Anesthesiology vs Emergency Medicine

[WilcoWorld]

My FBI buddy trained at UCLA in the 1990s. Even then, he said many of his residency classmates were writing screenplays. So 30 years ago, EM residents were looking for an out even before they finished training.

Excellent point, it's sort of our stereotype.

EM attending by day (err, by night)
Scuba Instructor by weekend (err, Tuesdays)

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Members don't see this ad.

 

[nimbus]

I worked with a guy that was in residency with Pam Dyne all those years ago, and, she was leadership material even then. This guy is a practicing attorney now, along with EM.

Excellent point, it's sort of our stereotype.

EM attending by day (err, by night)
Scuba Instructor by weekend (err, Tuesdays)

You all are pretty ADD😂


Attorney/FBI agent/scuba instructor/EM doc/astronaut/etc

 

[namethatsmell]

My fellowship was housed in an anesthesia dept and most of my co-fellows came from anesthesia base training.

Their job market is phenomenal right now and while gas jobs can certainly be stressful, it seems to be a standard deviation or two lower than what we deal with in the ED.

Thing is, nobody knows how the future will impact the job market. In 10 years the gas job market may be crap and, while very unlikely, the EM market may be wide open.

But an important thing to ponder: no matter what, in 10 years anesthesia will still be very protected from the worst aspects of our health care "system." Whereas EM will almost certainly still be the swiss army knife bandaid that everybody-- patients and "stakeholders" alike--will insist be at their disposal to help solve all their problems. And unless somehow EM docs band together to control how our turf operates, it'll continue to be PG-this and metric-that while we're still expected to juggle an increasing amount of flaming knives. Some people truly do love that challenge, and if you're lucky enough to find a job that protects you it can be a great field. Otherwise, consider gas.

 

[kidthor]

As a med student I went in thinking EM but eventually became a pediatric anesthesiologist. I actually applied to both EM and anesthesia in the match but ended up only ranking anesthesia programs. I liked EM a lot but the schedule flipping, constant weird turf/respect issues (coming from consultants and such), and field competitiveness turned me off (at the time it was getting hard to match). The final deciding factor was that almost all of the anesthesiologists seemed cool to me, whereas some EM people seemed off to me. By that I mean most were actually cool but the odd ones were very odd. And no offense to the EM people in here, it just wasn't a personality match between us. So I chose anesthesia because the people seemed like my people, I liked the field, and it had more personal/physical/emotional longevity potential.

All that said - anesthesia was the right field for me, but I immensely respect EM as a field. It's a tough job, the people who do it are wizards at managing multiple varied patients and people, and it's cool to be the one stop shop that can fix patient issues (or at least direct them onward). Certainly nobody comes to the OR to see me, but I'm ok with that.

 

[Dral]

Thanks for the response. You got it spot on.

Even if you don't do much general medicine, do you find anesthesia intellectually stimulating and rewarding enough?

Do you feel like you work with a satisfying amount of day-to-day variety?

Any major downsides you've encountered?

I need to clarify...I am not an anesthesiologist, but in a field that does less general medicine than Anesthesia does. I am perfectly happy with my day to day variety. It may sound odd to someone still in medical school, but a lot of days I am perfectly happy and content to have a day full of bread and butter with an interesting thing or two thrown in. Maybe not everyone feels the same way, but once you're out a few years, a full day of curve balls can get a bit unnerving and stressful tbh.

I'm hard pressed to come up with any significant downsides to what I do. However, I think you asked that in the context of me possibly being an anesthesiologist.

Whatever you choose, pick the bread and butter that you'll be happy with. It honestly doesn't have to be what you think you like best. If you like the idea of EM bread and butter (probably a bit harder to define than other specialties) better than Anesthesiology bread and butter, you can still be perfectly happy with Anesthesiology. There are numerous other parts to the equation. For instance, in my clinic days, I generally get more satisfaction from my patient interactions and teaching patients about their conditions and how to treat them than I get from the pathology I see.

I don't mean to burst any bubbles, but the further you are along, the more you realize this is generally just a job like anyone else is doing. There are some people who are in this as a calling. I'm not going to deny that. I mean, I wasn't 16 years old talking to all my friends about how that if I didn't get to be a small town family med doc or inner city trauma surgeon I just wouldn't know what to do with my life. Use a gestalt of all the things you know up to this point to pick what you think will make you happy and don't look back.

 

[turkeyjerky]

@Dral's post is spot-on.

I'm trying to think about what our 'bread and butter' our. When I was starting out, I thought it was trauma (major and minor), medical resuscitations and acute complaints (major and minor). Now I realize it's weak old people w/ poor social support, anxious young people and drug seekers feigning medical pathology.

 

[RuralEDDoc]

@Dral's post is spot-on.

I'm trying to think about what our 'bread and butter' our. When I was starting out, I thought it was trauma (major and minor), medical resuscitations and acute complaints (major and minor). Now I realize it's weak old people w/ poor social support, anxious young people and drug seekers feigning medical pathology.

Thankfully drug seekers are not as common in many places due to policies around IV opiates and sedatives. “We don’t refill scheduled meds” is a great policy for an ED.
“I’ve fallen and I can’t get up” is about half of what I see, which is pretty lame.

 

[oldtown]

I need to clarify...I am not an anesthesiologist, but in a field that does less general medicine than Anesthesia does. I am perfectly happy with my day to day variety. It may sound odd to someone still in medical school, but a lot of days I am perfectly happy and content to have a day full of bread and butter with an interesting thing or two thrown in. Maybe not everyone feels the same way, but once you're out a few years, a full day of curve balls can get a bit unnerving and stressful tbh.

I'm hard pressed to come up with any significant downsides to what I do. However, I think you asked that in the context of me possibly being an anesthesiologist.

