Any PGY-2's or 3's thinking of jumping ship?

[Bluebird12390]

Any other 2nd or 3rd year residents beginning to think that EM is not right for them? If so, what are your turn off's for EM (so far or that have arisen)? What fields are you thinking of jumping too?

Personally, I just feel burnt out at the end of this (PGY1) year. Between ungrateful patients to some crazy attendings who also seem pretty jaded. The thought of internal medicine or family medicine has crossed my mind on numerous occasions. Am I the only here that feels like way?
Serious replies only please.

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[RustedFox]

Any other 2nd or 3rd year residents beginning to think that EM is not right for them? If so, what are your turn off's for EM (so far or that have arisen)? What fields are you thinking of jumping too?

Personally, I just feel burnt out at the end of this (PGY1) year. Between ungrateful patients to some crazy attendings that don't want to teach. The thought of internal medicine or family medicine has crossed my mind on numerous occasions. Am I the only here that feels like way?
Serious replies only please.

Hello, past version of me.

 

[Tenk]

Everyone feels this way. Intern year blows. It does get better. Stay the course.

 

[visceral0775]

Any other 2nd or 3rd year residents beginning to think that EM is not right for them? If so, what are your turn off's for EM (so far or that have arisen)? What fields are you thinking of jumping too?

Personally, I just feel burnt out at the end of this (PGY1) year. Between ungrateful patients to some crazy attendings who also seem pretty jaded. The thought of internal medicine or family medicine has crossed my mind on numerous occasions. Am I the only here that feels like way?
Serious replies only please.

Yup! I am also a PGY-1 feeling the exact same way, and for many of the reasons you listed. I tried switching out but was unsuccessfu. Think I may even try again this year. Yes, most people say that it does get better...but honestly I don't see how Feel free to PM me anytime to chat/vent/whatever.

 

[HoosierdaddyO]

The hours get better, the pay gets better, the respect all be it a little gets better, the fund of knowledge gets better which in turn makes things easier. Every field of medicine is going to suck in some capacity. Don’t quit, see it through to the end and you’ll be surprised!!!

 

[SeekerOfTheTree]

It gets better but it doesn't get better. You can have some control of the things that make you unhappy but the things that are making you unhappy won't completely change either. The patients, admin, uncertainty, shift work, etc will all be there. Medicine does have sucky days but your goal is to pick a field where you have less sucky days and more good days.

I went into EM and felt the way you do during residency. I have been practicing for years now but it isn't that I feel happy, I feel better. I come to work and am indifferent most days. It's not something that defines me and makes me feel great about myself. I don't like telling people that I am a physician. For me I thought this was the next intellectual challenge and I would be constantly pushing myself but it becomes 99% the same with 1% unique.

You have to analyze what about it is making you unhappy. If it is medicine then I would say finish residency and do anything else you want in life but have that under your belt. If it is the specialty then I would switch.

You're right about the jaded attendings; they are jaded because they stuck around thinking it would get better. I have only met a handful of people in this field that genuinely seem happy to come to work. I get that we use dark humor to deal with our job and behaving like a teenage goth girl seems to be the new norm for most attendings but I don't want to end up like that. I will probably go to part-time in 10 years because I am like you and I wouldn't say I am happy with EM, I just go through the motions because what else would I do right now?

 

[hundreddaysoff]

For me I thought this was the next intellectual challenge and I would be constantly pushing myself but it becomes 99% the same with 1% unique.

One lesson I've learned about work over multiple careers: you can have a prestigious job where most people respect you, or you can have an intellectually challenging job, but very rarely both.

If your job is intellectually challenging to you, then you most likely still have that job only because no one smarter than you cares enough about what you're working on to try to take it away from you. In this kind of job you will probably ultimately fail at what you're trying to do and therefore there are very few gold stars to be found. Unless you're, like, Elon Musk and have already won the game [that the normies think you're playing which is different than the game you're actually playing].

This is all to say that medicine isn't that bad of a career once you really get into the alternatives.

 

[SeekerOfTheTree]

One lesson I've learned about work over multiple careers: you can have a prestigious job where most people respect you, or you can have an intellectually challenging job, but very rarely both.

