EM is not a lifestyle specialty

[pinipig523]

I don't really know where all this talk is coming from that EM is a lifestyle specialty... IMO, it's not.

I think EM is deceiving and that it's great for the young doc who is able to pull those nights and random shifts.... but as you age, it's not so fun having to reset your circadian rhythm every few days. At 25, night shifts are no problem (as an intern), at age 35 it's more of a nuisance but still not bad, at 45 it's becoming a pain, at 55 it sucks. At 65? I'd rather be retired.

As a graduating 4th year resident, I've met my share of attendings, many of whom have always shared the same and common sentiment - our specialty is a great launch pad right out of the gates of residency. You get a good paying job, you're amped to see patients, you can handle the schedule. But as you age, you don't really get any seniority at your job (you usually don't get any shift reductions or shift preferences for the same pay), your pay does not increase with respect to your experience (unless you're a partner), if you leave the job and move to another then you as a 20 year vet are treated the same as a new junior attending.

It even seems like the more experienced docs are at a disadvantage since I've been told that EM groups like the young sprouts because they usually have no malpractice records or dings to their licenses!

So it seems that EM is great to start out with... but not so great as you age and as you become a veteran.

Don't get me wrong, I like my job and I am glad I'm an EM doc. But, it is NOT a lifestyle specialty from my own experience.

Thoughts?

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[FMtoEM]

I thought EM was a field where you didn't have to be a clinician forever and could actually diversify your career in admin, etc because of the extra time we have...maybe i'm wrong.

I don't really know where all this talk is coming from that EM is a lifestyle specialty... IMO, it's not.

I think EM is deceiving and that it's great for the young doc who is able to pull those nights and random shifts.... but as you age, it's not so fun having to reset your circadian rhythm every few days. At 25, night shifts are no problem (as an intern), at age 35 it's more of a nuisance but still not bad, at 45 it's becoming a pain, at 55 it sucks. At 65? I'd rather be retired.

As a graduating 4th year resident, I've met my share of attendings, many of whom have always shared the same and common sentiment - our specialty is a great launch pad right out of the gates of residency. You get a good paying job, you're amped to see patients, you can handle the schedule. But as you age, you don't really get any seniority at your job (you usually don't get any shift reductions or shift preferences for the same pay), your pay does not increase with respect to your experience (unless you're a partner), if you leave the job and move to another then you as a 20 year vet are treated the same as a new junior attending.

It even seems like the more experienced docs are at a disadvantage since I've been told that EM groups like the young sprouts because they usually have no malpractice records or dings to their licenses!

So it seems that EM is great to start out with... but not so great as you age and as you become a veteran.

Don't get me wrong, I like my job and I am glad I'm an EM doc. But, it is NOT a lifestyle specialty from my own experience.

Thoughts?

 

[Veritas86]

Maybe its just me, but even at this early stage in the game for me, I never really thought of EM as a "lifestyle" specialty.

Sure its shift work, and blah blah. But to me, it seems emotionally stressful and financially doesn't make up for it in the way other specialties do.

EM is, at the moment, where my interests lie, and the above post is one of the reasons why. Potential for research, admin, branching out if I get bored, so forth.

 

[pinipig523]

I thought EM was a field where you didn't have to be a clinician forever and could actually diversify your career in admin, etc because of the extra time we have...maybe i'm wrong.

Which is exactly what I'm saying - you get into medicine to practice clinically (or at least the majority of us do).... and it's not first line thinking to go into a particular field only to be looking to move away from it as time goes on.

You don't see optho, ortho, GU guys looking to get out of the field just as soon as they start.

 

[Veritas86]

Which is exactly what I'm saying - you get into medicine to practice clinically (or at least the majority of us do).... and it's not first line thinking to go into a particular field only to be looking to move away from it as time goes on.

You don't see optho, ortho, GU guys looking to get out of the field just as soon as they start.

I think what he was saying is its not necessarily moving away from clinical practice, but becoming more diverse.

 

[pinipig523]

I think what he was saying is its not necessarily moving away from clinical practice, but becoming more diverse.

When you move into admin, you move away from clinical practice via shift reductions.

 

[danzman]

But in all fairness....

I think a big part of this discussion is how you frame it. When compared to Derm, EM aint a lifestyle field. But how many people can do derm? 3 in a class? maybe one or two more or less? But when compared to so many fields in medicine, its tough to beat what this field can offer.

