New Study: EM physicians significantly higher rate of burnout than other MDs

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

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I loosely read the article and I think its hugely flawed....

They did not specifically ask BOARD CERTIFIED EM Physicians.....

First of all, I think as being trained in EM, we are much better able to 'deal' with the so called stress of the job. I trained at an uber busy Trauma center; I work now at a 'busy' trauma center but I am not as 'stressed' or pulled to the ends as I was in residency. This makes my job 'easy' so to speak...

Second, and the bigger issue, understand that MANY non BC/BE in EM that are working in the ED, often are doing so as a second career. Some people did IM or FP and only ever worked in the ED, but MANY tried 'private practice' or a hospital group or whatever and guess what.. they HATED it. Instead of going to wash dishes, they turned to our specialty. So.. these people are already self selected to burn out ONCE, and naturally they are likely to wish to burn out AGAIN. I think they are likely skewing these results big time....

If you look more at their numbers, MOST respondents where >30 years out of residency. Some of them could be grandfathered, but likely NON of them actually trained in EM as we know it today...
 
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It'd be nice to see further breakdown of the specialties. Which practice settings experience more burnout? We suspect older physicians have more burnout, how does age affect burnout rates? What about salary or hours worked?

In any case, this is just one more study that makes me wish I were smarter and loved skin.
 
I think Rebuilder hit the nail on the head BUT.. 60+%... We all know that the majority of people practicing EM are EM residency trained.

As has long been discussed on here shifting schedules, uncertainty of the job and EM docs overspending all lead to this IMO.

I def find my job way way easier than residency but there is something to the grind. No off service months, no easy months etc. I have found controlling my schedule, enjoying life outside of work and taking proper time off refresh me. Throw in exercise, enjoying time with friends and I feel pretty good.

But these numbers shouldnt be tossed aside. Young and new attendings should heed these warnings. I think the scariest part I have seen (anecdotal) is thta once someone burns out they never seem to get right. Thats real real scary.
 
To paraphrase an old joke:

"There are bold EM docs and old EM docs, but no bold, old EM docs".

The ones I've seen burned out are the energetic, idealistic young ones. It seems like groups suck up their energy and then discard their husks by the wayside. Then the hospital/group wonders why they have to keep putting ads out for new meat.
 
It only makes sense that the easiest to access would actually have the highest burn out.

Surprised to see some surgical sub specialties above general surgery though.

Preventative medicine looks good from this study, lol.

Most interesting findings: Neurosurgery had a relatively low burnout rate and a relatively average work-life balance (alongside FM for work-life balance).

Scary #'s: 37% screened positive for depression and 6% had suicidal idealization in the last year? Wow. (on second look it appears that's pretty normal for all professions).
 
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I hope to be able to burn out by my early 50s. 🙂

Seriously though, I've said it before and I'll say it again. The secret to preventing burnout is to work less. 8 hours shifts. <2 patients per hour. Less than 15 shifts a month.

How many burned out EPs were working 10 or fewer 8 hour shifts? I'd bet very few. Don't minimize the difficulty of working rotating shifts in a stressful environment where you never know what's coming through the door, people routinely lie to you, and you're constantly interrupted. This is not an easy job.

Learn to live on $200K and have a great life and a wonderful career.

P.S. I'd be burned out doing anything for 30+ years.
 
ActiveDutyMD said:
I hope to be able to burn out by my early 50s. 🙂

Seriously though, I've said it before and I'll say it again. The secret to preventing burnout is to work less. 8 hours shifts. <2 patients per hour. Less than 15 shifts a month.

How many burned out EPs were working 10 or fewer 8 hour shifts? I'd bet very few. Don't minimize the difficulty of working rotating shifts in a stressful environment where you never know what's coming through the door, people routinely lie to you, and you're constantly interrupted. This is not an easy job.

Learn to live on $200K and have a great life and a wonderful career.

P.S. I'd be burned out doing anything for 30+ years.
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This is probably the best response to the topic. Anything done for long will probably burn you out. People that go into em seem to be the type that like to do multiple things and get bored with routine easily. They also seem to have low tolerance for beauracracy or however you spell it. Once the red tape gets old and you start being automated in your work, then your probably nearing burn out.

