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

[jdh71]

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.

Yeah. But he's NOT real. Why should you pretend otherwise?

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[GeneralVeers]

Yeah. But he's NOT real. Why should you pretend otherwise?

Exactly. You are not lying to the kids. My teachers called home and complained to my parents when I was 5 that I was making the other kids cry by telling them there was no Santa. Sometimes we all need a dose of reality.

 

[jdh71]

Exactly. You are not lying to the kids. My teachers called home and complained to my parents when I was 5 that I was making the other kids cry by telling them there was no Santa. Sometimes we all need a dose of reality.

Yeah. My wife got an earful from one mom in my son's kindergarten class. There is simply no good reason to pretend about this kind of stuff.

As to the thread. I'm kind of sad to hear it's this way for too many of you guys (all of us really in many ways). I suppose "eyes wide open" is the new theme here.

 

[circulus vitios]

Surgery is worse in terms of hours, true. But it is a technical skill not as amenable to high jacking by midlevels, quality is at least related to the actual job (though certainly they have some unfair measures like clinic wait time often beyond their control) and autonomy and earnings are better than EM. Plus, there's lots of avenues... general, trauma, sub speciality...

On an hourly basis? Uhhh, right.

 

[Birdstrike]

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.

It's Not Just In Your Head


I'm glad you love your version of Emergency Medicine, EmergentMD. I also love my very non-traditional, sub-specialty version of Emergency Medicine, that I've carved out for myself through extra training, extra work, time investment and additional sacrifice. I wouldn't describe myself currently as feeling "burned out" at all, but I've been there. And with all due respect, this post seems to me like the classic, "Suck it up. Get over it. You're imagining it. The problem is you," response to burnout in Emergency Medicine. I've been hearing various responses like this, since my years as a medical student, through residency, and it continues now in my years as an attending. The guy who got burned out, "Was weak. He had a midlife crisis. Or he just was chronically unhappy," or just needs to move and find a new job. It's the same old story, with various responses explaining the problem away, rather than addressing it's causes and solutions. Yet the survey's still show, that not only does Emergency Medicine consistently rank #1 out of specialties of physicians reporting burnout, in multiple surveys (Medscape survey, slide 2; JAMA, figure 1), but the proportion tends to be over 50%. In other words, if you don't report feeling of burnout, defined as "loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment," then you are actually the weird one.

I don't think any Emergency Residents or Physicians really, truly expect or demand to see "only really sick patients," as you claim. I don't know one Emergency Physician, that didn't know he'd be doing a lot of primary care. But your example of managing 5 crashing patients, leaves out one very, very large 900 lb gorilla in the room, doesn't it? The 900 lb gorilla in the room is the fact, that many ED directors, most of whom take their marching orders from the non-physician administrators of hospitals for higher pay and less clinical shifts, will still expect the 25 non-emergencies in the waiting room to be "greeted," "door-to-roomed," "arrival-to-physician'd" in some outrageous, unrealistic, unnecessary and impossible time goal, that a physician working a max capacity has no control over. I can honestly say, that just about every Emergency Physician I've ever known, if expected to manage 5 critical patients, would say, "Bring it on, baby," and high-five his partner who comes on a 7 am shift change when telling how he got through it. Certainly, most would not want every shift to go that way, but I don't know one that would "cry in the corner" over it, as you claim. But I've never know one single Emergency Physician, that ever felt he or she deserved to be told, directly or by implication, that he "sucked" if the 25 non-emergencies in the wait room weren't "greeted" or "roomed" or in some other way put in a box with a bow wrapped around them, while his head spun manging the five patients circling the drain of life.

So, I find it very interesting, and pertinent that you are or have been, an ED director for the majority of your 15 years. I find that very interesting, and telling, as ED directors typical work far less shifts, make the schedule and generally have as much or as little exposure to the trials and tribulations of the "pit doc" as they choose. I also find it very interesting that you made the point to write a post about how happy you were with your job, yet didn't really seem to offer anything that would allow those that described having trouble in their situations other that to seem to imply that all that is needed is for them to snap out of it, by realizing someone else has it worse, and if unable, they are flawed. That may work for some people, but it's not particularly helpful for some, because there's always someone with it "worse." Nobody wants to be "just a little bit better than 'worse.'" Some may want their job to make them happy, but I think most of all Emergency Physicians just want to be appreciated. And they don't want to be told they suck because a hang-nail waited and hour while they did manage 5 crashing patients. I've had many shifts, single coverage where I managed 5 crashing patients, as I'm sure you have over the years. I've had 12 beds full, with several sick and intubated and had a rollover MVA come in with 4 patients ejected, all on backboards covered in blood, with help no sooner than 30 minutes away, if I could get help on the phone and on their way in.

That's all stressful, and you know that. We all signed up for "stress." It's numbers one, two and three in the job description. But none of that was what changed things for me, personally. None of the emergencies, nor any of patients who came in with hang nails, work notes, earaches or med refills changed anything for me. I always welcomed the easy patients as a break between real emergencies. But what did it for me, and what made me realize I was fighting a futile and losing battle every day, was that despite the heroics, the shifts I didn't think I could handle but did, the chaos I didn't think I could bring under control but did...it was never good enough.

It was never good enough.

I came to the realization, that I could save a life, 2 lives, or three in a shift, and I could be told the next day that it wasn't good enough because the "hang nails" waited on average, 2-minutes longer than "corporate" wanted. And it never came as bluntly, or as direct as, "You suck." It always was dressed in pleasantries, cloaked with buzzwords like "patient satisfaction," "efficiency," and "administration," which I took on face value for a long time. The closing line was always the equivalent of, "Do the impossible, or you'll lose your contract." It's about nothing more than money. It has nothing to do with "healthcare," a "crisis," or "the sick." It's about maximizing flow, specifically of the "unsick" through the ED to make maximal profits for the hospital CEO, and/or shareholders, and/or to go into the not-for-profit hospital's kitty for next years administrator's salary increases. The more the billboard can push down the street to the ED, the better, with no limit. It took me quite a long time to learn the language and translate the message. And now, I thank God every day, that I don't have to go through the passive aggressive manipulation anymore, and have an ED director tell me it's all in my head. I am also equally as thankful, that I found a way that I can use my skills as an Emergency Physician without starting over, and was able to build on them in a way that I'm able to have much more control over my practice life, hours, and future.

So, did I have it "good compared to the general population"? Absolutely. Do I have it even better now, that I made some drastic changes? Yes. Do the 50-70% of Emergency Physicians who report burnout feel exactly the same way I did, or have the same exact experiences I did? Likely not. But there something there.

It's. Not. Just. In. Their. Heads.

They're not lying in those surveys. They're not "chronic complainers," "wimps," or having delusions of failure. Neither are any of the tough, hard-nosed, heroes on this thread or those in Emergency Departments across this country that have dedicated their lives to working on the front lines of the chaos that is Amercian Emergency Departments today. Despite the high salaries, the supposed "great hours," and despite the reports from those who just don't see what all the fuss is and think the rest need to just "suck it up," there's something there. So just keep telling the bright-eyed bushy-tailed hopefuls that its just a bunch of BS, that there's too many complainers out there that need to step aside and get out of the way. And do nothing to solve the problem, for those that signed up to go to battle with you, and for you.







Slide 2: http://www.medscape.com/features/slideshow/lifestyle/2013/emergency-medicine#2

Figure 1: http://archinte.jamanetwork.com/article.aspx?articleid=1351351

 

[@JackShephard]

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.

Agreed, with emphasis on:

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.

I don't know if Emergency docs are in the top 10%, 5%, 1% or whatever as far as being in a good position, but it's high up there.

I'm choosing to join your camp early on in my career. Thanks for all the feedback.

 

[@JackShephard]

It's Not Just In Your Head


I'm glad you love your version of Emergency Medicine, EmergentMD. I also love my very non-traditional, sub-specialty version of Emergency Medicine, that I've carved out for myself through extra training, extra work, time investment and additional sacrifice. I wouldn't describe myself currently as feeling "burned out" at all, but I've been there. And with all due respect, this post seems to me like the classic, "Suck it up. Get over it. You're imagining it. The problem is you," response to burnout in Emergency Medicine. I've been hearing various responses like this, since my years as a medical student, through residency, and it continues now in my years as an attending. The guy who got burned out, "Was weak. He had a midlife crisis. Or he just was chronically unhappy," or just needs to move and find a new job. It's the same old story, with various responses explaining the problem away, rather than addressing it's causes and solutions. Yet the survey's still show, that not only does Emergency Medicine consistently rank #1 out of specialties of physicians reporting burnout, in multiple surveys (Medscape survey, slide 2; JAMA, figure 1), but the proportion tends to be over 50%. In other words, if you don't report feeling of burnout, defined as "loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment," then you are actually the weird one.