Good money to hour ratio.
No call, ever.
Three (or four) year residency.
Tons of flexibility.
Shift work (8's, 10's, 12's, etc')
Essentially open job market.
Only moderately competitive match
Jack of all trades, master of nothing mentality.

I think that EM can offer to the average medical student one of the best possible lifestyles. Again, Derm, rad onc, and ophtho may be better, but there is a reason they are so dang competitive. When compared to most other fields, EM has a lot to offer that can be considered lifestyle friendly.

Also, my gut instinct is that trying to pick a specialty by what will happen in 30 yrs is a lot like canning fruit today for the coming zombie apocolypse. Tough to tell how that one will turn out.

 

[Hercules]

EM is not a lifestyle specialty. It seems like it to single med students but once you have a family it is no longer lifestyle friendly. EM is a great field and I enjoy it, but there is no other field that does 2/3 of their work during evenings and nights. You will work more weekends and holidays than any of your colleagues in other fields. Call is not as bad in private practice as it is in residency. The majority of a call night for most of the docs at my hospital is spent at home for them.

Again EM is great and does provide you with a lot of off time but it is not a lifestyle specialty.

 

[EctopicFetus]

As noted above.. EM isnt a lifestyle specialty. IMO any job where you work so many evenings, nights, weekends and holidays isnt a lifestyle specialty.

On another note, the advancement through your career matters on your group.

My group after 20 years there is no night requirement except if on backup. As the older guys get more money they cut their hours. I do 150-ish.. most of the older guys are 120 or less.

Gotta find the right job out there and it is conducive to a long career.

 

[NewAndImproved]

Seems like the arguments against EM being a "lifestyle specialty" always boil down to, "you have to work nights, weekends, and holidays."

Am I the only one who does not see these as negatives?

I could not care less if I have to work on a day that is everyone else's weekend day. In fact, it seems better to me. Why would I want to go to the gym/grocery store/amusement park/ski resort/etc on days when the rest of the world is there? I don't want to go out to eat on February 14th with the sheep stampede and I don't care if my "birthday bbq" is two days after the date on my birth certificate.

To each his own. Perhaps for some of us, emergency medicine IS a lifestyle specialty.

 

[BADMD]

EM is not a lifestyle specialty. It seems like it to single med students but once you have a family it is no longer lifestyle friendly.

I strongly disagree. The issue is that you are looking for a different lifestyle.

My wife has a demanding job. She frequently works 9ish to 6ish or later. I deliberately work mostly day and overnight shifts so that I am available to pick the kids up from school/daycare. I only have a 5-6 weekday, day shifts a month. I can often take the kids to doctor's appointments, meet delivery/workers, and if they get stick can often stay at home with sick kid. If my wife has a firm appointment, even out of town appointments, with 6 weeks notice, I can make sure I am available.

Do I feel like some weeks my wife and I talk on the phone more than in person? Oh yeah. But I get lots of kid time and my wife has the chance to advance in a demanding career.

 

[EM_Rebuilder]

Maybe one day I will eat my words, but I still stand by and say our specialty is pretty darn near a lifestyle specialty. Maybe I am just oblivous to what the Derms life is really like....

I can show you jobs BEGGING for people to come work even FOUR shifts a month and still make a >100K income. I also would bet money you could do those four shifts as day time only....

When I am 50, I dont plan on working 12-15 shifts a month. I will have a couple million dollars in retirement (at least) and other monetary vehicles and will work 'for the fun of it'. My son is 7 months old, by then maybe he will be having kids... I'd rather go visit my kids/grandkids and travel mostly when I am 50. I think I can do that financially easier from EM than most other specialties. Maybe I will be a director, charimen, etc etc... but even without those titles, my family and I are going to be in great shape.


I also will say the 'goob jobs' are out there.. just takes some looking. There are other younger people on here that rarely work nights. I do 6 night shifts every 4-5 months. Otherwise I work 6a-6, 7a-7, or 8a-8. When not on the month I do nights, I do 1-3: 3p-3a (evenings...granted, not far off from a night shift). I work approx 12 shifts and occasionally work a few more at another place... quite frankly, because I get bored. I have become active with medical students and some committee, etc with ACEP because I have too much free time.... I also see my son enough that the crying almost gets annoying.

My parents have their own business... he works days, evenings, weekends... granted never overnight... but hes >50 and works much of those times and I often worked with him while growing up. I assure you I put in 30% of the actual work time as him now and I make 4-5+ times as much money... and my hands rarely get dirty (well, I wear gloves... blood washes off easier than grease anyways).

