Second year medical student asking about the field

[Bulliedinschool2doc]

I get it. I have read all the older docs here complaining. I am aware of what is happening to EM.

However, given I was pretty set on EM, I do not know where to go from here. I was thinking of doing EM residency, then a fellowship if things are as bad as people here are saying. All of the ER docs I used to work with in rural, underserved areas have no complaints about salary, job opportunities-mostly the admin and patient stuff.

I am a slightly above-average medical student with lots of leadership and some research.

Perhaps I need some advice given the obvious unspoken tone to proceed with caution. How can I damage control my future given I like the aspects of EM? Do I just aim to match into another specialty?

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[DeadCactus]

I think going into EM with the realization that you may not want to do it forever and may at some point need to do some other learning or formal education to pivot is reasonable. Medicine clings to an ideal where your career is linear but I think it's insane to expect people to want to do the same thing from the time they are 30 until the time they are 65.

Should you do EM? No one else is going to be able to answer that for you. The truth is the majority of people can find contentment is a wide variety of specialties. Figure out the major themes for what you want in life (acute vs chronic, procedures vs not, rural vs urban, regular schedule vs flexible schedule, build a practice vs employee) and work backwards from there.

Really spend some time figured out what a successful life looks like to you - and not a career but the whole life. Is it living in a specific city? Is making it to every one of your kids' games or coaching their team? Is it spending 100+ days in the mountains? Is it being the only person in a 5 state area who can do procedure X? Is it being the national expert on a niche topic? Is it a $100k+ car and a Rolex collection? Is it being an entrepreneur? Is it buying a sailboat and cruising for months out of the year? Is it working as few hours a week as possible? Is it retiring as early as possible? Some of the answers will change throughout your life and that's alright - just be honest as changes happen and work on a plan to adapt your career to fit your new goals.

 

[thegenius]

I get it. I have read all the older docs here complaining. I am aware of what is happening to EM.

However, given I was pretty set on EM, I do not know where to go from here. I was thinking of doing EM residency, then a fellowship if things are as bad as people here are saying. All of the ER docs I used to work with in rural, underserved areas have no complaints about salary, job opportunities-mostly the admin and patient stuff.

I am a slightly above-average medical student with lots of leadership and some research.

Perhaps I need some advice given the obvious unspoken tone to proceed with caution. How can I damage control my future given I like the aspects of EM? Do I just aim to match into another specialty?

Lots of fields have problems. Outpatient medicine overall has problems getting approvals to do lots of things like start a medicine, order a CT, or refer a patient to another doctor. There are endless hoops you have to jump through and you have to create a whole organization set up to combat insurance companies desire to control costs. But the nice thing about outpatient medicine is you don't have to treat everyone that comes to your door and you can fire patients.

EM and hospital medicine sucks in other ways. For EM the single biggest problem is patient entitlement to your time. You are viewed as the "last place to go" and if other doctors and specialists can't figure out their problem, they will come to do and demand everything. You can't "fire them". They can keep on coming back, asking for more and more and more. You discharge them and say "You are not entitled to narcotics", and then they come right on back tomorrow, see your partner, and get narcotics. There are some cool aspects to EM but it's getting harder and harder to experience them because we are flooded with MILLIONS of forlorned adults who can't take care of themselves.

Private pay medicine can be rewarding, it's all cash. However you are only really available to a small subset of society who can afford you and you better put a mint on their pillow, rub their back, and answer their phone call immediately 24/7 and give them what they want, whether it's medically indicated or not.

It's really hard to find a job where you can practice good, sound, ethical, evidence based medicine with understanding patients. It just doesn't really exist in America.

I would generally avoid EM unless you really absolutely love taking care of people who come to your door 24/7 with their chronic problems. That's 95% of what we do. Look at the thread somewhere on this forum called "Post Your Boring, Nonsense Shifts" or something like that. People post what they see on a daily basis. We see 20-30 patients per shift and the vast majority is boring, nonsense, sometimes non-medical, and almost always non-emergency. It's just the way it is.

If you still "LOVE EM" after really thinking hard about it, then do it. You have to be happy with your job but I'd say that job satisfaction for ER docs who have been in the field for > 10 years is probably no higher than 10-15%.

