PGY1 in Crisis

[jumpter]

***Reading this back, it seems like I am just whining and hating intern year, but I do think no.8 is true and kind of making me sad to read it and confirm it is true...

Die hard EM person. Loved everything about it since MS1...I have posted on countless threads over the past 3-4 years mocking the naysayers and giving 'stay-the-course' advice to people in my exact position.

I don't know how it got so bad so quickly but here I am, contemplating quitting.

Background: I am a mid-tier US AMG from the midwest and now living in a huge coastal city, in a 'great' 3 year program. Over the course of my intern year the following has occurred, including the final straw (no. 7) which put me over the top into full-blown crisis mode:

1. Since last July 5 (FIVE!) attendings have left my program. Most recently the young one that I truly connected with; and he left not to go to another ED but to go into a completely non-clinical job. This is the attending that had the most love for his job that I have ever met, but it was all an act...

2. TWO residents in the years above me randomly left the program this year, one left to do gas as a PGY1 and the other no one knows what happened it was super shady and there are rumors about drugs but no one wants to talk about it.

3. The amount of questionable ethical decisions made by some of the attendings has drastically increased since I returned from an off service rotation; literally they do the opposite of what they teach in an effort to capture more reimbursables - it's unlike anything I had ever seen during my aways or my acting internship. The remaining faculty have been forced to practice business-minded medicine to keep their contracts.

4. I feel hungover all the time after a string of overnights. There is little regard to our circadian rhythm which is understandable as we are residents but then our attendings get the same horrible schedules as we do; no rhyme or reason to the days they have a night shift. And the shifts are all 12 hours. I don't know how I didn't notice this before maybe I was in med student denial...

5. The outgoing PGY3s have mostly taken jobs either in middle-of-nowhere or locums and their offers are a lot less $$$ than SDN would make it seem. The one who is staying here with an 'academic' appointment will get $180k/year.

6. We no longer can admit patients without speaking to a hospitalist who routinely pushes back hard for obs and discharge for the non-privately insured, and it's obvious; now I pray for a patient to have a private attending because they love taking admissions.

7. A 2nd year was named in an umbrella lawsuit on an off service rotation and the ED administration has been in full throw her under the bus mode, i.e. doing everything in their power to protect the attending including making sure it is clear that she went against their department protocol. This is despite the fact that her mistake was not a mistake but a miss that everyone else missed including the attending who signed off on the patient. She is contemplating leaving the program as well. That would be 3 residents in one year...

and finally, number 8....

8. I have come to realize I actually hate the job my attendings have. The aspects of the specialty that I love are still there and I still get excited for the cool case and 'save-a-life' moment but I am fast realizing that after residency I am going to be miserable if my career is anything like theirs. What scares me is that this is supposed to be a great program, it is horrible to think that this might be the best situation I can expect in the future (attendings have actually told me this exactly - this place is so much better than working for [EMA/equivalent]. But then they are all quitting to make more money at worse places. I am thinking about CCM fellowship or gas at this point. I don't think I could stomach 15 - 20 years of this life.

I don't know what I hoped to accomplish with this thread I just had to get it out there.

---

Members don't see this ad.

 

[deleted547339]

***Reading this back, it seems like I am just whining and hating intern year, but I do think no.8 is true and kind of making me sad to read it and confirm it is true...

Die hard EM person. Loved everything about it since MS1...I have posted on countless threads over the past 3-4 years mocking the naysayers and giving 'stay-the-course' advice to people in my exact position.

I don't know how it got so bad so quickly but here I am, contemplating quitting.

Background: I am a mid-tier US AMG from the midwest and now living in a huge coastal city, in a 'great' 3 year program. Over the course of my intern year the following has occurred, including the final straw (no. 7) which put me over the top into full-blown crisis mode:

1. Since last July 5 (FIVE!) attendings have left my program. Most recently the young one that I truly connected with; and he left not to go to another ED but to go into a completely non-clinical job. This is the attending that had the most love for his job that I have ever met, but it was all an act...

2. TWO residents in the years above me randomly left the program this year, one left to do gas as a PGY1 and the other no one knows what happened it was super shady and there are rumors about drugs but no one wants to talk about it.