Since finishing residency.. I have taken a trip almost every month. I am on a nine day stretch off right now, going to LA this weekend because there was nothing else to do. Next month I have oral boards.. in May i'll be at the L&A conference in DC.

Growing up in a family that never worked 8-5... I guess weekends never really meant anything to me. I do not have kids in school yet and I am certain that will change my ideas somewhat.. although most of the people I work with have their kids in a hybrid class/home school system of school Mon-Wed so that they are a bit more free for travel and doing some teaching at home...

Again, I do not have any close friends that are Derm, Opthal, etc... but I just dont see them being that better off than us time and financially. I have friends that are OB, Anes, Surgery... they are a bit jealous of my schedule. The Anes has an awesome job where he works pretty much 7A-3P M-F.... but its HARD for him to 'take a week off'... hes off almost every weekend... but travel is a bit difficult for them...

I'll get off my soap box... EM is a great balance of lifestyle, wealth, fun, etc etc... Everyone always thinks The grass is always greener...


*Only been out 8 months... Maybe I will get jaded someday. For now, I could not enjoy or be more enthusiastic about what I do!!!

 

[Chromatid]

Totally a lifestyle specialty. Anything less than 150hrs a month is, no matter how you slice it.

 

[pinipig523]

Totally a lifestyle specialty. Anything less than 150hrs a month is, no matter how you slice it.

It's not easy if your shifts are variable. When you're out when your kids are home or you're working the weekend your wife is off - that's not cool over a period of time.

EM is not a lifestyle specialty - the hours are variable and can be tough, the on-the-job stress can be high, you don't get a lunch if you're trying to move the room and your waiting room is backed up, and as reimbursements get cut - you have to see more just to keep the same pay. Add the fact that as you age, your lucrativity is not what you'd expect it to be as the newer junior attendings compete with you for the same jobs... there's quite a bit of negative to the field.

Still a good field though.

 

[pinipig523]

Maybe one day I will eat my words, but I still stand by and say our specialty is pretty darn near a lifestyle specialty. Maybe I am just oblivous to what the Derms life is really like....

Lifestyle specialty is probably more like:

Work 8-4p on MWF, with 1 hour lunch from 12-1.
Work 8-12p on Tuesday.

Off on Thursday, Sat, Sunday.

THAT'S a lifestyle specialty. That's what derm and orthodontists do while still hitting 300-400K.

Not - I have to work 10 days in a row so I can have a 6 day weekend.... And in those 10 days, I may have to do a double back once between a night shift and into an afternoon shift. That's not a lifestyle specialty. That's brutal work just so I can make it to a string of days off. I don't see what's so "lifestyle" about working 8-4p, 8-4p, 8-4p, then 4-12a, 4-12a, 4-12a then coming back for a 8-4p then 4-12a then 12a-8a, then back for a 4p-12a.

That's frickin' brutal.

EM has the variability and the option to move your shifts around so you can take a longer break here and there, but it's not easy.

 

[Birdstrike]

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[upright]

Seems like the arguments against EM being a "lifestyle specialty" always boil down to, "you have to work nights, weekends, and holidays."

Am I the only one who does not see these as negatives?

I could not care less if I have to work on a day that is everyone else's weekend day. In fact, it seems better to me. Why would I want to go to the gym/grocery store/amusement park/ski resort/etc on days when the rest of the world is there? I don't want to go out to eat on February 14th with the sheep stampede and I don't care if my "birthday bbq" is two days after the date on my birth certificate.

To each his own. Perhaps for some of us, emergency medicine IS a lifestyle specialty.

It's the constant shifting of your schedule and toying with your circadian rhythm that's the problem, not simply the fact that you're working nights. Try shifting your sleep schedule on its head every few days. It ain't fun. And a not so trivial portion of that "time off" is going to be spent in a bed, attempting to recover. It also shortens life span, google it.

 

[EMedGrrl]

I could not care less if I have to work on a day that is everyone else's weekend day. In fact, it seems better to me. Why would I want to go to the gym/grocery store/amusement park/ski resort/etc on days when the rest of the world is there? I don't want to go out to eat on February 14th with the sheep stampede and I don't care if my "birthday bbq" is two days after the date on my birth certificate.

Wait until you have kids that are school-age, and your only opportunity to spend time with them is evenings and weekends. You might start to care - a lot.

 

[Chromatid]

Not - I have to work 10 days in a row so I can have a 6 day weekend.... And in those 10 days, I may have to do a double back once between a night shift and into an afternoon shift. That's not a lifestyle specialty. That's brutal work just so I can make it to a string of days off. I don't see what's so "lifestyle" about working 8-4p, 8-4p, 8-4p, then 4-12a, 4-12a, 4-12a then coming back for a 8-4p then 4-12a then 12a-8a, then back for a 4p-12a.

