Longevity, Finances, and Retirement in Emergency Medicine

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[RustedFox]

Depends on the job, minimum at mine to maintain (generous) benefits is 141/month. Many work closer to 170 (I'm not one of them). With the many night/day switches it can be tough...

Yeah. I gotcha. My min is 120 for benefits, but they're not so super.

 

[Hercules]

Depends on the job, minimum at mine to maintain (generous) benefits is 141/month. Many work closer to 170 (I'm not one of them). With the many night/day switches it can be tough...

I am at a 50K community ED. Full-time for us is 110 to 120 hours per month. We staff that with four 8 hour shifts on the weekdays and three 10 hour shifts on the weekends (we do fewer shift with longer hours on the weekends to give people more weekends off) so that comes out to about 13 shifts/month with each person doing a little less than four night shifts per month.

 

[W19]

Wait a minute! You guys/gals are making 350k+/year working 120 hrs/month... No wonder EM is getting very competitive.

 

[WilcoWorld]

For a typical FT EM job, let say 12/12hr shift per month, how many night shift one has to work?

Roughly, at baseline, your fraction of nights will = the fraction of shifts that are nights.

If your shop has 2 x 12 hours shifts/day you'll work 1/2 nights. If your shop has 3 x 8 hours shifts/day you'll work 1/3 nights. If your shop has 8 shifts per day with double-coverage overnight...1/4 of your shifts will be night shifts.

There are many other factors that can change this (nocturnists, a good night differential, partnership tracks), but the above is a decent rule of thumb.

 

[RustedFox]

I want to point something out regarding the poll.

The most popular answer here was "cutting back on shifts", followed by "nights" and "reasonable pace at work", respectively.

If we could somehow improve the pace and setting that we worked in (crazy, I know?!) then I don't think that "cutting back" would be the number-one item.

We all agree that we like what we do. If we didn't, then we wouldn't do it. We all talk about HIPPO this and EmCRIT that and FOAM and EM/CC pathways, and we geek out over "talking shop".

We like the medicine.

Its the environment and pace that are poisonous. Seeing 4 patients per hour and having the Press-Ganey boots on our necks and staying "late" to finish charts and x-y-z.

These are things that can (and should) improve.

 

[Old_Mil]

Recruiters and hospitals are going to try and wring as much coverage out of you as possible. It is up to you to protect your longevity and sanity. Listen to Rusted Fox. Contract for about 120 hours a month max. You can always do locums at a higher rate if you feel like it.

12x12 is a lot of time to be at work given the nature of what we do.

Sent from my DAGGER DG550 using Tapatalk

 

[The White Coat Investor]

Wait a minute! You guys/gals are making 350k+/year working 120 hrs/month... No wonder EM is getting very competitive.

Crap! Secret's out!

 

[Birdstrike]

You will experience burn out at some point. Period. You will. Anyone saying anything else is either in denial, is too young to be there yet, or is just plain full of crap. So yeah. This whole thread is full of BS. Don't ask, "Will I get burned out?" Ask, "How will I manage my burnout (emotional exhaustion)?"

Sorry.


Truth.

Next question?

 

[wonderbread12]

You will experience burn out at some point. Period. You will. Anyone saying anything else is either in denial, is too young to be there yet, or is just plain full of crap. So yeah. This whole thread is full of BS. Don't ask, "Will I get burned out?" Ask, "How will I manage my burnout (emotional exhaustion)?"

Sorry.


Truth.

Next question?

So how did you manage your burnout?

 

[MD²]

You were right, a colleague eventually told me about your post. You make some good points, but the best one is your last:

"The secret to longevity in emergency medicine is to work less, be financially secure, and have the freedom to explore the academic and professional interests that come up along the way."

Cutting back: About age 40 (after 15 years as an attending) I came close to burning out. I realized that the main reason was that I was working too many hours (180-220 hrs/month) and not taking enough vacation. I cut back to 140 hrs, then found an academic job with 120 hrs clinical and 20 hrs teaching. Plus I always took all my vacation and CME time to actually do those things (4 weeks/year). Since then (for the ensuing 24 years), it's been great. So I did indeed cut back many years ago to add teaching time; in the last two years I've cut those hours to 85 hours/month with 20 hrs of teaching time.

About nights: many of us like them. Most don't. But almost all of us will experience building physiological intolerance in our 50's. Your breaking point may differ. But your younger partners WILL NOT sympathize with your plight. After all, they have never experienced it, and will expect you to work nights just like them. I think the key is coming up with a pre-planned, logical policy that everyone agrees to ahead of time. Avoid groups without one.

One house, one spouse: highly desirable. But not always our choice. I was not the one to file in either divorce, and no-fault divorce law means it will happen no matter what once it's filed. Plan for it if you can.

College: You're right, retirement is more important than kids college expenses. The key is to save for their college expenses from the day they're born, make it large enough, and let them know how much they've got to spend and stick with it. I was a pushover for some post-graduate expenses at too late a point in my life, and hadn't saved enough from the beginning.