 

[GonnaBeADoc2222]

Lots of fields have problems. Outpatient medicine overall has problems getting approvals to do lots of things like start a medicine, order a CT, or refer a patient to another doctor. There are endless hoops you have to jump through and you have to create a whole organization set up to combat insurance companies desire to control costs. But the nice thing about outpatient medicine is you don't have to treat everyone that comes to your door and you can fire patients.

EM and hospital medicine sucks in other ways. For EM the single biggest problem is patient entitlement to your time. You are viewed as the "last place to go" and if other doctors and specialists can't figure out their problem, they will come to do and demand everything. You can't "fire them". They can keep on coming back, asking for more and more and more. You discharge them and say "You are not entitled to narcotics", and then they come right on back tomorrow, see your partner, and get narcotics. There are some cool aspects to EM but it's getting harder and harder to experience them because we are flooded with MILLIONS of forlorned adults who can't take care of themselves.

Private pay medicine can be rewarding, it's all cash. However you are only really available to a small subset of society who can afford you and you better put a mint on their pillow, rub their back, and answer their phone call immediately 24/7 and give them what they want, whether it's medically indicated or not.

It's really hard to find a job where you can practice good, sound, ethical, evidence based medicine with understanding patients. It just doesn't really exist in America.

I would generally avoid EM unless you really absolutely love taking care of people who come to your door 24/7 with their chronic problems. That's 95% of what we do. Look at the thread somewhere on this forum called "Post Your Boring, Nonsense Shifts" or something like that. People post what they see on a daily basis. We see 20-30 patients per shift and the vast majority is boring, nonsense, sometimes non-medical, and almost always non-emergency. It's just the way it is.

If you still "LOVE EM" after really thinking hard about it, then do it. You have to be happy with your job but I'd say that job satisfaction for ER docs who have been in the field for > 10 years is probably no higher than 10-15%.

Listen to this man.

This is a balanced perspective on things.

I think if I were to "do it all again" I wouldn't go into medicine, but now that I'm here, EM isn't the worst choice, IF (big IF) you can find a gig with no nights like I did. Unless you're a night person, nights totally wreck your life and health.

 

[thegenius]

Here's what we see on a daily basis:

Post your boring, nonsense shifts!

Let's play the fun game of illustrating all the nonsense that comes into the ER! Write a numbered list with a one-liner of all the patients you saw on a particular shift. I'll start: 8 hr shift 23 yo man with CP and SOB after J&J COVID shot, vitals and EKG OK. discharged. 71 yo woman with...

forums.studentdoctor.net

 

[southerndoc]

Don't listen to those that are burned out. Emergency medicine is still a great field. No it's not as glorious as it once was, but if given the opportunity to choose EM again, I would 100% do so.

 

[bravotwozero]

Listen to this man.

This is a balanced perspective on things.

I think if I were to "do it all again" I wouldn't go into medicine, but now that I'm here, EM isn't the worst choice, IF (big IF) you can find a gig with no nights like I did. Unless you're a night person, nights totally wreck your life and health.

Feels so weird sleeping in your own bed after working a string of nights. Like I’ve been away from home for ages.

 

[Tenk]

It really depends on the ED. I think any job with routinely over 2 pph isn’t worth the stress and when the salary does not rise linearly with pph making it makes it double not worth it. I have friends that work probably 2-3 times harder than I do and make about the same amount of cash. 🤷‍♂️

 

[retro]

Just keep your life simple and do what you love. Pull the trigger and do not look back.

When I look at the folks in emergency medicine, they are very unique in many ways. They are definitely the atypical bunch compared to your general medical school class. People in EM often don't give a damn about continuity of care, and can't imagine following up with someone's lab results every few months and building long term relationships with them. To many, rounding for hours and talking on and on about the minute details of patient care comes off as a nightmare. My point is, many people with EM mindset will find themselves to be unhappy practicing other fields of medicine. I was one of those people, and I still think to this day that if it wasn't for EM, I would leave medicine for good and do something totally different. If you love EM that much, just stick with your plan and go from there. It's too risky to enter a field and end up unhappy for the rest of your life.