That's frickin' brutal.

EM has the variability and the option to move your shifts around so you can take a longer break here and there, but it's not easy.

aren't you a resident so isn't this kind of expected? most people call a 6 day "weekend" a vacation..

 

[RustedFox]

Yeah, brother Pig - it sounds like that schedule (in particular) just sucks. Hope it gets better for you in your first gig out.

I say it's definitely lifestyle - just a different type of desirable lifestyle. Remember: you can't have it ALL. I decided early-on that kids and a big empty house to clean just weren't for me. The wife is totally on-board with not ruining her body by putting it thru that nonsense called "pregnancy". Having more time to truly recreate (even if it's small-time stuff like a martial arts class, regular softball league, etc.) is what makes the next day worth looking forward to. I find that this attitude helps keep me humble and not chase dollar signs. Remember, the things you own can end up owning you.

Only working 3 or 4 days a week is great. Sure, you got your nights, your weekends, but there's no pager/thermal detonator on your hip just waiting to ruin what little time you DO get "off".

For the hours that we work, and for the freedom of no call... I think that we win.

 

[la gringa]

i have found that working at a larger shop w/ more variety of shift times is a good and bad thing.

good in that it's a lot more flexible as far as needing X time off for appointments, obligations, etc - b/c there are several shifts a day and several docs.

bad in that you don't have routines for each of the shift types, or at least it's harder. sometimes i wish i only had 3 day "types", but others i love it.

i'd say i feel that way about the EM schedule in general. you gotta look at the positives if you've decided you like the specialty in general. my coworkers spend PLENTY of time w/ their families... way more than my colleagues in more traditional fields.

the only specialty i look around at and sometimes envy are the dental specialties - but i chose medicine b/c i like taking care of sick people. while i'd probably be fiiine as a dentist... i love being a physician in the end.

 

[Apollyon]

i have found that working at a larger shop w/ more variety of shift times is a good and bad thing.

good in that it's a lot more flexible as far as needing X time off for appointments, obligations, etc - b/c there are several shifts a day and several docs.

bad in that you don't have routines for each of the shift types, or at least it's harder. sometimes i wish i only had 3 day "types", but others i love it.

i'd say i feel that way about the EM schedule in general. you gotta look at the positives if you've decided you like the specialty in general. my coworkers spend PLENTY of time w/ their families... way more than my colleagues in more traditional fields.

the only specialty i look around at and sometimes envy are the dental specialties - but i chose medicine b/c i like taking care of sick people. while i'd probably be fiiine as a dentist... i love being a physician in the end.

In a larger group (almost 60) docs, I found that that meant nearly 60 people that were unwilling to switch, and forgot how many times they had been helped individually. If you think 5 or 10 prima donnas is too many, try 5 times as much.

 

[pinipig523]

aren't you a resident so isn't this kind of expected? most people call a 6 day "weekend" a vacation..

Yes, I'm a resident... it is expected. But also - keep in mind that as an attending, your schedule doesn't necessarily change for the better if you sign up to work the same number of hours.

And although a 6 day off is a vacation - it's no fun when you've front loaded AND back loaded your shifts before AND after your little soiree.

Yeah, brother Pig - it sounds like that schedule (in particular) just sucks. Hope it gets better for you in your first gig out.

RF - hey bud!

That schedule is something that I've worked as a resident. As an attending - my main gig sounds like it's going to be great! I'm signed on to work 120 at least and I'm looking to hit 160/mo. I know it's a lot, but that's just my goal for the first few years while I'm still young at 29.

Then I'll scale back as I get older.

 

[FMtoEM]

You are absolutely right...I've always been a plan A, B, and C type of person all my post high school life so EM is extremely appealing to me that it allows me to explore other areas...I hope to always practice clinically but down the road it will be less.

Which is exactly what I'm saying - you get into medicine to practice clinically (or at least the majority of us do).... and it's not first line thinking to go into a particular field only to be looking to move away from it as time goes on.

You don't see optho, ortho, GU guys looking to get out of the field just as soon as they start.

 

[FMtoEM]

Exactly how I feel.

Seems like the arguments against EM being a "lifestyle specialty" always boil down to, "you have to work nights, weekends, and holidays."

Am I the only one who does not see these as negatives?

