Do you enjoy EM or just the lifestyle it affords?

[Cinclus]

I love those shifts. I get a whole day before work to get stuff done, plus I can wake up late.

Same. They match my preferred sleep schedule.

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[Birdstrike]

I pet an Alpaca today

#Lifestyle

 

[FootballFoot]

Do you guys think Academic EM is more tolerable than community EM in terms of hours? Workload? Any other on-job frustrations?

 

[Tungsten5]

This is my biggest worry about this field. I and a lot of friends are interested in EM, but it seems like everyone's trying to get out of the field as soon as they enter it...

That and my preferred location to live (southern New England) seems to be an EM wasteland.

 

[uhhhh]

Lifestyle

 

[RustedFox]

- to add a meaningful reply/post...


I enjoy EM a lot more now that I have a full-time job where my input is valued and my expertise is appreciated. This is in stark contrast to my former HCA/EmCare job where the first, middle, and last things that I heard during a shift were something along the lines of "Why aren't these numbers lower?"

It really was THAT bad with the HCA-Care (portmanteau) folks. They might as well have just come out and said: "How can we get you to swallow more liability while we steal more money?"
They frequently say things like: "We're committed to QUALITY care."
Lies.

Quality means doing the job right. Not doing a fast job, and hoping that it was done right.

There's a special place in hell for those administrators.

 

[FootballFoot]

- to add a meaningful reply/post...


I enjoy EM a lot more now that I have a full-time job where my input is valued and my expertise is appreciated. This is in stark contrast to my former HCA/EmCare job where the first, middle, and last things that I heard during a shift were something along the lines of "Why aren't these numbers lower?"

It really was THAT bad with the HCA-Care (portmanteau) folks. They might as well have just come out and said: "How can we get you to swallow more liability while we steal more money?"
They frequently say things like: "We're committed to QUALITY care."
Lies.

Quality means doing the job right. Not doing a fast job, and hoping that it was done right.

There's a special place in hell for those administrators.

Do you think it's reasonable for most EM docs to find a job like yours? What about a job like yours in places like LA/SF/Austin?

 

[RustedFox]

Do you think it's reasonable for most EM docs to find a job like yours? What about a job like yours in places like LA/SF/Austin?

Good question. Deserves a good answer.

Answer: Limited to no idea, speaking personally. I would never want to live in LA/SF/Austin, but I know the job markets there are tighter than a duck's butt to begin with... so, if you put me to an answer - I'm going to say that no, its not reasonable.

Your profile says that you're a pre-med, though. At this stage of the game, you are best served by figuring out whether you really like medicine or not enough to commit to it for 7 years (minimum) and 200,000 USD.

Pssst.

I can hear your thoughts.

You're thinking: "Pffft. Sure, I do. I like it enough."

If you haven't spent at least 2-3 months in heavy exposure, then you have no idea.

I made this mistake. Hard. I volunteered/shadowed for "like a month or so".

Reality is far, far different than what you think it might be.

 

[deleted245139]

Do you guys think Academic EM is more tolerable than community EM in terms of hours? Workload? Any other on-job frustrations?

Speaking from the academic side, just started my job in July.
I personally love it. It's a bit of a different beast from community work... during residency I spend time in a VERY busy community shop and it really was just push-push-push. Went home exhausted and really not feeling overly fulfilled.
I learned I loved teaching mid way through R2, and honestly, I remember interviewing for programs thinking I was set for a community gig and ready to get out (graduated HS in 2000 and lived A LOT of life between then and now)

It's a give and take.
(+)
Hours are less overall ( around 130/mo)
Meaningful education of residents/med students
Some perks or being aligned with a high end med school
Upward mobility within program leadership (this isn't common actually... I found myself in a unique situation and got pretty lucky)
Plans for scaling back clinically as I go and maybe see some longevity in the career

(-)
money is less. No way around this. I'm fortunate and see a much higher pay comparatively, and with less hours, time to moonlight/locums if needed though
research - personally, not my cup of tea, however ACGME has a publication expectation for core faculty (reasonable)
geography - you can be a bit limited to practice location, larger cities, etc. Plus or minus I suppose
variability in skill set between midlevels, residents within class and across classes... takes time to learn idiosyncrasies

(neutral)
Extra activities - this one is really glass half full/glass half empty. You need to want to involve yourself. You can probably minimize your involvement, but at least some is expected. That said... if you don't say 'no' to things, you can pull resident-like hours. I'm pretty personally invested in my job and I like to teach, so things like lecture and journal club are fun for me. Not everyone feels that way.