I don't think any Emergency Residents or Physicians really, truly expect or demand to see "only really sick patients," as you claim. I don't know one Emergency Physician, that didn't know he'd be doing a lot of primary care. But your example of managing 5 crashing patients, leaves out one very, very large 900 lb gorilla in the room, doesn't it? The 900 lb gorilla in the room is the fact, that many ED directors, most of whom take their marching orders from the non-physician administrators of hospitals for higher pay and less clinical shifts, will still expect the 25 non-emergencies in the waiting room to be "greeted," "door-to-roomed," "arrival-to-physician'd" in some outrageous, unrealistic, unnecessary and impossible time goal, that a physician working a max capacity has no control over. I can honestly say, that just about every Emergency Physician I've ever known, if expected to manage 5 critical patients, would say, "Bring it on, baby," and high-five his partner who comes on a 7 am shift change when telling how he got through it. Certainly, most would not want every shift to go that way, but I don't know one that would "cry in the corner" over it, as you claim. But I've never know one single Emergency Physician, that ever felt he or she deserved to be told, directly or by implication, that he "sucked" if the 25 non-emergencies in the wait room weren't "greeted" or "roomed" or in some other way put in a box with a bow wrapped around them, while his head spun manging the five patients circling the drain of life.

So, I find it very interesting, and pertinent that you are or have been, an ED director for the majority of your 15 years. I find that very interesting, and telling, as ED directors typical work far less shifts, make the schedule and generally have as much or as little exposure to the trials and tribulations of the "pit doc" as they choose. I also find it very interesting that you made the point to write a post about how happy you were with your job, yet didn't really seem to offer anything that would allow those that described having trouble in their situations other that to seem to imply that all that is needed is for them to snap out of it, by realizing someone else has it worse, and if unable, they are flawed. That may work for some people, but it's not particularly helpful for some, because there's always someone with it "worse." Nobody wants to be "just a little bit better than 'worse.'" Some may want their job to make them happy, but I think most of all Emergency Physicians just want to be appreciated. And they don't want to be told they suck because a hang-nail waited and hour while they did manage 5 crashing patients. I've had many shifts, single coverage where I managed 5 crashing patients, as I'm sure you have over the years. I've had 12 beds full, with several sick and intubated and had a rollover MVA come in with 4 patients ejected, all on backboards covered in blood, with help no sooner than 30 minutes away, if I could get help on the phone and on their way in.

That's all stressful, and you know that. We all signed up for "stress." It's numbers one, two and three in the job description. But none of that was what changed things for me, personally. None of the emergencies, nor any of patients who came in with hang nails, work notes, earaches or med refills changed anything for me. I always welcomed the easy patients as a break between real emergencies. But what did it for me, and what made me realize I was fighting a futile and losing battle every day, was that despite the heroics, the shifts I didn't think I could handle but did, the chaos I didn't think I could bring under control but did...it was never good enough.

It was never good enough.

I came to the realization, that I could save a life, 2 lives, or three in a shift, and I could be told the next day that it wasn't good enough because the "hang nails" waited on average, 2-minutes longer than "corporate" wanted. And it never came as bluntly, or as direct as, "You suck." It always was dressed in pleasantries, cloaked with buzzwords like "patient satisfaction," "efficiency," and "administration," which I took on face value for a long time. The closing line was always the equivalent of, "Do the impossible, or you'll lose your contract." It's about nothing more than money. It has nothing to do with "healthcare," a "crisis," or "the sick." It's about maximizing flow, specifically of the "unsick" through the ED to make maximal profits for the hospital CEO, and/or shareholders, and/or to go into the not-for-profit hospital's kitty for next years administrator's salary increases. The more the billboard can push down the street to the ED, the better, with no limit. It took me quite a long time to learn the language and translate the message. And now, I thank God every day, that I don't have to go through the passive aggressive manipulation anymore, and have an ED director tell me it's all in my head. I am also equally as thankful, that I found a way that I can use my skills as an Emergency Physician without starting over, and was able to build on them in a way that I'm able to have much more control over my practice life, hours, and future.

So, did I have it "good compared to the general population"? Absolutely. Do I have it even better now, that I made some drastic changes? Yes. Do the 50-70% of Emergency Physicians who report burnout feel exactly the same way I did, or have the same exact experiences I did? Likely not. But there something there.

It's. Not. Just. In. Their. Heads.

They're not lying in those surveys. They're not "chronic complainers," "wimps," or having delusions of failure. Neither are any of the tough, hard-nosed, heroes on this thread or those in Emergency Departments across this country that have dedicated their lives to working on the front lines of the chaos that is Amercian Emergency Departments today. Despite the high salaries, the supposed "great hours," and despite the reports from those who just don't see what all the fuss is and think the rest need to just "suck it up," there's something there. So just keep telling the bright-eyed bushy-tailed hopefuls that its just a bunch of BS, that there's too many complainers out there that need to step aside and get out of the way. And do nothing to solve the problem, for those that signed up to go to battle with you, and for you.







Slide 2: http://www.medscape.com/features/slideshow/lifestyle/2013/emergency-medicine#2

Figure 1: http://archinte.jamanetwork.com/article.aspx?articleid=1351351

To be fair, in the same JAMA study the EM physicians also report their work/life balance to be pretty good:

and the medscape report shows their severity of burnout is below dermatology/radiology!!! what?

And as for the burn out percentage, examine it by #'s:

So approximate stats:

EM 52%
CC 50%
FM 43%
OB/GYN 42%
IM 42%
IM 42%
Anes 42%
GSurg 42%
Neurology 41%
Urology 41%
Nephrology 40%
HIV 40%
Ortho 40%

So essentially, EM has a 10% higher chance of being burned out than all these other fields. That's not bad.

Also, ~50% of the EM physicians weren't burned out in the survey, and the severity of burnout was below that of Dermatology?

Even the easiest fields in medicine have a burnout response of somewhere in the 30%-40% range.

Anyway, EmergentMD may have an atypical EM career (or an upper 50th percentile non-burned out EM career), but it shows that there are people out there loving what they do. It looks like it may be hard to find these people in EM but I'm planning on being one even if >80% of the stuff on the site is about rough bad EM is.

Good luck to all, especially those on the journey of enjoying / being grateful for what they do - while being to acknowledge there are challenges in the field without constantly complaining.

 

[The White Coat Investor]

The impressive thing about those stats is how little they vary between specialty. We're all in this together apparently.

 

[EctopicFetus]

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.

I agree. I think its good to have options. I cant disagree with that. That being said that years worth of fellowship is gonna cost you 200+k. If you "lived like a resident" that delta post tax lets say is 100k. Over 25 years at 6% growth isnt a small bit of money. On the other hand If you burn out after 5-10 years and cant work it could be even more costly. Im glad I went right to work and I am even more happy about the fact that I am not burnt out. I love my job and since that sore throat pays me I dont mind in the least.

I really wonder if the people who get annoyed by the "easy" cases either get paid some other way.

Serious question.. If someone came to you and said "look Ill pay you $150 for you to look at my throat". Are there people on here who would say no? Everytime that sore throat comes in thats sort of whats happening. I think a Level 3 medicare pays $120.. Private insurance is more.. Is that not good for you guys?

Its kind of like all the chest painers.. I could see 8 an hour (maybe more). With the use of i-Stats I could dispo 8 an hour. I wish all my patients were 70 yr old chest painers with DM, CAD, HTN who havent seen a cardiologist in 7 years. Easy Dispo easy money.. is that not good?

 

[deleted547339]

I don't think we're all saying you're weak if you burn out. I think we have sympathy for those folks. I think we're saying we don't have sympathy for the guy who's burned out and has 7 figures in the bank after being out of residency for a handful of years. You don't like your job any more? Great, go sit on a beach and drink a margarita. Just don't expect me to feel bad for you.