3. The amount of questionable ethical decisions made by some of the attendings has drastically increased since I returned from an off service rotation; literally they do the opposite of what they teach in an effort to capture more reimbursables - it's unlike anything I had ever seen during my aways or my acting internship. The remaining faculty have been forced to practice business-minded medicine to keep their contracts.

4. I feel hungover all the time after a string of overnights. There is little regard to our circadian rhythm which is understandable as we are residents but then our attendings get the same horrible schedules as we do; no rhyme or reason to the days they have a night shift. And the shifts are all 12 hours. I don't know how I didn't notice this before maybe I was in med student denial...

5. The outgoing PGY3s have mostly taken jobs either in middle-of-nowhere or locums and their offers are a lot less $$$ than SDN would make it seem. The one who is staying here with an 'academic' appointment will get $180k/year.

6. We no longer can admit patients without speaking to a hospitalist who routinely pushes back hard for obs and discharge for the non-privately insured, and it's obvious; now I pray for a patient to have a private attending because they love taking admissions.

7. A 2nd year was named in an umbrella lawsuit on an off service rotation and the ED administration has been in full throw her under the bus mode, i.e. doing everything in their power to protect the attending including making sure it is clear that she went against their department protocol. This is despite the fact that her mistake was not a mistake but a miss that everyone else missed including the attending who signed off on the patient. She is contemplating leaving the program as well. That would be 3 residents in one year...

and finally, number 8....

8. I have come to realize I actually hate the job my attendings have. The aspects of the specialty that I love are still there and I still get excited for the cool case and 'save-a-life' moment but I am fast realizing that after residency I am going to be miserable if my career is anything like theirs. What scares me is that this is supposed to be a great program, it is horrible to think that this might be the best situation I can expect in the future (attendings have actually told me this exactly - this place is so much better than working for [EMA/equivalent]. But then they are all quitting to make more money at worse places. I am thinking about CCM fellowship or gas at this point. I don't think I could stomach 15 - 20 years of this life.

I don't know what I hoped to accomplish with this thread I just had to get it out there.

Sorry man (or woman).

A few thoughts:

Sounds like you're in a pretty malignant program. My program is NOT that way. I'm not saying this to rub it in, but to say that not all EDs are like this.

I know a lot of people in PP who love their job. I don't think I'm going to be that guy, but they are out there.

Then end of PGY-1 can be dark. Don't do anything you regret now. You're only in a 3 year program. By the time you could find another program, you'd already be 2 years in. You are 24 months away from being board-eligible. If you jump ship, you'll have more options at that time (e.g. fellowship).

This is SDN. Everyone on here complains about their job. The grass is NOT always greener. Read the gas forum...they talk about how all their jobs are being taken by CRNAs.

Some attendings at my shop bug me, but not because they are doing things to bolster billing - usually just crazy conservative. Again, not all departments are the same.

The nights suck. No changing that. Sorry. But every field has it's crap. Hospitalists have their social rocks, trauma has all of their non-op, surgery has their high-output fistulas, gas has the CRNAs, peds doesn't get paid, neurosurgery works a million hours a week, derm can't deal with anything other than a rash.

I'm going to be doing CCM after EM, but hopefully will do both. That being said, CCM is tough. Only do it if you love it.

For whatever reason, you're on the lower end of salary. Our academic attendings get 240s to start. One of our attendings is going to take a job at another academic center (transferring because they do more research in his particular interest) More than one of our attendings moonlight at a place that is 250/hr. A lot of our graduating residents are taking well-paying jobs in places that a lot of people wouldn't be too excited about, but work for them. Don't assume you're going to be the guy making 500k, but to think you'll be making 250-350k in a decent place with a relatively benign schedule isn't all that hard to come by.

Keep your head up.

 

[goodoldalky]

Don't do anything at the end of intern year. Let's be honest, intern year is terrible. It's horrible. Horrendous. Sucktastic. Really, really awful. I felt like you did at times in some ways, I think we all did. Take a step back and remind yourself that what you're feeling is not that unusual. It will get a lot better, I promise.