Whatever you choose, pick the bread and butter that you'll be happy with. It honestly doesn't have to be what you think you like best. If you like the idea of EM bread and butter (probably a bit harder to define than other specialties) better than Anesthesiology bread and butter, you can still be perfectly happy with Anesthesiology. There are numerous other parts to the equation. For instance, in my clinic days, I generally get more satisfaction from my patient interactions and teaching patients about their conditions and how to treat them than I get from the pathology I see.

I don't mean to burst any bubbles, but the further you are along, the more you realize this is generally just a job like anyone else is doing. There are some people who are in this as a calling. I'm not going to deny that. I mean, I wasn't 16 years old talking to all my friends about how that if I didn't get to be a small town family med doc or inner city trauma surgeon I just wouldn't know what to do with my life. Use a gestalt of all the things you know up to this point to pick what you think will make you happy and don't look back.

I’m with you on not needing the excitement or challenging cases anymore. I’ve gotten to the point where a perfect ER shift for me would be 20 uncomplicated UTI’s. UA- Keflex rx- next. Every damn day.

 

[nimbus]

OP, all what I say doesn't necessarily apply to you, but I'll say that the notion of giving up gen medicine knowledge sounds tough. It gives one an internal struggle and forces you to ask the question "Why did I even do this to begin with if I'm going to give up the general base of all of it?"

For most people, it's good to struggle with that concept. However, in the end most of us get over those things without regrets when we're doing whatever we've chosen that doesn't involve them.

I don't do general medicine. I'm personally ok with not remembering how to diagnose Addison disease just as much as I'm personally ok (understatement) with forgetting how to formulate insulin protocols.
I don't ever use a stethoscope, otoscope, ophthalmoscope, or read EKGs.
I can count on one hand the number of times I've worn a white coat over the last few years

I'm perfectly happy with what I'm doing and if I could go back in time, I wouldn't change my path

It sounds like Anesthesiology is what you want to do more.

As a final note, I do on occasion have the urge to wear one of those head mirror things and regret not ever getting and wearing one. They're pretty bad-assed.

Regarding giving up general medical knowledge, I know a couple of anesthesiologists who have gone the full-time Botox/filler/iv infusion route and are very happy with their Aston, G wagon, and boat. I’m sure EM docs have done the same. There are other ways to get satisfaction in life.

 

[EctopicFetus]

I was in this exact same position and remember scouring similar SDN threads trying to answer this question. I ultimately chose anesthesia and have no regrets.

Pros:
-Lower stress overall (occasionally things get hairy but most of my time is doing elective cases in somewhat healthy patients)
-Higher pay. I’m pretty sure I make more annually and per hour than most ER docs. Our group’s ‘base package’ is about 35-40hrs/wk with an embarrassing amount of vacation, but you can always work more if you want to make more.
-Better hours. I take a lot of call but ~80% of my work hours are during weekdays when my spouse is at work and kids are at school.
-Still get to do cool stuff. Plenty of big cases, lines, trauma etc in my job but the excitement from those things fade pretty quick.
-There’s a pretty big filter between us and all the dregs of society that show up in the ER. Also I haven’t had to tell anyone they or their family member are dying/dead since residency. I think it’s a less depressing job overall.

Cons:
- With rare exceptions I never know when I’m coming home. I leave when the case is done, or maybe when the add-on after that is done.
- Sleep in a hospital call room 4ish nights a month
- Screaming pregnant women at 2AM
- I’ve lost some of my general medical knowledge, can’t suture for ****. My kid had a nursemaid elbow and I totally missed it—had to pay an ER doc to fix it on a Saturday.


If you think you could be happy in anesthesia I suggest it pretty strongly. You could always do CT or ICU if you find bread and butter anesthesia boring and want more skills/excitement.

Overall I think I have a better life doing anesthesia than I would have had doing EM, but I sure respect the skills and knowledge of ER docs in the trenches 24/7. Hopefully things improve in your job market—you guys deserve way better.

Just chiming in. I think in EM the job market blows especially the outlook for the job market That being said as others pointed out paid vacation is a total misnomer In medicine.

Much of the answer to the question lies in the specific job you get after residency. I have a “unicorn” job. My pay is set in 3 month blocks as a % of collections. I can take a month off, I can also take a year long sabbatical. I work under 100 clinical hours a month. I make significantly more than the avg EM doc. I make more than most anesthesia docs and work way less. It’s not all sunshine and daisies as we are beholden to the C suite buffoons with little opportunity to control things like RN and tech staffing. In many ways we are like teenagers in our parents home asking for stuff. In Anesthesia I assume this is like dealing with a difficult surgeon. I dont know the comparison.

I am confident in anesthesia there are more “good” jobs than in EM. That being said anesthesia seems horrible to me. It doesnt meld with my personality. I like others would advise toward anesthesia but with the caveat that you have to get a good job. I would only train somewhere that put some effort into teaching you the business of anesthesia or EM. Don’t train at an HCA site as those are designed to create lemmings who will fill the corporate coffers and be excited about free pizza and pet rocks.

 

[turkeyjerky]

Thankfully drug seekers are not as common in many places due to policies around IV opiates and sedatives. “We don’t refill scheduled meds” is a great policy for an ED.
“I’ve fallen and I can’t get up” is about half of what I see, which is pretty lame.

Yeah, I misspoke. Meant to write something along the lines of 'patients w/ substance use disorders, often iatrogenic, who possess extremely poor insight and present repeatedly with non-emergent, often medically unexplainable, symptoms.' I don't actually mind true drug seeks that much, it's a quick discharge.

'Fell, couldn't get up and now refusing to try' is definitely in the top 5.

 

[nimbus]

Just chiming in. I think in EM the job market blows especially the outlook for the job market That being said as others pointed out paid vacation is a total misnomer In medicine.

Much of the answer to the question lies in the specific job you get after residency. I have a “unicorn” job. My pay is set in 3 month blocks as a % of collections. I can take a month off, I can also take a year long sabbatical. I work under 100 clinical hours a month. I make significantly more than the avg EM doc. I make more than most anesthesia docs and work way less. It’s not all sunshine and daisies as we are beholden to the C suite buffoons with little opportunity to control things like RN and tech staffing. In many ways we are like teenagers in our parents home asking for stuff. In Anesthesia I assume this is like dealing with a difficult surgeon. I dont know the comparison.

