Why I used to love EM...and now I don't (6 years out)

[NE2014]

I'm calling bull****.

You haven't been talking about solutions at all.

I do have to compare work to other work. I never said "it's not that bad". I said I enjoy it and am grateful to do it.

I understand there is lots of BS in medicine in general.



Please list 5 fields where it is easier to make money (average salary > 200k in 40 hrs) than being an EM doc that are readily available to the public. (I.e. not your 4 million dollar investment scheme).

Name 5 things you recommend that medical students/residents should be pursuing right now.

Let's use real examples.




Major emphasis on this:


I'm sure Bird and NE are smart individuals. They also are particularly negative. They will say their perspectives are nonetheless true - and mostly they are. Yet 90%+ of what is being said is negative and not even solution oriented.

"This career blows, I'm out, you guys have it bad.... later! I'm rich!"

Thanks for spreading your wonderful brand of humanity.

Bird and NE strike me as the type of people who would tell their kids that Santa isn't real the second they could understand English.

With respect to your question about other careers: The question for me wasn't “what other career is a guarantee” but rather getting one’s head around the idea of a guarantee at all. If I could change one thing retrospectively about myself from 10 years ago, it would be my focus on the "250k (or some other arbitrary salary) guarantee for 40 hour work week". In effect, I underestimated my ability to make whatever living it was I wanted. If I had grown up a little later with the internet, I might have realized that an engaging and well compensated career could be realized via many pathways – engineering, for example, or advanced mathematics (leading to a career in design or the intelligence service), architecture, languages leading to a role in the foreign service or government affairs (not the type where you run for office!) plus any number of entrepreneurial ventures where I could be solving problems, working in teams… (sound familiar?).

All of these would be engaging choices where if one had faith in innate ability, success and monetary reward could be had. And none are perfect to say the least! But there are options beyond medicine, especially EM.

I think physicians are, even among the A type aggressive ones, conservative in that they are afraid to eschew the "300k/40 hr" guarantee in some cases. I WAS ONE OF THESE!

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[NE2014]

I'm calling bull****.

You haven't been talking about solutions at all.

I do have to compare work to other work. I never said "it's not that bad". I said I enjoy it and am grateful to do it.

I understand there is lots of BS in medicine in general.



Please list 5 fields where it is easier to make money (average salary > 200k in 40 hrs) than being an EM doc that are readily available to the public. (I.e. not your 4 million dollar investment scheme).

Name 5 things you recommend that medical students/residents should be pursuing right now.

Let's use real examples.




Major emphasis on this:


I'm sure Bird and NE are smart individuals. They also are particularly negative. They will say their perspectives are nonetheless true - and mostly they are. Yet 90%+ of what is being said is negative and not even solution oriented.

"This career blows, I'm out, you guys have it bad.... later! I'm rich!"

Thanks for spreading your wonderful brand of humanity.

Bird and NE strike me as the type of people who would tell their kids that Santa isn't real the second they could understand English.

Wait... Santa's not real?!?

Very much respect your post, Shep.

 

[DeadCactus]

Alright, I'm just going to assume you live in the northeast...

 

[link2swim06]

With respect to your question about other careers: The question for me wasn't “what other career is a guarantee” but rather getting one’s head around the idea of a guarantee at all. If I could change one thing retrospectively about myself from 10 years ago, it would be my focus on the "250k (or some other arbitrary salary) guarantee for 40 hour work week". In effect, I underestimated my ability to make whatever living it was I wanted. If I had grown up a little later with the internet, I might have realized that an engaging and well compensated career could be realized via many pathways – engineering, for example, or advanced mathematics (leading to a career in design or the intelligence service), architecture, languages leading to a role in the foreign service or government affairs (not the type where you run for office!) plus any number of entrepreneurial ventures where I could be solving problems, working in teams… (sound familiar?).

All of these would be engaging choices where if one had faith in innate ability, success and monetary reward could be had. And none are perfect to say the least! But there are options beyond medicine, especially EM.

I think physicians are, even among the A type aggressive ones, conservative in that they are afraid to eschew the "300k/40 hr" guarantee in some cases. I WAS ONE OF THESE!

So here is the difference...

Medicine is the lowest risk way to ensure a high salary.
Investments, starting your own company, etc are all HIGH risk careers.

You are biased because it worked out for you. If you lost all your savings through multiple failed investments then you would not be giving the same advice.

And dare I say...it is impossible to know if you have that 'innate ability' until you have dedicated a ton of time (and succeed or failed)? Some people just want to take the safe route and put in the time and get a guaranteed paycheck.

 

[EctopicFetus]

Part of the impetus for me starting this thread is pointing out that EM really *could* be closer to what we all thought it owuld be like as residents. But collectively, we're too impudent to push back against the press gainey movement and the rich CEOs running hospitals. NEMPAC just doesn't cut it (and that's a whole secondary thread of wasted time, money and fat cats)

Serious question.. do u have kids?

 

[Perrin]

architecture

Yeah... I'll disagree with you on this one. I was in architecture school for 4 years before changing to a pre-med curriculum. It was a good primer on no sleep and constant stress.

You think press ganey is bad, try having try having monthly juries where your profs and fellow students critique your designs, commenting on subjective areas like color choice, lighting, and 'the feeling as you experience the space'. That's one of the main reasons I left.

Arch school is similar to med school. We were all dreamy eyed, thinking of careers designing the next Chrysler Building and Salk Reaserch Institute. In reality, you were going to be the floor architect making sure doors, windows, and bathrooms met code and haggling with the drafting guys to get construction documents out on time.

The economy tanked on '08 and new construction went with it. Some of my classmates were reduced to overseeing the drafting guys just to keep their jobs with the firm. One of my classmates was featured in a NYT's article about the economy. She was an arch in the NW, but is now making and selling homemade pottery in her parent's barn at their farm.

Is arch engaging, possibly. Most of your clients are like the folks on the house hunter shows. "What do you mean you can't get me a 3000 sf house in an exclusive neighborhood with a swimming pool, professional kitchen, and professionally landscaped yard for 200k under the comps!?!" Multiply that by 100. Those few arch's that are famous are very rare and their designs rest on the backs of 100's of junior arch's who did the grunt work.

/rant

The grass is always greener.

 

[emergentmd]

This post is ridiculous. With no disrespect, OP goes into the category of "some people are never happy". I see this all the time. There are reasons they say money and prestige doesn't buy happiness. Sure it buys you nice stuff but I see happier people who make 40k a year compared to specialists making 5ook.

I see it all the time. I see stressed out surgeons who come in at 1am for ischemic bowel pissed off at the world b/c they just worked at 12 hour day and finally got home to eat and slept for about 2 hrs. I see unhappy neurosugeons all the time. They make 1mil easy but man do they look stressed out, out of shape.