With regard to your specific points:

1. Since last July 5 (FIVE!) attendings have left my program. Most recently the young one that I truly connected with; and he left not to go to another ED but to go into a completely non-clinical job. This is the attending that had the most love for his job that I have ever met, but it was all an act...

This isn't a bad thing. Keep in mind that some EM physicians, if they have other non-clinical skills or interests, may transition to jobs that are only partly clinical or non-clinical at some point. You, if you prepare properly and keep an eye out for opportunities, may want to do this yourself in 5... 10.. 20 years.. etc.

2. TWO residents in the years above me randomly left the program this year, one left to do gas as a PGY1 and the other no one knows what happened it was super shady and there are rumors about drugs but no one wants to talk about it.

Would ignore what other people are doing, IMO

3. The amount of questionable ethical decisions made by some of the attendings has drastically increased since I returned from an off service rotation; literally they do the opposite of what they teach in an effort to capture more reimbursables - it's unlike anything I had ever seen during my aways or my acting internship. The remaining faculty have been forced to practice business-minded medicine to keep their contracts.

Every job is different, but let me promise you this: patient satisfaction, billing, documentation, coding, etc., is a fact of life for every physician in every field. It sounds like your faculty may be getting pinched in this regard but if you are a practicing physician in any specialty you are dealing with this to some extent.

4. I feel hungover all the time after a string of overnights. There is little regard to our circadian rhythm which is understandable as we are residents but then our attendings get the same horrible schedules as we do; no rhyme or reason to the days they have a night shift. And the shifts are all 12 hours. I don't know how I didn't notice this before maybe I was in med student denial...

Med students don't work enough to notice this disruption. 12 hour night shifts are awful. What you may come to realize is that when you get out, you may be looking for particular job or hour situations where the number of shifts you work a month is limited, leaving you with fewer nights. IMO, the whole "I'm going to work a ton of shifts and rake in the dough" is a recipe for burnout. Personally, I work 4 nights a month. Probably sounds a lot better than what you have going, just keep in mind it will get better.

5. The outgoing PGY3s have mostly taken jobs either in middle-of-nowhere or locums and their offers are a lot less $$$ than SDN would make it seem. The one who is staying here with an 'academic' appointment will get $180k/year.

Not sure what city you are in. Academic jobs pay less. Certain markets pay less. If you are willing to be flexible on where you live, you will find that salaries will vary. 180K a year is pretty low, IMO. Don't let the money throw you off too much. If you start thinking all the time about the money, you're going to stress yourself out, when nothing is concrete until you have some contracts in your hands.

6. We no longer can admit patients without speaking to a hospitalist who routinely pushes back hard for obs and discharge for the non-privately insured, and it's obvious; now I pray for a patient to have a private attending because they love taking admissions.

Consider that welcome practice for the occasional situation in the future when you run into pushback. It happens. You'll have to grow some tough skin and realize that doctors do this because they are... you guessed it... lazy! Repeat that to yourself (internally) next time, let the pushback roll off your back, and move on.

7. A 2nd year was named in an umbrella lawsuit on an off service rotation and the ED administration has been in full throw her under the bus mode, i.e. doing everything in their power to protect the attending including making sure it is clear that she went against their department protocol. This is despite the fact that her mistake was not a mistake but a miss that everyone else missed including the attending who signed off on the patient. She is contemplating leaving the program as well. That would be 3 residents in one year...

I can't speak to this, except to be thankful that you weren't involved in what sounds like a ridiculous mess.

8. I have come to realize I actually hate the job my attendings have. The aspects of the specialty that I love are still there and I still get excited for the cool case and 'save-a-life' moment but I am fast realizing that after residency I am going to be miserable if my career is anything like theirs. What scares me is that this is supposed to be a great program, it is horrible to think that this might be the best situation I can expect in the future (attendings have actually told me this exactly - this place is so much better than working for [EMA/equivalent]. But then they are all quitting to make more money at worse places. I am thinking about CCM fellowship or gas at this point. I don't think I could stomach 15 - 20 years of this life.

