Any EM guys 5-10+ years out who still love what they do?

[@JackShephard]

Any EM guys 5-10+ years out who still love what they do?

Yes? No? Why?

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[The White Coat Investor]

Best job I've ever had or heard of. Don't let internet pessimism get to you. I still can't believe I get paid what I do to talk to people about their anxiety or belly pain. Every now and then I even save a live.

 

[WilcoWorld]

Yep. The worst thing about my job is that it takes me away from my family, but fortunately I get to spend a lot of time with them.

 

[Hercules]

I'm 5 years out and I love it. It's a more mature love now (picture the difference between the infatuated dating love and the older married couple love). I can definitely appreciate the challenges and downsides of our specialty at this point, but I still love it and am confident I made the right choice.

 

[Alvarez13]

Thanks guys. This is much appreciated to someone about to match tomorrow.

 

[EctopicFetus]

I agree. I really enjoy my job. I get paid a decent wage and I have time and money to do the stuff I want with my family.

I think you cant underestimate the value of having time to hang with your family. I also think its nice you can spend your money on stuff you want without stressing.

One of the things to consider is that this "time" is sometimes at the expense of sleep. Not to be a downer but like I tell our scribes. Owe as little as possible. I work a decent bit as I am trying to pay down my debt asap. My rates are low but I need to dig out of my student loans a bit.

For me I work at night that means after a run I wake up early when my kids have stuff (like baseball games etc.). Guys who work a regular schedule will wake up early to take their kids to school etc. IMO there isnt a purer better job in medicine. You have to like a little bit of chaos, enjoy your free time and put whats important first.

IMO a large number of the unhappy guys in my group are those who live a lifestyle like they earn 50% more than we do. They work more than they want, they have to keep up a number of hours at work they are no longer comfortable with.

 

[@JackShephard]

Thanks for the replies. Sometimes it seems like you guys don't exist.

 

[EctopicFetus]

Thanks for the replies. Sometimes it seems like you guys don't exist.

Want to be happy in EM. understand the shortcomings of the professsion. AKA dealing with drug addicts, POS demanding pts and those who abuse the system.

put 25% of your income in retirement, another 30-45% away for taxes/SS/medicare (depending on your work status, W-2, 1099 etc) etc. This will limit your desire to work more and you will always have some room in your budget. If you live within your means you can quickly get to the point where you work as much as you WANT not as much as you need.

 

[The White Coat Investor]

I agree. I really enjoy my job. I get paid a decent wage

Decent? Last I checked you were the 1% of emergency physicians with your fancy wooden floored trauma bays.

Seriously though, I do fifteen 8s a month. In a 31 day month, that works out to 27 hours a week. I don't think I could make more money in that little time if I were robbing banks and selling crack. I keep thinking this can't persist, but amazingly, every month it does!

 

[scummie]

I don't think I could make more money in that little time if I were robbing banks and selling crack. I keep thinking this can't persist, but amazingly, every month it does!

Thank you for this. My SO keeps on saying he should have gotten a Master's in Chemistry instead and gone all Walter White. If that's the case, I am by Skyler by default...No thanks.

 

[southerndoc]

6 years out and still loving it.

 

[dchristismi]

6 years out and loving it - depending on the day.

Like right now, I might be a couple of drinks into unwinding after the last 6-in-7 with a night-day flip on my only day off... and another 5 to go (after a holy day off tomorrow)... at which point I'm off to Europe again. Ok, maybe just one really stiff vodka martini with Elderflower liquer... but still.

Really, I get paid ridiculously well. Does my heart break regularly? Yes. Do I have to deal with the dregs of society? Yep. Does it drive me crazy? You bet.
But then, I get to take 2 weeks off to eat - ahem, drink - my way across Tuscany, and that "bonus" shift I picked up for an ill colleague is mad money. Leather jacket in Florence? Private tour of the Sistine Chapel? Hell yes. Life is short.