I could not care less if I have to work on a day that is everyone else's weekend day. In fact, it seems better to me. Why would I want to go to the gym/grocery store/amusement park/ski resort/etc on days when the rest of the world is there? I don't want to go out to eat on February 14th with the sheep stampede and I don't care if my "birthday bbq" is two days after the date on my birth certificate.

To each his own. Perhaps for some of us, emergency medicine IS a lifestyle specialty.

 

[LastMinEMROLQs]

Lifestyle specialty is probably more like:

Not - I have to work 10 days in a row so I can have a 6 day weekend.... And in those 10 days, I may have to do a double back once between a night shift and into an afternoon shift. That's not a lifestyle specialty. That's brutal work just so I can make it to a string of days off. I don't see what's so "lifestyle" about working 8-4p, 8-4p, 8-4p, then 4-12a, 4-12a, 4-12a then coming back for a 8-4p then 4-12a then 12a-8a, then back for a 4p-12a.

That's frickin' brutal.

EM has the variability and the option to move your shifts around so you can take a longer break here and there, but it's not easy.

couple flaws here....arent you having to work 10 days in a row for 6 days off because you're doing 8 hrs shifts???

1) you can choose to do 18 8's or 14 10s or 12 12's. If you want to work less days per month, then increase the length of your shifts! If you worked 12hr shifts x 10 days in a row, you'd only have to work 2 more days for the REST OF THE MONTH. So here 10 days of work in a row would actually afford you an....18 day vacation???

2) 8 hr shifts are a joke. so honestly yea, you're working 10 days in a row for 6 days of vacation, but those shifts are extremely short and you still have plenty of time to be home with your kids and family. Yes, even those 4-12am i consider a joke because its still only 8 hrs.

you go to cook county dont you. you guys do 8 hr shifts right. i know people there. im pretty sure many of your co-residents will tell you themselves that 8 hr shifts are not hard and they feel they have PLENTY of time to do stuff the rest of the day after their shift.

 

[Hamhock]

Disclaimer: I'm one of the youngest in an a semi-large academic group.

Context: I am an active, single male without direct family or a significant other.

Opinion: I do not think EM is a lifestyle specialty. I currently work less than 150 hours per month clinically (yes, I do a fair bit beyond the ED -- teaching, admin, and such), and it is too much. I am young (<40y) and I struggle with transitions between my few overnights.

HH

 

[EctopicFetus]

Different strokes for different folks..

Me.. I work a lot.. Over 300k in student loans. I make real good money but I work nights for more money and a more manageable (read predictable) schedule.

I worked Monday night, got home and slept for 30 mins, kids got up, got them around with my wife and went to bed. Slept for 6.5 hours (good for me on nights) then had to ask someone to stay and extra hour so I could coach T ball for my son, then back for 12 more hours at night.

I wouldnt call that a lifeestyle specialty. I love my job. I really do and I think it works fairly well for me and my family. I worked in consulting prior to med school and that sucked the fat one.

IMO money doesnt have much to do with the term "lifestyle specialty" how much you work does. sure you could work 4 shifts amonth and make 100k.. who does that? My group has a minimum of 96 hours a month. I want to save and enjoy my life.. i work >150... perhaps that plus wanting to be there for my kids makes this not a lifestyle specialty....

IMO there are GREAT things about our schedules. My wife now hates going out on Fri or sat night cause going out is easy on Wednesday.. The problem is normal people schedule parties, get togethers and kids events on Sat or sunday.. I might be working and that sucks. I dont know how else to put that. I have come to accept that... My group requires us to work 2-3 of the 5 major holidays. So I work 2-3 of Thanksgiving, Xmas Eve, Xmas, NYE and NYD.

Derm doesnt do that.. Just something to consider when calling this a lifestyle specialty. I think it is the best specialty out there but not a lifestyle specialty. I would pick it again 100/100 times.. and ive been out of residency almost 3 years.

 

[RustedFox]

Just throwin' this out there; comments/criticism welcome -

I read this thread and thought about my new attending gig and its hours. My contract says that for full-time status, I need 120 hrs/month. We do 8 hour shifts, so that makes 15 shifts/month. In reality, I'll probably work 16, maybe 17 if its a long month.

I think that it's reasonable to work a four-day week every week, and then leave the rest of the time for the little things. Sure, I'm not buying a house or a sportscar anytime soon... but... I'd rather recreate more frequently and stay happier.

Now, I understand that I'm gonna be a rookie at this game - so anyone who can point out the unforseen pitfalls or throw pearls in my direction... g'head. I'm all ears.