Overall:
I love it. Would do it again. The money can be frustrating, but it's MORE than enough if you live frugally.

 

[InternistDO]

Speaking from the academic side, just started my job in July.
I personally love it. It's a bit of a different beast from community work... during residency I spend time in a VERY busy community shop and it really was just push-push-push. Went home exhausted and really not feeling overly fulfilled.
I learned I loved teaching mid way through R2, and honestly, I remember interviewing for programs thinking I was set for a community gig and ready to get out (graduated HS in 2000 and lived A LOT of life between then and now)

It's a give and take.
(+)
Hours are less overall ( around 130/mo)
Meaningful education of residents/med students
Some perks or being aligned with a high end med school
Upward mobility within program leadership (this isn't common actually... I found myself in a unique situation and got pretty lucky)
Plans for scaling back clinically as I go and maybe see some longevity in the career

(-)
money is less. No way around this. I'm fortunate and see a much higher pay comparatively, and with less hours, time to moonlight/locums if needed though
research - personally, not my cup of tea, however ACGME has a publication expectation for core faculty (reasonable)
geography - you can be a bit limited to practice location, larger cities, etc. Plus or minus I suppose
variability in skill set between midlevels, residents within class and across classes... takes time to learn idiosyncrasies

(neutral)
Extra activities - this one is really glass half full/glass half empty. You need to want to involve yourself. You can probably minimize your involvement, but at least some is expected. That said... if you don't say 'no' to things, you can pull resident-like hours. I'm pretty personally invested in my job and I like to teach, so things like lecture and journal club are fun for me. Not everyone feels that way.

Overall:
I love it. Would do it again. The money can be frustrating, but it's MORE than enough if you live frugally.

As a quick, semi-related question, do you find that you get comparable clinical experience working in an academic environment? I've heard from some academic EPs that much of their job involves teaching and supervising as opposed to direct clinical care, and they worry about skills atrophy (one said they intubated only a couple times a year, as an example). Is this the sort of thing that could vary wildly between shops? Or even vary based on personal preference for clinical exposure vs teaching in the same department?

 

[DetectiveAlonzo]

1) Too many. We have 5p-3a, 7p-4a, 10p-7a. I consider them all "nights".
2) You are referring to what is known as a "nocturnist". People will do it if you pay them extra money to work the nights. I don't like 100% nights but I would do it with a differential... just to stay on a single circadian rhythm. At the moment we all "share" the nights.
3) Everything. I can't stress enough what others have said on here about EM not being a lifestyle specialty. I can't count how many times I've promised friends, gf, family, etc.. that I would be home by a certain time and then leave 2 hours later. Just other night, I was literally walking out, poked my head into the trauma bay to see if colleague needed help with an anaphylactic shock code and got stuck in there doing a cric, icu admission and all the charting. I left 2 hours later. I'm lucky if I get 2 weekends off a month and it doesn't matter how many times I tell friends or family that I'm working a weekend or a string of nights, nobody ever truly "gets it" and I end up having to give the same excuses as to why I can't go hang out or go spend time with people... "I'm working". I can't count the times I've been "off all night" on a Tues or Wed night at 2a.m. and everybody else is sleeping. It's a tough environment to work day end day out and difficult to not become jaded, cynical and numb to a certain extent.

Other than that, I love it. Come join us.

Do you get paid for those 2 extra hour your stayed?

 

[deleted245139]

As a quick, semi-related question, do you find that you get comparable clinical experience working in an academic environment? I've heard from some academic EPs that much of their job involves teaching and supervising as opposed to direct clinical care, and they worry about skills atrophy (one said they intubated only a couple times a year, as an example). Is this the sort of thing that could vary wildly between shops? Or even vary based on personal preference for clinical exposure vs teaching in the same department?

No. Its an excellent point, I forgot to mention it. I'm a bit of a black cloud lol. I moonlight for added clinical exposure. I also have to get the tube or line after a few resident attempts ... Makes it a bit more technically challenging.

I've found that to be the hardest. It's an adjustment to sit on your hands and teach technique. But... That eureka moment, the moment your resident navigates a line complication correctly. Or gets the tough tube... It's awesome. Just awesome. Makes it all worth it

 

[uhhhh]

- to add a meaningful reply/post...


I enjoy EM a lot more now that I have a full-time job where my input is valued and my expertise is appreciated. This is in stark contrast to my former HCA/EmCare job where the first, middle, and last things that I heard during a shift were something along the lines of "Why aren't these numbers lower?"