Low pay: You're way off. I started at $21/hour out of residency, 40 years ago. I didn't make $100K per year until 10 years out, and I never made more than $200k except for a couple years. Still, it's plenty for a normal person, but nothing like what my workaholic private practice colleagues make at their rich hospitals with no indigent care. Better planning and more retirement saving would have been good ideas. But there were no advisers like you back then. No mentors either.

What to do in retirement: Oh, my problem with deciding what to do in retirement is figuring out what's first from a list of things that will take me 50 years to accomplish. I can't wait to start. This will include starting a consulting business for medical school applicants, a topic in which I have special expertise. Retiring at 65 completely was good enough for my country family doc father, and it will be good enough for me. We should all be so lucky as to be allowed and able to take care of patients until then.

But nice points, and thanks for the discussion.

This month's Annals of Emergency Medicine Change of Shift column was written by Dr. Mark Debard, an emergency physician who was grandfathered into the specialty 40 years ago and notes he had few if any mentors throughout his career and now as he moves into retirement. It takes a lot of guts to write about your own fears, finances, and life and publish it to the world, and I'm sure Dr. Debard will eventually read what is written here, so I'm going to make an effort to remain very polite and sympathetic and encourage you to do the same.

Reading the column made me sad for a number of reasons, which I can't list without seeming critical of important decisions Dr. DeBard made in his life, but which I think are worthwhile for young emergency physicians, residents, and students to consider.

1) When To Drop Nights

Dr. DeBard gives a recommendation that you should go to "half-nights" at 55 and "no-nights" at 60 and notes that he had to convince his partners of the wisdom of that policy. In my mind, he's at least 10-15 years too late! If I were going to give recommendations to a junior colleague, I would tell him to plan his life so that he can go to "half-nights" at 40 and off them completely by 50. I would also tell him to avoid a group that doesn't get that. Nights suck. Working them is a cardiac risk factor. It decreases your longevity, increases your burnout, and has serious effects on family life that are compounded by the fact that the vast majority of emergency medicine shifts are NOT banker's hours. In fact, in my department, less than 2 out of 7 shifts are even close to banker's hours (the 6 am to 2 pm shift and the 11am to 7 pm shift on weekdays that aren't holidays.)

2) Cutting Back

Dr. DeBard also notes he "went to three quarters clinical time at age 62, which is also helping prolong my career. I'd recommend it to anyone over 55 or 60. It really improves attitude and enthusiasm. Plus, it gave me enough time to finally get serious about my physical fitness." Again, I'd say he's 20 years too late. If you plan your finances well, you can be 3/4 time by 40, 1/2 time by 45, and retired by 50. If you find that you don't even have enough time to stay physically fit as an emergency physician, you're working WAAAYYYY too much. There's only one reason people do that, and it isn't for the love of seeing more cases of alcohol intoxication. Cutting back improves your attitude and enthusiasm at 40 just as much as at 60. What's the point of making gobs of money if you can't use it to create exactly the life you want?

3) One House, One Spouse

Dr. DeBard notes he went through two divorces (and three marriages.) One of the cardinal rules of personal finance is one house, one spouse. Every time you get divorced you not only cut your wealth in half, but you decrease your ability to accumulate it for years afterward due to the alimony that almost every divorcing emergency physician is going to pay.

4) Paying for children's college

Dr. DeBard laments that "Financially, 2 divorces, late-in-life children with college expenses, and the income of an inner-city emergency physician haven't left me in a great position." Another important rule of personal finance is that retirement comes before college. Kids can dramatically reduce the cost of college by choosing a less expensive institution or going to one to which they get a scholarship. They can also take out loans and work. Many of us (and probably Dr. DeBard) did. But it's pretty tough to get a loan for retirement. If you make decisions like that, you might find that just like Dr. DeBard, you'll get to retirement and find that you "traveled a lot and lived well while working [but] will just need to tighten the belt and resolve to live with it." That's a crappy feeling I don't want to have on the eve of my retirement. I want my thought to be "how am I ever going to spend all this and who can I give it to where it will make the biggest difference?"

5) Low pay?

And about that "inner-city emergency physician" income, I have no idea what Dr. DeBard makes/made. It appears he is at Ohio State College of Medicine as an academic physician. Last I checked, Ohio has about the lowest cost of living in the country. Academics do get paid less than most private practice emergency physicians, especially partners. But it's hardly poverty wages. The 25th percentile for employee emergency physicians in the 2015 Daniel Sterns Survey was $250K. Let's assume he did even worse than that. We'll call it the equivalent of $200K over his ~35 year career. If he had saved just 20% of that income, that's $40K a year. At 8% a year, that should have grown to nearly $7 Million. Even with a divorce or two he shouldn't be feeling like he has to cut back his lifestyle significantly in order to retire. Remember that with no need to save for retirement or college, no kids at home, no work expenses, no disability or life insurance, and a much lower tax bill, he should be able to retire at the exact same lifestyle on $100K of retirement income. If there is a significant spousal retirement and Social Security, he may need as little as $1-2M in retirement savings to maintain his pre-retirement lifestyle.