I totally agree with the above - I live simply for the most part, have a cheap mortgage, drive a paid-off VW, and have low living expenses (well, aside from the yearly passport stamp when I totally indulge), and sock away the maximum I can into retirement. But overall, yeah, EM totally fits me, and I'm so glad I get to do it.

 

[Spinach Dip]

IMO a large number of the unhappy guys in my group are those who live a lifestyle like they earn 50% more than we do.

THIS.

A million times over. THIS.



I've known people who make 20K a year and are happy as clams. On the other extreme, I've known people who pull in 7 figures a year and are barely scraping by.

Different worlds. Different mindsets.

 

[Spinach Dip]

Private tour of the Sistine Chapel? Hell yes. Life is short.

Can I come along?

 

[wjs010]

Decent? Last I checked you were the 1% of emergency physicians with your fancy wooden floored trauma bays.

Seriously though, I do fifteen 8s a month. In a 31 day month, that works out to 27 hours a week. I don't think I could make more money in that little time if I were robbing banks and selling crack. I keep thinking this can't persist, but amazingly, every month it does!

As an incoming student, you just gave me a career boner

 

[wjs010]

I agree. I really enjoy my job. I get paid a decent wage and I have time and money to do the stuff I want with my family.

I think you cant underestimate the value of having time to hang with your family. I also think its nice you can spend your money on stuff you want without stressing.

One of the things to consider is that this "time" is sometimes at the expense of sleep. Not to be a downer but like I tell our scribes. Owe as little as possible. I work a decent bit as I am trying to pay down my debt asap. My rates are low but I need to dig out of my student loans a bit.

For me I work at night that means after a run I wake up early when my kids have stuff (like baseball games etc.). Guys who work a regular schedule will wake up early to take their kids to school etc. IMO there isnt a purer better job in medicine. You have to like a little bit of chaos, enjoy your free time and put whats important first.

IMO a large number of the unhappy guys in my group are those who live a lifestyle like they earn 50% more than we do. They work more than they want, they have to keep up a number of hours at work they are no longer comfortable with.

Seems like the only negative would be not sleeping at night with your SO. Do you get sad about this? Does he or she understand and support a lot?

 

[EctopicFetus]

Decent? Last I checked you were the 1% of emergency physicians with your fancy wooden floored trauma bays.

Seriously though, I do fifteen 8s a month. In a 31 day month, that works out to 27 hours a week. I don't think I could make more money in that little time if I were robbing banks and selling crack. I keep thinking this can't persist, but amazingly, every month it does!

LOL.. who did you check with? We do ok. I think the SDGs do decently well. Its the CMG guys who are getting the business end of a carrot.

 

[EctopicFetus]

Seems like the only negative would be not sleeping at night with your SO. Do you get sad about this? Does he or she understand and support a lot?

My wife totally understands and when I signed up for all nights I told her (via the advice of a colleague) that she could pull me off nights whenever she wanted to. I probably have less than 24 months of nights left. That being said EM is a bit of an up and down job. Sometimes you are at work at 6am and sometimes you are asleep at 6am, sometimes you are at work at midnight, sometimes you are asleep at midnight.

You have to understand this.

I will say this since WCI said so, we do well.. really well. Sounds like a lot of people on here do. The key is my work environment is really great. Wthout that I would make a lot of money in a terrible system. As it satnds now I have a good income in an excellent work environment.

I cant stress this enough. I worked as a moonlighter for EmCare and the docs there wanted more coverage. There were a lot of non em docs (FP trained) and the volumes were around 2pph. They screamed and cried to the regional folks and were told where they could put their concerns.

Our group had a similar issue and the following month we had more staffing. Our leadership is directly accountable and elected by our partners. Surely does make a difference.