It really was THAT bad with the HCA-Care (portmanteau) folks. They might as well have just come out and said: "How can we get you to swallow more liability while we steal more money?"
They frequently say things like: "We're committed to QUALITY care."
Lies.

Quality means doing the job right. Not doing a fast job, and hoping that it was done right.

There's a special place in hell for those administrators.

Totally agree that it is that bad. I just want to be able to treat patients appropriately and practice good medicine. I like the medicine but I hate the arbitrary number games and customer service crap. The constant stress to move faster, see them faster, dispo within an arbitrary time number, and make them happier when I tell them they don't get narcotics or antibiotics for their sniffles.

Now that my loans are done, I do feel like I am able to take back a bit of control -- at least with my schedule. I do love that EM allows me to block my schedule and I have a lot of time off for my family and travel and the things that make life worthwhile.

Just still haven't found the job I trained for.

 

[BoardingDoc]

Do you get paid for those 2 extra hour your stayed?

Depends on the shop. In general, no. If your pay is determined by RVUs, however, and Groove was writing the chart which clearly had a lot of critical care time, then he probably got paid for it.

 

[Groove]

Hmm, I must have been a little sleep deprived and cranky when I wrote that.

 

[shookwell]

It is possible to find jobs with excellent lifestyles. I work a fixed schedule with one day shift a week plus two weekend shifts per month. I don't get paid as much as those who work 32 hrs/week but I supplement my income with locums which I can work as much or as little of as I want, and most months end up with much more income than I would if I was working full time, but I can also not take any locums for a month or a few months when I have other things I want to do.

 

[Doctor_Strange]

Could anyone comment on the difference in lifestyle for PEM physicians? From my understanding, their shifts are more evening/nights heavy, but one poster said that PEM physicians work fewer hours than most specialities...

 

[witzelsucht]

Could anyone comment on the difference in lifestyle for PEM physicians? From my understanding, their shifts are more evening/nights heavy, but one poster said that PEM physicians work fewer hours than most specialities...

my n=3 experience:

1. 7-7p and 7-7a with an occasional 1-p-9p person. slow nights, if you like watching movies good place

2. 8a- 4p and 4p - 1a. no true overnight. 3-8p swing covered by adult EM doc, kids after 1a go to adult ED (sweet gig, huh?)

3. 3 attending shifts, 7a-4p, 4p-MN, 11-7a, with a second non-teaching attending 5p-1a. extra upper level residents on the 5-1a so that 5-MN attending is really hustling

overall, doesn't seem TOO much different than adult except if you work at locaiton #2, but all EM will have some heavy swing/eve shifts. cuz that's where they money at

 

[CoolWhipp]

What is the point of this thread seriously

 

[DetectiveAlonzo]

What is the point of this thread seriously

For the foolish med students who think EM is a "lifestyle specialty" and want reasons they should pursue it.

They pretty much wanna hear if you can work no night shifts, make a gajillion bucks working only 3-4 times a week, and no stress.

Boy are they in for a ride if they use this thread to follow through with EM.

 

[DetectiveAlonzo]

Thanks for the input so far, just trying to do some soul searching.

Instead of posting an internet thread on it... go shadow, or volunteer, or go rotate if you are a med student at an ED.

 

[Zebra Hunter]

For the foolish med students who think EM is a "lifestyle specialty" and want reasons they should pursue it.

They pretty much wanna hear if you can work no night shifts, make a gajillion bucks working only 3-4 times a week, and no stress.

Boy are they in for a ride if they use this thread to follow through with EM.

Aren't you a med student?

I see you on every thread complaining about these dumb med students going into EM for the lifestyle. Having several family members in medicine ranging from surgeons to EM docs to OBs to cardiologists, I can say that EM is as close to a "lifestyle specialty" as you can get outside of derm. Sure there are plenty of stressful aspects to the job, working holidays sucks, working a weekend when your friends are out stinks, meeting metrics, stressful patient encounters, but there a very few specialties that you can pick up and move overnight without much of an issue, or not have to take call, or take a week off every month or two to go on vacation, or make as much as you do per hour despite doing a 3 year residency.

There are downsides to every specialty, but I really don't see why people try to downplay the amazing gig that EM is.

 

[DetectiveAlonzo]

Aren't you a med student?