6) What to do in retirement?

Another big issue for anyone who eventually plans to retire is how they will fill their time. Dr. DeBard doesn't want to work fast-track, has no interest in administration, and doesn't want to work at least 4 shifts a month (all of which might improve the financial situation.) Instead, he's been keeping a list the last few years of what he'd like to do once retired. I would submit rather than going full bore to 62, then 3/4 speed to 65, he would have a lot less difficulty knowing exactly what he wanted to do with his time if he'd been working a lot less all along. Figure out what you want to do "once you're retired" and start doing it now as much as possible. Then all you have to do is expand your plethora of hobbies and interests when you actually do pull the ejection handle.

The bottom line is this for young emergency physicians:

1) Assume you will want to stop working nights at 40, that you will want to start cutting back on shifts in your 40s, and that you will want to retire completely at some point in your 50s. Plan your finances accordingly. If that turns out not to be true, then you'll have a lot more money to spend, give, or leave to heirs.

2) Find your balance in life as early as possible. Too many shifts, especially night shifts, is incredibly stressful on a marriage. Far better to work less (and make less) and not have to split your assets in half once or twice. Balance also includes hobbies and other interests. If you don't have 4 or 5 things that make you excited about life at any given time, you're spending too much time at work. If you can't live on $200-400K, you have a spending problem, not an earning problem.

3) The secret to longevity in emergency medicine is to work less, be financially secure, and have the freedom to explore the academic and professional interests that come up along the way.

 

[emememem]

You were right, a colleague eventually told me about your post. You make some good points, but the best one is your last:

"The secret to longevity in emergency medicine is to work less, be financially secure, and have the freedom to explore the academic and professional interests that come up along the way."

Cutting back: About age 40 (after 15 years as an attending) I came close to burning out. I realized that the main reason was that I was working too many hours (180-220 hrs/month) and not taking enough vacation. I cut back to 140 hrs, then found an academic job with 120 hrs clinical and 20 hrs teaching. Plus I always took all my vacation and CME time to actually do those things (4 weeks/year). Since then (for the ensuing 24 years), it's been great. So I did indeed cut back many years ago to add teaching time; in the last two years I've cut those hours to 85 hours/month with 20 hrs of teaching time.

About nights: many of us like them. Most don't. But almost all of us will experience building physiological intolerance in our 50's. Your breaking point may differ. But your younger partners WILL NOT sympathize with your plight. After all, they have never experienced it, and will expect you to work nights just like them. I think the key is coming up with a pre-planned, logical policy that everyone agrees to ahead of time. Avoid groups without one.

One house, one spouse: highly desirable. But not always our choice. I was not the one to file in either divorce, and no-fault divorce law means it will happen no matter what once it's filed. Plan for it if you can.

College: You're right, retirement is more important than kids college expenses. The key is to save for their college expenses from the day they're born, make it large enough, and let them know how much they've got to spend and stick with it. I was a pushover for some post-graduate expenses at too late a point in my life, and hadn't saved enough from the beginning.

Low pay: You're way off. I started at $21/hour out of residency, 40 years ago. I didn't make $100K per year until 10 years out, and I never made more than $200k except for a couple years. Still, it's plenty for a normal person, but nothing like what my workaholic private practice colleagues make at their rich hospitals with no indigent care. Better planning and more retirement saving would have been good ideas. But there were no advisers like you back then. No mentors either.

What to do in retirement: Oh, my problem with deciding what to do in retirement is figuring out what's first from a list of things that will take me 50 years to accomplish. I can't wait to start. This will include starting a consulting business for medical school applicants, a topic in which I have special expertise. Retiring at 65 completely was good enough for my country family doc father, and it will be good enough for me. We should all be so lucky as to be allowed and able to take care of patients until then.

But nice points, and thanks for the discussion.

Wonderful post AND I love your username!

 

[The White Coat Investor]

You were right, a colleague eventually told me about your post. You make some good points, but the best one is your last:

"The secret to longevity in emergency medicine is to work less, be financially secure, and have the freedom to explore the academic and professional interests that come up along the way."

But nice points, and thanks for the discussion.

Welcome to the forum Dr. Debard and thank you for the additional details and your service to the profession. And thank you for being the mentor you never had.

Also glad to hear you've got a 50 year list. Here's to hoping you get through at least 35 years of it!

 

[katmandu]

WCI's plan sounds fabulous. However, as multiple posters have noted, it is a challenge to get out of nights and cut back on shifts as early as 40.

So, for longevity, do you think the better plan is to do EM but in a reduced capacity (cutting out night shifts, cutting back hours, etc) at a later age or to find a second career that is more friendly to circadian rhythms by completing a fellowship or some other avenue?