 

[RockDoc7]

I am glad to see that the fair number who have replied to this thread are all lovin' what they do still; but as has been discussed before, the topic of burnout and/or longevity of career will be continual topics. Considering that burnout has been discussed probably moreso than the latter, especially even with recent posts, I would like to ask about the longevity aspect. Specifically, when the average EP (who started med school mid 20's) who practices 'til their 50's, what does one normally do once you reach a point in your career/outside-lifestyle when the fluctuating shifts and circadian disregulation press on? Admin work, urgent care, consultant of sorts?

 

[Birdstrike]

.
"I'm just sitting here watching the wheels go round and round,

I really love to watch them roll,

No longer riding on the merry-go-round,

I just had to let it go"


-John Lennon (Watching the Wheels)

 

[ILEMres]

Give your work, as a gift to Jesus Christ and the Lord. Then you'll never get burned out.

 

[SeekerOfTheTree]

Give your work, as a gift to Jesus Christ and the Lord. Then you'll never get burned out.

I still gotta make that money to give to Caesar baby.

 

[EctopicFetus]

I still gotta make that money to give to Caesar baby.

Do you mean Mao-bama

 

[SeekerOfTheTree]

Do you mean Mao-bama

He is our God.

 

[RustedFox]

Give your work, as a gift to Jesus Christ and the Lord. Then you'll never get burned out.

Does he co-sign my charts ?

No?

Hm.

 

[Spinach Dip]

Do you mean Mao-bama

Thought it was Owe-bama.

 

[pagemmapants]

Obiwama Kenobarack.

Edit: Not allowed to have an opinion yet since I'm only <1 year out, but I'm still loving it. FWIW.

 

[da8s0859q]

Does he co-sign my charts ?

No?

Hm.

"I have reviewed the attending physician's documentation above and am in agreement with the history, physical exam findings, and medical decision-making as presented.

Jesus Christ, MD"

Electronically signed by CHRIST, JESUS H

 

[DocEspana]

"I have reviewed the attending physician's documentation above and am in agreement with the history, physical exam findings, and medical decision-making as presented.

Jesus Christ, MD"

Electronically signed by CHRIST, JESUS H

My lord and savior, and program director, jesus christ does not, generally speaking, find himself in agreement with my decision-making.

oops.

 

[Droperidol]

He doesn't cosign my charts per say. I would be more willing to call him the ultimate hospitalist service. There are an infinite amount of beds and he can't balk. Incidentally, he has a mortality of 100% on his service. The ultimate black cloud..

 

[Spinach Dip]

He doesn't cosign my charts per say. I would be more willing to call him the ultimate hospitalist service. There are an infinite amount of beds and he can't balk. Incidentally, he has a mortality of 100% on his service. The ultimate black cloud..

Then again, he does open his arms to a large number of what others label "hopeless" cases.

 

[circulus vitios]

I am glad to see that the fair number who have replied to this thread are all lovin' what they do still; but as has been discussed before, the topic of burnout and/or longevity of career will be continual topics. Considering that burnout has been discussed probably moreso than the latter, especially even with recent posts, I would like to ask about the longevity aspect. Specifically, when the average EP (who started med school mid 20's) who practices 'til their 50's, what does one normally do once you reach a point in your career/outside-lifestyle when the fluctuating shifts and circadian disregulation press on? Admin work, urgent care, consultant of sorts?

Why is EM burn out such a big deal? I've worked swing shift in a factory before, and I didn't think it was terrible. How is 30-40 hours a week in the emergency department so much worse than 50-60 hours a week in clinic or the operating room -- are surgeons spending the majority of their days f-ing off or something?

edit: I guess the tone of this post came across terribly. I'm not accusing EM physicians of being lazy, I just don't understand how 30-40 hours of non-stop work a week is so taxing, and how other specialties can put in 50 or 60 hours a week without burnout being such a huge deal. EM seems like an awesome lifestyle specialty, and I say this as someone who has worked swing shift.

 

[emergentmd]

Decent? Last I checked you were the 1% of emergency physicians with your fancy wooden floored trauma bays.