If you job is intellectually challenging to you, then you most likely still have that job only because no one smarter than you cares enough about what you're working on to try to take it away from you. In this kind of job there are very few gold stars to be found, unless you're, like, Elon Musk.

This is all to say that medicine really isn't that bad of a career once you really get into the alternatives.

I too was in another field before all this and was content but not happy with it. It was intellectually stimulating but not what I thought engineering and software development would be. I guess as you get older you look at the time you spend working and you ask yourself do you find your work personally satisfying. It's the individual that defines the satisfaction from what they do. If you like machine learning and building the neural networks that analyze roundabouts for Tesla and are not recognized for it but love the feeling of doing that then that makes you happy.

In OPs case find that thing that gives meaning to what you want to do or be content doing this without meaning and realizing that's okay too. The problem with our types is we become docs we begin to second guess ourselves and think we could have become CEOs and the next Elon Musk if we had picked a different path which would have brought us the happiness.

 

[Rekt]

Any other 2nd or 3rd year residents beginning to think that EM is not right for them? If so, what are your turn off's for EM (so far or that have arisen)? What fields are you thinking of jumping too?

Personally, I just feel burnt out at the end of this (PGY1) year. Between ungrateful patients to some crazy attendings who also seem pretty jaded. The thought of internal medicine or family medicine has crossed my mind on numerous occasions. Am I the only here that feels like way?
Serious replies only please.

Yeah all the time. More so from the outlook of the specialty itself. Likely going to be picking from scraps as the job market continues to decline. It's just an unfortunate continual thought process to come this far after having done well in med school/boards and skipping more competitive specialties for EM since I liked it. If I didn't have extenuating circumstances I would have tried to transfer specialties at the end of this year.

 

[B52forU]

For what the OP listed as his reasons for feeling crispy? No, those things don't really get better with time in terms of difficult patients. The way things can possibly become better in the future as an attending is really one of three ways in how I see it. You will always have difficult patients but you where you choose your job can help in deciding the general majority of the patient population you inevitably end up seeing. Another way is your perspective in dealing/interacting with patients can be modified as well as you are still early on in your career. The third way is as an attending you have more free time/money to "blow off steam" and redirect your focus on other things to balance out the stress/frustration from work as opposed to during residency.

For example I trained in multiple hospitals in various parts of Chicago during residency and I found a substantial amount of my patients to be both low functioning and high maintenance which isn't a very good combination to have to deal with on a constant basis. Where I work now the patients are generally more reasonable, compliant with discharge instructions (they actually do follow up and come back if they get worse!) and shared decision making is actually able to be understood. That said, there is still some level of burn out that will likely get worse as time progresses especially as the outlook for the field appears more and more tenuous but I still enjoy the concept of emergency medicine.

 

[Splenda88]

Any other 2nd or 3rd year residents beginning to think that EM is not right for them? If so, what are your turn off's for EM (so far or that have arisen)? What fields are you thinking of jumping too?

Personally, I just feel burnt out at the end of this (PGY1) year. Between ungrateful patients to some crazy attendings who also seem pretty jaded. The thought of internal medicine or family medicine has crossed my mind on numerous occasions. Am I the only here that feels like way?
Serious replies only please.

IM is no better...

 

[MechEDoc]

IM is no better...

PGY-7 (4 years out from residency). Not feeling to great about EM at the moment. It kind of sucked when I graduated - but I had lots of pretty well paying work. It sucks hard now. Working harder and harder for less. Pretty sure that the near term will suck. Hoping that the market with swing the other way at some point - it usually does.

 

[Bill Brasky]

I'm about to be a PGY3 and still struggle with this, especially with the job market imploding for the foreseeable future. I honestly wish I could leave medicine entirely, but that's not realistic at this point. I just have to do my best to pay off my loans quickly and reevaluate after a few years as an attending.

 

[solitarius]

Glad I jumped ship before residency.

Reasons:

• Presentations and patients.
• Circadian disruptions.
• Doing initial workup for every specialty.
• Metrics, hospital bosses, specialists, patients, laws & regulations.
• Colleagues.