I am confident in anesthesia there are more “good” jobs than in EM. That being said anesthesia seems horrible to me. It doesnt meld with my personality. I like others would advise toward anesthesia but with the caveat that you have to get a good job. I would only train somewhere that put some effort into teaching you the business of anesthesia or EM. Don’t train at an HCA site as those are designed to create lemmings who will fill the corporate coffers and be excited about free pizza and pet rocks.

That is a great point. There is a huge amount of variation within both specialties.

 

[Robotic Wis-Hipple]

As a med student I went in thinking EM but eventually became a pediatric anesthesiologist. I actually applied to both EM and anesthesia in the match but ended up only ranking anesthesia programs. I liked EM a lot but the schedule flipping, constant weird turf/respect issues (coming from consultants and such), and field competitiveness turned me off (at the time it was getting hard to match). The final deciding factor was that almost all of the anesthesiologists seemed cool to me, whereas some EM people seemed off to me. By that I mean most were actually cool but the odd ones were very odd. And no offense to the EM people in here, it just wasn't a personality match between us. So I chose anesthesia because the people seemed like my people, I liked the field, and it had more personal/physical/emotional longevity potential.

All that said - anesthesia was the right field for me, but I immensely respect EM as a field. It's a tough job, the people who do it are wizards at managing multiple varied patients and people, and it's cool to be the one stop shop that can fix patient issues (or at least direct them onward). Certainly nobody comes to the OR to see me, but I'm ok with that.

I find it hilarious that the guy who picked anesthesia over EM cuz a few EM docs were weird ended up a peds anesthesiologist….. 😜

 

[kidthor]

I find it hilarious that the guy who picked anesthesia over EM cuz a few EM docs were weird ended up a peds anesthesiologist….. 😜

Touché. Maybe I’m the weird one!!!

 

[Atomec]

I am an EM Attending. I did well in medical school, on board scores, got my pick up interviews, and was chief resident the year I graduated residency. I liked EM initially, but now that the novelty has worn off it's just not worth it.

Having considered both, I deeply regret choosing EM over anesthesia. I have family members in anesthesia. They warned me, and I didn't listen.

Neither trauma or medical resus is interesting anymore. These are just cases that take me away from addressing the constant influx of patients filling my waiting room and creating an unsafe condition of untriaged patients (or potentially poorly triaged patients). When you've practiced for a while the novelty runs out. Someone above mentioned choosing the bread and butter you want in your practice. Slogging away at the emergency medicine bread and butter is million times worse than slogging away at the anesthesia bread and butter.

Hourly rates are not what they used to be, even in the rural environment.

Worse still, you might not even be able to find a job. If you are able to find a job it might not be anywhere close to where you want to live. I know some of you in medical school or residency know the feeling of being torn from family/friends to a POS city you would not consider flying over much less living in. In medical school/residency this a temporary condition. Now imagine that because of market factors this is a permanent one.

You are an unprofitable or barely profitable cog in a corporate wheel. The number of non-corporate wheels you may jump to have been taken over by corporate wheels. Further there is an impending surplus of similar unprofitable/barely profitable cogs to replace you. The administrators know this and will treat you accordingly. Worse still, people keep making more cog factories.

To Summarize:
EM: No real viable fellowships to escape the practice of EM unless you want to do sports medicine or get an academic job in critical care. Tox/US/Wilderness/Sim/peds are academic garnish to help you get a job but not escape EM practice. The job sucks after the novelty is gone. You are a cog. All of this wouldn't be so bad if you get paid really well and can live wherever you want, but this isn't the case anymore either.

 

[turkeyjerky]

You are an unprofitable or barely profitable cog in a corporate wheel. The number of non-corporate wheels you may jump to have been taken over by corporate wheels. Further there is an impending surplus of similar unprofitable/barely profitable cogs to replace you. The administrators know this and will treat you accordingly. Worse still, people keep making more cog factories.

I agree strongly w/ nearly everything in your post, except this. Don't let admin gaslight you. We are very profitable. Dom Bagnoli bought a stadium with profits extracted from some of us.

 

[CoolDoc1729]

I agree strongly w/ nearly everything in your post, except this. Don't let admin gaslight you. We are very profitable. Dom Bagnoli bought a stadium with profits extracted from some of

I wish I could hit like 100 times

 

[HemorrhagicShock]

I am an EM Attending. I did well in medical school, on board scores, got my pick up interviews, and was chief resident the year I graduated residency.

In addition to a great post overall, this part in particular struck a chord with me.

I also had board scores good enough for dermatology, ENT, plastics, orthopedics, you name it. I went to a school where the prestige factor would have helped me get into those types of competitive specialties. I even thought about a few of them for a minute there. But the "thrill" of EM kept drawing me back.

I matched my #1 and was elated. Residency was hard but fun, and of course during the "golden years" of EM so all my seniors were getting great jobs. I graduated at the tail end of the golden age and took a job which at the time I thought was great, albeit at a corporate hospital/CMG type gig.

Now as an attending a few years into practice I cannot even begin to describe it better than Atomec's post above. It's this chronic feeling of "what if what if what if." I know it's not conducive to anything at this point, especially with a kid, a wife, and a mortgage. Oh and school debt! Overall my job isn't bad too bad despite the CMG connection (I think they do get a lot more heat here than they deserve on a local level). Despite this, it's hard to see clinical practice being satisfying even 5 years from now.

I considered academics but that almost seems like doubling down on a sinking ship. Hard to know what to do except soldiering on and telling myself I shouldn't complain about a job where the pay puts me nearly in the 1% of earners!

 

[Taurus]

If you’re considering EM or gas, I would also take a serious look at radiology.