Seriously though, I do fifteen 8s a month. In a 31 day month, that works out to 27 hours a week. I don't think I could make more money in that little time if I were robbing banks and selling crack. I keep thinking this can't persist, but amazingly, every month it does!

Your work and shifts sounds very similar to mine. I am 14 yrs into my career and LOVE everything about it. Even the stuff that pisses people off doesn't bother me. I guess I just don't take much things so seriously. I don't think I would trade my job for any other field right now. At about yr 5, I had thoughts of going back to doing a radiology residency b/c it fascinated me. I am so glad i didn't for many reasons.

Things I love about ER

1. I work 13-14 days a month and works out to 24 hr/wk of just Patient care. I chart after work though which probably adds another 6 hrs a week. So call it 30
2. I can schedule my life around my family activities. Sure, I miss some stuff b/c stuff pops up but I can be there for all the big events. Give me 2 months heads up (wedding, trips, church events, school events) and I can be there at any time. I do not think I have missed any of my kids school daytime activities like "easter egg hunt" b/c I can take off.
3. I can work as much and as little as possible. I could drop down to 10 shifts a month, or ramp up to 18 if I want. Great flexibility
4. No patient loads = no pager = never on call. Have you seen the General surgeon who does clinic all day from 8-5p. Take call overnight and sometimes have to be there all night taking care of a belly disaster? Then have to see clinic patients the next day from 8a-5p? I dont see how I can complain when I work until 3am two times a month
5. When I get tired of working in the ED, I can do Free standings/UC. The flexibility and plentiful jobs are great. I work in Texas and get phone calls all the time about jobs. If I lose my job today, I can find another job the next day. You can't say this about most fields.
6. Our job is Clean. I have no nursing staff to hire, supplies to buy. I don't care for the business end of medicine. I come to work, and leave. Nothing to worry about in between. Other than charting, there is nothing I ever have to worry about when I get home.
7. pay is good to great for what we do. I am highly paid and have been in the top 1 % of US income for the past 10 yrs. This for working 30 hrs a week. Yes, I know I am an outlier but most EM trained docs easily make 250K+ a year. Most in Texas make 300-350K+ working 15 shifts a month. If we worked the 60 hr weeks the surgeons do, we would make 600K+ a year.
8. So much more positives I can think of but those are the biggies.

Negatives
1. Drug seekers, homeless, difficult patients, psych pts - Not a big deal to me. Spend 5 minutes dealing with them and I go back to my work. Not difficult saying no to drug seekers. And if dealing with them is so difficult, give them 5 Norcos and they will on their way.

2. Flipping schedules/night shifts. This can really SUCK. I remember working 3 overnights when I was young and it was difficult. I was drained the next day and unpleasant. You have to find a group or make your group pay more overnight. This will get 3-4 docs who are willing to do overnights. I have not done a true overnight in 10 yrs and the two shifts I work until 3am is still just two day s a month. If I really wanted to get rid of these two shifts, I could pay someone to work those for me. Its possible. Even if your group do not pay extra for overnights, Find a doc who will love to do it and pay them outside of the group. Its possible, you just have to want to forego some pay. IMO, it is well worth it

3. Press Gainey, metrics, turn around times, blah, blah, blah. Annoying but nothing to get stressed about. Just do a good job and don't be the worse in your group. You will be fine.

4. Burn out - The only people who get burned out in EM are the ones who would be burned out b/c they
A - Didn't like EM in the first place. Can't fix this. They made a poor choice of fields. No different than I would be burned out doing OB/GYN in about 1 week
B - Spend too much and feel like they have to work 18 shifts a month. Again, poor choice. Work 13 days a month, still make 250K a year. Trust me, those extra 5 days off will refresh them and the burned out feeling will go away. I have seen this all the time.

If you get burned out, then go work in UC. Make your 150K-200K a year and see sore throats all day doing a 9-5 job. Go work in a Free standing ED making 200-250k a year seeing mostly sore throats and an occasional sick pt. Many opportunities in EM to slow down.