 

[alpinism]

Its going to interesting next year when some of the first of the new residencies start graduating EM docs.

Will also be the first time in history there will be over two thousand new graduates per year within our specialty.

 

[cyanide12345678]

Its going to interesting next year when some of the first of the new residencies start graduating EM docs.

Will also be the first time in history there will be over two thousand new graduates per year within our specialty.

2000 new grads? That's just terrible.

We're done. Game over.

 

[HoosierdaddyO]

What’s worse is that it’s 2000 new grads and then 2040 grads the year after then and up and up and away we go lol!!! Literally trying to saturate the market. I mean basic macro 101!!! Supply goes up, demand is obviously going to go down, and with that our salaries and livelihoods. Seriously disappointed in every EM society not addressing this issue :/. You think CMG’s don’t care now, wait till they have 4 other people in line waiting and wanting your ****ty job lol!!!

 

[zero0]

What’s worse is that it’s 2000 new grads and then 2040 grads the year after then and up and up and away we go lol!!! Literally trying to saturate the market. I mean basic macro 101!!! Supply goes up, demand is obviously going to go down, and with that our salaries and livelihoods. Seriously disappointed in every EM society not addressing this issue :/. You think CMG’s don’t care now, wait till they have 4 other people in line waiting and wanting your ****ty job lol!!!

Hey give a little credit to big academia for jacking up cost of attendance for med school and undergrad. People will work for scraps when they have 500k hanging over their heads and no other way to pay it back.

 

[Rekt]

Glad I jumped ship before residency.

Reasons:

• Presentations and patients.
• Circadian disruptions.
• Doing initial workup for every specialty.
• Metrics, hospital bosses, specialists, patients, laws & regulations.
• Colleagues.

What did you go into?

 

[solitarius]

What did you go into?

Psych

 

[namethatsmell]

Glad I jumped ship before residency.

Reasons:

• Presentations and patients.
• Circadian disruptions.
• Doing initial workup for every specialty.
• Metrics, hospital bosses, specialists, patients, laws & regulations.
• Colleagues.

EM may have issues. But my colleagues are, in fact, awesome.

 

[solitarius]

EM may have issues. But my colleagues are, in fact, awesome.

That's great. Nonetheless, ED attracts all types of people, many of whom are not cool. Unlike some other specialties, EM takes anybody including the SJW who wants to combat health disparities 24/7, the dweeb who really belongs in IM or Neuro, or the bro who didn't get into ortho.

Hit or miss.

 

[namethatsmell]

That's great. Nonetheless, ED attracts all types of people, many of whom suck.

Oh please. Sure every field has lame people and I'm sorry you didn't feel you meshed in well in EM. Of the many EM docs I've known over the years, relationships with their EM colleagues has almost never been one of their grievances with the field.

 

[Rekt]

Oh please. Sure every field has lame people and I'm sorry you didn't feel you meshed in well in EM. Of the many EM docs I've known over the years, relationships with their EM colleagues has almost never been one of their grievances with the field.

Agree with this. EM has a ton of issues and is currently burning to the ground, but my colleagues are the best part. The only SJW ones I've seen are the ones that vocalize themselves on Facebook.

 

[MechEDoc]

Agree with this. EM has a ton of issues and is currently burning to the ground...

Agree. This part sucks. Working more for less pay now.

The only SJW ones I've seen are the ones that vocalize themselves on Facebook.

SJWs don't last (or perhaps even enter) community ERs. They tend to be in some super woke Ivory Tower place.

 

[namethatsmell]

That's great. Nonetheless, ED attracts all types of people, many of whom are not cool. Unlike some other specialties, EM takes anybody including the SJW who wants to combat health disparities 24/7, the dweeb who really belongs in IM or Neuro, or the bro who didn't get into ortho.

Hit or miss.

Why did you edit the post where you said that "many" people in EM "suck?"

The original one, while insulting, was at least streamlined.

This second version, still insulting, now borders on pedantic.

 

[solitarius]

Why did you edit the post where you said that "many" people in EM "suck?"

The original one, while insulting, was at least streamlined.

This second version, still insulting, now borders on pedantic.