 

[turnupthegas]

In a perfect world - Ortho Joints.

In this scenario - Anesthesia.

 

[nimbus]

In a perfect world - Ortho Joints.

In this scenario - Anesthesia.

Demographic trends support this.

Projected Volume of Primary Total Joint Arthroplasty in the U.S., 2014 to 2030 - PubMed

Previously anticipated exponential TJA growth is inconsistent with the most recent trends. An updated projection based on 2000-to-2014 data is provided to project the growth of primary TJA procedures to the year 2030. These data will help guide health-care economic policy and allocation of...

pubmed.ncbi.nlm.nih.gov

 

[turnupthegas]

Demographic trends support this.

Projected Volume of Primary Total Joint Arthroplasty in the U.S., 2014 to 2030 - PubMed

Previously anticipated exponential TJA growth is inconsistent with the most recent trends. An updated projection based on 2000-to-2014 data is provided to project the growth of primary TJA procedures to the year 2030. These data will help guide health-care economic policy and allocation of...

pubmed.ncbi.nlm.nih.gov

Also, a good time to be in anesthesia. Boomer volume through the roof.

 

[whatupbrah]

I very much regret not doing anesthesiology. Or something else. Grass is always greener or whatever, but as someone that was first an EMT and thought for years that EM was the sexiest **** in medicine etc etc I wish I could go back and kick myself in the nads. Do anesthesia.

Would you mind elaborating on why?

 

[thegenius]

I don't mean to burst any bubbles, but the further you are along, the more you realize this is generally just a job like anyone else is doing. There are some people who are in this as a calling. I'm not going to deny that. I mean, I wasn't 16 years old talking to all my friends about how that if I didn't get to be a small town family med doc or inner city trauma surgeon I just wouldn't know what to do with my life. Use a gestalt of all the things you know up to this point to pick what you think will make you happy and don't look back.

I agree...I don't mind being an ER doc with all of the shift switching from days to nights. Hasn't really gotten to me. The most frustrating thing these days is that our hospital is full and I have to go to the waiting room and pull people out of there to give them care. It's just hard to do on a regular basis

 

[nimbus]

Alteon Health to be acquired by USACS next month.

Title says it all. CMGs consolidating, likely will limit job flexibility and reduce pay.

forums.studentdoctor.net

This trend has and will continue to harm both specialties. But it’s happening in ophtho and derm too. Big box stores and Amazon decimating mom and pops.

 

[TheComebacKid]

Literally 6 years ago the answer to this same question when I was entering the match was undoubtedly "EM". Today the answer is "Anesthesia". Tomorrow it will be something else. All of that combined with the fact that the entire US healthcare system feels like its on the verge of collapse. There are no right answers. Tomorrow any given specialty may change, the job market will dissolve, midlevels will takeover, etc. Nobody predicted what would happen to EM, and nobody can predict when or whom the next victim will be.

Both rads and anesthesia have had "doomsday events". EM is going through ours. Just like nobody could predict how poorly EM would be doing right now, we are equally bad at predicting how well we may do in the future.

I would caution against picking a specialty, like EM in particular, only because you are "afraid to lose your medical knowledge". The truth is, when you graduate medical school, you have absolutely no medical knowledge. There is nothing to lose. You can only gain the skills and experiences of doing something that you enjoy doing. If that's replacing 10 hips in a row in the OR on any given day, that's great. If that's seeing the hodge lodge of complaints that comes through the ED, great. If that's doing heart transplants at 2AM, more power to you.

Everyone in medicine is a specialist, including EM. We specialize in undifferentiated patients. We specialize in initial resuscitation. We specialize in disposition. It doesn't sound as tangible as specializing in "joints" or "corneas" but it's still a specialty, even if others in the house of medicine don't look at us that way.

EM is a great field that right now has been completely exploited and gutted by CMGs, midlevels, and C-suite dirtbags. There are some folks, namely McNamara at Temple and others who are leading the fight to take us back to the glory days, but it'll take awhile. I hope we get there eventually.

My decision to go into EM was very much shaped by the fact that I looked up to the EM faculty at my home program in medical school. These people were like Gods to me, and I thought if I went into EM I would be more like them. That was short sighted, and I wish someone told me to focus more on the bread and butter, the patient population, the day to day work as opposed to the heroic saves by these mythical figures. It really demonstrated my lack of maturity at the time. This goes for any specialty, not just EM, it's very easy to meet a "cool attending" and want to emulate them and as a result go into their specialty, which may end up being a grave mistake.

I did briefly consider trauma surgery, so I guess in a way, I dodged a bullet.

 

[Rekt]

Literally 6 years ago the answer to this same question when I was entering the match was undoubtedly "EM". Today the answer is "Anesthesia". Tomorrow it will be something else. All of that combined with the fact that the entire US healthcare system feels like its on the verge of collapse. There are no right answers. Tomorrow any given specialty may change, the job market will dissolve, midlevels will takeover, etc. Nobody predicted what would happen to EM, and nobody can predict when or whom the next victim will be.

Both rads and anesthesia have had "doomsday events". EM is going through ours. Just like nobody could predict how poorly EM would be doing right now, we are equally bad at predicting how well we may do in the future.

I would caution against picking a specialty, like EM in particular, only because you are "afraid to lose your medical knowledge". The truth is, when you graduate medical school, you have absolutely no medical knowledge. There is nothing to lose. You can only gain the skills and experiences of doing something that you enjoy doing. If that's replacing 10 hips in a row in the OR on any given day, that's great. If that's seeing the hodge lodge of complaints that comes through the ED, great. If that's doing heart transplants at 2AM, more power to you.

Everyone in medicine is a specialist, including EM. We specialize in undifferentiated patients. We specialize in initial resuscitation. We specialize in disposition. It doesn't sound as tangible as specializing in "joints" or "corneas" but it's still a specialty, even if others in the house of medicine don't look at us that way.