 

[emergentmd]

Why is EM burn out such a big deal? I've worked swing shift in a factory before, and I didn't think it was terrible. How is 30-40 hours a week in the emergency department so much worse than 50-60 hours a week in clinic or the operating room -- are surgeons spending the majority of their days f-ing off or something?

I think EM burn out is WAY over exaggerated. Most work less than 40 hrs a week. Most could find jobs where their schedule is less erratic. In my group of 100+docs, I a few docs in the past 10 yrs that left ED b/c they were burned out. Some did go work in urgent care b/c they were old and too slow to do it anymore. But rarely in our group does someone leave b/c they were just too burned out with EM.

I think I can work my 24-30 hr weeks until i am 55. And hopefully by then i will be financially set to work one or two days a week just to keep my mind working.

 

[RockDoc7]

Why is EM burn out such a big deal? I've worked swing shift in a factory before, and I didn't think it was terrible. How is 30-40 hours a week in the emergency department so much worse than 50-60 hours a week in clinic or the operating room -- are surgeons spending the majority of their days f-ing off or something?

edit: I guess the tone of this post came across terribly. I'm not accusing EM physicians of being lazy, I just don't understand how 30-40 hours of non-stop work a week is so taxing, and how other specialties can put in 50 or 60 hours a week without burnout being such a huge deal. EM seems like an awesome lifestyle specialty, and I say this as someone who has worked swing shift.

I think EM burn out is WAY over exaggerated. Most work less than 40 hrs a week. Most could find jobs where their schedule is less erratic. In my group of 100+docs, I a few docs in the past 10 yrs that left ED b/c they were burned out. Some did go work in urgent care b/c they were old and too slow to do it anymore. But rarely in our group does someone leave b/c they were just too burned out with EM.

I think I can work my 24-30 hr weeks until i am 55. And hopefully by then i will be financially set to work one or two days a week just to keep my mind working.

I agree with you both that burnout in EM is overexagerated iand thus was not the intended feature of my post - I even published some studies on burnout while I was in undergrad. Byt he same token, I think that burnout is a real malady that one ought to look at in every specialty; particularly within surgical specialties as was mentioned.

I was, and still am, more interested (along the lines of this thread) what a happy EP does when one reaches the "age of slowing down" as emergentmd pointed out (i.e. continue working but on a very part time basis; Urgent care/Free Standing ED). What other options does an EP have?

 

[emergentmd]

I feel like EP docs have more options to slow down compared to most fields. Atleast we have options to find work at slow places, clinic paced jobs. I guess an ED doc could open up their own practice, open a weight loss clinic, etc...

But there are way more options than what a surgeon would have. If you are a surgeon and hate operating, what are your options? I would guess non. If you are a radiologist, and hate to read Xrays there are no other option.

 

[RockDoc7]

I feel like EP docs have more options to slow down compared to most fields. Atleast we have options to find work at slow places, clinic paced jobs. I guess an ED doc could open up their own practice, open a weight loss clinic, etc...

But there are way more options than what a surgeon would have. If you are a surgeon and hate operating, what are your options? I would guess non. If you are a radiologist, and hate to read Xrays there are no other option.

Understood. Good points. I guess I was thinking comparively to arbitrary exampels like FM having capabilities of inpt/otpt mix, uro or ophtho having med/surg mix, and a few others I suppose that offer one some "flexibility." Although, it just came to mind that EP's have probably the most flexibiltiy in terms of geographic prowess (ability to move whenever and wherever to a new job/place without much difficulty). Anyway, thanks for the insight.

 

[@JackShephard]

#1 thanks for all the replies. Very nice.

#2 I think the reason why "EM and burnout" is way overblown is because every survey/research paper has EM leading by far.

But thanks for the replies, interesting to hear each person's thoughts/career path ideas.