 

[RustedFox]

Are you guys all forgetting how intolerable and unsatisfiable both admins and patients are?

EM is a game you can never win, OP.

You can lose, you can tie, but you can never win.

Bird?

 

[dozitgetchahi]

Lots of fields have problems. Outpatient medicine overall has problems getting approvals to do lots of things like start a medicine, order a CT, or refer a patient to another doctor. There are endless hoops you have to jump through and you have to create a whole organization set up to combat insurance companies desire to control costs. But the nice thing about outpatient medicine is you don't have to treat everyone that comes to your door and you can fire patients.

EM and hospital medicine sucks in other ways. For EM the single biggest problem is patient entitlement to your time. You are viewed as the "last place to go" and if other doctors and specialists can't figure out their problem, they will come to do and demand everything. You can't "fire them". They can keep on coming back, asking for more and more and more. You discharge them and say "You are not entitled to narcotics", and then they come right on back tomorrow, see your partner, and get narcotics. There are some cool aspects to EM but it's getting harder and harder to experience them because we are flooded with MILLIONS of forlorned adults who can't take care of themselves.

Private pay medicine can be rewarding, it's all cash. However you are only really available to a small subset of society who can afford you and you better put a mint on their pillow, rub their back, and answer their phone call immediately 24/7 and give them what they want, whether it's medically indicated or not.

It's really hard to find a job where you can practice good, sound, ethical, evidence based medicine with understanding patients. It just doesn't really exist in America.

I would generally avoid EM unless you really absolutely love taking care of people who come to your door 24/7 with their chronic problems. That's 95% of what we do. Look at the thread somewhere on this forum called "Post Your Boring, Nonsense Shifts" or something like that. People post what they see on a daily basis. We see 20-30 patients per shift and the vast majority is boring, nonsense, sometimes non-medical, and almost always non-emergency. It's just the way it is.

If you still "LOVE EM" after really thinking hard about it, then do it. You have to be happy with your job but I'd say that job satisfaction for ER docs who have been in the field for > 10 years is probably no higher than 10-15%.

I’m rheumatology but I also feel much of what you wrote so spiritually. It occurred to me yesterday in clinic that to be a doctor in America right now is to basically slowly lose faith in humanity. So many patients who can’t/won’t/don’t make good decisions for themselves, hurting themselves and everyone around them in the process. So many people who can’t/won’t/don’t take care of themselves and refuse to take any sort of initiative with regards to their health, forcing the exhausted practitioners within the healthcare profession to handhold them through basic things they should be doing themselves. And so many bratty, nasty, obnoxious, clingy, rude horrible patients that I encounter these days. And that’s just from my relatively sheltered perspective in rheumatology. I can’t fathom what you guys go through in EM.

A large part of why “the healthcare system is broken” is that America itself is frankly broken. The entire country seems to have become a culture of rude, lazy idiocy. But I digress.

 

[RustedFox]

Other Developed Nations: I must take care of myself, so when I have to do the responsible thing and go to the doctor; it will be a nice, easy visit. I will feel a sense of pride in keeping myself healthy.

Americans: You ain't gotta take care of yourself; that's the doctor's job! If I'm unhealthy, it means the doctor ain't doin' their job good. I better go and go and go again to make them work harder to make me healthier. The more healthcare I consoom, the healthiers I am. Gibs me more of them PILLS; them's what makes you healthy.

 

[DeadCactus]

Just keep your life simple and do what you love. Pull the trigger and do not look back.

When I look at the folks in emergency medicine, they are very unique in many ways. They are definitely the atypical bunch compared to your general medical school class. People in EM often don't give a damn about continuity of care, and can't imagine following up with someone's lab results every few months and building long term relationships with them. To many, rounding for hours and talking on and on about the minute details of patient care comes off as a nightmare. My point is, many people with EM mindset will find themselves to be unhappy practicing other fields of medicine. I was one of those people, and I still think to this day that if it wasn't for EM, I would leave medicine for good and do something totally different. If you love EM that much, just stick with your plan and go from there. It's too risky to enter a field and end up unhappy for the rest of your life.