I see you on every thread complaining about these dumb med students going into EM for the lifestyle. Having several family members in medicine ranging from surgeons to EM docs to OBs to cardiologists, I can say that EM is as close to a "lifestyle specialty" as you can get outside of derm. Sure there are plenty of stressful aspects to the job, working holidays sucks, working a weekend when your friends are out stinks, meeting metrics, stressful patient encounters, but there a very few specialties that you can pick up and move overnight without much of an issue, or not have to take call, or take a week off every month or two to go on vacation, or make as much as you do per hour despite doing a 3 year residency.

There are downsides to every specialty, but I really don't see why people try to downplay the amazing gig that EM is.

LoL... love the "med student" card that is always pulled on here. That must automatically mean I don't have past experience working in an ED or anything or have background knowledge or life experience of other aspects in medicine... instead just stuffing my face behind a goddamn book all day for years and not experience real life outside of school and fake ass clubs and other application prodding ECs.... right?

Get over yourself fam.

If that's "lifestyle" to you... so be it lol

Not ****ting on anybody. I'm just trying to get med students to understand there is more to EM than shift work and "high pay". People who do it solely for the shift work and "high pay" (which is coming down soon ... don't get how people don't understand this...) will be burnt out.

THERE IS A REASON WHY EM IS A NUMBER 1 BURNOUT SPECIALTY.

Just being realistic but plenty of folks are so sensitive.

You NEED those weeks of relaxation and No call because you would go postal if you didn't seeing the type of **** and balancing the type of **** you are dealing with in an ED.

It's not as simple as clocking in 3 shifts in a row and then balling out. You take some of that stuff home with you (mentally, emotionally, etc.)

It's NOT lifestyle by any means.

But hey... you wanna work weekends, work holidays, work OVERNIGHT shifts to spend the next day or two RECOVERING... be bossed around by admin, have high turnover of patients and yadda yadda yadda...

you do you.

Don't get butthurt is all I ask.

 

[GeneralVeers]

Not having kids makes it hard for me to relate, but I'd rather work weekends and Holidays. I like having weekdays off so I can get more business done.

For me working part time means I can pick and choose how much I work, what days I work, how much time off I get, and even what Holidays I work. That is an awesome lifestyle! Right now I work 14 days per month, and pick the times I want off. If I was still doing full time indentured servitude, like I did for 5 years I probably would have left the specialty. There is enough demand for EM in many markets that it allows for us to be picky, and only work how we want to work. I feel bad for the full-timers I work alongside: Trapped working more hours than they like, and not being able to control their time off.

 

[Zebra Hunter]

If that's "lifestyle" to you... so be it lol


Not ****ting on anybody. I'm just trying to get med students to understand there is more to EM than shift work and "high pay". People who do it solely for the shift work and "high pay" (which is coming down soon ... don't get how people don't understand this...) will be burnt out.

THERE IS A REASON WHY EM IS A NUMBER 1 BURNOUT SPECIALTY.

Just being realistic but plenty of folks are so sensitive.

You NEED those weeks of relaxation and No call because you would go postal if you didn't seeing the type of **** and balancing the type of **** you are dealing with in an ED.

It's not as simple as clocking in 3 shifts in a row and then balling out. You take some of that stuff home with you (mentally, emotionally, etc.)

It's NOT lifestyle by any means.

But hey... you wanna work weekends, work holidays, work OVERNIGHT shifts to spend the next day or two RECOVERING... be bossed around by admin, have high turnover of patients and yadda yadda yadda...

you do you.

don't get butthurt is all I ask.

I'm sorry, but your posts come off as absurd coming from a medical student, telling me why I need time off and how difficult it is for me to recover.

Yes, I think most would agree that 8-10 vacations in a year is a pretty solid lifestyle. Or the not taking call, ever. Or the not having to run a clinic. Or working 35-40 hrs/wk. Or making over $300k/yr. As for the "highest burnout", I guess you could go into anesthesia where you only burnout 50% of the time as opposed to 55% or even derm that has a burnout rate of 40%. Of course there are sacrifices to be made, and it's not all roses, but you'll find very few specialties in medicine with a better "lifestyle".

I get what you're saying, and some of it is true, although much of it is overexaggerated, and rings hollow coming from someone that hasn't even graduated medical school. It takes me as long to recover from a medicine call day as it does a 10 hr shift. I don't need weeks off or else I go "postal". I don't bring home emotional baggage.

Why are you even going into the specialty if you're already complaining about every single aspect of it? Sounds like a recipe for disaster.