I burned out so quick doing so many other jobs once I got the hang of it, so I can easily see how this job can burn you out if you don't start changing it up (starting to teach or going into administration) as you get older.

Another thing that ActiveDutyMD pointed out was toxic shifts. What I mean by that is 12's at 3 pph is pretty toxic to most individuals. Many of us remember how miserable we were on super long days of only holding a retractor on surgery.

Thanks for the awesome post Active.
 
ActiveDutyMD said:
I hope to be able to burn out by my early 50s. 🙂

Seriously though, I've said it before and I'll say it again. The secret to preventing burnout is to work less. 8 hours shifts. <2 patients per hour. Less than 15 shifts a month.

How many burned out EPs were working 10 or fewer 8 hour shifts? I'd bet very few. Don't minimize the difficulty of working rotating shifts in a stressful environment where you never know what's coming through the door, people routinely lie to you, and you're constantly interrupted. This is not an easy job.

Learn to live on $200K and have a great life and a wonderful career.

P.S. I'd be burned out doing anything for 30+ years.
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Can't make even close 200k for 10- 8 hour shifts where I live Active... and I am not in a big city or particularly desirable place either. Can't even make close to 200k for 15 - 8 hour shifts.
 
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Zanegray said:
Can't make even close 200k for 10- 8 hour shifts where I live Active... and I am not in a big city or particularly desirable place either. Can't even make close to 200k for 15 - 8 hour shifts.
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Show me the gig where active is talking about and I will sign...sight unseen, send me the papers! 😉
 
Hmm that's not great, zanegrey and trumpet. I thought 170-190k was fairly standard for academic jobs even in the northeast (which tends to be the lowest paying region in the country). If you're in a community setting but earning academic pay (or less), find a new job? Not getting 200k for 15 shifts per month is not so good unless somehow you have excellent benefits, although you are working less hours than people who're doing like 12 x 12's.

Anyway, money isn't the end point. To some degree it helps (mortgage, kids, pay back loans, auto loans, vacation, etc). But most of us were able to make it work on resident / fellow salary without too many complaints, so taking jobs for the money or doing a whole bunch of moonlighting isn't necessarily worth it in terms of sacrificing free time / happiness. That's going to lead to burnout right there - taking jobs for money. I've seen friends of mine take $300k+ jobs in eastbufu texas only to find they're working in extremely unethical places, treated like slaves, working with very corrupt administrators, working with ancillary staff who have pathological lying problems with the goal to just make enough money for 10 years and then quite medicine. Ok, but I wouldn't want to be miserable for 10 years - I'm cynical enough already and I don't want my life to be soured by that sort of lifestyle.

The thing that most leads to burnout in my mind is not only toxic shifts, but increasing proportion of toxic patients. I'll work plenty of 12's even at 3 pph with 1/3 of them needing MICU, if the patients weren't manipulative, drug-seeking, abusive, gorked-out *******s. And on the flip side, if they're at least educated and "manly" enough not to ask me to "numb up" their skin for putting steristrips on an already closed lac. Unfortunately, there's few places in this country where patients a) are predominantly nice and b) medically educated to a decent level. It's the combination of an increasing toxic population + toxic shifts that make people want to quit by noon-time.

I moonlight at an urgent care where sometimes I see 5-6 pph (but them sometimes it's really slow). switching to that kind of environment where there's less acuity, generally nicer people, doesn't really make the aggravation of a busy ED shift any less either. I think because of the whole "entitled" nature of people or the manipulative aspect of it too "The ED referred me to this UC for pain management," and inefficiency of ancillary staff.
 
Leo
I would like to be somewhere I could work that few "8hr shifts", see less than 2/hr, and still come out with 200.
Where I am I would need a lot more shifts and keep doing 2.5-3 per hr, which is what I actually do and I'm not a fan.
 