As a counterpoint, I felt like this as a medical student. Now in retrospect, I think a lot of the medical student hate for continuity, rounding, etc is partially the huge difference in the experience as a trainee vs as an attending. And at the same time I've come to believe medical students underestimate the value of a regular daytime schedule where you can just take a sick day or schedule a vacation without needing to find coverage, the reward of building relationships with patients and colleagues, the pleasure in seeing treatments through, and how mundane a lot of emergency medicine becomes after awhile. I think EM was the right choice for me but would I have been happy in a number of other specialties? Probably. There is so much room in most specialties to tailor the experience to what you want.

 

[FlaminHotER]

Oh For the Love of God…

Absolutely f ing not

 

[GonnaBeADoc2222]

I think the best advice for what field to choose is whatever field allows you to not be connected to a hospital and best allows you to dissociate from Medicare / Medicaid / private insurance.

 

[bravotwozero]

take a look at what it was that drew you to EM, and see if you can pursue other specialties that also have those aspects in common.

If you want acuity, can consider critical care or anesthesia.

If it’s scheduling flexibility, Hospitalist work may be an option.

If it’s the procedural aspect, pain management may be a good specialty.

 

[GatorCHOMPions]

Just take a look at the other sub forums on SDN. A lot of the burnout naysayers here claim SDN is an echo chamber. Undoubtedly some of that is true, but the burnout vibe is not nearly as crispy elsewhere on this site. People actually talk about practicing the field for the most part.

I was somewhat interested in surgery as a student but I was always told if you can see yourself outside of the OR do anything else. Same applies to EM, and I wish that were the prevailing wisdom back when I applied. I liked EM but definitely liked some other things too.

I think a big disconnect between student to resident to attending is the theory and hope of what EM should be and the reality. Perhaps rural practice could be different, but seems like just a different type of turd sandwich.

 

[Tiger26]

One thing many people here often don't appreciate is that the grass is generally just as brown on the other side of the fence

 

[Splenda88]

take a look at what it was that drew you to EM, and see if you can pursue other specialties that also have those aspects in common.

If you want acuity, can consider critical care or anesthesia.

If it’s scheduling flexibility, Hospitalist work may be an option.

If it’s the procedural aspect, pain management may be a good specialty.

I am a hospitalist and I like my job because of scheduling flexibility.

400k+/yr working 16-17 days/month and be able to watch an entire soccer/football/basketball game while at work is not bad either.

 

[Splenda88]

Just take a look at the other sub forums on SDN. A lot of the burnout naysayers here claim SDN is an echo chamber. Undoubtedly some of that is true, but the burnout vibe is not nearly as crispy elsewhere on this site. People actually talk about practicing the field for the most part.

I was somewhat interested in surgery as a student but I was always told if you can see yourself outside of the OR do anything else. Same applies to EM, and I wish that were the prevailing wisdom back when I applied. I liked EM but definitely liked some other things too.

I think a big disconnect between student to resident to attending is the theory and hope of what EM should be and the reality. Perhaps rural practice could be different, but seems like just a different type of turd sandwich.

There might be some truth to that. Had I listened to people in SDN, I probably would have never become a hospitalist.

I have been doing it for over 2 years now, the job is more tolerable than I thought it would be. See my post above.

 

[Birdstrike]

You can lose, you can tie, but you can never win.

Bird?

It’s the OP’s decision.

But what can I say that I haven’t already said?

The data is in. The results have been tabulated. It’s not debatable anymore.

If you choose EM, you’re more likely to be unhappy with the decision, than happy.


-Medscape

But that doesn’t mean the OP shouldn’t do EM.

Maybe he or she is like I was, and will listen to the few that tell them what they want to hear and ignore those spewing offensive, but stone-cold 100% truth.

They could also go into EM with a well planned, realistic plan for the second half of your career where their income isn’t dependent on shifts in EDs. That could be a fellowship or something else they create or plan for.

Or, they could do the rational thing, which I didn’t do originally, and choose a line of work where they don’t have to work nights, weekends, or be on call, even if it’s not a “sexy” or desirable specialty. Statistically, they’re much more likely to be happy, albeit without guarantees.

Or, they can chase their dreams, passions and desires and move forward with no regrets, like I did, with the option to course correct if needed.