In fairness, it doesn't sound like your attendings have great jobs to begin with. Realize that there are people out there who work part time, 6-8 shifts a month, people who work 24 hour shifts at slow EDs, people who work 8 hour shifts at insane trauma centers, and everything in between. No two jobs are the same. There are challenges at any job. Don't assume that your current attendings' jobs are "the best there are", sounds like most of them are quitting and working elsewhere.

In the end, I recommend you do two things: 1. Don't make any big decisions during your intern year, it sucks, by design, and what you are feeling is normal. 2. Read "How to Stop Worrying and Start Living", by Dale Carnegie. Just do it.

 

[Arcan57]

jumpter,
It gets better. As much as I'd like to use your post to illustrate my running theme of going into EM with eyes wide open, being beaten down by intern year is probably effecting your view of the department more than you realize.

1. Intern year as mentioned by other posters is horrible, and is frequently designed to keep you away from the type of patients that are rewarding early in your EM career. The ratio of sick:not sick typically goes up in PGY-2/3 years as well as the ease with which you disposition the not sick.

2. It sounds like your attendings are struggling with economic pressures. Change is hard and a couple of the types of docs that are attracted to academics find an emphasis on the business side of things distasteful/immoral/irrelevant. There could be a school of thought that runs something like "if I'm going to pull a bunch of crappy night shifts while working for well below the average EM pay then at least have the decency not to bother me about coding/productivity". If I had that mindset, I'd definitely be looking for a way out because my expectations aren't lining up with my reality.

3. Fighting hospitalists for admission sucks but it is so useful to come from that type of environment as an attending. Much like growing up in Florida, it's a good place to be from but you wouldn't want to spend your whole career there.

 

[Dral]

Sorry man (or woman).

derm can't deal with anything other than a rash.

You say that like it's a bad thing.

Talk to your colleague who consulted me for a rash...I knew the Dx in the first 10 seconds from looking at him (wouldn't really expect an ER doc to be able to do that, but many probably could), but within 30 seconds, ascertained that he was from Russia, never immunized, and had recently touched his roomate's Zoster (Not sure why that part wasn't gathered in the Hx taking part of admission to the ED).

Anyway, it's all good. I like the easy consults.

OP, intern year in everything sucks. I actually didn't mind mine looking back on it, but sometimes hindsight decides to put on rose colored glasses.

Remember that you are training at a place to equip you with the tools to go out and do what you want to do with your career. You are the one that ultimately molds and decides that. The sky is the limit! Just remember that to help you stay positive.

I gotta admit, I respect what you guys and gals go through. Dealing with some of those patients/issues would wear me down pretty quickly.

 

[filhodeinferno]

You say that like it's a bad thing.

Talk to your colleague who consulted me for a rash...I knew the Dx in the first 10 seconds from looking at him (wouldn't really expect an ER doc to be able to do that, but many probably could), but within 30 seconds, ascertained that he was from Russia, never immunized, and had recently touched his roomate's Zoster (Not sure why that part wasn't gathered in the Hx taking part of admission to the ED).

Anyway, it's all good. I like the easy consults.

OP, intern year in everything sucks. I actually didn't mind mine looking back on it, but sometimes hindsight decides to put on rose colored glasses.

Remember that you are training at a place to equip you with the tools to go out and do what you want to do with your career. You are the one that ultimately molds and decides that. The sky is the limit! Just remember that to help you stay positive.

I gotta admit, I respect what you guys and gals go through. Dealing with some of those patients/issues would wear me down pretty quickly.

You diagnosed a rash in 30 seconds? That's bad-ASS!

 

[Dral]

You diagnosed a rash in 30 seconds? That's bad-ASS!

Heh, I know you don't think it is, but I actually think it's kinda cool since honestly a lot of people outside of derm can't. It is all we do after all.

And it was 10, not 30. 30 seconds is what it should have taken a person to diagnose it based on Hx (granted, knowing the correct questions to ask)

Ok, I'm getting out of here before this turns into another one of the 5 million threads on SDN that rag/hate on derm. Gotta go deal with some pain med seeking patients...wait, no I don't. Kidding Kidding!

Peace out, GL OP, stick with it. You'll be glad you did in the end!

 

[two guys]

There's some good advice above.