 

[TheOther]

LoL... love the "med student" card that is always pulled on here. That must automatically mean I don't have past experience working in an ED or anything or have background knowledge or life experience of other aspects in medicine... instead just stuffing my face behind a goddamn book all day for years and not experience real life outside of school and fake ass clubs and other application prodding ECs.... right?

Get over yourself fam.

If that's "lifestyle" to you... so be it lol

Not ****ting on anybody. I'm just trying to get med students to understand there is more to EM than shift work and "high pay". People who do it solely for the shift work and "high pay" (which is coming down soon ... don't get how people don't understand this...) will be burnt out.

THERE IS A REASON WHY EM IS A NUMBER 1 BURNOUT SPECIALTY.

Just being realistic but plenty of folks are so sensitive.

You NEED those weeks of relaxation and No call because you would go postal if you didn't seeing the type of **** and balancing the type of **** you are dealing with in an ED.

It's not as simple as clocking in 3 shifts in a row and then balling out. You take some of that stuff home with you (mentally, emotionally, etc.)

It's NOT lifestyle by any means.

But hey... you wanna work weekends, work holidays, work OVERNIGHT shifts to spend the next day or two RECOVERING... be bossed around by admin, have high turnover of patients and yadda yadda yadda...

you do you.

Don't get butthurt is all I ask.

I dunno man. If someone loves the work of EM, it's a pretty damn sweet gig to get into. Especially if you're ok with not living in LA, SF, Austin, etc...you can have a lot more control of your schedule.
Also, there's a better way to communicate your point without the use of asterisks and all caps. It actually makes it harder to take you seriously, even though you do have some valid points.

 

[DetectiveAlonzo]

I dunno man. If someone loves the work of EM, it's a pretty damn sweet gig to get into. Especially if you're ok with not living in LA, SF, Austin, etc...you can have a lot more control of your schedule.
Also, there's a better way to communicate your point without the use of asterisks and all caps. It actually makes it harder to take you seriously, even though you do have some valid points.

Which comes back to what I have been saying.

Plenty of lazy ass med students want more for less. You will have to work and more importantly LOVE what you are doing.

Apologize for all caps. I use it for emphasis but people take it as shouting. It is what it is.

 

[DetectiveAlonzo]

Not having kids makes it hard for me to relate, but I'd rather work weekends and Holidays. I like having weekdays off so I can get more business done.

For me working part time means I can pick and choose how much I work, what days I work, how much time off I get, and even what Holidays I work. That is an awesome lifestyle! Right now I work 14 days per month, and pick the times I want off. If I was still doing full time indentured servitude, like I did for 5 years I probably would have left the specialty. There is enough demand for EM in many markets that it allows for us to be picky, and only work how we want to work. I feel bad for the full-timers I work alongside: Trapped working more hours than they like, and not being able to control their time off.

Veers, you married or dating?

 

[Tungsten5]

For the foolish med students who think EM is a "lifestyle specialty" and want reasons they should pursue it.

They pretty much wanna hear if you can work no night shifts, make a gajillion bucks working only 3-4 times a week, and no stress.

Boy are they in for a ride if they use this thread to follow through with EM.

It is possible to find jobs with excellent lifestyles. I work a fixed schedule with one day shift a week plus two weekend shifts per month. I don't get paid as much as those who work 32 hrs/week but I supplement my income with locums which I can work as much or as little of as I want, and most months end up with much more income than I would if I was working full time, but I can also not take any locums for a month or a few months when I have other things I want to do.

Interesting sides to this argument. Wish I knew who to believe.

 

[GeneralVeers]

Veers, you married or dating?

You looking?

Married, but it's easy in a 24 hour town.

 

[DetectiveAlonzo]

You looking?

Married, but it's easy in a 24 hour town.

Nah. Just curious.

 

[DetectiveAlonzo]

Interesting sides to this argument. Wish I knew who to believe.

Go rotate and see for yourself.

 

[Tungsten5]

Go rotate and see for yourself.

Can't get a sense of lifestyle in any shadowing experience

My other choice field also requires aways so those free blocks are precious.

Anyway, don't think the evaluating attending would take kindly to "can I work part time and do locums for best lifestyle???"

Sent from my XT1254 using Tapatalk

 

[DetectiveAlonzo]

Can't get a sense of lifestyle in any shadowing experience

My other choice field also requires aways so those free blocks are precious.

Sent from my XT1254 using Tapatalk

There's exactly the ****ing point. Because 3-4 weeks in a rotation or no matter what others may say about how baller their specialty is DOES NOT mean it will be for you.