How any EM doc could be unhappy is beyond me. If they paid me 3-400k a year working 30 hrs a week, getting 15-16 days off a month, working 8-9 hour days; I would be beyond happy assembling cardboard boxes.

Seriously, if you asked 100000 americans if they would trade their work/pay situation for an Em doc, 999000 would jump at it in a heart beat.

People have to remember that they call it WORK for a reason. It is work. It is not called Recreational time. In general, work should be bearable and then you enjoy stuff outside of work. If you actually enjoy your job, then thats just sprinkles on your ice cream. Work is to be able to make money to enjoy life outside of work.

Even if I had 4 mil in the bank right now (hopefully I will get there in less than 10 yrs), I would still work in EM. I enjoy 90 percent of the job and I am am luckier than most to be able to like 90 percent of my job. If you think admin looking over your shoulders and the constant metrics is a pain, put yourself in an engineers shoes where there are deadlines all over the place.

 

[DeadCactus]

Even if I had 4 mil in the bank right now (hopefully I will get there in less than 10 yrs), I would still work in EM. I enjoy 90 percent of the job and I am am luckier than most to be able to like 90 percent of my job. If you think admin looking over your shoulders and the constant metrics is a pain, put yourself in an engineers shoes where there are deadlines all over the place.

What part of the country do you live in?

 

[NE2014]

This post is ridiculous. With no disrespect, OP goes into the category of "some people are never happy". I see this all the time. There are reasons they say money and prestige doesn't buy happiness. Sure it buys you nice stuff but I see happier people who make 40k a year compared to specialists making 5ook.

I see it all the time. I see stressed out surgeons who come in at 1am for ischemic bowel pissed off at the world b/c they just worked at 12 hour day and finally got home to eat and slept for about 2 hrs. I see unhappy neurosugeons all the time. They make 1mil easy but man do they look stressed out, out of shape.

How any EM doc could be unhappy is beyond me. If they paid me 3-400k a year working 30 hrs a week, getting 15-16 days off a month, working 8-9 hour days; I would be beyond happy assembling cardboard boxes.

Seriously, if you asked 100000 americans if they would trade their work/pay situation for an Em doc, 999000 would jump at it in a heart beat.

People have to remember that they call it WORK for a reason. It is work. It is not called Recreational time. In general, work should be bearable and then you enjoy stuff outside of work. If you actually enjoy your job, then thats just sprinkles on your ice cream. Work is to be able to make money to enjoy life outside of work.

Even if I had 4 mil in the bank right now (hopefully I will get there in less than 10 yrs), I would still work in EM. I enjoy 90 percent of the job and I am am luckier than most to be able to like 90 percent of my job. If you think admin looking over your shoulders and the constant metrics is a pain, put yourself in an engineers shoes where there are deadlines all over the place.

It's interesting that most of you have focused on your interpretation of how ridiculous it is that I was unhappy doing EM. And it would be ridiculous except I wasn't unhappy *doing EM*. It was all the other stuff that had nothing to do with EM. (shrug).

But I, like most of you, was powerless to change it. The only difference is that I made enough to leave the game. So by that metric, it was worth it to do EM. But unless you're planning on having a viable exit strategy (or get lucky like I did) just know what you're in for. Because until you walk away, I think you delude yourselves and don't even realize how all that bright potential you thought you had... was pissed away because you got caught in the golden handcuffs.

 

[Arcan57]

What is so wrong with just shifting our view of the profession? As I've stated time and time again, we are now factory workers turning out widgets. No point in being upset about it. I for one am grateful for my current salary. My life has gotten immensely better since I realized the new realities of our profession. Stop fighting go with the flow, and enjoy your life.

I'm torn on this. Giving up control (or at least the illusion of) makes the day to day significantly easier. Without docs stepping up into leadership positions and using their talent and knowledge to make things better for themselves, their colleagues, and the patients then things go poorly and focus is lost on what matters.

"In the absence of light, darkness prevails"

In regard to salary being at risk with customer satisfaction, there are a couple of different ways to handle it. The method I've seen most commonly is that there is some type of bonus (sometimes additional hourly, sometimes some increased chunk of profit sharing) for being above percentile x. This may be a graduated system (y dollars/hr at level x, y+4 dollars/hr at level z, etc). Since it's not like highly satisfied customers are tipping you, where is this money coming from? The money for this bonus typically is coming from the hospital system and is paid out to the group/CMG based on hitting satisfaction metrics written into the contract. If that goal isn't met, there isn't going to be additional money to pay out a bonus. That's where you have to examine the offer and ask about past PG performance when you're comparing contracts. If there is a huge bump between levels (say $4/hr for 75th percentile, $12/hr for 90th percentile), when your resident self is reading the contract you sort of mentally factor in that higher bonus by reasoning "I'm a nice guy, it's not like patients complain about me every shift, I'm sure I'll be above the 90th percentile". Of course because math, 9/10 EPs aren't going to be above the 90th percentile. Ask to see the last 6mo of PG scores for the shop. If it's not consistently (say 5/6 months) in the HIGH 90s, assume you aren't going to get that higher bonus and compare accordingly.

Like gman said, it's about aligning expectations and reality. If I'm expecting to make $252/hr and I'm only making $240 I'm pissed. If I'm expecting to make $240/hr and I occasionally make $252/hr then I'm delighted.

 

[@JackShephard]

This post is ridiculous. With no disrespect, OP goes into the category of "some people are never happy". I see this all the time. There are reasons they say money and prestige doesn't buy happiness. Sure it buys you nice stuff but I see happier people who make 40k a year compared to specialists making 5ook.

I see it all the time. I see stressed out surgeons who come in at 1am for ischemic bowel pissed off at the world b/c they just worked at 12 hour day and finally got home to eat and slept for about 2 hrs. I see unhappy neurosugeons all the time. They make 1mil easy but man do they look stressed out, out of shape.

How any EM doc could be unhappy is beyond me. If they paid me 3-400k a year working 30 hrs a week, getting 15-16 days off a month, working 8-9 hour days; I would be beyond happy assembling cardboard boxes.

Seriously, if you asked 100000 americans if they would trade their work/pay situation for an Em doc, 999000 would jump at it in a heart beat.

People have to remember that they call it WORK for a reason. It is work. It is not called Recreational time. In general, work should be bearable and then you enjoy stuff outside of work. If you actually enjoy your job, then thats just sprinkles on your ice cream. Work is to be able to make money to enjoy life outside of work.

Even if I had 4 mil in the bank right now (hopefully I will get there in less than 10 yrs), I would still work in EM. I enjoy 90 percent of the job and I am am luckier than most to be able to like 90 percent of my job. If you think admin looking over your shoulders and the constant metrics is a pain, put yourself in an engineers shoes where there are deadlines all over the place.

Great post.

Apparently this is an atypical experience.