The guy who is burned out 10 year in but still owes 6 figures on his student loans, has no money in the bank for retirement, has a wife who doesn't work and three kids, has two 10-year old honda civics that both need work, has a roof that needs to be replaced and has to work 18 shifts a month in a crappy group where there's only one shop in town? Yea, that guy gets my sympathy.

It's Not Just In Your Head


I'm glad you love your version of Emergency Medicine, EmergentMD. I also love my very non-traditional, sub-specialty version of Emergency Medicine, that I've carved out for myself through extra training, extra work, time investment and additional sacrifice. I wouldn't describe myself currently as feeling "burned out" at all, but I've been there. And with all due respect, this post seems to me like the classic, "Suck it up. Get over it. You're imagining it. The problem is you," response to burnout in Emergency Medicine. I've been hearing various responses like this, since my years as a medical student, through residency, and it continues now in my years as an attending. The guy who got burned out, "Was weak. He had a midlife crisis. Or he just was chronically unhappy," or just needs to move and find a new job. It's the same old story, with various responses explaining the problem away, rather than addressing it's causes and solutions. Yet the survey's still show, that not only does Emergency Medicine consistently rank #1 out of specialties of physicians reporting burnout, in multiple surveys (Medscape survey, slide 2; JAMA, figure 1), but the proportion tends to be over 50%. In other words, if you don't report feeling of burnout, defined as "loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment," then you are actually the weird one.

I don't think any Emergency Residents or Physicians really, truly expect or demand to see "only really sick patients," as you claim. I don't know one Emergency Physician, that didn't know he'd be doing a lot of primary care. But your example of managing 5 crashing patients, leaves out one very, very large 900 lb gorilla in the room, doesn't it? The 900 lb gorilla in the room is the fact, that many ED directors, most of whom take their marching orders from the non-physician administrators of hospitals for higher pay and less clinical shifts, will still expect the 25 non-emergencies in the waiting room to be "greeted," "door-to-roomed," "arrival-to-physician'd" in some outrageous, unrealistic, unnecessary and impossible time goal, that a physician working a max capacity has no control over. I can honestly say, that just about every Emergency Physician I've ever known, if expected to manage 5 critical patients, would say, "Bring it on, baby," and high-five his partner who comes on a 7 am shift change when telling how he got through it. Certainly, most would not want every shift to go that way, but I don't know one that would "cry in the corner" over it, as you claim. But I've never know one single Emergency Physician, that ever felt he or she deserved to be told, directly or by implication, that he "sucked" if the 25 non-emergencies in the wait room weren't "greeted" or "roomed" or in some other way put in a box with a bow wrapped around them, while his head spun manging the five patients circling the drain of life.

So, I find it very interesting, and pertinent that you are or have been, an ED director for the majority of your 15 years. I find that very interesting, and telling, as ED directors typical work far less shifts, make the schedule and generally have as much or as little exposure to the trials and tribulations of the "pit doc" as they choose. I also find it very interesting that you made the point to write a post about how happy you were with your job, yet didn't really seem to offer anything that would allow those that described having trouble in their situations other that to seem to imply that all that is needed is for them to snap out of it, by realizing someone else has it worse, and if unable, they are flawed. That may work for some people, but it's not particularly helpful for some, because there's always someone with it "worse." Nobody wants to be "just a little bit better than 'worse.'" Some may want their job to make them happy, but I think most of all Emergency Physicians just want to be appreciated. And they don't want to be told they suck because a hang-nail waited and hour while they did manage 5 crashing patients. I've had many shifts, single coverage where I managed 5 crashing patients, as I'm sure you have over the years. I've had 12 beds full, with several sick and intubated and had a rollover MVA come in with 4 patients ejected, all on backboards covered in blood, with help no sooner than 30 minutes away, if I could get help on the phone and on their way in.

That's all stressful, and you know that. We all signed up for "stress." It's numbers one, two and three in the job description. But none of that was what changed things for me, personally. None of the emergencies, nor any of patients who came in with hang nails, work notes, earaches or med refills changed anything for me. I always welcomed the easy patients as a break between real emergencies. But what did it for me, and what made me realize I was fighting a futile and losing battle every day, was that despite the heroics, the shifts I didn't think I could handle but did, the chaos I didn't think I could bring under control but did...it was never good enough.

It was never good enough.

I came to the realization, that I could save a life, 2 lives, or three in a shift, and I could be told the next day that it wasn't good enough because the "hang nails" waited on average, 2-minutes longer than "corporate" wanted. And it never came as bluntly, or as direct as, "You suck." It always was dressed in pleasantries, cloaked with buzzwords like "patient satisfaction," "efficiency," and "administration," which I took on face value for a long time. The closing line was always the equivalent of, "Do the impossible, or you'll lose your contract." It's about nothing more than money. It has nothing to do with "healthcare," a "crisis," or "the sick." It's about maximizing flow, specifically of the "unsick" through the ED to make maximal profits for the hospital CEO, and/or shareholders, and/or to go into the not-for-profit hospital's kitty for next years administrator's salary increases. The more the billboard can push down the street to the ED, the better, with no limit. It took me quite a long time to learn the language and translate the message. And now, I thank God every day, that I don't have to go through the passive aggressive manipulation anymore, and have an ED director tell me it's all in my head. I am also equally as thankful, that I found a way that I can use my skills as an Emergency Physician without starting over, and was able to build on them in a way that I'm able to have much more control over my practice life, hours, and future.

So, did I have it "good compared to the general population"? Absolutely. Do I have it even better now, that I made some drastic changes? Yes. Do the 50-70% of Emergency Physicians who report burnout feel exactly the same way I did, or have the same exact experiences I did? Likely not. But there something there.

It's. Not. Just. In. Their. Heads.

They're not lying in those surveys. They're not "chronic complainers," "wimps," or having delusions of failure. Neither are any of the tough, hard-nosed, heroes on this thread or those in Emergency Departments across this country that have dedicated their lives to working on the front lines of the chaos that is Amercian Emergency Departments today. Despite the high salaries, the supposed "great hours," and despite the reports from those who just don't see what all the fuss is and think the rest need to just "suck it up," there's something there. So just keep telling the bright-eyed bushy-tailed hopefuls that its just a bunch of BS, that there's too many complainers out there that need to step aside and get out of the way. And do nothing to solve the problem, for those that signed up to go to battle with you, and for you.







Slide 2: http://www.medscape.com/features/slideshow/lifestyle/2013/emergency-medicine#2

Figure 1: http://archinte.jamanetwork.com/article.aspx?articleid=1351351

 

[Birdstrike]

I don't think we're all saying you're weak if you burn out. I think we have sympathy for those folks. I think we're saying we don't have sympathy for the guy who's burned out and has 7 figures in the bank after being out of residency for a handful of years. You don't like your job any more? Great, go sit on a beach and drink a margarita. Just don't expect me to feel bad for you.

The guy who is burned out 10 year in but still owes 6 figures on his student loans, has no money in the bank for retirement, has a wife who doesn't work and three kids, has two 10-year old honda civics that both need work, has a roof that needs to be replaced and has to work 18 shifts a month in a crappy group where there's only one shop in town? Yea, that guy gets my sympathy.

Is that guy really out there? You're tearing my heart out here, man. Two 10-yr old Honda Civics, 10 years post EM residency, with no hope of a German upgrade in sight? Damn, that is a heartbreaker. I mean, if you had said Honda mini-van and four kids, it would've been too much for my sensitive heart to take.

 

[DeadCactus]

I think medicine actively selects for people with a predisposition to depression and dissatisfaction. The vast majority of people decide that being an engineer, nurse, paramedic, teacher, accountant, etc is more than enough pay, prestige, social value, whatever to be happy. Then you have physicians, the people for whom the already productive and comfortable life of numerous other fields wasn't enough and so they pressed onward to make more money, have more prestige, be more helpful to people, or whatever other driving factor it was for them. It's not really surprising that we get to the end of the track and want something more. I don't think it's a bad thing. It's this sort of dissatisfaction that pushes society forward and forward. But it's something we should be cognizant of to more effectively tackle our dissatisfaction. And while medicine has its unique frustrations, I think it's a lie to pretend that physicians are all just normal happy people who have just been thrust into a woefully terrible situation that makes them so unhappy. Frankly, a lot of it is arrogance. A sense of entitlement that even with an income 6 times the national average you deserve something better in life for dealing with *gasp* customer service and the general public because someone else has something you perceive as a better deal and you want that...