I hear ya... There's some academic places where you can buy down your time and do 8 x 8's a month (or less). Not likely to be < 2 pts pph regularly, though. And of course, those jobs are very hard to come by and the academic committments are far greater than the clinical ones, which may not suit many people. I guess there's no real ideal job that's also financially viable.
 
quagmire223 said:
I hear ya... There's some academic places where you can buy down your time and do 8 x 8's a month (or less). Not likely to be < 2 pts pph regularly, though. And of course, those jobs are very hard to come by and the academic committments are far greater than the clinical ones, which may not suit many people. I guess there's no real ideal job that's also financially viable.
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As illustrated by the above posts, it very much depends on what you mean by financially viable. I haven't looked into academics recently, but unless you have significant by-down the total hours worked is the same or only slightly less than in the community. I honestly can't imagine seeing <2pph on a regular basis, and the standard for the big CMGs is to be between 2.2-2.5 pph. If you're routinely seeing >3pph, unless your admit rate is absolutely dismal, than your shop is understaffed (either by intention or the inability to recruit). Patient population makes a huge difference, and with the right population you can work far longer hours and be busier and still have minimal burn-out. I moonlit at two places in residency that had polar opposites in terms of patient population. Hospital 1 was in a very rural area and had amazingly pleasant patients (even the one's that left AMA were really nice and gracious) and I'd see 3+ pph and feel great on the hour long drive home. Hospital 2 was in a rural area where 75% of the patients I saw were there either directly or indirectly as a result of substance abuse (primarily meth). Most of the visits ended up being transparent grabs for Schedule II meds. I left feeling like crap, despite seeing maybe 1.5 pph and never went back after completing the shifts I had initially scheduled.
 
leorl said:
The thing that most leads to burnout in my mind is not only toxic shifts, but increasing proportion of toxic patients. I'll work plenty of 12's even at 3 pph with 1/3 of them needing MICU, if the patients weren't manipulative, drug-seeking, abusive, gorked-out *******s. And on the flip side, if they're at least educated and "manly" enough not to ask me to "numb up" their skin for putting steristrips on an already closed lac. Unfortunately, there's few places in this country where patients a) are predominantly nice and b) medically educated to a decent level. It's the combination of an increasing toxic population + toxic shifts that
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Agree with this. I can see 3 pts/hour and be perfectly happy and not depressed when I go home, if they were mostly nice, reasonable people who aren't asking for insane thing and/or threatening me.

There are some shifts where I think each and every patient is going out of their way to make me hate them. It's those shifts where I feel drained of energy and question going on. It's Press-Ganey and the fear of retaliation from the hospital for too many complaints that makes it so hard to deal with these people.
 
I fortunately work at a place that doesn't seem to put too much weight on PG scores. Obviously to the hospital it matters a bit, but everyone in our dept including our chair recognizes it's a crap way to assess people and there's so many confounding and false variables. I can call out the pain seekers, rip up their narcotic prescriptions in front of their faces and tell people they have unrealistic expectations without worrying about them writing me up. What's really funny is that we have the same staff that rotates through 2 sites, one site has excellent PG scores and the other site has dismal PG scores. That right there highlights the inaccuracy and variability in PG scores.

There needs to be a large study (like the one that recently came out against the CMS and CT scanning) that blasts use of PG scores, especially in an ED setting where we are not in charge of the chronic conditions that most people come in with. I approach each of my patients with some degree of empathy and try to explain things to the best of my ability, but if they're either a) an ******* b) entitled up the wazoo c) sorry to say too uneducated, then it really is not worth my time or anxiety. You can't fix problems that are behavioral or just can't be fixed. (I once asked a patient about the scar she had on her LUQ. She said "Oh, yeah I had knee surgery there." There's no point explaining anything in that situation.)

I'd say if I had unreasonable pressure of PG scores + toxic population + toxic shift, I would probably quit really early. People wonder why we see the negative aspects of things when indeed, negative crap is really what actually comes through our doors and what we see the most, and it's actually a blessing to receive someone who is "normal."
 
leorl said:
What's really funny is that we have the same staff that rotates through 2 sites, one site has excellent PG scores and the other site has dismal PG scores. That right there highlights the inaccuracy and variability in PG scores.
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Is there a difference between wait times at the two sites? I would be unsurprised if the same doc got much worse scores at a place with an average wait time of 90 min than at his or her other shop with an average wait time <10 minutes.