Goodoldalky's in particular is worth re-reading. I see how adding all those things up make everything seem crappy. But, most of those things have nothing to do with you, your program or your situation. We all do this when we get down - we start to pile other things on to justify how we feel (not that it needs justification).

In practical terms - there is no easy escape from this. You need to finish your program. Every residency program has its residents by the balls. If you leave you will be in a significantly shatier situation. There is no guaranteed specialty where residency will be better and there is no guarantee that a specific program will be less malignant. As far as expecting a "great program" to be less malignant or better run than a "good" program - I doubt there's a correlation. I suspect some of the crappiest conditions occur in places where people perceive the institution to be excellent.

You can expect that all your peers know you wrote this. There's too many details for someone in your program to not figure it out. That's okay, you might get some good support from them. Just be careful, some people don't want to hear negativity even if it is deserved.

Okay, now for the uplifting part:
- this is temporary - you will be done in 24 months (and the last 12 are cake).
- you can treat your patients however you want. Just because you don't agree with your attendings "ethics" doesn't mean you can't learn from it. You will be the decision maker. You'd be surprised how well people (admin, etc) can listen if you can frame the discussion in terms of doing best for the patient. That being said, there will always be pressure to code properly. It is not unethical to make sure a chest pain is a level 5 chart or to document the actual length of a laceration. It's ok to get paid for the services you provide. I doubt you will face significant pressure to do any unethical billing or to do unneeded care to capture reimbursement.
- if you loved EM before you will love it again. Nothing colors the world shat colored better than working your tail off while being under constant pressure from all angles. You'd be wise to be suspicious of any "feeling" you have in the first 2 years about your job or relationships. It is likely not an accurate reflection of how you will feel later.
- EM is not all milk and honey but it is a great job. I know of very few people who don't feel that way long term. That being said, most of us have a moment like yours at least once, the pendulum will swing back.
- residency is incredibly hard. It will be better every month.
- consider any pushback to be weightlifting for attendinghood. I don't get much pushback where I am, but when I do I can dispose of it relatively quickly without pissing people off and while getting what's best for the patient. I owe that to some seriously overworked and creative admitting services during residency.

Keep your head up. Take good care of your patients and show them compassion. When you talk to attendings and peers, try to talk about things you're excited about. Focusing on negative stuff just snowballs all those feelings.

 

[Birdstrike]

Don't rush to decide on any of this. You're in the fog of residency. What you need to do will become clear in time. My advice would be to put this all aside temporarily, until your next long weekend or preferably, week log vacation away from work. Pick who you trust most in life regarding wisdom and advice with decision making and talk it over with them. It's very likely, that things are not as bad as they seem at the current moment of crisis. I think it's likely to get better for you. Put all these questions aside for the immediate moment, and focus on getting through today and only today. What is best, will come to you in time.

 

[dchristismi]

Birdstrike speaks wise words. You are in a thick fog, indeed. Intern year sucks, regardless, but it gets so much better. Really.

12 hour overnights are a bitch anywhere. A string is even more painful.

There are tons of jobs out there. Hell, I'll hire you in a couple years. Community life is much different than academics, and there is a lot more out there... including nice patients, good reimbursement, and getting to leave it all at the hospital at the end of your shift.

Head down, plow through, and yes, you can do this for 24 more months. After that, the world opens up. Seriously. If you need to talk or vent, well, that's why this forum exists.

 

[emergentmd]

Background: I am a mid-tier US AMG from the midwest and now living in a huge coastal city, in a 'great' 3 year program. Over the course of my intern year the following has occurred, including the final straw (no. 7) which put me over the top into full-blown crisis mode:

1. Since last July 5 (FIVE!) attendings have left my program. Most recently the young one that I truly connected with; and he left not to go to another ED but to go into a completely non-clinical job. This is the attending that had the most love for his job that I have ever met, but it was all an act...

Who Cares? Its life. People move and get different jobs. People come and go all the time. You will probably meet 100 people in your lifetime that you connect with that moves for a zillion reasons. Get focused. You are there for a reason. Pay the price and you will be rewarded in 3 yrs. When I did residency, it was much worse and everyone just sucked it up

2. TWO residents in the years above me randomly left the program this year, one left to do gas as a PGY1 and the other no one knows what happened it was super shady and there are rumors about drugs but no one wants to talk about it.