 

[DeadCactus]

Medicine is a lifestyle specialty, physicians just aren't lifestyle people.

 

[xaelia]

I like my lifestyle OK.

But, then, I'm grant-supported in academics and down to 88 clinical hours a month at the moment. I'd say I end up doing a little bit of work almost every day, but it has great flexibility.

No kids yet.

 

[pinipig523]

couple flaws here....arent you having to work 10 days in a row for 6 days off because you're doing 8 hrs shifts???

1) you can choose to do 18 8's or 14 10s or 12 12's. If you want to work less days per month, then increase the length of your shifts! If you worked 12hr shifts x 10 days in a row, you'd only have to work 2 more days for the REST OF THE MONTH. So here 10 days of work in a row would actually afford you an....18 day vacation???

2) 8 hr shifts are a joke. so honestly yea, you're working 10 days in a row for 6 days of vacation, but those shifts are extremely short and you still have plenty of time to be home with your kids and family. Yes, even those 4-12am i consider a joke because its still only 8 hrs.

you go to cook county dont you. you guys do 8 hr shifts right. i know people there. im pretty sure many of your co-residents will tell you themselves that 8 hr shifts are not hard and they feel they have PLENTY of time to do stuff the rest of the day after their shift.

8 hours is not as bad as 10 which is not as bad as 12. Yes, we do 8h shifts but with a 1h sign out - you're looking at 9h.

In the community, as an attending, those 8h shifts are tougher than as a resident. You don't have anyone else around you to help you out when poop hits the proverbial fan.

If you're seeing 1.5/h then yeah - I agree, an 8h shift is easy-peasy but if you're seeing 3/h like the place I'm rotating at right now... 8h is tough and by the time I get to 11h, I'm tired.

I use an 8h example because my job as an attending is moving to 8h shifts (from 12... no one likes the 12). And because I choose to work 160, I'm looking at approx 20 shifts each month.

And btw, you can't just choose what kind of shifts you're going to work if your group doesn't offer it.

And lastly, if you actually talk to the residents at Cook County - you'll know that a majority of them (at least the seniors and those who have kids at home) complain about the lack of actual days off in a 20x8h month. Especially when your days off are following a NIGHT shift and you have to come back the next day for an AM shift.

Like I said before, I'm ok with it because I know what I signed up for - I love my job. But to call it a lifestyle specialty is wrong.

 

[WilcoWorld]

couple flaws here....arent you having to work 10 days in a row for 6 days off because you're doing 8 hrs shifts???

1) you can choose to do 18 8's or 14 10s or 12 12's. If you want to work less days per month, then increase the length of your shifts! If you worked 12hr shifts x 10 days in a row, you'd only have to work 2 more days for the REST OF THE MONTH. So here 10 days of work in a row would actually afford you an....18 day vacation???

2) 8 hr shifts are a joke. so honestly yea, you're working 10 days in a row for 6 days of vacation, but those shifts are extremely short and you still have plenty of time to be home with your kids and family. Yes, even those 4-12am i consider a joke because its still only 8 hrs.

you go to cook county dont you. you guys do 8 hr shifts right. i know people there. im pretty sure many of your co-residents will tell you themselves that 8 hr shifts are not hard and they feel they have PLENTY of time to do stuff the rest of the day after their shift.

Going out on a limb here...but I'm guessing you haven't worked a lot of 12 hour shifts as an attending in a busy ED?

 

[Arcan57]

couple flaws here....arent you having to work 10 days in a row for 6 days off because you're doing 8 hrs shifts???

1) you can choose to do 18 8's or 14 10s or 12 12's. If you want to work less days per month, then increase the length of your shifts! If you worked 12hr shifts x 10 days in a row, you'd only have to work 2 more days for the REST OF THE MONTH. So here 10 days of work in a row would actually afford you an....18 day vacation???

2) 8 hr shifts are a joke. so honestly yea, you're working 10 days in a row for 6 days of vacation, but those shifts are extremely short and you still have plenty of time to be home with your kids and family. Yes, even those 4-12am i consider a joke because its still only 8 hrs.

you go to cook county dont you. you guys do 8 hr shifts right. i know people there. im pretty sure many of your co-residents will tell you themselves that 8 hr shifts are not hard and they feel they have PLENTY of time to do stuff the rest of the day after their shift.