But it proves there is hope for many of us if we take the proper approach.

Thanks for sharing a positive perspective. It's good to hear.

 

[NE2014]

Great post.

Apparently this is an atypical experience.

But it proves there is hope for many of us if we take the proper approach.

Thanks for sharing a positive perspective. It's good to hear.

Come back in a few years kid for the "I told you Sos". Until then, keep deluding yourself, and know that you're part of the problem and going into a specialty on the downslope of the glory years.

 

[Birdstrike]

Threads like this really grind my gears.

Threads like this can be very discouraging, I admit, especially if you're a medical student or resident who's chosen (or trying to choose) a certain direction. Here's my advice: If you're going to bother to read something like the OP, or a long post by myself or others, commit to taking away one nugget that you can use to make your journey a little better. Don't necessarily buy into their past becoming your future. You don't know what other factors are behind a persons motivation to write a specific post.

For example, the OP mentioned a bunch of stuff that he was happy to leave behind, and that maybe shouldn't be the way they are. Okay. Does that mean you can't be an ER doctor, or that you'll hate life if you do? No.

I look at it very much like a student pilot going to a pilot forum. The pilots aren't going to be writing posts about smooth flying, or flights where they just hit "cruise control" and leaned back and enjoyed the view over the clouds, are they? No. They're gonna post some s--t about how all young pilots today don't know what it used to be like, the young guys aren't trained how to fly right, or talk about flying through some awful thunderhead while losing all 4 engines, and make a point to tell you it's going to happen every time you fly from now on, and that the days of smooth sailing are over.

Don't be overwhelmed. Just try to take one point away from each post, even if, and especially if, the post is very negative (unless an obvious troll).

My personal take home point from the OP is this, "Damn. How nice to be able to have some outside investments so that mid career I have more options if I'm in a situation in not happy with. Maybe I should invest more/save more so I can have more options, sooner."

From my post: "Hey, this Birdstrike guy sounds a little crazy and weird at times, but you know what, maybe that fellowship might not be such a bad idea so that I have more options down the road if things change. He does keep saying he's much happier now. Hmm..." Or, "Wow. Sounds like there are some malignant job environments out there just like their can be in residency. Let's think about some ways to spot signs of these places and remember to think about having a plan B to quickly detach myself if I find myself in one of these situations unexpectedly."

Some of the negative posts can have some of the best information in them, although the person writing it isn't always going to put it on a silver platter for you. It doesn't have to mean the sky is falling, you made the wrong career decision or that your future isn't going to go well. Use the information to your advantage.

 

[@JackShephard]

Come back in a few years kid for the "I told you Sos". Until then, keep deluding yourself, and know that you're part of the problem and going into a specialty on the downslope of the glory years.

Hope remains.

You want me to buy into pessimism, misery and cynicism. I refuse to. Maybe only 10% of emergency physicians love what they do and feel lucky/grateful to participate. I'm determined to be one of those people. I'm determined to find the good in every situation and to be grateful for everything I receive even if others mock me or patients give me poor PG scores. I'm human like anyone else - which means I'll have dark days that seem hopeless. But I won't give up and I'll find a way to encourage myself and others. And I believe I'll be successful even in the most unfavorable climates for physicians.

I don't believe the grass is greener on the other side. I'm going to work on my plot of land with all I got. At this point, I have no reason to buy into your pessimism. I live in a great country, I was able to chose what I do, I'll make a good income and I enjoy the shifts.

Good luck in your endeavors.

 

[Arcan57]

Come back in a few years kid for the "I told you Sos". Until then, keep deluding yourself, and know that you're part of the problem and going into a specialty on the downslope of the glory years.

Disagree. You didn't like it and didn't see it getting better and you had other options so you bugged out. You absolutely had the right to do so and I hope that you enjoy a post-EM career that is fulfilling and (if possible) makes society a better place. Your approach, especially if taken as a widespread goal, is far more destructive to EM than JS's enjoying a post about EM not being a soul-sucking wasteland. I know you and emergentMD have a fair amount of antipathy towards each other's viewpoints from other threads but to lash out at JS just comes off as mean-spirited. And I'm legitimately confused about your use of "downslope" and "glory days".

In terms of downslope, never before have EM trained docs had more options, better pay, or more legislative protection. My current state was a f^%&ing nightmare from a medmal standpoint 10-15 yrs ago (physicians settling for $500k on cases where they weren't even involved in order to avoid kangaroo courts). Additional states have enacted legislation in the last handful of years that provide additional legal protection to physicians providing emergency care. Washington state just fought off legislation designed to nerf payments for care they are required by federal mandate to provide. The more widespread availability of competent midlevel providers has allowed groups that choose so to focus physician resources on the higher acuity patient. Our current method of being reimbursed essentially guarantees we can't be soloed out for having our specialty's reimbursement cut since we don't rely on a small number of highly reimbursing DRGs. Increased demand and a continuing inadequate supply of newly trained EPs have dramatically increased salaries for large portions of the country. Even the dreaded CMGs have been forced to raise pay in many areas (I've witnessed it personally in my current city) in order to keep the ED staffed.

In terms of "glory days", when were those? Was that when EDs were staffed by failed family practice docs and surgeons that were pyramided out their residency? Was it when the founders of the specialty had to fight for every inch of respect that we have as a specialty? Was it when they had to do stupidly risky things because other specialties were allowed to refuse to provide care to patients based on the patient's net worth? Was it before we had a solid literature base for risk stratifying the most common dangerous conditions, including support for outpatient management? Was it before widespread availability of CT and US that allowed us to take what used to be horrific diseases and either simplified (PE) or drastically reduced (unstable ruptured ectopic) their diagnosis?

If you view the rise of CMGs and increasing pressure to achieve metrics as the end of EM then nothing I've just said will matter. But I would argue that this is a willfully myopic view of the specialty.

 

[Birdstrike]

In terms of downslope, never before have EM trained docs had more options...

This is one area I see as a bright spot, but in a totally different way than you've explained. I think the subspecialty options are changing the specialty a lot, and for the better. As we've established in other threads, and as becomes inherently obvious after spending no more than a few hours in an Emergency Department, the specialty of Emergency Medicine isn't and shouldn't be, limited to only the medicine of "emergencies." Therefore, why in God's name, must an "emergency" doctor be limited in scope and forced to spend his entire career in an "emergency" department, where he will spend his entire career treating a vast, vast majority of non-emergencies, in an "emergency" department?

To expect such a limitation is absurd.

In 1992, Sports Medicine was approved as an EM subspecialty. Why can't an EP subspecialize in Sports Medicine and practice in an outpatient setting with a group of Orthopedic doctors, doing what is essentially non-operative orthopedics?

Answer: You can.

In 2006, ABEM was approved to co-sponsor Hospice and Palliative Medicine. Why can't an EP subspecialize in this and work 2 days per week in an ED and 2 days per week practicing HPM outside of an "emergency" department?