EM is a great field that right now has been completely exploited and gutted by CMGs, midlevels, and C-suite dirtbags. There are some folks, namely McNamara at Temple and others who are leading the fight to take us back to the glory days, but it'll take awhile. I hope we get there eventually.

My decision to go into EM was very much shaped by the fact that I looked up to the EM faculty at my home program in medical school. These people were like Gods to me, and I thought if I went into EM I would be more like them. That was short sighted, and I wish someone told me to focus more on the bread and butter, the patient population, the day to day work as opposed to the heroic saves by these mythical figures. It really demonstrated my lack of maturity at the time. This goes for any specialty, not just EM, it's very easy to meet a "cool attending" and want to emulate them and as a result go into their specialty, which may end up being a grave mistake.

I did briefly consider trauma surgery, so I guess in a way, I dodged a bullet.

You must live in fairytale land. The only people that believe EM Docs are specialists are EM docs. Every other specialty thinks we're borderline intellectually disabled. Just a truth you have to accept going into EM.

 

[kidthor]

You must live in fairytale land. The only people that believe EM Docs are specialists are EM docs. Every other specialty thinks we're borderline intellectually disabled. Just a truth you have to accept going into EM.

FWIW I view y’all as specialist-generalists and smart people in a giant swamp of undifferentiated stuff. Certainly not borderline intellectual disabled.

 

[Brigade4Radiant]

You must live in fairytale land. The only people that believe EM Docs are specialists are EM docs. Every other specialty thinks we're borderline intellectually disabled. Just a truth you have to accept going into EM.

That's because consulting us is easy. Go to the ER. All types of clinics from psych to rheum send us their patients. Blood pressure issues etc. Also EM is also critiqued much which is good and bad. Compare this to a clinical specialty where one could be straight awful at it but no one will know or say anything

 

[Apollyon]

FWIW I view y’all as specialist-generalists and smart people in a giant swamp of undifferentiated stuff. Certainly not borderline intellectual disabled.

That dude is kinda about the hyperbole.

 

[seebelcherrun]

my wife is anesthesia and I'm EM--we've both been out about 4 years.

I think it depends on your personality. She's very introverted and likes somewhat predictable/organized situations. I'm a bit more extroverted and appreciate the more random smattering and occasional chaos of the ED.

My day to day schedule is much more tolerable than hers as she is at the whim of the OR/Surgeon for that day. When I'm done, i'm done. And I don't have to deal with surgeon's BS as much as she does.

But while working, it's probably less stressful for her on the whole and more tolerable for 30 years. To be determined.


for me, it comes down to being a generalist and knowing how the hospital works a little better. Generally if family member/friend has a medical question that doesn't directly deal with anesthesia, it comes to me or she directs them my way. So if that's your jam, you have your answer.

 

[TheComebacKid]

You must live in fairytale land. The only people that believe EM Docs are specialists are EM docs. Every other specialty thinks we're borderline intellectually disabled. Just a truth you have to accept going into EM.

Have you heard how surgeons talk about anesthesiologists? Have you heard how medicine docs talk about orthropods? Have you heard how ophthalmologists talk about neurologists? You can go on and on.

Yes, I do feel like we get disproportionately dumped on. And I do think it's a source of frustration and definitely overall decreased job satisfaction. But why are all these clinics referring patients to the ER? It's not because they think we are fools. It's because they don't have the tools, and sometimes expertise/training to workup undifferentiated patients.

People can think what they want about us, but we do have a very specific set of skills that not a lot of people have. Our knowledge of ultrasound, toxicology, EMS, resuscitation, cardiac arrest management (this list can go on) is probably far superior than that of anyone else. I've had multiple consultants say, "I really don't know how to manage this, this is in your realm" or "I don't know what's going on with this person in my clinic, please figure it out, I'm nervous and I'm not equipped to handle this".

I know in med school EM docs were portrayed to me like gods (lets say I went to a home program that was "a powerhouse" to use SDN nomenclature). I definitely drank the kool-aid, and I think that was a mistake. EM has a lot of drawbacks, now more than ever. I routinely counsel people to think really long and hard before going into EM.

That being said, we are still specialists. Generalist specialists. Don't fight it.

 

[thegenius]

That being said, we are still specialists. Generalist specialists. Don't fight it.

Damn straight we are specialists. I tell patients all the time we are specialists just like cardiologists, urologists, and allergists. I literally say it just like that.

At times it can be challenging when patients say "well if you don't know can't you just admit me?"

 

[Apollyon]

We are three miles wide, and one inch deep. Whomever we call, they are one inch wide, and three miles deep. It's like Crohn's vs UC (sort of). Cards wants "pain, EKG, troponin". Neuro wants "NIHSS". Psych wants "real suicidal, or not. Real hallucinations, or not". Ortho wants "broken, or not". Give them what they want, and, not more, because, they ain't interested!

 

[nimbus]

I thought this Twitter thread was funny and sad.

 

[nimbus]

Damn straight we are specialists. I tell patients all the time we are specialists just like cardiologists, urologists, and allergists. I literally say it just like that.

At times it can be challenging when patients say "well if you don't know can't you just admit me?"