1) As mentioned by pinipig, not all of those shift options are offered at all shops. In fact, I have yet to even interview at a place where 8h shifts were an option since leaving residency. 8 hour shifts with double coverage (or even significant overlap) requires a lot of docs to be able to implement, as most attendings won't sign up for working >20 shifts month. 168 hrs/month as 14 12s is going to be a lot more popular than 21 8s. And most places are only going to offer one set of hrs. It may vary depending on day (we do 9s or 10s depending on the day of the week), but it gets quite difficult to produce shifts where certain providers only work certain length shifts. So the flexibility exists in general, but is often lacking in specific circumstances.

2. I'm going to assume you are a resident, so I'm glad that you find 8s easy. You can get your behind handed to you on an 8, but in general you'll leave the shift with some energy left. Which if you are single is awesome. Even as a married, no-kids resident I loved the swing shifts although if I put a string of them together I never got to see my wife. Now, I'm woken up at 7am after every non-overnight shift and if I had to stay over on the swing I may only be getting 4-5 hrs of sleep. The pros outweigh the cons for me, but EM without a stay-at home spouse is rough (either you shortchange your family by paying attention to your changing Circadian rhythm or your self by just doing without sleep.)

 

[pinipig523]

Just throwin' this out there; comments/criticism welcome -

I read this thread and thought about my new attending gig and its hours. My contract says that for full-time status, I need 120 hrs/month. We do 8 hour shifts, so that makes 15 shifts/month. In reality, I'll probably work 16, maybe 17 if its a long month.

I think that it's reasonable to work a four-day week every week, and then leave the rest of the time for the little things. Sure, I'm not buying a house or a sportscar anytime soon... but... I'd rather recreate more frequently and stay happier.

Now, I understand that I'm gonna be a rookie at this game - so anyone who can point out the unforseen pitfalls or throw pearls in my direction... g'head. I'm all ears.

RF - congrats on the job man! Aren't you a 2nd year going into 3rd? You got a job that early? Niiiice.

Btw, when I quickly read your post - I thought you said procreate.... not recreate.

 

[pinipig523]

Going out on a limb here...but I'm guessing you haven't worked a lot of 12 hour shifts as an attending in a busy ED?

I'd say you hit the nail on the head.

The pros outweigh the cons for me, but EM without a stay-at home spouse is rough (either you shortchange your family by paying attention to your changing Circadian rhythm or your self by just doing without sleep.)

This is exactly the problem with our field and exactly why it isn't a lifestyle specialty. Your lifestyle is hampered by your work. You're either working or sleeping when the kids and wife are at home!

That's the #1 issue as to why this isn't an easy gig to handle if you choose to work a full 150-160h a month.

People will say that any job that gets you to work 160h or less is a lifestyle specialty - I would agree if you worked 8-4 every M-F and you're off every afternoon, night, weekend, AND holiday. Yes, that's a lifestyle specialty.

But with how we operate and the random-ness of our shifts - no way. Not a lifestyle specialty.

Are there worse predicaments to be in? You betcha.... for sure. We have it good compared to many other careers out there.

But this ain't no lifestyle specialty. I leave that to the dermatologists, cosmetic plastics, orthodontists of the world.

 

[RustedFox]

RF - congrats on the job man! Aren't you a 2nd year going into 3rd? You got a job that early? Niiiice.

Btw, when I quickly read your post - I thought you said procreate.... not recreate.

Thanks, bud.

I'm a graduating PGY-3. 3 months away from electricattendingland.

... and I choose not to procreate. Ha ha !

 

[la gringa]

i still think EM wins most specialty wars when it comes to hours worked, pay, variety of work day, and flexibility. it's really damn tough to have your own issue of any sort when you work every weekday 8-4 - try having an injury and needing to do PT, and working that schedule. it's absolutely impossible.

if you know from day 1 that family life and kids are #1 in your life and you want to be at ever t-ball game and piano recital and see all of the firsts every one of your kids have, AND see your spouse for hours a day... you probably shouldn't be a physician. i'm not trying to be callous (and yes i'm a woman, and a rather bleeding heart/great patient satisfaction sort of softie, so don't even go there!) -- but medicine is a PROFESSION. it cuts both ways sometimes.

and i'll say it again - given the medicine is a PROFESSION, i think EM has a nice balance of factors. i agree w/ most of what Ectopic said. you get to be a "real" doctor, get paid well, stay in tune w/ the real world (whether that's good or bad sometimes).... not a bad gig imho. despite its warts, and the fact that i was damn cranky on Sunday after having a rough Saturday, there's not another specialty i'd pick over EM.