Answer: You can.

In 2011-2013 (depending whether IM, Anesth or Surg) Critical Care was approved as an EM subspecialty. Why can't an EP work entirely (or partially) outside of an ED and practice critical care medicine, in an ICU?

Answer: You can.

In 2014, ABEM was approved to co-sponsor Pain Medicine along with Anesthesiology, PMR, Neuro/psych. Can an EP do a Pain fellowship and practice in an office, or ASC setting with a group of Anesthesia-Pain doctors, practicing interventional pain medicine?

Answer: It can be done. These options haven't always been there.

Similarly, the Undersea and Hyperbarics as well as Toxicology subspecialties gives one an opportunity to have a consult service that isn't entirely dependent on solely working in, and never leaving, an "emergency" department.

All of these pathways have come along in recent years, that make the specialty better, and give EPs more options in the future. What it does challenge, however, is the traditional image of an EP limiting himself to only high-acuity emergency care, provided only in an "emergency" department.

 

[Arcan57]

This is one area I see as a bright spot, but in a totally different way than you've expained. I think the subspecialty options are changing the specialty a lot, and for the better. As we've established in other threads, and as becomes inherently obvious after spending no more than a few hours in an Emergency Department, the specialty of Emergency Medicine isn't and shouldn't be, limited to only the medicine of "emergencies." Therefore, why in God's name, must an "emergency" doctor be limited in scope and forced to spend his entire career in an "emergency" department, where he will spend his entire career treating a vast, vast majority of non-emergencies, in an "emergency" department?

To expect such a limitation is absurd.

In 1992, Sports Medicine was approved as an EM subspecialty. Why can't an EP subspecialize in Sports Medicine and practice in an outpatient setting with a group of Orthopedic doctors, doing what is essentially non-operative orthopedics?

Answer: You can.

In 2006, ABEM was approved to co-sponsor Hospice and Palliative Medicine. Why can't an EP subspecialize in this and work 2 days per week in an ED and 2 days per week practicing HPM outside of an "emergency" department?

Answer: You can.

In 2011-2013 (depending whether IM, Anesth or Surg) Critical Care was approved as an EM subspecialty. Why can't an EP work entirely (or partially) outside of an ED and practice critical care medicine, in an ICU?

Answer: You can.

In 2014, ABEM was approved to co-sponsor Pain Medicine along with Anesthesiology, PMR, Neuro/psych. Can an EP do a Pain fellowship and practice in an office, or ASC setting with a group of Anesthesia-Pain doctors, practicing interventional pain medicine?

Answer: It can be done. These options haven't always been there.

Similarly, the Undersea and Hyperbarics as well as Toxicology subspecialties gives one an opportunity to have a consult service that isn't entirely dependent on solely working in, and never leaving, an "emergency" department.

All of these pathways have come along in recent years, that make the specialty better, and give EPs more options in the future. What it does challenge, however, is the traditional image of an EP limiting himself to only high-acuity emergency care, provided only in an "emergency" department.

I did mean fellowship options as well as different EM practice environments such as free standings, low volume surgical hospitals, as well as traditional rural, community, and academic environments.

 

[The White Coat Investor]

Seriously, if you asked 100000 americans if they would trade their work/pay situation for an Em doc, 999000 would jump at it in a heart beat.

Careful with those big numbers.

 

[ChEMD]

Threads like this always make me worry at first and think twice about how I perceive my current/future career. But then I remember that there have always been people who complained about how much their job sucks and how they wish they were doing something different. Those people existed in high school, college, med school, etc...I have yet to be one of them, and I certainly don't plan on becoming one in the future.

 

[kat82]

For me, there is no point in trying to keep EM on a pedestal. I quickly learned about the "dark side" of EM and medicine as a whole, as I went through residency and then as an attending. I've just decided to accept it for the most part. Of course I get annoyed at my boss and the hospital CEOs and all the butt kissing and backwards policies and metrics and threats of malpractice and ridiculous patients who make me hate people in general. But for the most part I've adapted to let it roll off my back because I still find the work interesting, the hours good, and the salary makes me happy. I just shrug my shoulders at the end of the day and say, it is what it is. I still feel rewarded, stimulated and well compensated. If I were getting paid 60k a year, I would quit.

I think the bottom line is that some people will accept the negatives and some wont, hopefully if you don't want to accept the ugliness, you have the courage to try something else.

 

[GeneralVeers]

For me, there is no point in trying to keep EM on a pedestal. I quickly learned about the "dark side" of EM and medicine as a whole, as I went through residency and then as an attending. I've just decided to accept it for the most part. Of course I get annoyed at my boss and the hospital CEOs and all the butt kissing and backwards policies and metrics and threats of malpractice and ridiculous patients who make me hate people in general. But for the most part I've adapted to let it roll off my back because I still find the work interesting, the hours good, and the salary makes me happy. I just shrug my shoulders at the end of the day and say, it is what it is. I still feel rewarded, stimulated and well compensated. If I were getting paid 60k a year, I would quit.

I think the bottom line is that some people will accept the negatives and some wont, hopefully if you don't want to accept the ugliness, you have the courage to try something else.

We think very much alike. I can't think of anything else I would do that would pay >$200/hour and only a 30-40 hour work week. Yes it does suck a lot of the time, but then I take a vacation to a fancy 5-star hotel in Europe or Asia, and I quickly forget my troubles.

 

[EctopicFetus]

Ill ask again.. does the OP have kids.. this matters a lot in your life choices..

 

[EctopicFetus]

Maybe some will take this as a pessimistic post but it is what it is and it is me.

I am 5+ years out and I still love my job... HOWEVER, I dont get some "meaning" out of my job. It doesnt define me.. AT ALL. you wont see EF, MD anywhere on anything I have outside of my scrubs. Im just a dude. What defines me? Its my family. As long as the job keeps paying good money (and it will for a while), Ill keep working. I derive my meaning from my loving wife, loving family and my kids. If I have that and everyone is healthy I have everything that matters to me.

If EM was taken away from me, it would be a shoulder shrug and on to the next thing. What would I miss most? The income.. not "the job" per se. Keep in mind I love my job.. i really do. I havent had a shift since I have been out where I dreaded going in for any reason other than missing something my kids are doing.

Its the reality. if I was rich and I mean rich enough not to work rich, I still would.. for 2 reasons. My kids need to understand the connection between work and money and because I like what I do.

This forum and others makes me believe that our experiences are more different than I ever believed. Some jobs are good and some arent. I advise people to choose the good jobs and make sure you succeed as a resident to have that option.