That's to say that PG does NOT actually measure what it's supposed to.
 
We work at 3 different sites with different populations. Our PGs are reported as 3 separate scores. One month I'll be at 99 percentile at one place and 20 percentile at another. Makes no sense whatsoever.
 
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GeneralVeers said:
We work at 3 different sites with different populations. Our PGs are reported as 3 separate scores. One month I'll be at 99 percentile at one place and 20 percentile at another. Makes no sense whatsoever.
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It makes perfect sense - your PG score is totally unrelated to the care you provide.
 
WilcoWorld said:
It makes perfect sense - your PG score is totally unrelated to the care you provide.
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If you're an ass than it correlates well, otherwise it's almost completely tied to length of stay and how nice your nurses are to the patient. There was a nurse that was new to triage who didn't radiate compassion, every pt she triaged that got a PG survey rated everyone significantly lower than they usually scored. It basically takes one poor part of the encounter to toss your scores down into the dumpster. Shops with good PG scores tend to be extremely authoritarian, since even minor deviations in perceived courtesy will drop you out of the vaunted 90% or even 75% percentile.
 
Arcan57 said:
If you're an ass than it correlates well, otherwise it's almost completely tied to length of stay and how nice your nurses are to the patient. There was a nurse that was new to triage who didn't radiate compassion, every pt she triaged that got a PG survey rated everyone significantly lower than they usually scored. It basically takes one poor part of the encounter to toss your scores down into the dumpster. Shops with good PG scores tend to be extremely authoritarian, since even minor deviations in perceived courtesy will drop you out of the vaunted 90% or even 75% percentile.
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Perhaps in an attempt to be punchy I came across as an ass above, if so I apologize. I'm not trying to be argumentative - I agree with GV & Leorl. What I'm trying to say is that for the majority of docs PG scores do not reflect courtesy or quality of care - they reflect wait times and length of stay.
 
WilcoWorld said:
Perhaps in an attempt to be punchy I came across as an ass above, if so I apologize. I'm not trying to be argumentative - I agree with GV & Leorl. What I'm trying to say is that for the majority of docs PG scores do not reflect courtesy or quality of care - they reflect wait times and length of stay.
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Sorry, not implying you were an ass. I meant to say that the only way to guarantee a certain PG doc score is to aim low and be rude consistently. The saints and gamers will have higher scores than the average and unschooled in the ways of PG, but very few providers will have enough surveys to be statistically significant in any given year. Thus noise and general trends have a higher impact as you mentioned.
 
Where are you guys working?

8 hours per shift x 10 shifts a month x 12 months a year =960 hours a year

$200K/960 hours = $208/hour

If that seems unreasonable I suggest you look around. Our group is seeing far less than 2 pph and $208/hour would be probably the lowest paycheck we've seen in years.

Are you guys seeing 50% Medicaid and 25% self-pay or are you somebody's employee?

If you need 15 8-hour shifts to make $200K, that's a total of 1440 hours, or $138/hour. That seems pretty far below market rate for a BC EP to me, but you can work for whatever you want I guess.

According to the Daniel Sterns 2012 survey of EPs, the average employee makes $150 per hour (10th percentile $110/hr, 90th percentile $200/hr), the average independent contractor makes $170 ($120-230), the average partner makes $180 ($123-230).

So I don't think $208/hr is all that unreasonable. If I was seeing 3 an hour I'd expect A LOT more compensation.

But even if $200K is too much, just rephrase my statement to read that the secret to being happy as an EP is to learn to live on $150K or $100K or whatever.
 
I can say that our hourly is far less than that. We re in las Vegas. Its a large CMG so we do loose some to the "corp"
I suppose the benefits are good.
What part I the country you in Active?
 
TrumpetDoc said:
I can say that our hourly is far less than that. We re in las Vegas. Its a large CMG so we do loose some to the "corp"
I suppose the benefits are good.
What part I the country you in Active?
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Just up the road 6 hours.