But do you guys have National Physician Emergency Physicians Week? Our society had to invent a week to remind people we are actually doctors😞

 

[WilcoWorld]

 

[emergentmd]

Reading this thread makes me feel like EM docs all have the battered wife syndrome. Agree or not, this is what I take as close to fact

1. You are either a happy person or unhappy person. If EM is really making you this unhappy, then you need to figure out why you are not a happy person and fix it for your mental health. If you are making 350K/yr working 30hrs a week then it is NOT the job but more so your expectations. 99% of Americans would kill for this job and they would do worse things than the typical EM job. Instead of focusing on the bad, focus on the good which greatly outweighs the bad.
2. EM is the most flexible medical job around. Period. I have an anesthesiologist friend who rarely can go to their kids school activities b/c he wakes up at 530am for a case and take overnight/weekend calls. His wife complains all the time that he is working, coming off shift, etc. I almost never miss any of my kids activities b/c I schedule off or I can switch easily with a partner. This is for all 17 yrs when practicing in the hospital
3. EM job market sucks but all relative. If you compare it to 5 yrs ago, then yes it sucks when I was getting 5-800/hr for coverage. But compare it to other fields who have had their troughs and it is not bad. Remember when no one wanted to go into Rads/Anesth 20 yrs ago? yeah, they job market had a bad outlook back then too. But from what I can tell from increased locums phone calls, it is picking up. I have job offers and can pick up shifts in places like Austin if I wanted to, not saying a full time job is avail in places like Austin but I hear that they need coverage at my old place.
4. Yes EM job is/can be difficult. BUT there are so many more difficult jobs I can think about making 1/5 the pay. Some guy is replacing my roof right now, and that is a 100x more difficult job esp in the Texas heat. But with any other job, you get better. Stuff that seemed difficult becomes cookie cutter. Figure out to ignore what you can't change. Metrics, just jump through the hoops. Overbearing CMG, punch your clock and do your best. Drunks/druggies - See them and move on. I don't think I have ever hated going into work and the stuff that bothers other EM docs so much barely hits my stress radar. Every job has aspects that many hate, either let it eat you up or its just part of the job.

Look, EM is not perfect like any other job. Things I love includes

1. Feeling like I am a "real doctor" I may not know everything in depth but know 90% of almost everything which is good enough for me. I could not imaging being an anesthesiologist who have a lack of breath about most things medicine. This is not an indictment, but just what I like. Many may disagree, but what does an orthopod really know anything about medicine?
2. I have almost complete control of my schedule. Take 1-2 wk vacations almost any time I want. Rarely did true overnight, just pay the nocturnist more.
3. My shifts are typically 8-9 hrs long. Some shifts I walk in at 9am after the anesthesiologist been there since 6am and I leave at 5pm when they are still finishing up the last case. How about the OB doc who have been in the hospital til midnight after a full day of clinic waiting for the final push? Or the GS who finished clinic and now taking call all night with a 11pm surgical emergency. No thank you, I like to know when I am done.
4. The EM staff family is amazing. You get to know the staff well and make alot of great connections. I don't think floor docs have the same interaction, plus most of the EM staff are young and cool.

Bottom line is I may just be one of the lucky EM docs who find the great aspects great and the bad aspects a small nuisance. EM has been good to me, have given me alot of opportunities to live a very comfortable life, and given me time to spend with my family. I would not trade EM for anesthesiology just for the mere fact that I would have missed alot of my kids activities.

 

[sylvanthus]

Reading this thread makes me feel like EM docs all have the battered wife syndrome. Agree or not, this is what I take as close to fact

1. You are either a happy person or unhappy person. If EM is really making you this unhappy, then you need to figure out why you are not a happy person and fix it for your mental health. If you are making 350K/yr working 30hrs a week then it is NOT the job but more so your expectations. 99% of Americans would kill for this job and they would do worse things than the typical EM job. Instead of focusing on the bad, focus on the good which greatly outweighs the bad.
2. EM is the most flexible medical job around. Period. I have an anesthesiologist friend who rarely can go to their kids school activities b/c he wakes up at 530am for a case and take overnight/weekend calls. His wife complains all the time that he is working, coming off shift, etc. I almost never miss any of my kids activities b/c I schedule off or I can switch easily with a partner. This is for all 17 yrs when practicing in the hospital
3. EM job market sucks but all relative. If you compare it to 5 yrs ago, then yes it sucks when I was getting 5-800/hr for coverage. But compare it to other fields who have had their troughs and it is not bad. Remember when no one wanted to go into Rads/Anesth 20 yrs ago? yeah, they job market had a bad outlook back then too. But from what I can tell from increased locums phone calls, it is picking up. I have job offers and can pick up shifts in places like Austin if I wanted to, not saying a full time job is avail in places like Austin but I hear that they need coverage at my old place.
4. Yes EM job is/can be difficult. BUT there are so many more difficult jobs I can think about making 1/5 the pay. Some guy is replacing my roof right now, and that is a 100x more difficult job esp in the Texas heat. But with any other job, you get better. Stuff that seemed difficult becomes cookie cutter. Figure out to ignore what you can't change. Metrics, just jump through the hoops. Overbearing CMG, punch your clock and do your best. Drunks/druggies - See them and move on. I don't think I have ever hated going into work and the stuff that bothers other EM docs so much barely hits my stress radar. Every job has aspects that many hate, either let it eat you up or its just part of the job.

Look, EM is not perfect like any other job. Things I love includes

1. Feeling like I am a "real doctor" I may not know everything in depth but know 90% of almost everything which is good enough for me. I could not imaging being an anesthesiologist who have a lack of breath about most things medicine. This is not an indictment, but just what I like. Many may disagree, but what does an orthopod really know anything about medicine?
2. I have almost complete control of my schedule. Take 1-2 wk vacations almost any time I want. Rarely did true overnight, just pay the nocturnist more.
3. My shifts are typically 8-9 hrs long. Some shifts I walk in at 9am after the anesthesiologist been there since 6am and I leave at 5pm when they are still finishing up the last case. How about the OB doc who have been in the hospital til midnight after a full day of clinic waiting for the final push? Or the GS who finished clinic and now taking call all night with a 11pm surgical emergency. No thank you, I like to know when I am done.
4. The EM staff family is amazing. You get to know the staff well and make alot of great connections. I don't think floor docs have the same interaction, plus most of the EM staff are young and cool.

Bottom line is I may just be one of the lucky EM docs who find the great aspects great and the bad aspects a small nuisance. EM has been good to me, have given me alot of opportunities to live a very comfortable life, and given me time to spend with my family. I would not trade EM for anesthesiology just for the mere fact that I would have missed alot of my kids activities.

nm not worth it, feels like ill be trying to reason with an antivaxxer.