 

[deuist]

Are these problems as bad in rural ERs -if not, do you foresee that trend continuing? What about the idea of dual boarding or fellowship (tox, EMS, etc) right out of residency? In hindsight, are there any other fields that you feel come close to the parts of EM that gave you passion once upon a time? -would rural/inner-city/international (in some way significantly underserved) family med satisfy many of you?

I don't think anyone can give you simple, blanket answers for all of your questions. You may indeed find a rural emergency department that is a nice place to work. However, many of the rural hospitals have a difficult time staffing the ED's and will turn to the contract management group's to provide physicians. You may end up with the same situation of arbitrary metrics as a result.

My problem with some of the fellowships are that you may not be able to escape the emergency department. Although there are a few medical director jobs at poison control centers, many toxicologists are forced to work in an ED because they cannot make enough money by billing for tox services. The same is true for EMS. Only a few of the fellowships would pay enough so that you could pack up and leave emergency medicine altogether if you desired.

Your question about similar fields to emergency medicine is difficult to answer. There are lots of specialties that can offer high acuity and procedures, but none of them are going to be directly like emergency medicine. And I'm not sure any of them would solve the physician satisfaction problem. Anesthesiology comes to mind is a specialty with lots of procedures. However, a quick look at the anesthesia threads on SDN reveals a lot of unhappiness there, too. You could pursue a surgical subspecialty, critical care, interventional pain, or a number of other things, but the end result is that your happiness will be dependent upon your personality as well as external factors you have no control over.

No way I'm doing family medicine.

 

[studentp0x]

My thought process was exactly the same (back then). The ability to "improve and save lives" and "see interesting stuff" and get paid well (and you do... but there's better ways to "get paid well")... I absolutely know where you're coming from! But the point I'm trying to make is that I wish as a resident I was more savvy.... had the benefit of a crystal ball to see that EM was being perverted by the various factors that, well, wreck the specialty. I'm not denying that you can help people in EM and see interesting stuff... but my point is that there are better choices in terms of other specialties or careers to do that.

I think it is appealing as a med student and even resident to focus on the "coolness" (and it is) of EM as a resident. But as a real-world attending, it's a different game (and I've worked in both community and academic). In community, our group was also kissing the ass of admin, responding weakly to complaints so we could keep the contract. In academics I was forced to keep quiet and let sub-specialists let patients languish in the ED, or get unnecessary studies, or get pissed with me if I didn't give them a "courtesy call" for something I could easily handle.

Full disclosure: My shrug-the-shoulders response when I was a resident to someone spouting what I'm spouting now would have been "well, doesn't sound that bad for 250k - 350k a year!"

But it ate at my soul. The whole 'customer satisfaction' movement is a big part of it. As a resident, my exposure was limited to it. But now? Every month being judged solely on the bitchy opinion of someone who was so healthy they got to go home but they got pissed I didn't CT scan them for appy when they had constipation? The patient who gave me a zero because NSG wouldn't revise the shunt for her headahces? My EM colleagues are increasingly meek and unwilling to push back to admin... unwilling to stand up and say "NO! We will not be subject to arbitrary and statistically meaningless metrics that have nothing to do with real patient care!".

All the while, some MBA ****head who drives a Porsche and has a nice parking spot makes 900K a year and is at the hospital 3 weekdays a week and never on holidays and weekends?

I realize the audience here is largely EM residents, the EM interested, and others. And I will forever be grateful that I got to be (or am) an ER doc. But at the end of the day, I know I'm young enough, smart enough, to still do something with my life since it was so vastly different than I thought it would be. I'm glad I got financially lucky such that I don't look at myself in the mirror every morning, going to another day of sucking modern American medicine's teat, reassuring myself that what I'm doing is worthwhile because I'm making 300K a year. It's not and it wasn't. Very excited to be able to do 'big think' and really get a lot out of this life rather than looking back at my life when I'm 60, grisled and angry with only the reassurance that I have a lot of EM-derived money in the bank.

The real question I ask myself is if I *didn't * have the inverstment cash in the bank, would I have the courage to walk away?

I don't think I would. I hated myself for that for a year before I finally quit this week.

Why cant you find work somewhere that allows you to take fewer shifts? And cmon you can buy any available car on the market lol.

 

[The White Coat Investor]

There are a few take-home lessons from this thread:

1) Some people go in to medicine, and even emergency medicine, thinking it is what they want to do for the rest of their life. At some point, perhaps in residency, perhaps 6 years out, perhaps 20 years out, they realize it isn't. At that point, it sure is nice to have another option. That might be urgent care. It might be something a fellowship qualified you to do. It might be real estate. It might be to just retire and go ride your mountain bike. It's always a good idea to have an exit plan, just in case you start hating your job or your job starts hating you. But "burnout" certainly is not inevitable. Many people practice EM right into their 60s, working night shifts and everything.

2) If you make a lot of money (like emergency docs do), live well below your means, and invest your money in a reasonable way, you do not HAVE to do medicine/emergency medicine for the rest of your life. Most of us won't be able to punch out in 6 years. But 20 is very, very doable without getting lucky or taking undue risks. All you have to do is squirrel away a good percentage of your money (20%+ of the gross.) You can still have a very nice life spending $150-250K a year and retiring at 50.

3) Very few people, even those who profess to love their job, are willing to do it for free. When you have "FU Money," it's a lot easier to say "I don't gotta take this anymore" whatever "this" is. It's easier to overlook "little things" when you really need/want the money.

4) Emergency Medicine, while it has some very awesome upsides (like a great hourly rate, fun stories, procedures, no call, low # of hours per week. easily scheduled vacations) also has some very serious downsides that all students/residents should understand before going in to the field- constant threat of contract loss vs not being your own boss, drug-seekers, night shifts, holiday shifts, weekend shifts, metrics etc.) It would be wise to weigh the upsides and downsides and make a wise decision regarding your career.

5) Some EM jobs are better than others. If you do well in med school and residency, and undergo the job hunt process aggressively, and are willing to relocate, you may be able to get one of the really good ones. There is a substantial difference between these and the sucky jobs.

Thanks for sharing your experience, OP.

 

[two guys]

Thanks for the thread OP, I found it useful.

- I understand the criticism this type of thread almost always generates, but try to remember that the OP gains nothing from spending his time sharing his experience with us. That's just HIS experience, most of us won't have an identical one but its still useful hearing from folks with other perspectives.

- Any thread that involves job satisfaction or money is almost always equally split between the medical student/resident types stating "how can you possibly be unsatisfied" and those of us attendings saying "I hear where you're coming from." This doesn't make either group right, it just means it's kind of hard to anticipate how people will feel when there life is completely and entirely different (older, have a 401k, kids, more miles on your body, etc). I personally like this about SDN compared to attending only forums. We at least get to hear from the point of view most of us had when in training.

- I can't say I know what I'd do if I had 4 mil stashed, but I bet it'd change some things. I doubt I'd quit the field entirely, I do actually enjoy most of my shifts and the patient satisfaction/ admin interference stuff isn't very bad where I am.