 

[Arcan57]

i still think EM wins most specialty wars when it comes to hours worked, pay, variety of work day, and flexibility. it's really damn tough to have your own issue of any sort when you work every weekday 8-4 - try having an injury and needing to do PT, and working that schedule. it's absolutely impossible.

Although the list of MSK injuries you can have and still be an effective ED doc is pretty small. Which is why own-occupation disability insurance is so damn important.

 

[Postictal Raiden]

With the increasing number of graduating residents every year, coupled with more midlevel professional working in the ER, do you doctors expect the lifestyle of emergency medicine to remain the same in the near future? Would the situation worsen to a point when residency grads wouldn't be able to secure decent jobs?

I, currently, volunteer at a high volume ER at a teaching hospital, and I'm deeply in love with this profession. I am truly concerned about my future profession.

 

[Birdstrike]

.

 

[ensuii]

With the increasing number of graduating residents every year, coupled with more midlevel professional working in the ER, do you doctors expect the lifestyle of emergency medicine to remain the same in the near future? Would the situation worsen to a point when residency grads wouldn't be able to secure decent jobs?

I, currently, volunteer at a high volume ER at a teaching hospital, and I'm deeply in love with this profession. I am truly concerned about my future profession.

Read less SDN

 

[vengaaqui]

How draining is 18 eight hour shifts per month? I realize EM means flip flopping of schedules and not just sitting at a desk, but that still leaves 12 days off per month...sounds nicer than working 23 days out of 30 in an average job.

 

[arb011]

How many EM staff do you know who work more than a couple weekends per month and a few holidays per year, unless they choose to. My guess is not many. Couple that with working ~15 days per month and I would say it is more than a fair trade.

 

[la gringa]

Although the list of MSK injuries you can have and still be an effective ED doc is pretty small. Which is why own-occupation disability insurance is so damn important.

yeahhhh i can't get a reasonably priced individual policy, possibly ever. took my new job partly b/c it has group own-occ DI (short and long term), and no 12 hr shifts.

i am currently still in rehab after a back operation. doing wonderfully all things considered!!! 6 months ago i was barely able to function w/o a TENS unit, and i haven't touched the thing since the night before my disc replacement surgery.

 

[pinipig523]

How many EM staff do you know who work more than a couple weekends per month and a few holidays per year, unless they choose to. My guess is not many. Couple that with working ~15 days per month and I would say it is more than a fair trade.

In my group - there are 7 or so full time ER docs and about 7 part time. So, we are expected to work at least 4-5 weekend days a month... that means I only get 1 true full weekend off a month (this is what we call a "golden" weekend). Not to mention I have to staff half the holidays - I can't have NYE off if I have Christmas off.

How draining is 18 eight hour shifts per month? I realize EM means flip flopping of schedules and not just sitting at a desk, but that still leaves 12 days off per month...sounds nicer than working 23 days out of 30 in an average job.

Let me correct your error - there's only 28 days in a 4 week work period. So, you work 18, you're off 10 not 12. And 18 is not full, full time. 20 is. So with 20, you're off 8 days. Consider you have 2-3 night shifts going into a day off - you really have 5-6 "true" days off in a month.

 

[zinjanthropus]

During my first year out, I have no complaints - life is good. Work a few days a week, enjoy it when I go in, good income to enjoy myself when not there. I have a family - wife and 2 year old, see them plenty, travel a lot. I can't think of anyone I know in medicine or other fields that has a better lifestyle.

 

[RustedFox]

In my group - there are 7 or so full time ER docs and about 7 part time. So, we are expected to work at least 4-5 weekend days a month... that means I only get 1 true full weekend off a month (this is what we call a "golden" weekend). Not to mention I have to staff half the holidays - I can't have NYE off if I have Christmas off.



Let me correct your error - there's only 28 days in a 4 week work period. So, you work 18, you're off 10 not 12. And 18 is not full, full time. 20 is. So with 20, you're off 8 days. Consider you have 2-3 night shifts going into a day off - you really have 5-6 "true" days off in a month.

I dunno, brother pig - sounds like a raw deal to me. You sure you want this gig ?

 

[arb011]

During my first year out, I have no complaints - life is good. Work a few days a week, enjoy it when I go in, good income to enjoy myself when not there. I have a family - wife and 2 year old, see them plenty, travel a lot. I can't think of anyone I know in medicine or other fields that has a better lifestyle.

Thank you for shedding some positive light on the conversation.

 

[deleted109597]

I dunno, brother pig - sounds like a raw deal to me. You sure you want this gig ?

I agree. Sounds like a lot of days.