There are things we need to fix both externally and internally.

 

[Birdstrike]

Frankly, a lot of it is arrogance...

That's right. And most of us relied on at least a pinch of it to help us get here and stay here.

 

[DeadCactus]

Like I said, I don't think it's a bad thing. It drives success. It drives people to points of diminishing personal returns but continuing social benefit. Society needs people unhappy and dissatisfied with "good enough" when life presents the opportunity to go further. But it's a personal trait we should be cognizant of.

 

[EctopicFetus]

I don't think we're all saying you're weak if you burn out. I think we have sympathy for those folks. I think we're saying we don't have sympathy for the guy who's burned out and has 7 figures in the bank after being out of residency for a handful of years. You don't like your job any more? Great, go sit on a beach and drink a margarita. Just don't expect me to feel bad for you.

The guy who is burned out 10 year in but still owes 6 figures on his student loans, has no money in the bank for retirement, has a wife who doesn't work and three kids, has two 10-year old honda civics that both need work, has a roof that needs to be replaced and has to work 18 shifts a month in a crappy group where there's only one shop in town? Yea, that guy gets my sympathy.

Whats funny is I wouldnt feel bad for that guy. Anyone who is 10 years out in EM and his life is that much of a mess.. I dont feel bad for those who make bad choices.

I commend the OP for being lucky or whatever the case of having a decent bank account. Maybe the OPs job sucked. The OP was stuck in some job in a place they couldnt move from. That same person got lucky (their term) in investments. Kudos to them.

Also, as an aside the more people quit EM the better it will be for those of us still willing to work in EM.

 

[EctopicFetus]

Like I said, I don't think it's a bad thing. It drives success. It drives people to points of diminishing personal returns but continuing social benefit. Society needs people unhappy and dissatisfied with "good enough" when life presents the opportunity to go further. But it's a personal trait we should be cognoscente of.

IM not a big spell check guy.. but it was hard for me to understand.. It should be cognizant.

Also, I 100% agree with you.

 

[Birdstrike]

it's a personal trait we should be cognoscente of.

IM not a big spell check guy.. but it was hard for me to understand.. It should be cognizant.

Also, I 100% agree with you.

I kinda liked, "cognoscente." Sounds fancy, and delicious.

"Cogno-scente. Amore! Bellisimo!"

 

[DeadCactus]

Autocorrect got me. On the plus side, I learned a new word.

co·gno·scen·te
ˌkänyəˈSHentē,ˌkägnə-/
noun

1. a connoisseur; a discerning expert.

We should all be discerning experts of our personal traits.

 

[emergentmd]

I must be an atypical director. I work about the same amount of shifts as a line doc. I just have extra admin stuff on the side, constant emails about what the docs did wrong, constant distractions while I am working, constant meetings with admin about core measures/metrics. I am not a CMG director who just walks around rubbing his elbows with admin.

But if that makes you feel justified in feeling depressed about a field that is still well respected, well paid then it just proves my point even more. Some people are destined to be depressed.

I deal with unhappy ED docs all the time. As I said, some people are never happy.

I get doctors complaining how busy they are. Yes we are busy. I see on avg 3pt/hr. But they dont complain when their paychecks are high
then some will complain that their paychecks are too low and want to see more patients. Its just the flavor of the month depending on how busy the ED is.

I get docs who complain about private pt referrals for admission. They whine that the pt should be a direct admit. Am I missing something here? These are slam dunk admission, I bless them in 5 minutes, order bunch of labs, and call in the admission. These are the same docs that complain when their checks are low and want to be busier.

Being a director is like being a babysitter. The constant whining is tiresome. But I have been able to be at peace with this as I accept that some people are just not happy people and like to complain. They will continue to be unahppy no matter how good they have it. Its just their nature. I am sure they complain all the time at home too...... poor wife and kids I say.

I think I have one of the toughest EM jobs. I see 3 pts/hr, bring charting home, no scribes, archaic charting system, satisfaction scores, metrics, core measures, etc..... I fell everyone's pain. Yes, some things suck. Yes, even when you do a good job, you get a pt complaint that you have to answer to bc the pt did not get their norco.

I get it. I have been through it, I live it. I just do not let this stuff bother me. I am a half full person and see how good I have it. I come home to three great kids, a great wife, and never let work stress follow me into the house.

 

[@JackShephard]

I must be an atypical director. I work about the same amount of shifts as a line doc. I just have extra admin stuff on the side, constant emails about what the docs did wrong, constant distractions while I am working, constant meetings with admin about core measures/metrics. I am not a CMG director who just walks around rubbing his elbows with admin.

But if that makes you feel justified in feeling depressed about a field that is still well respected, well paid then it just proves my point even more. Some people are destined to be depressed.

I deal with unhappy ED docs all the time. As I said, some people are never happy.

I get doctors complaining how busy they are. Yes we are busy. I see on avg 3pt/hr. But they dont complain when their paychecks are high
then some will complain that their paychecks are too low and want to see more patients. Its just the flavor of the month depending on how busy the ED is.

I get docs who complain about private pt referrals for admission. They whine that the pt should be a direct admit. Am I missing something here? These are slam dunk admission, I bless them in 5 minutes, order bunch of labs, and call in the admission. These are the same docs that complain when their checks are low and want to be busier.

Being a director is like being a babysitter. The constant whining is tiresome. But I have been able to be at peace with this as I accept that some people are just not happy people and like to complain. They will continue to be unahppy no matter how good they have it. Its just their nature. I am sure they complain all the time at home too...... poor wife and kids I say.

I think I have one of the toughest EM jobs. I see 3 pts/hr, bring charting home, no scribes, archaic charting system, satisfaction scores, metrics, core measures, etc..... I fell everyone's pain. Yes, some things suck. Yes, even when you do a good job, you get a pt complaint that you have to answer to bc the pt did not get their norco.

I get it. I have been through it, I live it. I just do not let this stuff bother me. I am a half full person and see how good I have it. I come home to three great kids, a great wife, and never let work stress follow me into the house.

Great attitude. I am taking notes.

Thanks for your feedback.

 

[GeneralVeers]

Wow being a director sounds awful! I'm more than happy just being a line doc, seeing patients, going home and not worrying about it. After being on some committees (like trauma), I'm glad I don't have to deal with the soulless vampires that are hospital administration, and grateful for people like you for doing the job for me.

 

[carbonizedeyesockets]

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.

With this viewpoint, you're no better than the politicians and administrators. Stop fighting? Just go with the flow? Spend time on SDN waxing poetic over your discontentment, but do nothing about it? You're doing exactly what the administrators and politicians want you to do and you're encouraging others to do the same. If the profession is changing for the worse or changing to something less enjoyable, you and others like yourself are as much the cause as anyone else.

 

[GeneralVeers]

With this viewpoint, you're no better than the politicians and administrators. Stop fighting? Just go with the flow? Spend time on SDN waxing poetic over your discontentment, but do nothing about it? You're doing exactly what the administrators and politicians want you to do and you're encouraging others to do the same. If the profession is changing for the worse or changing to something less enjoyable, you and others like yourself are as much the cause as anyone else.

I used to think as you do, and fought against windmills. Unfortunately it got me nowhere. I ended up depressed, burnt out, and needed to be "counseled" by my directors for complaining too much and criticizing the hospital and EMP. I think you should take whatever approach that satisfies you, and if fighting against the system and trying to improve it is what you want to do, then I give you my full, 100% support! For those of us who are tired of fighting, and tired of being ripped off by the CMGs there is always my (imperfect) solution that has given me a bit more longevity in the profession.

 

[e30ftw]

Autocorrect got me. On the plus side, I learned a new word.

co·gno·scen·te
ˌkänyəˈSHentē,ˌkägnə-/
noun

1. a connoisseur; a discerning expert.

i am using this in a sentence tonight.

 

[Birdstrike]

i am using this in a sentence tonight.

Be careful. It has "Kanye" in it.

co·gno·scen·te
ˌkänyəˈSHentē,ˌkägnə-/
noun

1. a connoisseur; a discerning expert.