- My goal has always been to make myself secure enough to be able to change jobs/hours etc without too much heartache. The most unhappy folks in EM I've met are stuck due to high living expenses, alimony, etc. The best way I know to keep things light are:
- Commit to as few hours as possible (120 ish for me)
- Have a big backup fund (enough for 6-12 months living expenses)
- Keep your monthly living expenses as low as possible. We live off of 3 shifts pay.
- Become debt free (see above)
- Work 1-2 shifts a month at another job. This gives you a back up if things go sour and also helps you see that the grass isn't greener at either place.

 

[Birdstrike]

Here's another point, for what it's worth. Rather than immediately dismissing these viewpoints as outliers, or invalid negativity from chronically toxic people that should be dismissed out of hand, why not use it to our advantage? Why not use it as a spark to trigger a stronger and more consistent focus on EP wellness, improving working conditions and job satisfaction?

This stuff bubbles up frequently enough that I think such viewpoints should be viewed as having enough of a grain of truth, such that EP wellness should not be an afterthought, but should have a consistent focus and presence for improvement. A certain percentage feel all is well and there's no need for improvement. That's fine. A significant percentage think there's room for improvement. That's okay, too. Looking to see where improvements can be made can only help those who feel there's a need and only make things even better for those who feel things are good as they are.

 

[GeneralVeers]

Birdstrike, the other players in EM (hospital admin, CMGs, politicians, lawyers) are not at all concerned about EP wellness, working conditions or job satisfaction. For all of those parties, it's simply about taking advantage of us for financial gain. The attitude I've seen with most CMGs is that if you're not happy with the job, then you can quit and they will just higher someone newly out of residency who doesn't know enough to be dissatisfied yet. I'm not sure how we increase job satisfaction in that environment.

 

[DreamingTheLive]

There are a few take-home lessons from this thread:

1) Some people go in to medicine, and even emergency medicine, thinking it is what they want to do for the rest of their life. At some point, perhaps in residency, perhaps 6 years out, perhaps 20 years out, they realize it isn't. At that point, it sure is nice to have another option. That might be urgent care. It might be something a fellowship qualified you to do. It might be real estate. It might be to just retire and go ride your mountain bike. It's always a good idea to have an exit plan, just in case you start hating your job or your job starts hating you. But "burnout" certainly is not inevitable. Many people practice EM right into their 60s, working night shifts and everything.

2) If you make a lot of money (like emergency docs do), live well below your means, and invest your money in a reasonable way, you do not HAVE to do medicine/emergency medicine for the rest of your life. Most of us won't be able to punch out in 6 years. But 20 is very, very doable without getting lucky or taking undue risks. All you have to do is squirrel away a good percentage of your money (20%+ of the gross.) You can still have a very nice life spending $150-250K a year and retiring at 50.

3) Very few people, even those who profess to love their job, are willing to do it for free. When you have "FU Money," it's a lot easier to say "I don't gotta take this anymore" whatever "this" is. It's easier to overlook "little things" when you really need/want the money.

4) Emergency Medicine, while it has some very awesome upsides (like a great hourly rate, fun stories, procedures, no call, low # of hours per week. easily scheduled vacations) also has some very serious downsides that all students/residents should understand before going in to the field- constant threat of contract loss vs not being your own boss, drug-seekers, night shifts, holiday shifts, weekend shifts, metrics etc.) It would be wise to weigh the upsides and downsides and make a wise decision regarding your career.

5) Some EM jobs are better than others. If you do well in med school and residency, and undergo the job hunt process aggressively, and are willing to relocate, you may be able to get one of the really good ones. There is a substantial difference between these and the sucky jobs.

Thanks for sharing your experience, OP.

Pretty much this.

 

[@JackShephard]

Thanks for all the posts, this has been a great thread.

I'm as excited as I've been to be entering this field. Good luck to everyone.

 

[Birdstrike]

Thanks for all the posts, this has been a great thread.

I'm as excited as I've been to be entering this field. Good luck to everyone.

Welcome aboard. Just make sure you also learn a skill that allows you to also earn a living in an EMTALA-exempt, non-ED setting. You won't regret it. And remember, Birdstrike told ya'.

 

[EctopicFetus]

I think anyone who bashes the OP is definitely missing something. While I have been clear on my personal position I can tell you that from my SDG I would guess we would have 50% of my group quit tomorrow if they could from a financial viewpoint. That number is honestly probably low.

Once you start taking a beating because of your patient sat, slow speed, angry consultants your tune changes. No doubt as a resident you are quite protected from most of this. Outside of academics they pressure to do more with less mounts to the point where I would say the average doc wont like their job.

Given the recent expansion push by the CMGs I fully expect fewer and fewer of those "great jobs" to be around. I think the pendulum is swinging toward the CMGs in a big way and while I hope it swings back I am less certain.w

 

[emergentmd]

I bet 75 percent of people would quit their job if money was not an issue. Like I said, for most, a job is the means to an end. A small percentage actually loves their job so much that they could not do anything else. A small percentage hates their job so much that they would not do it for any amount of money. The majority would quit their job and do something else with their life which they find more enjoyable.

 

[EMIM2011]

Anyone else who's just terribly bored by the amount of primary care and convenience complaints we see? It's not even the level 4 sore throat, I can see you, do your note and make you feel better in 10 mins. It's the weird numbness patient that we all know is just crazy, but now we have to run a bunch of tests to cover our ass. Or the low-risk chest painers. Often, it feels like we are really just the "primary-care drive through and triage doctor".

From a recent blog post:

"Sometimes I receive a call from the ER to admit a patient and the "presentation" if you would call it that amounts to rattling off a list of the laboratory abnormalities. "What is the problem?" I ask. "He's going to have to come in," is the reply. No, my friend, moving the patient out of the ED is YOUR problem. I'm asking what is the PATIENT'S problem. You are here, after all, to serve the patient, right? Some ERs appear to be evolving into glorified triage centers, with a primary focus on differentiating those who can be sent home, flown out, or admitted,"
http://statusiatrogenicus.blogspot.com/2014/09/mindless-medicine-importance-of-minding.html

 

[EctopicFetus]

I bet 75 percent of people would quit their job if money was not an issue. Like I said, for most, a job is the means to an end. A small percentage actually loves their job so much that they could not do anything else. A small percentage hates their job so much that they would not do it for any amount of money. The majority would quit their job and do something else with their life which they find more enjoyable.

right. i think there is this expectation that we "love" our job to a degree where money is truly secondary. I dont feel that way at all. again my job doesnt define me. I think there are people who enjoy their job due to the challenge (think Fortune 500 CEOs most of which dont need more money). I think in EM we are so sick and disgusted by the challenges many would quit. Again not me but we know this is true.

