(I've posted this before, but I thought it would be more appropriate to place it here on the sticky. So, if you've already read this, I apologize.)
Warning: just one man's opinion.
Pros:
There is no call and no business/practice to run. No staff to hire and fire.
The adrenaline rush can be cool at times.
When you are off, you are off (sort of, see "cons").
It's the highest paid specialty for the shortest residency (3yrs).
You are a "real doctor". Despite the many consultants who will try to make you think they are superior, you are the only one who can see ANYTHING. The only one with the courage. You are the only one with the courage to walk in that room and take on any patient, any challenge. You're not a neurosurgeon who says, "I only do spines, not brains". Or the plastic surgeon who says, "I do eyelids, but not tear ducts." You do brains, spines, car accidents, heart attacks, adults, kids, normal people, crazy people, surgical patients, non-surgical patients, everything. You at least see the patient, do what you can, a do what's right. This is probably the coolest thing about the specialty. I think most of the ER bashing you see and hear from other specialties is that deep down it kills them to know they gave this up. It covers up a huge insecurity that a lot of "specialists" have. Deep down they know that when the s—t hits the fan, and the secretary at their office collapses and goes into cardiac arrest and they're shaking in their boots, they're going to call 911-that's you. If someone collapses on an airplane at 37,000 feet and they call for a doctor you'll know what to do. You're everyone's hero even if they don't say it. You won't have to say, "Yes I'm a doctor, but I only do rectums". Also, there is nothing cooler than bringing a young person through a life-threatening situation and saving a life.
It's the most secure profession on the planet. Recession, depression, peace, war, people will always get sick. And if not, they'll still go to the ER, trust me. People love the ER. More visits yearly than Disneyworld. You'd think they're giving away free stuff (oh, wait, they are).
Cons-
When you're off, you're not really off. On a huge number of days "off", you may have worked the night before until 2, or 3, or 5 in the morning on the day you are "off". The shift work thing is fine, when you're 28 single, or even just married without kids. Who cares, you just sleep all day. You work Friday, Saturday and Sunday…who cares? You're off Monday, Tuesday and Wednesday. When you have a family, the "lifestyle specialty" does a complete 180 on you. If you work 2 pm – midnight Monday through Friday one week, you don't see your kids, at all (if they're in school). Or you work a stretch of 4 or 5 or 6 night shifts….no big deal right, you've got 4 days off? Well, the first 2-3 days, you're a post-nights zombie who wants to sleep all day and be up all night. Your first 2-3 days "off" you're miserable trying to recover from your nights. Then guess what, back to day shift. Jobs where you don't work any nights are rare. If you have one, never let it go. It still doesn't get you out of the 3pm-11pm shifts, or 6pm – 4am shifts, etc. Those aren't "nights". In my medical school ER rotation, they let us off easy and didn't make us do any overnights. I think if I had been forced to work a tougher schedule that month, I may have chose differently. Probably not, though. The shift work is the biggest reason I'm leaving the specialty. I think if I could work in the ED 7-3pm or even 8am-6pm, Monday through Friday, I probably wouldn't be leaving the specialty. There's just very little way around it at most jobs. It's a necessary evil of the specialty and just kills you as time goes on. It has eaten away at me like a cancer. Shift work sleep disorder is actually a diagnosable disease now, and I think most, if not all ER doctors have some degree of it (yet we pretend it's no big deal and soldier on). Rotating shift work has actually been shown to take years off your life, much equivalent to the effect of a pack per day smoking, due to the stresses. I can't wait until I can live a normal life again.
You are either an employee or a "de-facto" employee of a group or hospital. You may be a "partner" but really you are highly paid hourly help. You or your group can be thrown out any day, sometimes with no notice. It happens all the time. It hasn't happened at my group, yet, but guys have left my group and gotten thrown out, or been thrown out and come to work at my group. They bring in cheaper help. Yes, it's that simple. See, you don't bring any "business" into the hospital. In fact, the hospital is doing you a favor by giving you patients to see, that you can bill. If you leave, your patients will not follow you and take business (money) from the hospital. Yes, it's all about money. All "for-profit" hospitals care about is profits. All "not-for-profit" hospitals care about is profits (they just don't call it "profit", its called "re-investment"). The "profits" are put back into the system (and not necessarily in your pocket). When you don't bring any money into the system, what you say doesn't matter. If your department wants an ultrasound machine, it may not be in the budget. If the hospital wants some new computer system that saves money but makes your job miserable, tough. If there are ten things about the hospital that you could easily fix to make your job easier, they may not care, if the fix is not in the budget.