 

[wjs010]

Question is... What can you docs do about the CEO's and whatever the press gainey is? If yo try to do anything, don't you think the powers that be would see to it that you lose your jobs? That sucks and sounds like a scary opposition. Medicine didn't use to be like this did it?

 

[Silent Cool]

I think medicine actively selects for people with a predisposition to depression and dissatisfaction. The vast majority of people decide that being an engineer, nurse, paramedic, teacher, accountant, etc is more than enough pay, prestige, social value, whatever to be happy. Then you have physicians, the people for whom the already productive and comfortable life of numerous other fields wasn't enough and so they pressed onward to make more money, have more prestige, be more helpful to people, or whatever other driving factor it was for them. It's not really surprising that we get to the end of the track and want something more. I don't think it's a bad thing. It's this sort of dissatisfaction that pushes society forward and forward. But it's something we should be cognizant of to more effectively tackle our dissatisfaction. And while medicine has its unique frustrations, I think it's a lie to pretend that physicians are all just normal happy people who have just been thrust into a woefully terrible situation that makes them so unhappy. Frankly, a lot of it is arrogance. A sense of entitlement that even with an income 6 times the national average you deserve something better in life for dealing with *gasp* customer service and the general public because someone else has something you perceive as a better deal and you want that...

There are things we need to fix both externally and internally.

I would like to nominate this post for one of the best and most accurate I have ever read on SDN.

Holy $hit, kudos.

 

[ryuuzaki]

+1 with Jack, I love the positivity.

I must be an atypical director. I work about the same amount of shifts as a line doc. I just have extra admin stuff on the side, constant emails about what the docs did wrong, constant distractions while I am working, constant meetings with admin about core measures/metrics. I am not a CMG director who just walks around rubbing his elbows with admin.

But if that makes you feel justified in feeling depressed about a field that is still well respected, well paid then it just proves my point even more. Some people are destined to be depressed.

I deal with unhappy ED docs all the time. As I said, some people are never happy.

I get doctors complaining how busy they are. Yes we are busy. I see on avg 3pt/hr. But they dont complain when their paychecks are high
then some will complain that their paychecks are too low and want to see more patients. Its just the flavor of the month depending on how busy the ED is.

I get docs who complain about private pt referrals for admission. They whine that the pt should be a direct admit. Am I missing something here? These are slam dunk admission, I bless them in 5 minutes, order bunch of labs, and call in the admission. These are the same docs that complain when their checks are low and want to be busier.

Being a director is like being a babysitter. The constant whining is tiresome. But I have been able to be at peace with this as I accept that some people are just not happy people and like to complain. They will continue to be unahppy no matter how good they have it. Its just their nature. I am sure they complain all the time at home too...... poor wife and kids I say.

I think I have one of the toughest EM jobs. I see 3 pts/hr, bring charting home, no scribes, archaic charting system, satisfaction scores, metrics, core measures, etc..... I fell everyone's pain. Yes, some things suck. Yes, even when you do a good job, you get a pt complaint that you have to answer to bc the pt did not get their norco.

I get it. I have been through it, I live it. I just do not let this stuff bother me. I am a half full person and see how good I have it. I come home to three great kids, a great wife, and never let work stress follow me into the house.

 

[ryuuzaki]

double post.

 

[Plectron]

I know I am opening myself up for a beat down. I am one of those burnt out docs. It is not the medicine that burns you out but the stuff outside of the medicine. I love every day I work in the department. Yeah there are those pts that annoy the hell out of you but what job doesn't have customers/clients/people/patients like that? I work for a great group with a great bunch of people. I'm not overly pleased with the area we moved to but it's tolerable.

I've been out about 8 years, have a wife and 3 kids with about $300k in loans. We moved after residency and purchased a house (in June 2006, right before the bubble). We both drive American cars that we are still paying off. I work for an independent democratic group. They pay was great when I first took the job, paying the bills (including extra towards some things), saving for retirement, emergency fund with money left over. We never blew our budget. After about 3 years here, the local insurance monopoly decides they are paying too much and say, "Sign this contract which cuts our reimbursement by almost 50% or else." We tried to hold out and fight but they started sending the payments to the pts and telling us that we would have to collect the money directly from the pt. Let's just say that in the middle of the great recession, we didn't see too many people giving up their checks. So, we finally settle with a few concessions from the insurer. I've seen about a 30% drop in my overall pay rate. We can't sell the house because we are 15-20% underwater (it's not a McMansion, just an average house). We've cut corners where we can. I've had to increase the number of shifts I work per month and we have gone from 12 to 8 hour shifts, so it's even more. Needless to say, I'm working about 160+ hours per month. You could say I am feeling the burn at this point. I feel like I am missing things at home that I wouldn't normally miss and just don't enjoy life overall as much as I used to. There are no other jobs in a reasonable commute since the system we contract with owns most of the hospitals in the area and we staff them. We could move but the kids are flourishing where we are and I would hate to pull them away from it (they are all around middle school age). I know once they are done with school, moving is a very real possibility so the light is there but it is one long tunnel to look be looking through on a day-to-day basis.

The hospital system constantly reminds us that our group can be replaced (and they actually own the largest insurer so they are no help) and constantly sends us letters about things we have done wrong.

Sorry for the long rant, but feel free to flame away.

 

[The White Coat Investor]

I know I am opening myself up for a beat down. I am one of those burnt out docs. It is not the medicine that burns you out but the stuff outside of the medicine. I love every day I work in the department. Yeah there are those pts that annoy the hell out of you but what job doesn't have customers/clients/people/patients like that? I work for a great group with a great bunch of people. I'm not overly pleased with the area we moved to but it's tolerable.

I've been out about 8 years, have a wife and 3 kids with about $300k in loans. We moved after residency and purchased a house (in June 2006, right before the bubble). We both drive American cars that we are still paying off. I work for an independent democratic group. They pay was great when I first took the job, paying the bills (including extra towards some things), saving for retirement, emergency fund with money left over. We never blew our budget. After about 3 years here, the local insurance monopoly decides they are paying too much and say, "Sign this contract which cuts our reimbursement by almost 50% or else." We tried to hold out and fight but they started sending the payments to the pts and telling us that we would have to collect the money directly from the pt. Let's just say that in the middle of the great recession, we didn't see too many people giving up their checks. So, we finally settle with a few concessions from the insurer. I've seen about a 30% drop in my overall pay rate. We can't sell the house because we are 15-20% underwater (it's not a McMansion, just an average house). We've cut corners where we can. I've had to increase the number of shifts I work per month and we have gone from 12 to 8 hour shifts, so it's even more. Needless to say, I'm working about 160+ hours per month. You could say I am feeling the burn at this point. I feel like I am missing things at home that I wouldn't normally miss and just don't enjoy life overall as much as I used to. There are no other jobs in a reasonable commute since the system we contract with owns most of the hospitals in the area and we staff them. We could move but the kids are flourishing where we are and I would hate to pull them away from it (they are all around middle school age). I know once they are done with school, moving is a very real possibility so the light is there but it is one long tunnel to look be looking through on a day-to-day basis.

The hospital system constantly reminds us that our group can be replaced (and they actually own the largest insurer so they are no help) and constantly sends us letters about things we have done wrong.

Sorry for the long rant, but feel free to flame away.

You are looking for a new job, right? You're not living where you want to live and you have a "mega-toxic" job? Why wouldn't you leave? Rent the house out and move on. Maybe even give a serious look at a job that would qualify you for PSLF even if the pay were less.

 

[Birdstrike]

I know I am opening myself up for a beat down. I am one of those burnt out docs. It is not the medicine that burns you out but the stuff outside of the medicine. I love every day I work in the department. Yeah there are those pts that annoy the hell out of you but what job doesn't have customers/clients/people/patients like that? I work for a great group with a great bunch of people. I'm not overly pleased with the area we moved to but it's tolerable.