It’s your decision, OP. Either way, you’ll have a place to come to, where you can share how happy or unhappy your were with that decision.

 

[Splenda88]

It’s the OP’s decision.

But what can I say that I haven’t already said?

The data is in. The results have been tabulated. It’s not debatable anymore.

If you choose EM, you’re more likely to be unhappy with the decision, than happy.

View attachment 376909
-Medscape

But that doesn’t mean the OP shouldn’t do EM.

Maybe he or she is like I was, and will listen to the few that tell them what they want to hear and ignore those spewing offensive, but stone-cold 100% truth.

They could also go into EM with a well planned, realistic plan for the second half of your career where their income isn’t dependent on shifts in EDs. That could be a fellowship or something else they create or plan for.

Or, they could do the rational thing, which I didn’t do originally, and choose a line of work where they don’t have to work nights, weekends, or be on call, even if it’s not a “sexy” or desirable specialty. Statistically, they’re much more likely to be happy, albeit without guarantees.

Or, they can chase their dreams, passions and desires and move forward with no regrets, like I did, with the option to course correct if needed.

It’s your decision, OP. Either way, you’ll have a place to come to, where you can share how happy or unhappy your were with that decision.

These stats confirm my suspicion about CCM... it's as bad as I thought it was.

 

[Apollyon]

They could also go into EM with a well planned, realistic plan

And recall what Mike Tyson, the skilled elocutor, said - "Everybody has plans until they get hit for the first time".

 

[BoardingDoc]

And recall what Mike Tyson, the skilled elocutor, said - "Everybody has plans until they get hit for the first time".

The actual quote is "Everyone has a plan, until you're punched in the mouth."

 

[Apollyon]

The actual quote is "Everyone has a plan, until you're punched in the mouth."

Actually, it isn't. I thought it was what you said, but I found the original quote from 1987. It morphed over time, and the way it's said now sounds better.

 

[BoardingDoc]

Actually, it isn't. I thought it was what you said, but I found the original quote from 1987. It morphed over time, and the way it's said now sounds better.

Interesting. I searched for your quote as I had remembered it as the version I posted and found this: .

That said, I also found your quote from 87 as you mentioned. It appears that Mike himself has been changing what he said over time.

In any event, all of this is largely a re-quotation of Helmuth von Molkte. "No plan of operations extends with any certainty beyond the first encounter with the main enemy forces." Or more succinctly: "No plan survives first contact with the enemy."

 

[Birdstrike]

25 years ago I was a cocky, know-it-all, wanna-be hero. I didn't need advice from older, "burned out" veterans who weren't happy the road they went down. I knew better. I listened to the “happy” people. So I took the hard road. I wasn't afraid of doing hard things.

I took that HARD, eye-watering, bone-jarring, knock-out punch in the face. But I got up. And I got punched, got up, again, and again, and again.

I went 11 rounds with the beast that is EM and I'm proud to say I did. I lost that fight, because EM is the champ and never loses. EM always wins and never tires of handing out beat-downs to whoever is tough enough, cocky enough and idealistic enough to get in its ring.

But it's not wrong to do hard things. I don't regret my time in EM. But I'm glad I got out when I did.

You can tie, you can lose, but you can never win.

 

[The Knife & Gun Club]

One counterpoint that I don’t think others have mentioned - if you’re the EM “type” then the colleagues you have in EM are the best in medicine by miles. I still do a bit of EM, mostly academic, and am in fellowship for CCM, so your mileage may vary. But the people in EM are some of the best people I’ve ever worked with.

Now I work with surgeons and anesthesiologists and medicine peeps. Some are fine, a few are fun, most are grumpy and unpleasant. Same for the nurses and the techs - the camaraderie of a good EM crew is hard to beat. They’re dark, funny, and almost all interesting people with a wide variety of takes on life and varied experiences. I can’t tell you how boring the day is hanging out with some PGY9 surgeon who went straight through and has no interests outside of medicine. Give me the EM doc/nurse who was a green beret, or started their own side gig, or kite surfs all weekend for fun any day - they’re just vastly more interesting to work with.