I should mention that my benefits including malpractice insurance and the employer's share of payroll taxes haven't yet been taken out of that hourly I'm talking about.
 
Reno?
That sounds like good stuff!
Jealous 🙂
 
ActiveDutyMD said:
I looked at jobs in Reno, and found a group I really liked there, but they weren't hiring the year I needed a job. Try the other road out of town. 🙂
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What is your schedule like? How many overnights in a month?
 
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I think the discussion above, and this figure highlights that the burnout seems mostly related to our work environment - being evaluated on metrics which we have little control over, difficult patient population, always applying work-arounds to hospital-wide problems etc - rather than from our work-life balance. Though, I agree if you are working to live then that is always going to be stressful.

iride
 
community shop, 40k/yr, northeast

base rate $150/hr as an employee, extra $30-50/hr quarterly as a partner. though that hourly does not take into account expenses such as med mal, insurance, etc., which drives the hourly down.

most of my group average 1200 hr/year and are happy. for us young hungry dudes we hit 1400-1600/yr. getting a little crispy after two years of this. pph 1.5 on average. you may think this is low, but we have highly educated, but also highly entitled patient population. there's also a significantly higher percentage of flat-out insane patients where i work.
 
I worry.. am I in the Mecca of EM?

One of the groups in town hires their employees at $180/hr add another $40/hr for nights. Work as much as you want. Less than 2 pph..

My job is even better than that and there are other jobs in town at $200/hr..

Medicare is paying around $40/RVU.. if you are at a below avg job with self pay (avg is 16%) so 25%.. you are likely doing 4 RVUs per patient so.. im just missing something.. the numbers dont seem to add up..
 
Employee of "big corporate group" in Florida. $175/hr plus benefits. 2 pts/hour by yourself for sure... and then you have to oversee the midlevels. I like my job.

There's two things that I want to add here:

ActiveDuty's ideal holds up.... as long as you don't have crushing student debt. I pay on the north side of 5K/month OUT in debt. Then there's all the other expenses, etc.

Also, I have found my own "grand folly". I used to think that I would enjoy face-time with patients and educating them as to what's gone wrong and how they can be involved in their care. Now, (only six weeks in), please.... please give me the critical care patients so I don't need to hear whining about how they're dissatisfied with X-Y-and Z and how there wasn't a chocolate on their pillow when the nurse wheeled them to their room.

It really says something about the field when I'm brand-spanking-fresh-new to the attending-world and I already feel this way. Don't get me wrong: I walked in to the hospital early today, walked up to the ICU, and hugged the guy that I resusc'ed two nights ago that was extubated, off of his pressors, and giving me two thumbs up, saying "thank you".

He had an emergency. Emergency Medical Services brought him to the Emergency Room for Emergency Care.

The rest of the folks...
 
Dude, you are way too cynical, way too early.
 
RustedFox said:
Employee of "big corporate group" in Florida. $175/hr plus benefits. 2 pts/hour by yourself for sure... and then you have to oversee the midlevels. I like my job.

There's two things that I want to add here:

ActiveDuty's ideal holds up.... as long as you don't have crushing student debt. I pay on the north side of 5K/month OUT in debt. Then there's all the other expenses, etc.

Also, I have found my own "grand folly". I used to think that I would enjoy face-time with patients and educating them as to what's gone wrong and how they can be involved in their care. Now, (only six weeks in), please.... please give me the critical care patients so I don't need to hear whining about how they're dissatisfied with X-Y-and Z and how there wasn't a chocolate on their pillow when the nurse wheeled them to their room.

It really says something about the field when I'm brand-spanking-fresh-new to the attending-world and I already feel this way. Don't get me wrong: I walked in to the hospital early today, walked up to the ICU, and hugged the guy that I resusc'ed two nights ago that was extubated, off of his pressors, and giving me two thumbs up, saying "thank you".

He had an emergency. Emergency Medical Services brought him to the Emergency Room for Emergency Care.

The rest of the folks...
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The saves are awesome but are even rarer in the community than in residency. It's not enough to balance out constant negativity. If you can establish rapport and set expectations early, it can mitigate a lot of the routine soul-draining whining that patients produce.
 