You seem very upset. I appreciate all that you guys do.

 

[namethatsmell]

You seem very upset. I appreciate all that you guys do.

Heh, my emotions are irrelevant here.

Introspection can be a useful exercise however. How would you respond if somebody crassly talked trash about your field that "takes anybody" and insulted your colleagues? And why do you think somebody would say those things?

That said, I am glad you ended up in a field that makes you happy.

 

[Mr. Vandemar]

Another SDN dumpster fire, only made better by the psychiatrist who uses "combating health disparities 24/7" as an example of something bad.

 

[Spikebd]

Glad I jumped ship before residency.

Reasons:

• Presentations and patients.
• Circadian disruptions.
• Doing initial workup for every specialty.
• Metrics, hospital bosses, specialists, patients, laws & regulations.
• Colleagues.

I did a couple EM aways in fourth year and even went on two interviews before I bailed. My reasons were the circadian flips and the language barrier in acute settings made me very uncomfortable I would miss something.
The money and short residency drew me in but I ultimately went a different direction. EM in an affluent area is still probably a nice career.

 

[deleted859535]

I did a couple EM aways in fourth year and even went on two interviews before I bailed. My reasons were the circadian flips and the language barrier in acute settings made me very uncomfortable I would miss something.
The money and short residency drew me in but I ultimately went a different direction. EM in an affluent area is still probably a nice career.

EM in an affluent area is the same career with a different subset of bull****. Some here would argue there is a higher proportion of entitlement, or a differently frustrating entitlement, with some worried well.

 

[MechEDoc]

I did a couple EM aways in fourth year and even went on two interviews before I bailed. My reasons were the circadian flips and the language barrier in acute settings made me very uncomfortable I would miss something.
The money and short residency drew me in but I ultimately went a different direction. EM in an affluent area is still probably a nice career.

What did you pick?

 

[Zebra Hunter]

EM in an affluent area is the same career with a different subset of bull****. Some here would argue there is a higher proportion of entitlement, or a differently frustrating entitlement, with some worried well.

I would much rather deal with the low income population I saw in residency compared to the affluent population I care for at one of the hospitals I work at. You don't know burn out until you are having your 3rd argument of the day for the 5th day in a row about why you are not waking up their cardiologist at 3 in the morning to talk to them about their asymptomatic hypertension. Then having to deal with a couple ridiculous patient complaints and a call from the the hospital CEO about their family friend being upset that we didn't fix their high blood pressure.

The amount of entitlement among the rich boomer population is suffocating. The low income population certainly has its frustrating encounters, but they typically are not the type to go after your license, call hospital admin, or make patient complaints, which will be your biggest headaches of attendinghood.

 

[RustedFox]

I would much rather deal with the low income population I saw in residency compared to the affluent population I care for at one of the hospitals I work at. You don't know burn out until you are having your 3rd argument of the day for the 5th day in a row about why you are not waking up their cardiologist at 3 in the morning to talk to them about their asymptomatic hypertension. Then having to deal with a couple ridiculous patient complaints and a call from the the hospital CEO about their family friend being upset that we didn't fix their high blood pressure.

The amount of entitlement among the rich boomer population is suffocating. The low income population certainly has its frustrating encounters, but they typically are not the type to go after your license, call hospital admin, or make patient complaints, which will be your biggest headaches of attendinghood.

All of this is soooo true.

My primary job site is t.h.e. country club ER in my neck of the state.

Add on to this that the hourly rate will be low, because the CMG jackasses know that docs will see it as a "desirable" place to work, and they'll ratchet the pay down.

I really, really hate the entitled boomers.

 

[RustedFox]

Piggybacking off of my earlier comment:

"I really, really hate the entitled boomers."

Whatever happened to rugged individualism? Whatever happened to self-reliance? Whatever happened to knowing a bit about a lot of things that goes a long way in 'life in general'?

You know where I got those virtues?
The Boomers.

My Boomer Dad (Happy Father's Day) taught me so many things because he was and still is a great dad.

Simple personal responsibility and capability goes a long way.

Sure, life is infinitely more complicated in the year 2020 than it was in 1950, but we're doing far better than we ever have before.