You have to LOVE the work or choose something you HATE the LEAST.

Lifestyle WILL change. It always does.

 

[Angry Birds]

I've come to the realization that I would not have chosen EM if I had to do this over again. Everyone is different and there is no right answer, but I personally find EM to be (1) too stressful, (2) too irregular schedule-wise, and (3) not rewarding enough.

Tomorrow I have a Monday evening shift, and I am absolutely dreading it.

 

[racerwad]

There's exactly the ****ing point. Because 3-4 weeks in a rotation or no matter what others may say about how baller their specialty is DOES NOT mean it will be for you.

You have to LOVE the work or choose something you HATE the LEAST.

Lifestyle WILL change. It always does.

Generally, your posts and the way you communicate your point drive me nuts. However, I agree with you on this, especially in light of the post from Angry Birds right after. I think much of the dissatisfaction in EM is due to an "over-promise, under-deliver" phenomenon. Our specialty is well suited to TV shows that highlight the easy to see cool stuff and minimize the overwhelming majority of mundane BS. Even our name suggests that cool **** will be happening all shift, when nothing could be further from the truth. This misconception is then reinforced on short audition rotations where med students are tourists in the ED (I forget who coined this term, but it is super appropriate). We cruise through for a month, get pulled in to see and do cool things, get shielded from admin BS, have a less than full-time schedule, and voila - an artificial perception of what the specialty is like.

Anyhow, to answer the OP - I love what I do and I would choose it again in a heartbeat. It is not always awesome and there are issues that probably never improve, despite how perfect your practice setting might be (consultants, metrics, admin, etc). However, I definitely believe that it is the best job in the house of medicine, for me. The more difficult question is if it is true for anyone else.

 

[Arcan57]

I dunno man. If someone loves the work of EM, it's a pretty damn sweet gig to get into. Especially if you're ok with not living in LA, SF, Austin, etc...you can have a lot more control of your schedule.
Also, there's a better way to communicate your point without the use of asterisks and all caps. It actually makes it harder to take you seriously, even though you do have some valid points.

Does someone have an SO that's a tourism rep for Austin? It's a pretty decent place ( that's kind turning into South Portland) but having LA, SF, and Austin being your top three American cities is a little... weird.

 

[e30ftw]

I would answer, "Both." to the original poster's question. I genuinely enjoy EM for the most part and love the lifestyle.

Currently 2 hrs away from being done with a 5 night stretch. Single coverage, community ED. Tonight had a GI bleeder w/ an INR >15 hct 19, a DKAer w/ AMS, HR 150, and ph 6.8, and a uroseptic pt w/o IV access BP 70/30 all come in at the same time. Dispo'd them all to the ICU down the road in around an hour, made a 3 y/o w/ a bad lip lac look great, hematoma blocked and reduced a displaced MC fx in like 15 minutes, played anesthesiologist and orthopaedist for a slightly more difficult than usual shoulder dislocation, and had a lady literally cry tears of joy when she finally had pain relief from her dry socket after paste and an inferior alveolar block. Never consulted anyone or needed help other than an accepting physician for the ICU patients.

Oh yeah, and managed to get about 2 hours of sleep while getting paid. Worked with a bunch of great people and to be honest, it was actually kind of fun..

Also make a couple hundred thousand dollars more than most of my friends and have about 3x the time off.

No job is perfect but even at my middle-of-the-road CMG job it seems kind of ridiculous to complain..

 

[Apollyon]

LA, SF, and Austin being your top three American cities is a little... weird.

Keep Austin weird!

 

[emergentmd]

I have 3 kids, married, been doing this for 15+ yrs, been only at a community place, been just a line doc, director, Med Exec Committee. Have a perm job, do locums, done FSED, work at a referral center. I have done most of EM stuff. This is my feeling.

1. I LOVE this job. best field IMO given the # hrs, pay/hr, flexibility. I would not trade it for almost any other fields.
2. having Kids makes the job harder but it all depends on your spouse. When i was single, I could do a long string of nights and be fine. I am an easy sleeper and could turn around on a dime without any issues. With kids, its harder b/c life does not revolve around you anymore. But with an understanding spouse, life is much easier. Spouse has to let you sleep when you are tired, sleep before your shift, deal with the family and any issues without bothering you. Because of the odd hours, SLEEP and low stress household means everything.