In summary one other thing to consider is how important having colleagues you look up to and mesh with is. I would’ve left clinical EM 100% (still might) but the one thing keeping me around for now is the non-patient people.

 

[cyanide12345678]

Read the jobs report in jama really really closely before going down a path where you are 5-6 years away from making any real money.

Be critical of the data, evaluate the trends, see where the specialty has gone in the last 5 years, see the trajectory that may happen in 5 years.

Don’t just use confirmation bias to Cherry pick what you want to believe - yes, it’s reassuring for the job market that EM has really high turn over, but is it really reassuring to pick a specialty with really high turn over?

You can love EM all you want, but if your dream life was working in Dallas/Austin/Denver/Houston/or whatever other desirable city, close to friends, close to your parents etc, then 5 years from now that simply might not be possible.

Figure out what you actually value. Because no matter how much you like EM, if you don’t like the idea of working somewhere undesirable - high volume, poor staffing, far from desirable cities, then give a long hard look at emergency medicine before committing to it.

 

[EctopicFetus]

I think it really really depends. If your reference point is rural EM and you want to live rural you can probably do fine. The pay is decent in many places, the expectations manageable. If your aim is to work rural and make $200/hr and work in a decent setting whilst your skills slowly deteriorate I think that is fine. If your goal is an urban / suburban 35k+ volume ED it’s unlikely you will be happy. Just being frank. The “good” jobs are shrinking and to get into those the path is longer. Many of the SDGs have chosen or been forced to grow and have created a multi tiered partnership As a byproduct of this.

I frankly personally love EM, if i could go along the path I have I would do it again 100x over. It has afforded me much and I laugh every shift and enjoy my time on shift 95% of the time. I see Urology, Ortho Rads and those guys are f‘in miserable. I don’t interact with Derm and the like, maybe they are happy as PE is just starting to bite into those fields. In the end, if you have low expectations you wont be disappointed. You would be wise to be wary of what your career will look like 5,10,15 years+ post residency.

 

[cyanide12345678]

When a jama published article predicts a 10,000 ER doctor surplus by 2030 and you graduate 2029 or 2030…. Really really think long and hard.

Yes, data isn’t perfect. Yes, attrition rate is much higher than initially presumed. So it won’t be as bad right? I mean…maybe it will be a 2000 ER doctor surplus? Is that acceptable to you?

Supply and demand. Always always listen to supply and demand.

Basic economics says supply and demand determine pricing. Then research the following questions:

1) What has the supply trend of emergency medicine docs been? What number of ER docs were being created 10 years ago, 5 years ago, today? What do you anticipate supply looking like 5 years from now?

2) What has emergency medicine as a specialty, or acep or aaem done to stop residency proliferation to control supply?

3) what’s the demand like? What were ER volumes 10 years ago, 5 years ago, today, and future predictions?

4) what number of Mid levels were working in the ER 10 years ago, 5 years ago and today? What do you anticipate that tend to look like in the future. This affects our demand.

Fundamentals matter. Fundamentals are heading for a surplus. Doesn’t matter whether it’s in 2030 or 2035 or 2040, if supply continuously outpaces demand, opportunities will diminish year over year. Until you are left with terrible places to work, high burn out crap holes with very high turn over. Those jobs will always be open because no body would stay there.

 

[EctopicFetus]

While attrition is higher they also didn’t account for more residencies opening. 10k is accurate and if that’s what it is in 2030 what’s 2035 gonna look like? More importantly using the concept of 10k too many means we are at par around 2026/2027. So finding work in a desireable city will be near impossible then.

 

[cyanide12345678]

While attrition is higher they also didn’t account for more residencies opening. 10k is accurate and if that’s what it is in 2030 what’s 2035 gonna look like? More importantly using the concept of 10k too many means we are at par around 2026/2027. So finding work in a desireable city will be near impossible then.

Yea, I’m 100 percent aware that every single year will keep getting worse.

It’s a simple math problem honestly.

I don’t think a 30 year career decision should be based on feelings. It should be based on cold hard facts.

In 2015 when i decided on EM, the future was supposed to be bright. $250-300/hr. Live anywhere you want. Work in whatever setting you want. Every job you applied to, you basically got. I feel let down because the outlook and future essentially completely changed. Just within a few years, the specialty i applied to, isn’t the specialty i got.