I find these studies and the attending's responses who have been out working for several years to be immensely valuable. Basically... this is a second career for me and I'll graduate at 38 next year. I sometimes wonder about the burnout issue and how it should affect my decision on what type of practice environment to look for as my first job. At the moment, I feel pretty energetic and positive but I sometime wonder what I'll feel like 10 years from now or 20. I had a candid discussion with a locums physician who is probably around 60 and had worked in every ED environment imaginable. We were working in different ED's that weekend for the same company and he had an amazing amount of insight into how to avoid burnout. We must have talked for about an hour outside our hotel rooms and he had some great advice. I've never considered it a threat, but studies like this worry me sometimes when my gut instinct is to look for level 1&2, high acuity ED's to work in my first year out. Maybe I should be looking for a less stressful environment, but I enjoy the challenge.... at the moment.

Do you guys think you first job outside of residency should be a significant challenge or not?
 
Groove said:
I find these studies and the attending's responses who have been out working for several years to be immensely valuable. Basically... this is a second career for me and I'll graduate at 38 next year. I sometimes wonder about the burnout issue and how it should affect my decision on what type of practice environment to look for as my first job. At the moment, I feel pretty energetic and positive but I sometime wonder what I'll feel like 10 years from now or 20. I had a candid discussion with a locums physician who is probably around 60 and had worked in every ED environment imaginable. We were working in different ED's that weekend for the same company and he had an amazing amount of insight into how to avoid burnout. We must have talked for about an hour outside our hotel rooms and he had some great advice. I've never considered it a threat, but studies like this worry me sometimes when my gut instinct is to look for level 1&2, high acuity ED's to work in my first year out. Maybe I should be looking for a less stressful environment, but I enjoy the challenge.... at the moment.

Do you guys think you first job outside of residency should be a significant challenge or not?
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Yes, it should be a challenge. Dropping down in acuity is much easier than the reverse. Especially as you are setting practice patterns for your attending career, it's important I see enough sick people that what you learned in residency is reinforced. The more you get used to seeing unchallenging patients the duller your Spidey sense becomes. If you get used to cutting corners ( because you never see complex patients or because the hospitalist cleans up your messes), when you move to an environment that's less forgiving than M&Ms start racking up. And there usually isn't an awareness that you can't meet the challenge because you spent a couple of years as an attending getting away with things that you never should have gotten used to doing.
 
Groove, medicine is my second career as well.

I also graduated from residency when I was 38.

I've been practicing for 10 years now. I was and am a nocturnist.

I have found that with kids and family, that I seem to be doing more days, so that I can be with my family more.

I've also found that I can't do a string of 7-8 nights without feeling it more. I used to do those so that I could take 7-10 days off.

I think how one handles stress is very individual dependent.

Do whatever you can do to recharge the batteries and heal your mind and body.

I'm at a point where the place I work is a trauma center but we also staff rural places. We also have an urgent care. Some our older staff who's been here 20+ years have transitioned to urgent care w/o a misstep.

I can see myself doing this for another 20 years. Knock on wood.

Don't look for a place. No ideal place exists.

Look for the people and environment where you can thrive, prosper, and mature.
 
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Groove said:
I had a candid discussion with a locums physician who is probably around 60 and had worked in every ED environment imaginable. We were working in different ED's that weekend for the same company and he had an amazing amount of insight into how to avoid burnout. We must have talked for about an hour outside our hotel rooms and he had some great advice.
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Would you mind sharing some of this insight/advice?
 
I think you have to compare the burnout to the work life balance... I mean, you could be more burned out than a general surgeon, but the general surgeon also is divorced and has a non-existent work-life balance.

There are certainly trade-offs. Comparing EM to derm is one thing, but comparing EM to some other fields like Anesthesia / surgery / radiology... lots of fields have problems. Anesthesia will probably have mostly nurses in 15 years, radiology will always have the issue of competiting across the entire US or maybe even the entire globe if medical laws change (I mean, what if someone approves the use of radiologists in a certain foreign country to lower costs... anything is possible, especially when the words "lower costs" are involved in that anything).
 
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