Thus, whenever the BOOMER who can troubleshoot auto repairs, HVAC problems, do some carpentry, and swaddle a baby comes to the ER and can't even tell me (1) the medications he takes, (2) why he takes them, (3) his cardiologist's name, or (4) why there's a giant scar in his mid-abdomen... I am left feeling betrayed. These guys taught me (we, if y'all don't mind) to be great through a combination of example and austerity... yet today, they're not exemplary, and they're soft.

Just yesterday, I took care of some BOOMER with CLL that couldn't be bothered to keep track of his baseline CBC values (you know, the IMPORTANT ones, like the WBC). When I asked him about what "number his white count usually is", the reply that I received was: "Ohh, these numbers. All I gotta know is that I'm number one, baby."

Thanks. Strong work there, John Wayne.

Look, I'm no shining example of masculinity. I'm not fixing a carburetor and then going out to play rugby.

But you know what? My body is my responsibility. Nobody else's.

The BOOMERS seem to have forgotten that.

 

[RoyBasch]

the language barrier in acute settings made me very uncomfortable I would miss something.

Obviously its a past decision at this point, but this is one of the strangest reasons I've ever heard cited for not picking the specialty.

I would be the first to whine about "blue phone" patients, and on some level the added risk in these cases unnerves me, but that being said, almost everywhere I have ever worked has freely available interpreting services, and utilizing them is considered a reasonable standard of care second best option to speaking the patient's language fluently yourself.

Furthermore, this reality can be greatly mitigated based on final practice location, which you can choose.

Also, other specialties must see non-english speaking patients to.

 

[RustedFox]

Obviously its a past decision at this point, but this is one of the strangest reasons I've ever heard cited for not picking the specialty.

I would be the first to whine about "blue phone" patients, and on some level the added risk in these cases unnerves me, but that being said, almost everywhere I have ever worked has freely available interpreting services, and utilizing them is considered a reasonable standard of care second best option to speaking the patient's language fluently yourself.

Furthermore, this reality can be greatly mitigated based on final practice location, which you can choose.

Also, other specialties must see non-english speaking patients to.

Doesn't make it any less agitating, amigo.

Couple that agitation with "YOU'RE here wanting something from ME and I am expending myself to make accommodations for YOU" and you have a real recipe for burnout. Especially when the patient has been here 42 times in the past three years, and has been seen by eleventeen specialists, but... can't speak a word of the local language.

I'm reaching fully "bilingual" status here soon. I get it. But you know what? You don't see me kicking it in Slovenia for several years with an attitude of: "Why don't these people speak MY language?!"

 

[Arcan57]

Fulfillment in EM is all about perspective. Maybe you've had a very different life course than most, but the average end-year PGY-1's perspective isn't very comprehensive. You've had to deal with off-service rotations were you were either thrown into the deep end on day one and spent the month trying to flounder out or were such a superfluous part of patient care that it was hard to even engage. The patients you saw may well have been cherry-picked to be seen by you due to charge nurses that figure you're unlikely to f$%@ up too bad taking care of them either because they have no potential for decompensation or they're such malignant trolls that it didn't matter who saw them.

But those parts get better. You gain at least a veneer of competence in a pretty wide range of things and you become really good at some things that other specialties are frankly horrible at dealing with. You start getting fed the sick patients as the nurses start trusting you to keep them alive. But there are some things that don't change, and some skills that are mission critical for being successful that aren't formally taught in residency.

If I can offer one piece of advice for when you decide to stick it out (which statistically is what's most likely to happen) - put time and effort into getting good at conflict resolution. It's something that we hope passively soaks into our impassioned trainees but all too often you're either given too little guidance or you never have the freedom to figure out your own path before you're thrown into the solo world of being an attending. There, you'll learn conflict resolution. Everyone that's teaching you is going to be focused on making everyone but you happy, however. PG disciples will teach you how to please the most bridge dwelling of trolls, your director will sit you down and explain in exquisite detail how to keep the powerful but Axis II afflicted members of the med staff happy. But few are the people that will show you how to navigate the moral hazards and conflicting values inherent in our specialty while keeping your sense of self. There will always be things that go disastrously wrong, but if you can calm a room down without it burning up some of your soul then you have a chance at a long, fulfilling career in EM.