I've been out about 8 years, have a wife and 3 kids with about $300k in loans. We moved after residency and purchased a house (in June 2006, right before the bubble). We both drive American cars that we are still paying off. I work for an independent democratic group. They pay was great when I first took the job, paying the bills (including extra towards some things), saving for retirement, emergency fund with money left over. We never blew our budget. After about 3 years here, the local insurance monopoly decides they are paying too much and say, "Sign this contract which cuts our reimbursement by almost 50% or else." We tried to hold out and fight but they started sending the payments to the pts and telling us that we would have to collect the money directly from the pt. Let's just say that in the middle of the great recession, we didn't see too many people giving up their checks. So, we finally settle with a few concessions from the insurer. I've seen about a 30% drop in my overall pay rate. We can't sell the house because we are 15-20% underwater (it's not a McMansion, just an average house). We've cut corners where we can. I've had to increase the number of shifts I work per month and we have gone from 12 to 8 hour shifts, so it's even more. Needless to say, I'm working about 160+ hours per month. You could say I am feeling the burn at this point. I feel like I am missing things at home that I wouldn't normally miss and just don't enjoy life overall as much as I used to. There are no other jobs in a reasonable commute since the system we contract with owns most of the hospitals in the area and we staff them. We could move but the kids are flourishing where we are and I would hate to pull them away from it (they are all around middle school age). I know once they are done with school, moving is a very real possibility so the light is there but it is one long tunnel to look be looking through on a day-to-day basis.

The hospital system constantly reminds us that our group can be replaced (and they actually own the largest insurer so they are no help) and constantly sends us letters about things we have done wrong.

Sorry for the long rant, but feel free to flame away.

No apologies needed and you'll see no flames from me on this. I see where you're coming from, definitely. And yes, inevitably someone will flame you or tell you you "just don't get it." (But hey, that will just make two of us.) Nobody who values their own hard work and skills expects to work this hard, for this long to have their pay decreased, and work load increased. Point blank: That's grade-A bullsh¡t, with no side of sauce. Does somebody, somewhere have it "worse"? Irrelevant.

Also, nobody outside of emergency medicine, even doctors in other specialties, understand that 160hr/month in a busy, stressful emergency department and flipping back from nights to days, to nights and back all of the time, takes more of a toll on your mind and body than 240hr/month doing just about anything else. So, I'm with you on this.

My opinion: You deserve better. What, and where that is, and how to get it, is another story. Let me know what I can do to help.

 

[DOFutureEM22]

I know I am opening myself up for a beat down. I am one of those burnt out docs. It is not the medicine that burns you out but the stuff outside of the medicine. I love every day I work in the department. Yeah there are those pts that annoy the hell out of you but what job doesn't have customers/clients/people/patients like that? I work for a great group with a great bunch of people. I'm not overly pleased with the area we moved to but it's tolerable.

I've been out about 8 years, have a wife and 3 kids with about $300k in loans. We moved after residency and purchased a house (in June 2006, right before the bubble). We both drive American cars that we are still paying off. I work for an independent democratic group. They pay was great when I first took the job, paying the bills (including extra towards some things), saving for retirement, emergency fund with money left over. We never blew our budget. After about 3 years here, the local insurance monopoly decides they are paying too much and say, "Sign this contract which cuts our reimbursement by almost 50% or else." We tried to hold out and fight but they started sending the payments to the pts and telling us that we would have to collect the money directly from the pt. Let's just say that in the middle of the great recession, we didn't see too many people giving up their checks. So, we finally settle with a few concessions from the insurer. I've seen about a 30% drop in my overall pay rate. We can't sell the house because we are 15-20% underwater (it's not a McMansion, just an average house). We've cut corners where we can. I've had to increase the number of shifts I work per month and we have gone from 12 to 8 hour shifts, so it's even more. Needless to say, I'm working about 160+ hours per month. You could say I am feeling the burn at this point. I feel like I am missing things at home that I wouldn't normally miss and just don't enjoy life overall as much as I used to. There are no other jobs in a reasonable commute since the system we contract with owns most of the hospitals in the area and we staff them. We could move but the kids are flourishing where we are and I would hate to pull them away from it (they are all around middle school age). I know once they are done with school, moving is a very real possibility so the light is there but it is one long tunnel to look be looking through on a day-to-day basis.

The hospital system constantly reminds us that our group can be replaced (and they actually own the largest insurer so they are no help) and constantly sends us letters about things we have done wrong.

Sorry for the long rant, but feel free to flame away.

Thank you for sharing. I read posts like this I can't help but worry about my own future. I know that the golden days of medicine are long gone, and its unfortunate that nowadays we can only hope that we can break even and provide a decent home for our families. Its sad that it has come to this. I wish you and your family the best

 

[namethatsmell]

The hospital system constantly reminds us that our group can be replaced (and they actually own the largest insurer so they are no help) and constantly sends us letters about things we have done wrong.

Sorry for the long rant, but feel free to flame away.

Sucks to hear. Only a PGY2, but have you considered doing some locums to mix things up? It may give you a little bit more control in some regards (good pay, not really having to worry about BS from admin, etc) and it would allow you to vote with your feet. It sounds like it'd also be a way to increase your buck for your bang (heh) and make some connections for if/when you decide to move. You may be able to keep working at your current shop but just scale back your hours. Good luck.

 

[@JackShephard]

I know I am opening myself up for a beat down. I am one of those burnt out docs. It is not the medicine that burns you out but the stuff outside of the medicine. I love every day I work in the department. Yeah there are those pts that annoy the hell out of you but what job doesn't have customers/clients/people/patients like that? I work for a great group with a great bunch of people. I'm not overly pleased with the area we moved to but it's tolerable.

I've been out about 8 years, have a wife and 3 kids with about $300k in loans. We moved after residency and purchased a house (in June 2006, right before the bubble). We both drive American cars that we are still paying off. I work for an independent democratic group. They pay was great when I first took the job, paying the bills (including extra towards some things), saving for retirement, emergency fund with money left over. We never blew our budget. After about 3 years here, the local insurance monopoly decides they are paying too much and say, "Sign this contract which cuts our reimbursement by almost 50% or else." We tried to hold out and fight but they started sending the payments to the pts and telling us that we would have to collect the money directly from the pt. Let's just say that in the middle of the great recession, we didn't see too many people giving up their checks. So, we finally settle with a few concessions from the insurer. I've seen about a 30% drop in my overall pay rate. We can't sell the house because we are 15-20% underwater (it's not a McMansion, just an average house). We've cut corners where we can. I've had to increase the number of shifts I work per month and we have gone from 12 to 8 hour shifts, so it's even more. Needless to say, I'm working about 160+ hours per month. You could say I am feeling the burn at this point. I feel like I am missing things at home that I wouldn't normally miss and just don't enjoy life overall as much as I used to. There are no other jobs in a reasonable commute since the system we contract with owns most of the hospitals in the area and we staff them. We could move but the kids are flourishing where we are and I would hate to pull them away from it (they are all around middle school age). I know once they are done with school, moving is a very real possibility so the light is there but it is one long tunnel to look be looking through on a day-to-day basis.

The hospital system constantly reminds us that our group can be replaced (and they actually own the largest insurer so they are no help) and constantly sends us letters about things we have done wrong.

Sorry for the long rant, but feel free to flame away.

I don't think any of the people trying to stay positive are want to flame the burned out or stressed.

The people trying to stay positive are focused on all the benefits of being an emergency physician, while acknowledging yet not magnifying the challenges.

I sympathize with your situation. At the same time, it sounds like a lot of your stress is coming from finances. I think it's very reasonable for a person > 10 years removed from residency with student loans < 200k* to have paid off their debt and have a networth anywhere from 500k - 1 million (See: TheWhiteCoat Investor's book). With the current mean salary (240k), this amounts to around 2.4 million in gross income in a decade. Anyway, this situation sounds like it's more financial than it is medicine (i.e. if I wrote you a 500k check today, you could easily lower your burnout/stress). This could afford you to take 3 months off of work or work less (120 hrs/month).

In closing, those of us focused on the positives are trying to separate criticisms like the OP gave, which were essential problems with medicine or being employed vs. criticisms of EM. Likewise, it seems like your criticism have more to do with finances than with Emergency Medicine. Which again, writing you a check for 500k seems like it could solve a majority of your problems.

No flaming. Good luck.

*(2013 means for debt are 162k for public and 181k for private, with 86% of students owing less than 250k: https://www.aamc.org/download/152968/data/debtfactcard.pdf).

 

[Plectron]

Thanks everyone for the replies and the opportunity to vent.

You are looking for a new job, right? You're not living where you want to live and you have a "mega-toxic" job? Why wouldn't you leave? Rent the house out and move on. Maybe even give a serious look at a job that would qualify you for PSLF even if the pay were less.