 

[RuralEDDoc]

In 2015 when i decided on EM, the future was supposed to be bright. $250-300/hr. Live anywhere you want. Work in whatever setting you want. Every job you applied to, you basically got. I feel let down because the outlook and future essentially completely changed. Just within a few years, the specialty i applied to, isn’t the specialty i got.

Talk to path from 2005
Or radonc 2010
Same story. It’s more common in medicine than realized.

 

[Splenda88]

I think the issue from my observation is that most Americans and especially physicians have a very high expectation of what a job should be.

I am ok with my job but I am not sure my job should be a source of happiness. If a job is at least a 5 on a scale of 1 to 10 (with 10 being the best), that is good enough.

Is EM really that bad to the point of intolerability?

 

[sloh]

I think the issue from my observation is that most Americans and especially physicians have a very high expectation of what a job should be.

I am ok with my job but I am not sure my job should be a source of happiness. If a job is at least a 5 on a scale of 1 to 10 (with 10 being the best), that is good enough.

Is EM really that bad to the point of intolerability?

Yup “follow your passion” is like the worst career advice ever. Tying up livelihood with passion often spoils the latter bc financials become the bottom line. Much rather work a job I find tolerable that pays me a ton of money and leaves me plenty of free time for passions unencumbered by financial concerns, loved ones, family.

 

[timpview]

I wouldn’t do anything that…

1. Heavy call that works the next day (cardiology)

2. Night shifts where you actually work (ER)

Blows my mind how stupid I was not to take that into account and how dumb it is that people never truly warn you of chronic sleep deprivation in training. It ruins you.

Get a job that you work 4 days a week with no nights/weekends and where people aren’t actively trying to die on you.

I could do that until I’m 90… and I couldn’t care less what pre-authorization form my nurse has to fill out.

 

[Splenda88]

Yup “follow your passion” is like the worst career advice ever. Tying up livelihood with passion often spoils the latter bc financials become the bottom line. Much rather work a job I find tolerable that pays me a ton of money and leaves me plenty of free time for passions unencumbered by financial concerns, loved ones, family.

Unfortunately, that is the prevailing sentiment here in the US. From what I have noticed, the brainwashing starts in middle school.

 

[EctopicFetus]

Yea, I’m 100 percent aware that every single year will keep getting worse.

It’s a simple math problem honestly.

I don’t think a 30 year career decision should be based on feelings. It should be based on cold hard facts.

In 2015 when i decided on EM, the future was supposed to be bright. $250-300/hr. Live anywhere you want. Work in whatever setting you want. Every job you applied to, you basically got. I feel let down because the outlook and future essentially completely changed. Just within a few years, the specialty i applied to, isn’t the specialty i got.

You have Acep to thank for this. Hopefully u aren’t a member.

 

[dozitgetchahi]

I wouldn’t do anything that…

1. Heavy call that works the next day (cardiology)

2. Night shifts where you actually work (ER)

Blows my mind how stupid I was not to take that into account and how dumb it is that people never truly warn you of chronic sleep deprivation in training. It ruins you.

Get a job that you work 4 days a week with no nights/weekends and where people aren’t actively trying to die on you.

I could do that until I’m 90… and I couldn’t care less what pre-authorization form my nurse has to fill out.

That’s why I did rheumatology…sounds like my current schedule now, except that I work 4.5 days a week.

 

[emergentmd]

There are Plus and Minuses in all Jobs and all specialties. DO NOT pick a field where you have a "Passion" for something and instead pick the field where you can "tolerate" the negatives. Seems backwards but its the truth.

If you have a passion for delivering babies, it gets old after the 100th and really gets old having to come in at 3am to catch said baby.

I picked EM b/c I hated rounding, clinics, taking call and to this day, never regretted this decision. I can tolerate the rest including shift work, weekends, nights, etc. Don't love it but can tolerate it.

 

[Birdstrike]

...But no, OP. The rational thing, is to not do EM. Remember that.