 

[Arcan57]

Anyone else who's just terribly bored by the amount of primary care and convenience complaints we see? It's not even the level 4 sore throat, I can see you, do your note and make you feel better in 10 mins. It's the weird numbness patient that we all know is just crazy, but now we have to run a bunch of tests to cover our ass. Or the low-risk chest painers. Often, it feels like we are really just the "primary-care drive through and triage doctor".

From a recent blog post:

"Sometimes I receive a call from the ER to admit a patient and the "presentation" if you would call it that amounts to rattling off a list of the laboratory abnormalities. "What is the problem?" I ask. "He's going to have to come in," is the reply. No, my friend, moving the patient out of the ED is YOUR problem. I'm asking what is the PATIENT'S problem. You are here, after all, to serve the patient, right? Some ERs appear to be evolving into glorified triage centers, with a primary focus on differentiating those who can be sent home, flown out, or admitted,"
http://statusiatrogenicus.blogspot.com/2014/09/mindless-medicine-importance-of-minding.html

I followed your link and he comes off as a arrogant tool who seems to have an understanding of what EDs do but at the same time completely miss why they exist.

 

[Birdstrike]

I followed your link and he comes off as a arrogant tool who seems to have an understanding of what EDs do but at the same time completely miss why they exist.

I agree. Rants about other specialties and services are almost never useful, in either direction. It's usually just a sign someone hates their job and is frustrated with something they know isn't likely to ever change.

The PCP can whine about why a patient came in, then send him to the ED. Then the ER doctor can b¡tch about how it's an abuse of the ED, then admit. Then the hospitalist can whine about how the ER "knows nothing" and shouldn't have called with the "BS story." Then they consult surgery who rants that they don't need surgery, one on it goes blah, blah, blah...

It's pointless. People just need to shut up and do their jobs, or just come to terms with why they are miserable.

 

[WilcoWorld]

This guy clearly misunderstands the function of the ED. I shouldn't have followed that link. By doing so I added a view to his blog, and in the currency of today's Googlesphere, viewing his blog equates to a vote for the "truth" of his statements. Ug.

 

[GeneralVeers]

"Sometimes I receive a call from the ER to admit a patient and the "presentation" if you would call it that amounts to rattling off a list of the laboratory abnormalities. "What is the problem?" I ask. "He's going to have to come in," is the reply. No, my friend, moving the patient out of the ED is YOUR problem. I'm asking what is the PATIENT'S problem. You are here, after all, to serve the patient, right? Some ERs appear to be evolving into glorified triage centers, with a primary focus on differentiating those who can be sent home, flown out, or admitted,"

Even though he comes across as arrogant, he has nailed it in the last sentence. Being a glorified triage nurse IS my job now. It is my job to determine the disposition of every patient. I may not be able to diagnose them, cure them, or even satisfy them, but at the end of the day they need to leave the ED. Either they are being admitted, or they are being discharged. You don't have to go home, but you can't stay here.

 

[MSmentor018]

i read the article too, I think it's best summed up by a comment someone left.....and a damn good response at that:

"In short, I think your article as just a rant of someone who is unstisfied and feels a little to good about their abilities. This sounds like something an intern would write before they spend a decade or so learning that all of their colleagues work pretty hard and are pretty smart and talking bad about other specialties (or good about yourself) is an obvious and pathetic attempt at self esteem. They go on to realize that any specialty can write a nearly identical piece about another specialty."

 

[WilcoWorld]

"Sometimes I receive a call from the ER to admit a patient and the "presentation" if you would call it that amounts to rattling off a list of the laboratory abnormalities. "What is the problem?" I ask. "He's going to have to come in," is the reply. No, my friend, moving the patient out of the ED is YOUR problem. I'm asking what is the PATIENT'S problem. You are here, after all, to serve the patient, right? Some ERs appear to be evolving into glorified triage centers, with a primary focus on differentiating those who can be sent home, flown out, or admitted,"

Even though he comes across as arrogant, he has nailed it in the last sentence. Being a glorified triage nurse IS my job now. It is my job to determine the disposition of every patient. I may not be able to diagnose them, cure them, or even satisfy them, but at the end of the day they need to leave the ED. Either they are being admitted, or they are being discharged. You don't have to go home, but you can't stay here.

You're of course correct, what he misunderstands is that a) This has always been our function and b) It's an important job that requires skill to do well (but, I'll admit, is a pretty easy job if you do it poorly).

It's sort of like criticizing the ICU by saying "Some ICU's appear to be evolving into glorified stabilization centers, with a primary focus on stabilizing patients until they're either dead or stable enough to go to the floor." Or criticizing the Orthopods by saying "Some Orthopedists appear to be evolving into glorified carpenters, with a primary focus on straightening crooked bones - as soon as the patient doesn't need surgery, they loose all interest." Or criticizing the PCP's by saying "Some PCP's appear to be evolving into glorified consultant generators, with a primary focus on differentiating the patients who need specialty care from those who just need a few prescriptions."

 

[Birdstrike]

By doing so I added a view to his blog, and in the currency of today's Googlesphere, viewing his blog equates to a vote for the "truth" of his statements. Ug.

Does it? Sometimes blog posts go viral because of how insulting or outrageous they are. It definitely will move you up the Google search list, but I don't know how well it translates into truth, or even perceived truth, necessarily. Generally, striking a nerve with people, regardless of whether positive or negative, will boost page views. His google analytics will likely show a boost of page views from this link, actually. He'll probably see that and be happy, unless people post negative comments to show dissent. (Go Wilco!)

It's funny. When I've guest posted stuff on DrWhiteCoat or KevinMD it's interesting to see what articles blow up and what get mostly ignored. Sometimes you post something you think is brilliant and it gets a yawn, then something seemingly innocuous blows up with >10,000 Facebook likes. It's weird. Definitely though, if view p¡ss people off, you greatly enhance your chances of greater page hits. Look at this one from Billy Mallon. It blew up in epic fashion, with hundreds of comments compared to the typical 1 or two, because he compared radiologists to parasites. Three years later, it's still getting hits and even more comments:

http://www.epmonthly.com/departments/columns/in-my-opinion/the-life-cycle-of-a-parasitic-specialist/

 

[TooMuchResearch]

I agree. Rants about other specialties and services are almost never useful, in either direction. It's usually just a sign someone hates their job and is frustrated with something they know isn't likely to ever change.

The PCP can whine about why a patient came in, then send him to the ED. Then the ER doctor can b¡tch about how it's an abuse of the ED, then admit. Then the hospitalist can whine about how the ER "knows nothing" and shouldn't have called with the "BS story." Then they consult surgery who rants that they don't need surgery, one on it goes blah, blah, blah...

It's pointless. People just need to shut up and do their jobs, or just come to terms with why they are miserable.