Cons:
1. Scheduling, Odd Hours, overnights, swing shifts. This is by far the worse. This was a nonissue without kids. With kids, its a big issue from a sleep and activity standpoint. I have made this workable by working in a place with nocturnist. I have not worked a true overnight shift without sleeping atleast 3-4 hrs for prob 10 yrs. I do FSED overnights, but gets 3-4 hrs a night. My latest partial overnight (8-3shift), I atleast get home and sleep for 2-4 hrs before dealing with the kids.
2. Working 2 weekends a month. Yeah it sucks. If you are full time, nothing to do. Move on, accept it. I am mid career so I am going part time which should put me at 1 weekend a month.
3. Admin metrics - this is EM life but affects all hospital based docs. Ask the anesthesiologist, radiologist, IM, etc... Just do it and don't fight it, move on.
4. Hard work, busy - Yup, it can get very busy. But there is also many occasions when there is downtime (like right now). But its EM medicine. You knew it was going to busy, not sure why complain about it now. If you didn't want to be busy, you SHOULD NOT go into EM.

Pros
1. Odd Hours/weekends - this is also my favorite part of EM. I work 120 hrs/mo, work 12-14 shifts a month. I get 16-18 days off a month. I get to do alot of fun things with my spouse when kids are in school and EVERYONE is working. No traffic, no big crowd, cheaper activities. Love it.
2. Scheduling - Before kids, I took 1 vacation every other month. You can ask a week off everyone month, you can tailor your schedule. I am able to take my kids to school and pick them up 90% of the time and Never miss any important events. Kids have alot of events during school time, and I can make all of them. Give me 2 months and I take off, or switch if needed.
3. I make 225/hr with benefits at my reg job, 4-500/hr at my locums. Can't beat the pay.
4. Flexibility. This is not your father's EM. You have UC, FSED, if you want to slow down. You can work part time (I am going to do this next yr) and still make 200K working 60 hrs/mo. You have ultimate flexibility if you look around. Sure some cities won't have this, but its starting to spread.
5. No Call. I hate call.
6. You actually do medicine and feel like you can take care of everything.

 

[TheOther]

Does someone have an SO that's a tourism rep for Austin? It's a pretty decent place ( that's kind turning into South Portland) but having LA, SF, and Austin being your top three American cities is a little... weird.

Haha I arbitrarily threw those cities up -- California is generally a pretty highly desirable location (not for everyone, I know), and Austin...I've never been but there's been this explosion of interest in Austin lately.

 

[DetectiveAlonzo]

Generally, your posts and the way you communicate your point drive me nuts. However, I agree with you on this, especially in light of the post from Angry Birds right after. I think much of the dissatisfaction in EM is due to an "over-promise, under-deliver" phenomenon. Our specialty is well suited to TV shows that highlight the easy to see cool stuff and minimize the overwhelming majority of mundane BS. Even our name suggests that cool **** will be happening all shift, when nothing could be further from the truth. This misconception is then reinforced on short audition rotations where med students are tourists in the ED (I forget who coined this term, but it is super appropriate). We cruise through for a month, get pulled in to see and do cool things, get shielded from admin BS, have a less than full-time schedule, and voila - an artificial perception of what the specialty is like.

Anyhow, to answer the OP - I love what I do and I would choose it again in a heartbeat. It is not always awesome and there are issues that probably never improve, despite how perfect your practice setting might be (consultants, metrics, admin, etc). However, I definitely believe that it is the best job in the house of medicine, for me. The more difficult question is if it is true for anyone else.

Seriously.. I apologize. In real life, I'm pretty chill about stuff. I am more coherent and calm and less uptight about my thoughts. On reddit, I'm much more chill because the target med audience there is less nerdy and less type A I guess ... just MY perception. A lot of less butthurt folks on there. There are a few on here that are chill too.

Whatever. I appreciate your insight nonetheless.

 

[GeneralVeers]

Haha I arbitrarily threw those cities up -- California is generally a pretty highly desirable location (not for everyone, I know), and Austin...I've never been but there's been this explosion of interest in Austin lately.

I'm always mystified by California. It's literally the worst place in the U.S. to live if you make a high salary. Yes it has great 72 degree weather in parts, but to live in those areas you are either being gouged on rent, or have to pay $1,000,000 for a small shack near the ocean. Anywhere affordable is inland where it's 100 degrees most of the year. Add to that the relatively lower salary, and 1-2 hour daily commutes and it is a nightmare. Having lived there for 2 years in residency, I would never go back.

One of the great things about EM is you can pick where you want to live. If you move somewhere, hate it, or want to try something else it's easy to pack up and leave.