Again, Who Cares. If I was in a program and they all left but the program was still accredited, its all good.

3. The amount of questionable ethical decisions made by some of the attendings has drastically increased since I returned from an off service rotation; literally they do the opposite of what they teach in an effort to capture more reimbursables - it's unlike anything I had ever seen during my aways or my acting internship. The remaining faculty have been forced to practice business-minded medicine to keep their contracts.

Thats life. If you don't learn it in residency, you will learn it as an attending. We all practice outside of the books. Abx for viral infections. Overorder to protect our A$$es. Chart everything to collect more money. It sounds like you work in a private group. Thats what private groups do. Its a business and the number one priority is to KEEP the contract and Make money.

4. I feel hungover all the time after a string of overnights. There is little regard to our circadian rhythm which is understandable as we are residents but then our attendings get the same horrible schedules as we do; no rhyme or reason to the days they have a night shift. And the shifts are all 12 hours. I don't know how I didn't notice this before maybe I was in med student denial...

Thats residency. We did 7 straight nites all of the time. Again easier now, but residency is not supposed to be easy. When you get out, it gets better. You can find groups that will have night only docs

5. The outgoing PGY3s have mostly taken jobs either in middle-of-nowhere or locums and their offers are a lot less $$$ than SDN would make it seem. The one who is staying here with an 'academic' appointment will get $180k/year.

HUH? I no clue about academics, but if you are full time Private and make any thing under 200k/yr, someone is robbing you. I have not made less than 350k/yr working 14 shifts a month. The competing group (after talking to one of their new hires) were absolutely Rapping them. This poor guy was making 150-160k/hr IC. I make much more with Full Benefits. I told him straight up that that group was preying on his ignorance.

6. We no longer can admit patients without speaking to a hospitalist who routinely pushes back hard for obs and discharge for the non-privately insured, and it's obvious; now I pray for a patient to have a private attending because they love taking admissions.

Live with it in Academics. In private, I have NO problems admitting. All I do now, is Text and I am done. Orders put in. I almost Never get push back. There are some hospitals that have more push back but overall, you just have to figure out the game. If you have a soft admit, make it sound like a great admit. By the time the Hospitalists sees them, its too late to back out. Even with real soft ones like old and weak, I just tell them they can't walk and no one can take care of them. Done

7. A 2nd year was named in an umbrella lawsuit on an off service rotation and the ED administration has been in full throw her under the bus mode, i.e. doing everything in their power to protect the attending including making sure it is clear that she went against their department protocol. This is despite the fact that her mistake was not a mistake but a miss that everyone else missed including the attending who signed off on the patient. She is contemplating leaving the program as well. That would be 3 residents in one year...

This one is the only red flag to me. Not sure what to say, but this SUCKS. I would still say stick with it and get out. Can you tell me what program this is so I can tell my Friends to Avoid?

and finally, number 8....

8. I have come to realize I actually hate the job my attendings have. The aspects of the specialty that I love are still there and I still get excited for the cool case and 'save-a-life' moment but I am fast realizing that after residency I am going to be miserable if my career is anything like theirs. What scares me is that this is supposed to be a great program, it is horrible to think that this might be the best situation I can expect in the future (attendings have actually told me this exactly - this place is so much better than working for [EMA/equivalent]. But then they are all quitting to make more money at worse places. I am thinking about CCM fellowship or gas at this point. I don't think I could stomach 15 - 20 years of this life.

This is a personal decision. Remember grass and greener. I know docs is many fields that hate their job and would jump into ER if they could. Talk to any field and they would gladly throw away their beeper, go home at a set time, never take call, never have to deal with office staff. People go into medical fields thinking they will do Cool cases every day. Guess what, most days are without cool cases. And those Cool cases that you see as a resident are not Cool after doing it 10 times. Trust me. If I never have to do an LP, shoulder reduction, suture, fracture reduction, CPR, Central Line, etc... I would be a happier man. Ask a Surgeon if that Bowel obstruction is Cool anymore.