There was a surgical resident in the premedical forum last week commenting on how EM docs are lazy, useless, and can all be replaced by PAs/NPs and how EM doesn't need to exist as a specialty since (burned out alcoholic) IM docs and surgeons handled it just fine 40 years ago. I started to write a post refuting his points and twisting his points to show how all specialties can easily be replaced by PAs. Then I deleted it. If that guy hates his life and wants to **** on other specialties, fine. I'm not going to waste my time explaining why he's wrong.

 

[WilcoWorld]

There was a surgical resident in the premedical forum last week commenting on how EM docs are lazy, useless, and can all be replaced by PAs/NPs and how EM doesn't need to exist as a specialty since (burned out alcoholic) IM docs and surgeons handled it just fine 40 years ago. I started to write a post refuting his points and twisting his points to show how all specialties can easily be replaced by PAs. Then I deleted it. If that guy hates his life and wants to **** on other specialties, fine. I'm not going to waste my time explaining why he's wrong.

You're wise beyond your years.

 

[EctopicFetus]

We are always in the proverbial fishbowl. That wont change. Residents are notoriously work averse. In the real world where docs get paid to actually do work and not wander halls for time served the attitudes are better.

We have one hospitalist group where we joke that when we can with a patient the convo goes like this.

EF: Hey Hospitalist, I have a patient for you. He is an agitated rectal bleeder with HIV who is biting and spitting on everyone. He has greatly improved my knowledge of curse words and said whoever admits him will be sued and he will send the mexican mafia to kill their family. oh his hgb is 12. rectal negative but his tone almost broke my finger."
Hospitalist: Oh, great thanks so much. I cant wait to hear from you again.

Why are they so happy to admit? if you hit "shift+4" on your keyboard you get the answer. Residency on the wards is like prison and there is some seemingly a disconnect between work and income.

 

[inspirationmd]

Warning, long stream of consciousness and sleep deprived post:

So I have mixed feelings about the OP in this thread. I certainly see where he is coming from with the way Emergency Medicine is going and if I had $4 million in the bank I certainly would not be as stressed about the type of attending job I ultimately pursue. Loans plus family considerations for many mean the practical considerations can not be ignored.

Truthfully, if we are honest with ourselves, Emergency Medicine is not what a lot of us thought we were getting when we committed to this specialty. Emergency Medicine is supposed to be management of acute conditions that are potentially life threatening. I see more primary care complaints on the low acuity side of the ED than I see in my IM primary care clinic and the small community EDs I moonlight at are largely urgent care complaints mixed with a little bit of acute pathology. It is the reality of the specialty that not everything can be an acute process but the numbers are a little too skewed the wrong way. Complaints of "I just want to get checked out" at 3AM are all too common for non-emergent complaints. Meanwhile the CMGs as well as quite a few of my academic attendings are a little too "customer service" happy which is kind of bothersome to see when the obvious abuse is there to see. The saving grace for a lot of people I think is that as alluded the $$$ works out pretty well if you can compartmentalize the irritation and, for the most part, people who work in the ED including MDs, RNs, EMTs, etc tend to be cool as **** to hang out with. A collegial environment goes a long way.

I recently heard of a few well regarded attendings burn out at my med school, clinical sites where I rotated as a student and where I am in residency all within the last few years. Its not pretty. One quit to just do locums while he prepares his application to Palliative Care fellowship. The guy is at least 50 y/o. Another left and is doing another residency now. Another one has $3 million cash in the bank and is planning his retirement in a few years with no intentions of looking back (bit older than the OP). Still another EM attending routinely counsels everyone that they need to do something extra to get themselves options outside of the ED once they get older. He pushes fellowships, MBA/MPH, or whatever your interests are but he states to get something that can translate to not having to be in the ED for the majority of your income in the later years of your career. I have to say that after reading various related topics on SDN for years, seeing my anecdotal folks and reading the woefully inadequate literature addressing this issue in our specialty I am now inclined to agree.

I have a lot of fun in the ED and anticipate I will for many years to come. I like the prospect of acuity and especially when I get it. The ready for anything nature that is required for the specialty is very appealing. The fact that people look to you in an emergency to know what to do. However, I plan to give up some time now to have options when I am older which is why I am still a resident while my co-residents have left and are banking gorgeous salaries. EM is a great specialty but I think Birdstrike and the OP are somewhat right. You don't want to be 20 years from now and then trying to figure out what to do then. The answer may be moving to a different job but what if thats not feasible due to geographic restrictions, family circumstances, etc. If you end up with full ED longevity then you wasted a little time early on in your career but the options are very valuable and potentially can turn into lucrative non-clinical opportunities such as EMS leadership, executive hospital leadership, etc.

Most folks will practice clinical EM for the duration of their careers but just like we all considered the pros and cons of all the specialties before we made our final choices I think every EM Physician owes it to themselves to consider the potential validity of the comments in the enitre thread rather than just dismissing ideas that differ from your current viewpoint. You never know what you will think 10 years from now. Just think about how you were in the M1 year and how your viewpoint has changed in that time.

 

[inspirationmd]

Also do not force yourself to do another specialty/fellowship just for options. If you do not like it then it becomes a waste of your time and you won't excel at it. You should do whatever you do well, not half *** it.

 

[Birdstrike]

Birdstrike ... somewhat right.

I'm not here to p--- in your Wheaties, man. I been there. I'm here to help out. Read what I write very carefully. It comes from the heart, man. It's not just pointless ranting, though admittedly, some of it is pretty "out there." It's not just some made up b--- s---.

 

[emergentmd]

There are alot of depressed docs on here. I am glad I am not one of them. I love EM. I have one of the best jobs in this world. Never in my wildest dream could I be making 2-300/hr, getting any day off I want.

Again, I feel like some are just unhappy people who will be unhappy no matter what they do. I have been an attending for 15 yrs, EM director for a good portion of that. I see pissed off docs in all specialties.

Just to make a point out of one of the reasons why some are disenchanted with EM. Some thought coming into EM that they would be taking care of mostly emergencies. I trained at one of the busiest trauma centers in the US and I saw a crapload of sick patients. Could you imagine if EM just saw sick patients? I would be burned out in a year if I had to care of 5 crash patients at one time.

An hour of my day could end up being a massive GI Bleed, a pneumothorax, A gunshot wound to the chest, cardiac arrest, septic pt needing a central line. Tell me how anyone could handle just these five patients at once? Most of the Rambo docs here would be crying in the corner if this happened. Just be happy that there are easy patients. Grass is not greener on the other side.

I see neurosurgeons or general surgeon come into the ED all the time pissed off that they have to take someone for a major surgery at midnight. They would beg to be an ED doc taking care of a sore throat.

The unhappy docs really need to step back and realize how good they have it compared to the general population. But again, some are destined to be unhappy but hopefully those will be able to figure it out as life is too short.