 

[emergentmd]

I also heard burnout was a big deal but the 100+ private doc group I am in right now has had VERY few Burnouts. Some left for other reasons, some went to UC type stuff b/c they didn't want to deal with the pace. I don't know of one person who left b/c they just didn't like ER medicine anymore

I guess its hard to feel burned out when

1. I went on a two week NYC trip last year
2. Went skiing for 1 week in Feb
3. In vegas for a weekend trip last week
4. Going to New Orleans for a week in May
5. Going to San Francisco for 2wks in June/July
6. Taking a beach trip sometime in the summer but not quite sure where.

It still amazes me why ED dcos would get burned out when they have so much time off. I don't think many specialists could take 5-6 trips a year anytime they want. Someone has to see their clinic patients.

 

[@JackShephard]

I also heard burnout was a big deal but the 100+ private doc group I am in right now has had VERY few Burnouts. Some left for other reasons, some went to UC type stuff b/c they didn't want to deal with the pace. I don't know of one person who left b/c they just didn't like ER medicine anymore

I guess its hard to feel burned out when

1. I went on a two week NYC trip last year
2. Went skiing for 1 week in Feb
3. In vegas for a weekend trip last week
4. Going to New Orleans for a week in May
5. Going to San Francisco for 2wks in June/July
6. Taking a beach trip sometime in the summer but not quite sure where.

It still amazes me why ED dcos would get burned out when they have so much time off. I don't think many specialists could take 5-6 trips a year anytime they want. Someone has to see their clinic patients.

Yeah, balance appears to be key. Sounds like you're enjoying your time.

 

[MGG1848]

6 years out. Have had multiple different types of jobs. Had some amazing bosses/colleagues. Had some crappy ones. Worked in well functioning and poorly functioning hospitals.

Compared to other people's jobs, i think we have it good.

Mainly, its life outside of work that really defines me these days.

 

[EctopicFetus]

To me I think you have to really learn to enjoy life outside of work. I think anything else you will look back and see that your life is perhaps empty.

 

[filhodeinferno]

To me I think you have to really learn to enjoy life outside of work. I think anything else you will look back and see that your life is perhaps empty.

This is the type of attitude that drew me to EM. I love medicine, but I love my life more.

 

[DocEspana]

I was once told that if your favorite place in the world is the OR, be a surgeon. If your favorite place in the *hospital* is the OR, be an anesthesiologist.

I'm sure there is a pretty nice parallel to draw with our gas sniffing brethren on how the joy of EM is, at least partially, derived from the freedoms outside of it.

 

[LifetimeDoc]

me was once told that if yer favorite place in the world be the OR, be a surgeon. If yer favorite place in the *hospital* be the OR, be an anesthesiologist.

me be sure thar be a pretty nice parallel to draw wit our gas sniffin' brethren on how the joy of EM be, at least partially, derived from the freedoms outside of it.

Huh?

 

[@JackShephard]

Huh?

What?

 

[gutonc]

Squirrel!

 

[DocEspana]

Huh?

Anesthesiologists tell students that they should pick anesthesia over surgery if they love being in the OR but care about lifestyle. Only pick surgery if being in the OR is the only thing that drives them in life.

A paralell can be made to EM I think.

 

[Perrin]

I was once told that if your favorite place in the world is the OR, be a surgeon. If your favorite place in the *hospital* is the OR, be an anesthesiologist.

I'm sure there is a pretty nice parallel to draw with our gas sniffing brethren on how the joy of EM is, at least partially, derived from the freedoms outside of it.

If your favorite place in the world is anywhere but the hospital, choose EM.

Just spent a few days at Lake Havasu for a bachelor party. Going to LA for the wedding and staying a few extra days for fun. Weekend at the lake for one of our friend's going away party. Kickball league every week. That's why.

 

[dchristismi]

At the moment, my favorite place in the world is a little cafe along the seashore in the tiny hamlet of Atrani on the Amalfi Coast... Where I just was and desperately wanted to stay longer than my short itinerary allowed.
At least I'm used to the jetlag. Back to the grind tomorrow.