Like I said, my kids are about half way done with school and I would rather not move them at this point. I figure if I can survive a month in the SICU (horribly toxic at my program) I can survive another 6-7 years here.

I don't think any of the people trying to stay positive are want to flame the burned out or stressed.

The people trying to stay positive are focused on all the benefits of being an emergency physician, while acknowledging yet not magnifying the challenges.

I sympathize with your situation. At the same time, it sounds like a lot of your stress is coming from finances. I think it's very reasonable for a person > 10 years removed from residency with student loans < 200k* to have paid off their debt and have a networth anywhere from 500k - 1 million (See: TheWhiteCoat Investor's book). With the current mean salary (240k), this amounts to around 2.4 million in gross income in a decade. Anyway, this situation sounds like it's more financial than it is medicine (i.e. if I wrote you a 500k check today, you could easily lower your burnout/stress). This could afford you to take 3 months off of work or work less (120 hrs/month).

In closing, those of us focused on the positives are trying to separate criticisms like the OP gave, which were essential problems with medicine or being employed vs. criticisms of EM. Likewise, it seems like your criticism have more to do with finances than with Emergency Medicine. Which again, writing you a check for 500k seems like it could solve a majority of your problems.

No flaming. Good luck.

*(2013 means for debt are 162k for public and 181k for private, with 86% of students owing less than 250k: https://www.aamc.org/download/152968/data/debtfactcard.pdf).

You are right, it is not the medicine that has me burnt out but the volume of it leading to the financial issues. I will PM the address you can send that check to.

 

[Birdstrike]

Thank you for sharing. I read posts like this I can't help but worry about my own future. I know that the golden days of medicine are long gone, and its unfortunate that nowadays we can only hope that we can break even and provide a decent home for our families. Its sad that it has come to this. I wish you and your family the best

Reality check time:

Not to minimize anything Plectron posted, but your future is going to be fine if you commit to making it that way. Keep things in context, and in perspective. There are some things to consider that he (or she) brings up, but you shouldn't feel your future is doomed because you read this post or this thread, anymore than I am going to feel mine is. The future is has the potential to be very good. Make it that way.


"The future's so bright, I gotta wear shades."-Timbuk 3

 

[emergentmd]

Plectron,

I will not judge as everyone's situation is different. Most come out with some loans but 300k seems like a heafty burdon. I came out with only 100k but paid that off in about 1 yr and there are options to pay that back even quicker.

I realize that you do not want to uproot your family/kids but sometimes as the leader of the house you have to make the tough decisions. Do you want to stay there stressed out just so your kids can finish school. I am not sure how old they are but I would think the youngest have probably 10 yrs to go given that you finished residency in 8 yrs.

It sounds like you enjoy emergency medicine but just trapped financially especially with decreased reimbursement.

There are so many high paying opportunities in the south. There are so many Locum opportunities that you can make over 700K working 15 shifts a month. I have partners who moonlight for 4k/12 hr shift. Do the math and you can get to 700k very easily. Why not suck it up for 1 yr and even fly into these small towns and pay off all of your debt? Think about it. I know a guy who lives in Hawaii b/c he likes it there and travels to do Locum gigs at 4k/12hr shift. He comes down here 10 days a month (5 days straight at a time) and he grosses over 450k.

I currenly work in a private doctor group where the pay is good but things are changing around us quickly. Groups are being taken over by CMGs everywhere and I realize that we will be eventually taken over. When this happens and if the CMG offers crappy pay, I will be seeking some of those easy Freestanding ED gigs 5 shifts at 190/hr and then work 5 locums at 4k/shift. Not a bad way to make 350K+

In the south there is such a great need for board certified ED jobs. I would say that eventhough our automony at hospitals are getting blunted, metrics are overbearing, patient complaints too numberous, the current ED Physician financial environment is at its peak.

There is a shortage of docs, Freestanding ED are popping up like weeds sucking up a bunch of really good ED docs, and thus leaving most hospitals short where the CMGs are paying outrageous prices. Why would a good doc work in a stressful busy ED at 225/hr when he can work in a FSED getting 190/hr? Think about how crazy this is. You can do locums, pick up 20 shifts a month (12 hrs), and take home well over 900K. You are making neurosurgery money while working much less (55hr/wk) than what a NSG works. I get that our job is stressful but Locums are not as stressful. Admin leaves you along, no one complains even if you are slow or rude to patients. What are they going to do? Fire you? They can't even get docs to cover these places less fire a low performing ED doc.

Take a step back and be thankful that as a boarded ED doc, you have options to make alot of money but it will take sacrafices.

 

[@JackShephard]

Thank you for sharing. I read posts like this I can't help but worry about my own future. I know that the golden days *** are long gone, and its unfortunate that nowadays we can only hope that we can break even and provide a decent home for our families. Its sad that it has come to this. I wish you and your family the best

Sometimes these responses make me think I'm reading a lost journal from a WWII veteran... then I realize we're all talking about the struggles of being the wealthiest humans on earth.

It's quite jarring.

 

[EctopicFetus]

Sometimes these responses make me think I'm reading a lost journal from a WWII veteran... then I realize we're all talking about the struggles of being the wealthiest humans on earth.

It's quite jarring.

I agree this isnt WW2 or the Great Depression however you shouldnt minimize the struggle. Maybe it is different for you.

Ill say this. If you owe over 300k, have a family and have a job where regardless of your starting income is down by 30% if you arent stressed then you are likely too stupid to understand your situation or completely ignorant of the finances of things.

While it may be easy to live like a resident in theory the reality is that after years of hard work and putting things off everyone wants to indulge a little. If you owe 300k and have a buy-in to your SDG I would argue that there isnt a lot of "extra" money.

I will say that the most recent post proves my point. 1) live well within your means and dont spend like a fool. Spending like you think you deserve or like your retina specialist med school buddy is a recipe for disaster.

 

[@JackShephard]

I agree this isnt WW2 or the Great Depression however you shouldnt minimize the struggle. Maybe it is different for you.

Ill say this. If you owe over 300k, have a family and have a job where regardless of your starting income is down by 30% if you arent stressed then you are likely too stupid to understand your situation or completely ignorant of the finances of things.

While it may be easy to live like a resident in theory the reality is that after years of hard work and putting things off everyone wants to indulge a little. If you owe 300k and have a buy-in to your SDG I would argue that there isnt a lot of "extra" money.

I will say that the most recent post proves my point. 1) live well within your means and dont spend like a fool. Spending like you think you deserve or like your retina specialist med school buddy is a recipe for disaster.

#1: I wasn't comment on a specific scenario (the 300k / family / cut income), I was commenting on the idea that everyone going into EM has to have this mindset: "we need to worry about our future, the golden days are gone, and all we can hope to do is break even."

With that said, I do sympathize with Plectron as I said. My goal isn't to minimize his struggles, but instead to focus on the benefits of this field for those going into it. I agree with your post though:

I will say that the most recent post proves my point. 1) live well within your means and dont spend like a fool. Spending like you think you deserve or like your retina specialist med school buddy is a recipe for disaster.

 

[Birdstrike]

#1: I wasn't comment on a specific scenario (the 300k / family / cut income), I was commenting on the idea that everyone going into EM has to have this mindset: "we need to worry about our future, the golden days are gone, and all we can hope to do is break even."

With that said, I do sympathize with Plectron as I said. My goal isn't to minimize his struggles, but instead to focus on the benefits of this field for those going into it. I agree with your post though:

If you like really like EM and want to do it, why do you care what anyone else thinks? I shouldn't really matter.

 

[Birdstrike]

There are so ...opportunities that you can make over 700K working 15 shifts a month... you can get to 700k very easily...You can ...take home well over 900K.

With all due respect, I'm going to have to raise a big red flag of misinformation here, and I now seriously question the validity of anything you post or have posted, after this one. 2013 MGMA data (which is often held as industry standard on physician salary) reports mean Emergency Physician salary at $318,794/yr and 90th%ile at $447,073. So, either the jobs you're referring to that approach $1million/yr don't exist, or are exceedingly rare, to the extent that they are less than 1% of EP jobs in existence. If they do exist, there's an extreme likelihood of such outlier high-salary jobs being gobbled up by CMGs paying closer to mean. Either way, anyone expecting close to $1 million dollars per year as an Emergency Physician is likely to be very disappointed. But whatever...