 

[emergentmd]

nm not worth it, feels like ill be trying to reason with an antivaxxer.

Actually not, but its ok to disagree.

Offer 99% of Americans 350K for 30hrs/wk working in an AC cooled room wearing comfortable scrubs and they would take it. Its not like someone is putting you in a water torture apparatus all day long.

But truthfully, if it was so difficult, you could easily become an Uber driver making $20/hr or QRS job for $20/hr.

 

[thegenius]

Offer 99% of Americans 350K for 30hrs/wk working in an AC cooled room wearing comfortable scrubs and they would take it. Its not like someone is putting you in a water torture apparatus all day long.

The truth is, offer them the opportunity to do well in college, pass a hard exam, get into medical school, and work 80 hrs/week for the next 8 years, and then pass 3 other exams for the ability to make 350K for 30 hrs/week.

Most americans are too lazy to do this

 

[emergentmd]

The truth is, offer them the opportunity to do well in college, pass a hard exam, get into medical school, and work 80 hrs/week for the next 8 years, and then pass 3 other exams for the ability to make 350K for 30 hrs/week.

Most americans are too lazy to do this

I absolutely agree but in life what you have done in the past does not guarantee you future success. I never understood why docs think they are so special where past sacrifices should translate into an iron clad ticket to success.

Many College Athletes in Div I put in as much or more time to their craft and never make it to the Pros. All they have to show for it is multiple surgeries and chronic pain.
PHDs who do research put in as much time as docs (trust me, I helped do research in College) without any guarantees
Musicians put in countless hours and never guaranteed to hit it big.

There are sooooo many jobs that require a high level of commitment and will never sniff what docs make.

 

[i-doctor]

I absolutely agree but in life what you have done in the past does not guarantee you future success. I never understood why docs think they are so special where past sacrifices should translate into an iron clad ticket to success.

Many College Athletes in Div I put in as much or more time to their craft and never make it to the Pros. All they have to show for it is multiple surgeries and chronic pain.
PHDs who do research put in as much time as docs (trust me, I helped do research in College) without any guarantees
Musicians put in countless hours and never guaranteed to hit it big.

There are sooooo many jobs that require a high level of commitment and will never sniff what docs make.

You’re right. I went into med school. My best friend in college—equally smart— went into grad school, got his PhD. in political science.
He can’t land a stable tenured-track full-time university position in his field. (Had one good position once, then the University cut costs and let him go). Every (rare) opening has 100+ applicants. So, like thousands of other PhD’s, he’s doing hodge-podge adjunct teaching gigs. And writing academic books. Maybe makes $30K in a good year.

 

[thegenius]

I absolutely agree but in life what you have done in the past does not guarantee you future success. I never understood why docs think they are so special where past sacrifices should translate into an iron clad ticket to success.

Many College Athletes in Div I put in as much or more time to their craft and never make it to the Pros. All they have to show for it is multiple surgeries and chronic pain.
PHDs who do research put in as much time as docs (trust me, I helped do research in College) without any guarantees
Musicians put in countless hours and never guaranteed to hit it big.

There are sooooo many jobs that require a high level of commitment and will never sniff what docs make.

It's not a true market for docs, it's a consequence of whomever decided decades ago to highly regulate who gets into medical school, the number of residency spots.

I don't believe lawyers have the same belief that they will all make a lot of money, or maybe they do. The barrier to becoming a lawyer is finding a job, not getting into law school. The entire dynamic of our health care system would be totally different is the barrier to becoming a doctor would be finding a job.

So I do think I'm special, I expect the cartel and government-regulated physician environment to continue (although it will probably be slowly whittled away) and I wouldn't feel as special if any tom dick and harry could become a doctor.

I do believe however that becoming a lawyer, athlete, top real estate agent, etc, is much more meritorious. The very best make it to the top. Doctors are not slouches but we are screening 22-24 year olds in belief that they will with the proper training be the cream of the crop.

 

[southerndoc]

Reading this thread makes me feel like EM docs all have the battered wife syndrome. Agree or not, this is what I take as close to fact

1. You are either a happy person or unhappy person. If EM is really making you this unhappy, then you need to figure out why you are not a happy person and fix it for your mental health. If you are making 350K/yr working 30hrs a week then it is NOT the job but more so your expectations. 99% of Americans would kill for this job and they would do worse things than the typical EM job. Instead of focusing on the bad, focus on the good which greatly outweighs the bad.
2. EM is the most flexible medical job around. Period. I have an anesthesiologist friend who rarely can go to their kids school activities b/c he wakes up at 530am for a case and take overnight/weekend calls. His wife complains all the time that he is working, coming off shift, etc. I almost never miss any of my kids activities b/c I schedule off or I can switch easily with a partner. This is for all 17 yrs when practicing in the hospital
3. EM job market sucks but all relative. If you compare it to 5 yrs ago, then yes it sucks when I was getting 5-800/hr for coverage. But compare it to other fields who have had their troughs and it is not bad. Remember when no one wanted to go into Rads/Anesth 20 yrs ago? yeah, they job market had a bad outlook back then too. But from what I can tell from increased locums phone calls, it is picking up. I have job offers and can pick up shifts in places like Austin if I wanted to, not saying a full time job is avail in places like Austin but I hear that they need coverage at my old place.
4. Yes EM job is/can be difficult. BUT there are so many more difficult jobs I can think about making 1/5 the pay. Some guy is replacing my roof right now, and that is a 100x more difficult job esp in the Texas heat. But with any other job, you get better. Stuff that seemed difficult becomes cookie cutter. Figure out to ignore what you can't change. Metrics, just jump through the hoops. Overbearing CMG, punch your clock and do your best. Drunks/druggies - See them and move on. I don't think I have ever hated going into work and the stuff that bothers other EM docs so much barely hits my stress radar. Every job has aspects that many hate, either let it eat you up or its just part of the job.