 

[Dr G Oogle]

That's great. Nonetheless, ED attracts all types of people, many of whom are not cool. Unlike some other specialties, EM takes anybody including the SJW who wants to combat health disparities 24/7, the dweeb who really belongs in IM or Neuro, or the bro who didn't get into ortho.

Hit or miss.

Wow. I’m not an EM and have certainly had my fair share of disagreements with them, but this is straight up wrong. EM docs are some of the chillest, normal doctors in the hospital including in the ivory towers. There are lots of every type of person in every field from SJW to people who couldn’t match into another field, but the brush your painting with was dipped in the wrong bucket on this one.

 

[RoyBasch]

Couple that agitation with "YOU'RE here wanting something from ME and I am expending myself to make accommodations for YOU" and you have a real recipe for burnout. Especially when the patient has been here 42 times in the past three years, and has been seen by eleventeen specialists, but... can't speak a word of the local language.

Again, I agree that foreign language encounters are irritating, but this is not a feature unique to emergency medicine, as you noted in your own post, multiple other (non ER) specialist had to see the patient as well, and presumably they also had to deal with the language barrier.

I doubt this aspect of medicine is improved by picking a different specialty, it is more influenced by practice environment (which perhaps some specialties can control more than others such as a hypothetical all cash-only cosmetic plastics practice). But let's be real, if we had the wherewithal to train and certify in PRS, and build a cash-only cosmetics plastics practice, we wouldn't be ER physicians, or many other things for that matter.

 

[RustedFox]

Again, I agree that foreign language encounters are irritating, but this is not a feature unique to emergency medicine, as you noted in your own post, multiple other (non ER) specialist had to see the patient as well, and presumably they also had to deal with the language barrier.

I doubt this aspect of medicine is improved by picking a different specialty, it is more influenced by practice environment (which perhaps some specialties can control more than others such as a hypothetical all cash-only cosmetic plastics practice). But let's be real, if we had the wherewithal to train and certify in PRS, and build a cash-only cosmetics plastics practice, we wouldn't be ER physicians, or many other things for that matter.

Yeah, you're right.
Its just one of those cherries on top of the ****ty-sundae that is ER that will really pour gasoline on the fire at the end of a toasty shift.

Great username, BTW.
I'm halfway thru the book for the second time just now.
Can't wait to go home, curl up, and read some more.

 

[Doc Doc Doc Goose]

That's great. Nonetheless, ED attracts all types of people, many of whom are not cool. Unlike some other specialties, EM takes anybody including the SJW who wants to combat health disparities 24/7, the dweeb who really belongs in IM or Neuro, or the bro who didn't get into ortho.

Hit or miss.

And ..... Psyc doesn’t?

 

[Doc Doc Doc Goose]

Obviously its a past decision at this point, but this is one of the strangest reasons I've ever heard cited for not picking the specialty.

I would be the first to whine about "blue phone" patients, and on some level the added risk in these cases unnerves me, but that being said, almost everywhere I have ever worked has freely available interpreting services, and utilizing them is considered a reasonable standard of care second best option to speaking the patient's language fluently yourself.

Furthermore, this reality can be greatly mitigated based on final practice location, which you can choose.

Also, other specialties must see non-english speaking patients to.

i think in a previous post he mentioned that he worked in an ED located in a remote jungle of the Amazon

 

[The Knife & Gun Club]

i think in a previous post he mentioned that he worked in an ED located in a remote jungle of the Amazon

You are replying to a thread that is nearly a year old at this point.

“Sir, this is an Arby’s.”

 

[Old_Mil]

IM is no better...

IM gives you the ability to specialize in a wide variety of things.

IM and FM give you the ability to set up a concierge/DPC practice and divorce the hospital and insurance companies.

FM and fellowships give you the ability to leave the country easily.

If you have the ability to get out, do it.

 

[Old_Mil]

I really, really hate the entitled boomers.

Someday, someone will do an analysis of that generation to figure out why they ended up aging the way they did.