If the med students and residents on here want to gobble this stuff up, then I'm wasting my time on this forum and seriously question why I bother. Posts like this, that go unchallenged, make me seriously question the validity of this forum as a whole.

 

[GeneralVeers]

With all due respect, I'm going to have to raise a big red flag of misinformation here, and I now seriously question the validity of anything you post or have posted, after this one. 2013 MGMA data (which is often held as industry standard on physician salary) reports mean Emergency Physician salary at $318,794/yr and 90th%ile at $447,073. So, either the jobs you're referring to that approach $1million/yr don't exist, or are exceedingly rare, to the extent that they are less than 1% of EP jobs in existence. If they do exist, there's an extreme likelihood of such outlier high-salary jobs being gobbled up by CMGs paying closer to mean. Either way, anyone expecting close to $1 million dollars per year as an Emergency Physician is likely to be very disappointed. But whatever...

If the med students and residents on here want to gobble this stuff up, then I'm wasting my time on this forum and seriously question why I bother. Posts like this, that go unchallenged, make me seriously question the validity of this forum as a whole.

IF there are jobs that pay 700-900K I would love to hear about them. Trust me when I say I have inquired about every opportunity paying $250/hour or more. Even to make 500K per year a the top salary levels I've seen would require a pretty consistent 150 hours or more of work every month.

 

[LaughingMan]

If the med students and residents on here want to gobble this stuff up, then I'm wasting my time on this forum and seriously question why I bother. Posts like this, that go unchallenged, make me seriously question the validity of this forum as a whole.

Even as a first year med student I can tell those numbers are fishy--unless there is more to emergents story.

 

[EctopicFetus]

One of my frustrations with all the "numbers" is we rarely talk about the only number that IMO matter which is $/hr.

IIRC Stern Survey top 10% of hours is like 2600+ hours.

I dont know of a human being in EM who has worked 2600 clinical hours. Whoever that person is I feel bad for them and their families.

I think most of the jobs paying 250+/hr are your SDGs. For whatever reason they dont openly report their incomes. I imagine thats where the $$s are.

I think incomes over 500k/yr are tough to find but they definitely exist. More specifically I think jobs at $300/hr are out there but I dont know of a consistent one that isnt an SDG.

 

[two guys]

...

I sympathize with your situation. At the same time, it sounds like a lot of your stress is coming from finances. I think it's very reasonable for a person > 10 years removed from residency with student loans < 200k* to have paid off their debt and have a networth anywhere from 500k - 1 million (See: TheWhiteCoat Investor's book). With the current mean salary (240k), this amounts to around 2.4 million in gross income in a decade. Anyway, this situation sounds like it's more financial than it is medicine (i.e. if I wrote you a 500k check today, you could easily lower your burnout/stress). This could afford you to take 3 months off of work or work less (120 hrs/month).

In closing, those of us focused on the positives are trying to separate criticisms like the OP gave, which were essential problems with medicine or being employed vs. criticisms of EM. Likewise, it seems like your criticism have more to do with finances than with Emergency Medicine. Which again, writing you a check for 500k seems like it could solve a majority of your problems.

I agree with some of what you're saying, but you are missing half of the point.

Yes, writing anyone a check for 500k will solve a lot of problems. That being said, his problems aren't solely financial (although they are certainly complicated by debt and reliance on high income).

He is locked in a situation due to buying into a SDG and having kids where it is hard to move. His income has then been cut by 30% with constant threats for it to go down further. And then, HIS JOB IS THREATENED DAILY by administration making demands that are unreasonable and by reminding him that his is an easily replaceable cog in a machine.

When folks are complaining about patient satisfaction and admin demands, they're not just complaining that they have to keep the patients and bosses happy. That's true everywhere. What they are saying is the requests from SOME of the patients and admin are completely unattainable and are in a setting where everyone's contract reads "we can replace you without notice and for no cause". That is not standard at any job, even at Wendy's I'd get due process and unemployment.

This isn't to say EM is a bad gig. I am perfectly happy and would do absolutely nothing else. But, to claim it's all about money management mistakes that you won't make is utter hubris.

If you think it's sooo easy to pay off all your loans in a few years, why is it that 90% of EM docs haven't done this? They must all be much less enlightened than you. (For they record, mine are almost gone a few years out, but none of my partners are in that situation - it wasn't hard but it IS rare).

 

[EvoDevo]

* @emergentmd 's comment about locums working paying $700K-900K? Not ridiculous. Of course, it involves the kind of life or situations that one may not want to deal with.

But to the overall debate in this thread about the "complainers" vs. those saying "Just suck it up" all seems to come down to one fundamental fact:

Are you (yes YOU!) content with practicing medicine for everyone else's benefit? You know, the hospital c-suite, the CMG execs, politicians, the folks who want unlimited care because they deserve it? If you are the you're probably wondering what all the fuss is about.

Or you may be like me (and @GeneralVeers) and the op and you're decidedly NOT okay with practicing medicine that way. Now, you can either opt out and leave like the OP (good on her) or do locums work for as long as it lasts. Or you can fight. I don't know how to fight this just yet...do y'all?

Too many physicians are full of hot air and aren't doing jack to solve the problem. And ACEP? Fuggeddaboutit. They most assuredly do not care about you, or you, or even you in the back reading this debate but not participating. And the AMA? Hah! Where is the meaningful, well funded push back against the ridiculousness being promulgated against EM physicians (as @Birdstrike so eloquently describes over and over again)? Against other physicians?

*Crickets*

And for @EctopicFetus : Brother, not working for a CMG just isn't an option for a lot of us. Just saying....

 

[EctopicFetus]

* @emergentmd 's comment about locums working paying $700K-900K? Not ridiculous. Of course, it involves the kind of life or situations that one may not want to deal with.

But to the overall debate in this thread about the "complainers" vs. those saying "Just suck it up" all seems to come down to one fundamental fact:

Are you (yes YOU!) content with practicing medicine for everyone else's benefit? You know, the hospital c-suite, the CMG execs, politicians, the folks who want unlimited care because they deserve it? If you are the you're probably wondering what all the fuss is about.

Or you may be like me (and @GeneralVeers) and the op and you're decidedly NOT okay with practicing medicine that way. Now, you can either opt out and leave like the OP (good on her) or do locums work for as long as it lasts. Or you can fight. I don't know how to fight this just yet...do y'all?

Too many physicians are full of hot air and aren't doing jack to solve the problem. And ACEP? Fuggeddaboutit. They most assuredly do not care about you, or you, or even you in the back reading this debate but not participating. And the AMA? Hah! Where is the meaningful, well funded push back against the ridiculousness being promulgated against EM physicians (as @Birdstrike so eloquently describes over and over again)? Against other physicians?

*Crickets*

And for @EctopicFetus : Brother, not working for a CMG just isn't an option for a lot of us. Just saying....

with the ridiculousness that is being pushed on us I will be joining AAEM. I havent been a member but I am convinced that ACEP is run and owned by the CMGs. Our own college is selling us out to the corporate raiders. While this isnt some panacea and I know they wont necessarily change a thing but at least they stand for what I believe in. I wish I could say the same for ACEP.

@EvoDevo Ill just say this, and it is something I firmly believe. We all make CHOICES and while I dont know your specifics I doubt many of us are stuck working at a CMG. You may choose to only live in one location. Your reasons may seem inflexible or they really may be inflexible. I live 2000+ miles from my parents and where I grew up. I chose not to work in a place with horrible job options.

Personally if my current job fell apart I would be on the lookout for another decent job. At some point I may choose to stay here in a crappy job but it wont be for any reason other than my choice which I will then live with.

 

[filhodeinferno]

I don't think any of the people trying to stay positive are want to flame the burned out or stressed.

*(2013 means for debt are 162k for public and 181k for private, with 86% of students owing less than 250k: https://www.aamc.org/download/152968/data/debtfactcard.pdf).

I wanna know where the heck I went wrong with my loans and why I, as a single guy, ended up with more loans than 90% of my peers?

I went to an average priced school, got some modest scholarships, lived within my means...and I have debt in the high 200s. Do most people just get a bunch of kick backs from their daddy that I never got, or what? Where did I go wrong?