Burnt out. Some advice?

[LilsnLena]

Hi All,

I am looking for some help/advice. I am ~5 years out of residency ABEM certified. I enjoy my day to day work and the medicine involved. The requirements of the specialty have started to become a drag.

I knew this was a 24/7, 365 job when I signed up for EM as a career. At that time I was single and was attracted to the medicine and the total hours worked. I figured when I got married and had children the extra days off would offset the issues.

Now I find it very difficult to work 2/4 weekends per month every month along with 1/3 afternoon shifts (which I don't see my wife or children). Days and nights really don't bother me. If days and nights and one weekend a month were possible I wouldn't have these issues.

I am looking for some way to transition out. I know I am not going to make $375-400k/year doing other things but I think for my sanity it needs to happen.

The things that came to mind were admin, urgent care, medical consulting or others. Administration interests me but I feel that takes quite some time to make roads into and to some extent is based on right time right place. Some of the other pathways I am just not really even sure how to get into.

What are your thoughts? I'm sure I am not the only one who is burnt out this way. My wife is very supportive but I can tell how all the nights and weekends by herself affect her.

---

Members don't see this ad.

 

[Birdstrike]

Hi All,

I am looking for some help/advice. I am ~5 years out of residency ABEM certified. I enjoy my day to day work and the medicine involved. The requirements of the specialty have started to become a drag.

I knew this was a 24/7, 365 job when I signed up for EM as a career. At that time I was single and was attracted to the medicine and the total hours worked. I figured when I got married and had children the extra days off would offset the issues.

Now I find it very difficult to work 2/4 weekends per month every month along with 1/3 afternoon shifts (which I don't see my wife or children). Days and nights really don't bother me. If days and nights and one weekend a month were possible I wouldn't have these issues.

I am looking for some way to transition out. I know I am not going to make $375-400k/year doing other things but I think for my sanity it needs to happen.

The things that came to mind were admin, urgent care, medical consulting or others. Administration interests me but I feel that takes quite some time to make roads into and to some extent is based on right time right place. Some of the other pathways I am just not really even sure how to get into.

What are your thoughts? I'm sure I am not the only one who is burnt out this way. My wife is very supportive but I can tell how all the nights and weekends by herself affect her.

I hit the wall 5 years out, too. I did an Interventional Pain fellowship, and it’s worked out great. See other thread.


Sent from my iPhone using Tapatalk

 

[bravotwozero]

Before leaving EM altogether, I would suggest trying a different shop. I moved to another ED that is less busy but I get paid the same because of a batter payor mix. We have a nocturnist so that means less nights. It’s single coverage with mlps so I don’t work the dreaded 6p-3a shift because it doesn’t exist here. You may work less weekends if you go nocturnist, and make more money than you are.

Can also try locums work, or do 24 hour shifts at ultra low volume EDs where you can pocket 5k per shift. Do 6 of those and you’re set for the month.

Plenty of options out there if you’re willing to look.


Sent from my iPhone using Tapatalk

 

[TheComebacKid]

I know I'll probably get torched for this... but why not look into academics?

Many of the faculty at my residency program pull very few clinical shifts a month (6-7). If you enjoy research, teaching, administration, hospital committees etc there's a possibility to add a lot of flexibility to your schedule if you are willing to take the pay cut. A lot of my academic EM attendings work from home. It's still a busy job and they spend a good deal of time away from the family. But I think it really offsets the daily grind of working back to back shifts.

 

[GeneralVeers]

See if there are any locums near where you live. You can usually make your own schedule, and not work weekends if you don't want.

 

[LilsnLena]

Pain fellowship is an interesting idea. So would any anesthesia based program accept EM trained people or is it only certain ones?

I did some locums straight out of residency and loved it. The problem is the city we live in has about 5 shops that are all staffed by Team Health. No locums within an acceptable driving distance that I could find. Same deal with ultra low volume shops.

Academics I guess is an option but I remember in residency my attendings working a pretty similar schedule to my current one for half the pay.

