple shifts a month for near $200 an hour...... you probably can't be satisfied.

For that money, I would almost stand outside naked in the arctic...maybe cut myself with a razor... go to church with a mohawk...etc. Point is, you can do ANYTHING for a few days a month.

I think the whole burnout thing is old news when the burned out FP and IM doctors 'worked in the ER'..of course they burned out, they already did once. Either way, these days if you do get burned out and do not want to work 12 shifts a month (TWELVE days a month!) then tune it down to 1 day a week. You can still do a 6 figure income if you go to the right part of the contry...

In an effort to help this thread to it's natural SDN EM conclusion, I'll just jump ahead a bit here....

http://www.planetrodi.net/BEER%20shiner%20bock.gif

Thank you and good night.

Take care,
Jeff

Merry Christmas, Jeff, and to all a good night.
http://miasmaticreview.mu.nu/mt-static/Shiner%20Holiday%20Cheer.jpg

My typical reply to this question stands...

If you can not be satisfied working a couple shifts a month for near $200 an hour...... you probably can't be satisfied.

For that money, I would almost stand outside naked in the arctic...maybe cut myself with a razor... go to church with a mohawk...etc. Point is, you can do ANYTHING for a few days a month.

I think the whole burnout thing is old news when the burned out FP and IM doctors 'worked in the ER'..of course they burned out, they already did once. Either way, these days if you do get burned out and do not want to work 12 shifts a month (TWELVE days a month!) then tune it down to 1 day a week. You can still do a 6 figure income if you go to the right part of the contry...

I completely disagree. Burn out still exists. I actually think it exists in medicine as a whole but that's another story altogether. While I am perfectly happy right now, I can see it in colleagues. They work slower. They complain. And to be honest, working in an ER is hard work. You have to be "on" your entire shift. There's no sitting at your desk, replying to emails, google searching for the latest Tiger Woods story (unless it's a real slow night). In addition, time shifting wears on you. Nights only get harder.

You have to be adaptable and I feel that most who choose EM have this ability, but some clearly do it better than others. The varying shifts, work, patients is part of what makes the job fun but it can also be seen as a challenge.

In an effort to help this thread to it's natural SDN EM conclusion, I'll just jump ahead a bit here....

http://www.planetrodi.net/BEER%20shiner%20bock.gif

Thank you and good night.

Take care,
Jeff

Sigh. I never make any headway.
http://blog.glenfiddich.com/wp-content/uploads/Glenfiddich%20Rare%20Collection%2040%20Year%20Old. jpg

Sigh. I never make any headway.

No, but your persistence is admirable.

Take care,
Jeff