The adrenaline rush gets old. 4 critical traumas at 5 in the morning when a minivan full of kids rolls over may not always be fun when it's just you and a few nurses. Putting a chest tube in when you're a resident: cool. Telling a 10 year olds' parents that their son is dead, when they didn't even know he was in the ER: brutal. This never gets any easier. Not for me anyways. Not if you're even partly human. Dermatologists don't have to do this. Radiologists don't have to do this.
Working a small set-number of shifts per month is getting harder and harder to do. In the future, it may be impossible. Let me explain: there is a huge shortage of ER doctors. In fact, roughly 40% of ER hours are covered by non-board certified (non-ER) doctors. Could you imagine if 40% of neurosurgeon jobs were covered by non-neurosurgeons? Hospitals and the government are getting more and more intolerant of 12hr, 6hr, or even 1 hr waits in hospital EDs. In fact, at my hospital, if the ER wait is more than 45 min the hospital CEOs boss's, boss's, boss, who is in another state watching a computer screen following all of his ED wait times, calls immediately in a panic and raises h--l due to the increased wait times. Of course this is always when you're most stressed and working way over red-line. They never send in an extra nurse, tech or unit secretary. The assumption is that you're all a bunch of inefficient screwballs. It's infuriating. The point is this: they may want you to work 14, 15, 18 or 24 shifts a month because there aren't enough ER doctors, PAs or nurse practitioners to achieve these numbers. The old policy of "see the sick ones and the not-so-sick can wait, is becoming extinct. Patients are money, and they want you to see them fast, and 24 hours a day, at night, on weekends and holidays, too. They want you to see everybody within 5 minutes, even if there are critical patients to attend to. Its impossible, but they don't care. Not all hospitals are as aggressive about this as the one I'm at, but they will be. When they see the $ signs, they'll all be doing it. They've got live ER wait times posted on a billboard now on the highway, directing people in!
Despite the hero factor, you won't get paid like one, or be appreciated like one. Yes, you'll do very well, but like a soldier, police officer, school teacher, you'll always get way less than you deserve. 2/3 of the bills your group sends to patients won't get paid. That's your money down the drain. People who can't afford their own house payment will save up for years for breast implants, or drop cash on beer, drugs or cigarettes, but when it comes down to paying you a couple hundred bucks for literally saving their life, they won't hesitate to rip that bill up and throw it in the garbage, because you're a "rich greedy doctor" and you "make too much". Yes, a 2nd string football player on the worst football team in the NFL, makes thousands for making a catch in a losing football game. You save a life and 2/3 of the time you make nothing. Yes, nothing. You can, however, get sued for millions of dollars by patients who you're required by law to see, yet who are required to pay you nothing.
You're treated with unfathomable contempt and disrespect at times. One day, I had the most hair-raising, sphincter-clenching airway case I've ever had. I had a 500lb asthmatic who came in on Bipap who needed to be intubated (put on life support). I go in to intubate her and she's got a tongue the size of a football, her sat drops to 50% (dying) and I can't get the tube. My two partners and I take turns struggling to get this lady intubated using multiple techniques before she dies, which is going to be very soon, minutes, seconds. She's young and she's going to die, right now. No one can get any airway in and she's not breathing, at all. I call ENT and anesthesia (which I'd never done before, in years of practice) and plan on cric-ing this ladies' neck (cutting a hole in her neck and putting a tube in), which is going to be an abominable nightmare since she's 500lbs with no neck at all. Luckily, thank god, my partner tries again and blindly, luckily, gets the airway before we need to cric her and before any consultant arrives. It's the worst case of almost any kind I've had in years, but thank god, we saved this ladies life. None of this so far is what bothers me. Here's the kicker: I walk out of the room and this old man in the room next door starts swearing at me, pointing his finger in my face nearly spitting centimeters from my nose saying he's been on the phone with his lawyer and he's going to sue me because his (adult) daughter who's totally stable and barely sick enough to be in the hospital had been in the ER 4 hours and wasn't upstairs to a room yet. I said to the guy, "I was next door, working to save that ladies life. We saved her life." He had watched the whole thing, he said "I don't care, we're going to sue you!! We're going to sue you! You hear me, sue the pants off you!" This is not the first time this has happened. I've coded children who've died after working to save them for what seems like forever and immediately after returning to my other patients who've now been waiting for hours, I've been sworn at and verbally berated because someone who came in for a stubbed toe had to wait while I worked on a dying child. It's truly unbelievable. You can let this roll of your back the first 50 times, but at some point enough is enough.
I'm not saying the specialty is all bad. There's lots of great things about it, but make no mistake about it, it's not for p-----s. It takes a special person to do this. It takes an even more special person to do it for 25 years.
