What are the options when an EM physican gets old?

[theWUbear]

This is probably one of the top questions on the minds of anyone considering EM, so I imagine it has been well documented - if anyone has insight or can point me to some writing on the topic that would be great.

Basically, how difficult does it become for a 60 year old, 70 year old to be an EM physician? The overnight shifts must be (literally) killer. I've seen that options include being in a practice that 'rewards' old age/seniority with fewer/no night shifts, being in a practice that incentivizes night shifts and deincentivizes day shifts monetarily, joining in on an urgent care group....

Is it harder to stay employed/stay working in old age for an EM physician, than, say an IM physician? Is it possible for EM physicians to do IM later in life? Perhaps that's the big thing with EM/IM residency.

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[TraumaLlamaMD]

I've known several EM docs who did fellowships in areas like toxicology, and shifted to solely or mostly working in those areas as they got tired of doing so many general EM shifts. I believe it's not uncommon to wind up in administration, either. That said, I've also met a few in their mid 60s who still love the job and wouldn't change it.

 

[Doctor Bob]

This is probably one of the top questions on the minds of anyone considering EM, so I imagine it has been well documented - if anyone has insight or can point me to some writing on the topic that would be great.

Basically, how difficult does it become for a 60 year old, 70 year old to be an EM physician? The overnight shifts must be (literally) killer. I've seen that options include being in a practice that 'rewards' old age/seniority with fewer/no night shifts, being in a practice that incentivizes night shifts and deincentivizes day shifts monetarily, joining in on an urgent care group....

Is it harder to stay employed/stay working in old age for an EM physician, than, say an IM physician? Is it possible for EM physicians to do IM later in life? Perhaps that's the big thing with EM/IM residency.

1. Keep in mind EM is a very young specialty... only been around as a separate field since the late 70s. So there aren't a lot of 60 and 70 year olds who went through an EM residency. People who grandfathered in might be older but didn't train in the field. So there's little data about older people who knew what they were getting into from the start.

2. EM physicians can't go work as an IM doc later in life. They didn't train in that field. Maybe an urgent care or something slower. But EM docs don't train in the chronic management of disease which is what a lot of clinic docs do.

3. There are practice setups that incentivize people for seniority.

But there are all kinds of things that EM docs can do in their golden years... cruise ship medicine, urgent care, fewer shifts. It's an issue in every specialty. What does a surgeon do when they can't get up at all hours of the night for call, or their hands get the shakes, or their eyes go... etc, etc, etc. Older docs adapt and overcome.

 

[da8s0859q]

/thread with above.

At one of my program's departments, we have:
- One who went to urgent care work, ~3 shifts a week, then retired.
- One who has literally 1-2 shifts a week in the ED at most, formerly full-time.
- One who did retire from a full-time schedule as partner.

I know people who:
- Completed a fellowship to have an "out" in (of) the specialty as a backup plan, essentially.
- Plan on going part-time or working at a lower-volume, +/- rural or freestanding, department.

There are options. Just depends on how you want to go about it and your financial considerations.

 

[AlbinoHawk DO]

I met someone that transitioned into occupational medicine, but I don't know if they had to do extra training.

 

[arewethereyet...]

My dad is a 61 year old EM physician. He works in a pretty rural hospital and is having trouble finding new docs, so he currently works 4-5 shifts/week (much more than he would like). He's working on getting a larger corporation to buy their ED and get more docs so he can work 2-3 shifts per week until he's 65. He's head of the department so he sets the schedule and makes his night shifts all in a row so it's not as bad.

 

[Winged Scapula]

Or you could just retire (presuming you'd saved some $$).

 

[bc65]

As an outsider looking in, I always thought that the ability to work one or two shifts a week in "retirement" was an advantage of EM/ urgent care. It's harder to do that in most specialties, which require some continuity of care. I would think that EM, radiology, pathology, and anesthesia all share that advantage.

 

[jl lin]

Seriously, unless the person has some sort of limitations d/t health issue/s, um, an age such as 61 really isn't that old. Now if they don't want to do EM anymore, that's different. There are a few programs that are FM/EM, but I imagine the seats are limited given the limited number of programs. 61 is not an age issue, it's a "in what kind of biological/mental energy condition is the person" issue.

 

[sonofva]

They either put you out to stud or take you out back to barn and shoot you.

 

[jl lin]

They either put you out to stud or take you out back to barn and shoot you.

Yes. LOL. As people learn to take better care of themselves and live well past 70+ something, I am sure this will go over like a zephyr. LOL. More like a lead balloon. People never seem to get that very quickly they shall be whatever age. They will, with some varying perspectives, feel that they are the same person they have always been. And with that, these same individuals will not feel the negative way they feel now about their age--for the most part.

It's quite humorous to me that people think that aging has to be this huge deal and one's life is over at a certain age. This is why, even though I love pediatrics, I don't want to give up caring for people of all ages. And I love the perspectives of many folks over 60 or >.

We have these stereotypes in our minds about people. You have to live in the here and now, but you also have to try to get the perspective that time is this relative function and, in a very real sense, it is almost as if "you are already there."

I also know ED docs and other docs that work well past 60. I know a CT surgeon that was still doing good work after 70. It's kind of an individual thing, really.

 

[Lysinee]

1. Go into academics or get a job that offers daytime shifts. You would be paid less
2. Some in the EM forum have mentioned paying other Drs to take their night shifts.
3. Decrease your number of shifts per month.

 

[mimelim]

1. Keep in mind EM is a very young specialty... only been around as a separate field since the late 70s. So there aren't a lot of 60 and 70 year olds who went through an EM residency. People who grandfathered in might be older but didn't train in the field. So there's little data about older people who knew what they were getting into from the start.

2. EM physicians can't go work as an IM doc later in life. They didn't train in that field. Maybe an urgent care or something slower. But EM docs don't train in the chronic management of disease which is what a lot of clinic docs do.

3. There are practice setups that incentivize people for seniority.

But there are all kinds of things that EM docs can do in their golden years... cruise ship medicine, urgent care, fewer shifts. It's an issue in every specialty. What does a surgeon do when they can't get up at all hours of the night for call, or their hands get the shakes, or their eyes go... etc, etc, etc. Older docs adapt and overcome.

Here in Texas they just keep going until they die in the CVICU next to their patients. But, maybe that isn't a good thing...

 

[Danbo1957]

Teach; or as mentioned above, Urgent Care in an undeserved area.

 

[theWUbear]

Thank you all for your perspective. When exi stated that some complete a fellowship to have an "out", what fellowships may allow for daytime work in EM? Policy/administration fellowships? Are these done right out of residency or later?

 

[eefen]

I actually just wrote a little bit about this here. If I do EM, I'll probably do a fellowship right after residency.