 

[DetectiveAlonzo]

I'm always mystified by California. It's literally the worst place in the U.S. to live if you make a high salary. Yes it has great 72 degree weather in parts, but to live in those areas you are either being gouged on rent, or have to pay $1,000,000 for a small shack near the ocean. Anywhere affordable is inland where it's 100 degrees most of the year. Add to that the relatively lower salary, and 1-2 hour daily commutes and it is a nightmare. Having lived there for 2 years in residency, I would never go back.

One of the great things about EM is you can pick where you want to live. If you move somewhere, hate it, or want to try something else it's easy to pack up and leave.

Agreed.

Lived in Cali for 20+ years.

Weather is terrible. Traffic is terrible.

But the ganja.... OTOH.



Austin is the Berkeley of Texas.

Frickin' love Austin.

 

[TheOther]

I'm always mystified by California. It's literally the worst place in the U.S. to live if you make a high salary. Yes it has great 72 degree weather in parts, but to live in those areas you are either being gouged on rent, or have to pay $1,000,000 for a small shack near the ocean. Anywhere affordable is inland where it's 100 degrees most of the year. Add to that the relatively lower salary, and 1-2 hour daily commutes and it is a nightmare. Having lived there for 2 years in residency, I would never go back.

One of the great things about EM is you can pick where you want to live. If you move somewhere, hate it, or want to try something else it's easy to pack up and leave.

Haha I agree. Living outside of CA for the first time makes me see how nice it is to live in areas with sweet cost of living.
Where else have you've lived that you loved?

 

[GeneralVeers]

Haha I agree. Living outside of CA for the first time makes me see how nice it is to live in areas with sweet cost of living.
Where else have you've lived that you loved?

States I've lived in:
Nebraska
Indiana
South Dakota
Texas
California
Nevada

Honestly, I would live in Texas if I didn't have family in Nevada. I love Nevada, but Texas is the mecca for high-paying EM jobs. I hated the Midwest. There is literally no redeeming factor from taxes, to weather.

 

[shishka32]

There's no doubt that EM is a fantastic field and I am considering it strongly. Does anyone worry about the rapidly expanding residencies and number of residency spots? It seems like there is no end in sight. A radiologist I know said it was the same in the early 2000's in rads and we all know how that went. Jobs were available everywhere, pay was great, etc. so they just expanded residencies because the job market was "so good" that nobody could possibly foresee the job market crashing. That strategy eventually lead to a terrible job market that still hasn't fully recovered and radiology is now an extremely noncompetitive field compared to the past.

Any opinions on this? It may sound superficial but the future marketability and job market is one of the most important aspects of choosing a specialty for me. I don't want to go through the next 5+ years and all the BS of medical training just to end up working for some CMG for $75 an hour.

 

[DetectiveAlonzo]

There's no doubt that EM is a fantastic field and I am considering it strongly. Does anyone worry about the rapidly expanding residencies and number of residency spots? It seems like there is no end in sight. A radiologist I know said it was the same in the early 2000's in rads and we all know how that went. Jobs were available everywhere, pay was great, etc. so they just expanded residencies because the job market was "so good" that nobody could possibly foresee the job market crashing. That strategy eventually lead to a terrible job market that still hasn't fully recovered and radiology is now an extremely noncompetitive field compared to the past.

Any opinions on this? It may sound superficial but the future marketability and job market is one of the most important aspects of choosing a specialty for me. I don't want to go through the next 5+ years and all the BS of medical training just to end up working for some CMG for $75 an hour.

LOL $75? Nahhh.

It'll most likely be what they are paying PAs + $10-15 give or take while the CMG dudes and administration take a cut out of your check every month.

Hospitals are a business after all. Get ready to lube up because this EM bubble is finna burst soon son!

 

[emergentmd]

EM pay is not going to burst b/c we are increasing residencies. There are way too many jobs now and options that can absorb the increase.

What will burst is regulations getting rid of FSEDs or Hospitals/CMS feeling the financial pain and hiring non EM docs or increasing APC coverage.

 

[emergentmd]

States I've lived in:
Nebraska
Indiana
South Dakota
Texas
California
Nevada

Honestly, I would live in Texas if I didn't have family in Nevada. I love Nevada, but Texas is the mecca for high-paying EM jobs. I hated the Midwest. There is literally no redeeming factor from taxes, to weather.

I have a partner who lived in they bay area for 5 yrs, made 250K a yr, and could barely afford a 2 bedroom condo.
Moved to Tx, and in a few months didn't know why he stayed so long.