I don't know what I hoped to accomplish with this thread I just had to get it out there

 

[The White Coat Investor]

First, don't do anything. You're having the end of intern year blues. This is the darkest time (except perhaps last November/December) of your career. If you didn't see some stuff that made you hate life you would be unusual.

Second, all EM jobs don't suck. I'm sitting in a brand spanking new facility, having seen 6 patients this shift (I'm 9 1/2 hours into it) with great nurses farting around on SDN. Nobody is around to tell me to practice any differently than the way I think is best.

Third, maybe medicine/emergency medicine isn't right for you. But now isn't the time to bail (unless it is to another specialty.) Your job opportunities will be far greater if you finish training and practice a couple of years before leaving clinical medicine.

Fourth, I don't know why you think this is a great program. It sounds like a terrible program. None of that crap happened in my program except 1 of my fellow residents had a Vicodin problem.

 

[emergentmd]

First, don't do anything. You're having the end of intern year blues. This is the darkest time (except perhaps last November/December) of your career. If you didn't see some stuff that made you hate life you would be unusual.

Second, all EM jobs don't suck. I'm sitting in a brand spanking new facility, having seen 6 patients this shift (I'm 9 1/2 hours into it) with great nurses farting around on SDN. Nobody is around to tell me to practice any differently than the way I think is best.

Third, maybe medicine/emergency medicine isn't right for you. But now isn't the time to bail (unless it is to another specialty.) Your job opportunities will be far greater if you finish training and practice a couple of years before leaving clinical medicine.

Fourth, I don't know why you think this is a great program. It sounds like a terrible program. None of that crap happened in my program except 1 of my fellow residents had a Vicodin problem.

I just finished my 12 hr FSED ED shift, saw 7 pts with no one even remotely sick. Had grilled burgers in the break room. watched the NBA finals. Got to take a 3 hr nap. And I got paid more than the Hospitalist who was up all night admitting in the busy ED.

yeah.... my life sucks

 

[Birdstrike]

I just finished my 12 hr FSED ED shift, saw 7 pts with no one even remotely sick. Had grilled burgers in the break room. watched the NBA finals. Got to take a 3 hr nap. And I got paid more than the Hospitalist who was up all night admitting in the busy ED.

yeah.... my life sucks

So are you saying you're a highly-paid burger-flipper?

 

[SpaceLeftBlank]

So are you saying you're a highly-paid burger-flipper?

Sounds a little more like "highly paid burger eater."

Which would have been a dream career for 10-year-old me.

Actually, I can think of worse things now....

 

[emergentmd]

So are you saying you're a highly-paid burger-flipper?

I got a free burger and didn't even flip but I would have been happy to flip a few burgers too. If I was told in medical school that I would make 2k for 12 hrs working prob a total of 2 hrs, I would have never believed it.

 

[RuralEDDoc]

Others have said plenty above, but to echo some comments and make some new ones:
1. Residency often sucks and is demoralizing in ways you couldn't predict. As distasteful as it can be, it helps you understand the realities of life, and helps you develop the thick skin you need to practice modern medicine.
2. The practice of clinical medicine, and emergency medicine in particular, is at times antagonistic. Patients are asking for things that you cant provide, administration makes demands that are unreasonable, consultants can be jerks, etc. Its the reality of modern medicine. There's no getting around it, so get used to that aspect.
3. Post-residency practice, if you're at the right job, can be much better. There are aspects that are worse, but overall, my professional happiness is much higher than it was in residency. And my bank account is much fuller.
Keep your head up.

 

[gman33]

You could be describing any program in the country.
If the program is big enough, residents will leave, attending will leave.
Most hospitals are under a lot of financial pressure. Hence the need to move patients and maximize billing.

Learning to deal with jerks may be some of the best training you get.
It's just another skill that you need to learn.

At times during intern year, I was looking for a way out.
Now that I'm at the end of residency, so glad I didn't switch.
For the most part, I really like EM.
There are bad parts, but I couldn't imagine being happier in another field.
Maybe just as happy, but not happier.

Stick it out.
If you still hate it, do a fellowship.