Look, EM is not perfect like any other job. Things I love includes

1. Feeling like I am a "real doctor" I may not know everything in depth but know 90% of almost everything which is good enough for me. I could not imaging being an anesthesiologist who have a lack of breath about most things medicine. This is not an indictment, but just what I like. Many may disagree, but what does an orthopod really know anything about medicine?
2. I have almost complete control of my schedule. Take 1-2 wk vacations almost any time I want. Rarely did true overnight, just pay the nocturnist more.
3. My shifts are typically 8-9 hrs long. Some shifts I walk in at 9am after the anesthesiologist been there since 6am and I leave at 5pm when they are still finishing up the last case. How about the OB doc who have been in the hospital til midnight after a full day of clinic waiting for the final push? Or the GS who finished clinic and now taking call all night with a 11pm surgical emergency. No thank you, I like to know when I am done.
4. The EM staff family is amazing. You get to know the staff well and make alot of great connections. I don't think floor docs have the same interaction, plus most of the EM staff are young and cool.

Bottom line is I may just be one of the lucky EM docs who find the great aspects great and the bad aspects a small nuisance. EM has been good to me, have given me alot of opportunities to live a very comfortable life, and given me time to spend with my family. I would not trade EM for anesthesiology just for the mere fact that I would have missed alot of my kids activities.

Another epic post. Couldn't agree more.

 

[TrailRun]

Rarely did true overnight, just pay the nocturnist more.

Wish more shops did this...

 

[Groove]

Rarely did true overnight, just pay the nocturnist more.

Love your post and agree for the most part about perception and good attitude being key to most things in life, including EM...BUT, I couldn't help but notice this statement and wonder if that has made a huge impact on your ability to stay positive in EM for so long. The frequent nights and circadian disruption is probably the number one thing that wears me down over time. If you've never had to do many nights in your career and have always had a steady supply of nocturnists then you are truly blessed...unlike the rest of us.

 

[EctopicFetus]

I usually agree with emergent and I’m truly happy. I love my job but I think it’s because I put myself on a path of financial independence early and then caught a few breaks along the way to get me there about 7 years earlier than expected.

The job is hard and every job is different. I work few nights, I give up shifts when convenient etc. My wife and I make good $$ and so we spend a fair bit. I don’t worry about the same things I used to. In hs I worries about every dollar in college I worried about every 10-20 (I did work study ) once I got married my wife had a good job we worried about every $100 or so. Now I don’t even know the number but it’s high. That’s a relief. Took me a while to change my mindset.

It’s easy to say be happy but when you are a new grad at 30 years old and you had to move to an undesirable place to make that 350k it’s not hard to understand why you are unhappy. Maybe now your spouse is pissed at you too? They didn’t sign up to live in bfe and expected the doctor life in Denver. The 300k in debt at 7% is quite the noose. You can’t quit working. A phd in poli sci can go teach high school. They have no debt. Getting a degree no one wants or cares about is a recipe in foolishness. No offense to your friend. Just cause you get a phd in something doesn’t mean squat. Soon finishing residency in em won’t guarantee you a job either.

Much is expectations and contentment. I find that this keeps my outlook positive. My expectations of others and my investments is low. I am extremely content with very little.

 

[GassYous]

I usually agree with emergent and I’m truly happy. I love my job but I think it’s because I put myself on a path of financial independence early and then caught a few breaks along the way to get me there about 7 years earlier than expected.

The job is hard and every job is different. I work few nights, I give up shifts when convenient etc. My wife and I make good $$ and so we spend a fair bit. I don’t worry about the same things I used to. In hs I worries about every dollar in college I worried about every 10-20 (I did work study ) once I got married my wife had a good job we worried about every $100 or so. Now I don’t even know the number but it’s high. That’s a relief. Took me a while to change my mindset.

It’s easy to say be happy but when you are a new grad at 30 years old and you had to move to an undesirable place to make that 350k it’s not hard to understand why you are unhappy. Maybe now your spouse is pissed at you too? They didn’t sign up to live in bfe and expected the doctor life in Denver. The 300k in debt at 7% is quite the noose. You can’t quit working. A phd in poli sci can go teach high school. They have no debt. Getting a degree no one wants or cares about is a recipe in foolishness. No offense to your friend. Just cause you get a phd in something doesn’t mean squat. Soon finishing residency in em won’t guarantee you a job either.

Much is expectations and contentment. I find that this keeps my outlook positive. My expectations of others and my investments is low. I am extremely content with very little.

Same
I recently looked at my expenses for last year and somehow I spent nearly 100k. When I was young my parents lived on less than 1/10th of that. I still penny pinch and get a little upset over all the stuff my wife buys but don't really worry about expenses. It is truly a privilege.

 

[emergentmd]

Love your post and agree for the most part about perception and good attitude being key to most things in life, including EM...BUT, I couldn't help but notice this statement and wonder if that has made a huge impact on your ability to stay positive in EM for so long. The frequent nights and circadian disruption is probably the number one thing that wears me down over time. If you've never had to do many nights in your career and have always had a steady supply of nocturnists then you are truly blessed...unlike the rest of us.

Not doing true nights is definitely a contributing factor for not burning out. I made a decision for 3 months in the summer to do all nights so I could be with the kids during they day when they were awake. Miserable summer, never would not it again, have great respect for nocturnists, Don't think I had more than 5 hr straight sleep most nights.

Even if your group do not have a nocturnist, you can typically find someone willing to do nights for the right price.

My old group paid the nocturnist $750/shift stipend for doing nights. As I did no nights, and typically would have done 3 nights a month, I essentially paid the nocturnist $2250/month. We were all partners so the stipend came from somewhere which was essentially out of everyone's pocket who did not do nights.

In most groups, you can find a doc willing to do nights for the right price. I would have gladly paid $750/shift not to do nights and had a frank discussion with my partners that I would have been willing to go up to $1500/nt.

$30-50K/yr in lost salary is well worth never doing nights.