 

[EctopicFetus]

Yup “follow your passion” is like the worst career advice ever. Tying up livelihood with passion often spoils the latter bc financials become the bottom line. Much rather work a job I find tolerable that pays me a ton of money and leaves me plenty of free time for passions unencumbered by financial concerns, loved ones, family.

This times 100.

I like my job. It wouldn’t ruin me if I could make the same money doing something else tomorrow.

 

[EctopicFetus]

That’s why I did rheumatology…sounds like my current schedule now, except that I work 4.5 days a week.

What’s avg rheum pay? Honest question.

 

[dozitgetchahi]

What’s avg rheum pay? Honest question.

I’m in a PP group and I’m clearing $400k this year. You?

 

[EctopicFetus]

I’m in a PP group and I’m clearing $400k this year. You?

Avg em is 350-375. I’m in PP (an sdg) so I can’t say specifically but I’ll just say more. My avg partner is also more. Major variability in hours worked. Some docs work under 800 clinical hours a year. A few work 2x that.

What’s avg rheum? That question still stands. Much like the discussion on this board recently. I would rather see 2.5pph and make $300/hr than see 2pph and make 250/hr. It’s a personal choice. Note I put those numbers in there just as an example pointing out regardless of the unit of labor I would rather earn more per hour within Reason.

Had a locums offer for 250+/hr for 0.5 pph and I said no.

 

[cyanide12345678]

Yup “follow your passion” is like the worst career advice ever. Tying up livelihood with passion often spoils the latter bc financials become the bottom line. Much rather work a job I find tolerable that pays me a ton of money and leaves me plenty of free time for passions unencumbered by financial concerns, loved ones, family.

YES!!!!! Passion is over rated.

If your passion gets tied to a chore/job, usually you’ll lose the passion anyway.

Passions change. Priorities change. Having a good lifestyle, that should be the focus in making a decision.

 

[thegenius]

I’m in a PP group and I’m clearing $400k this year. You?

That's fantastic. This will sound uneducated and silly, but how is it treating people with a wide variety of inflammatory conditions. Symptoms seem so vague, PE findings are vague, and my impression from the little I know is people with moderate to severe inflammatory conditions are just miserable all the time.

 

[cyanide12345678]

That's fantastic. This will sound uneducated and silly, but how is it treating people with a wide variety of inflammatory conditions. Symptoms seem so vague, PE findings are vague, and my impression from the little I know is people with moderate to severe inflammatory conditions are just miserable all the time.

My friend who is finishing his rheumatology fellowship is seeing anywhere between 250-400k. He’s having me review his contracts so i know the exact specifics.

350-400k for 4.5 days usually. Community practice.

250-300 for university academic settings. One of his university offers is literally 250k, 3 days a week, 5 wks paid vacation. 10 days cme. 200% 401k match and rvu bonus after 2600 rvus. The match itself is worth 40k essentially. I forget what each rvu was worth, but i think it was around $50. Literally with all benefits he was getting 300k for working 24 hours a week clinically. The rest was protected research time because he’s into research and has like 15 publications….

 

[The Knife & Gun Club]

There are Plus and Minuses in all Jobs and all specialties. DO NOT pick a field where you have a "Passion" for something and instead pick the field where you can "tolerate" the negatives. Seems backwards but its the truth.

If you have a passion for delivering babies, it gets old after the 100th and really gets old having to come in at 3am to catch said baby.

I picked EM b/c I hated rounding, clinics and to this day, never regretted this decision. I can tolerate the rest including shift work, weekends, nights, etc. Don't love it but can tolerate it.

The passion lie that gets told in medicine has started to irk me a bit. I used to be proud - “I’m an EM doc, I’m a badass MF”. Then “I’m an EM doc, I am a valueless cog in a machine that prints money for people whose position I could never attain, at the cost of my sanity and circadian rhythm.” One can easily become the other and lead to untold personal angst.

Lately it’s “I’m a guy that likes fishing and catching lobsters. I love my friends and care about my family. I have a job where I work hard to do a good job.”

That viewpoint can be obtained in any job, from EM, to Ortho, neurosurgery, or pathology. Pick the job that doesn’t bother you too much. But you’re not a doc, you’re a person that does medicine stuff to make money and support the rest of the person you already are.