 

[GeneralVeers]

Pain fellowship is an interesting idea. So would any anesthesia based program accept EM trained people or is it only certain ones?

I did some locums straight out of residency and loved it. The problem is the city we live in has about 5 shops that are all staffed by Team Health. No locums within an acceptable driving distance that I could find. Same deal with ultra low volume shops.

Academics I guess is an option but I remember in residency my attendings working a pretty similar schedule to my current one for half the pay.

Doing traditional EM as a full time employee your options are limited. Every group you work for will require you to work weekends.

 

[Birdstrike]

Pain fellowship is an interesting idea. So would any anesthesia based program accept EM trained people or is it only certain ones?

At most places the preference is for Anesthesia > PM&R >>everyone else, primarily due to historical factors. Some are going to be more EM friendly than others. Some make that known, others may not. The best insurance against this is to apply widely, preferably to every program, and sell yourself. Coming from an EM background, you’re as qualified, if not more qualified than anyone else who applies.



Sent from my iPhone using Tapatalk

 

[Brigade4Radiant]

How many shifts are you working?

 

[Perfect Hair Day]

Concierge = the Uber of Medicine.

 

[The White Coat Investor]

Hi All,

I am looking for some help/advice. I am ~5 years out of residency ABEM certified. I enjoy my day to day work and the medicine involved. The requirements of the specialty have started to become a drag.

I knew this was a 24/7, 365 job when I signed up for EM as a career. At that time I was single and was attracted to the medicine and the total hours worked. I figured when I got married and had children the extra days off would offset the issues.

Now I find it very difficult to work 2/4 weekends per month every month along with 1/3 afternoon shifts (which I don't see my wife or children). Days and nights really don't bother me. If days and nights and one weekend a month were possible I wouldn't have these issues.

I am looking for some way to transition out. I know I am not going to make $375-400k/year doing other things but I think for my sanity it needs to happen.

The things that came to mind were admin, urgent care, medical consulting or others. Administration interests me but I feel that takes quite some time to make roads into and to some extent is based on right time right place. Some of the other pathways I am just not really even sure how to get into.

What are your thoughts? I'm sure I am not the only one who is burnt out this way. My wife is very supportive but I can tell how all the nights and weekends by herself affect her.

I'm not sure you need out. I think you need a different mix of shifts, perhaps fewer shifts. If you can't get those at your current shop, you can change shops or do locums. You can tell the locums company- no nights, weekends, evenings, holidays etc.

Of course, this is almost surely going to decrease your pay. Are you in a position where that is going to have a dramatic effect on your life? I hope not. If so, making some changes before cutting back may be wise.

If admin is interesting, you may not find it that difficult to move in. It's mostly a coalition of the willing.

 

[Brigade4Radiant]

Also I'm confused in your previous posts last year you say you are an Internal medicine resident but now you are ABEM certified in only one year?

 

[RustedFox]

Seems to me like its an account shared by two people: "Lils" and "Lena".

Also, I feel I should point out that while locums is an "option", it also involves long stretches away from home and irregularity of work/schedule - which is what the OP stated that they wanted to avoid.

 

[goodoldalky]

Sounds like you need to cut your workload by 25% and then reassess.

I guarantee you are working too much.

 

[Old_Mil]

Seems to me like its an account shared by two people: "Lils" and "Lena".

Also, I feel I should point out that while locums is an "option", it also involves long stretches away from home and irregularity of work/schedule - which is what the OP stated that they wanted to avoid.

Also keep in mind that most shops that are having to use locums or a regular basis are having to do so for a reasaon. That reason usually involves some combination of:

1. An undesirable location
2. A problem patient population
3. A difficult environment to move the meat (consultant/admissions/charting issues)
4. The compensation for their regulars is too low.

(I once interviewed at a shop for a locums position at a quoted rate of $300 (to me, which means they were probably on the hook to the locums company for $330-360 an hour). It seemed like a reasonable department so I asked them about the potential of a full time transition and what the rate would be. Answer: $150 - $175 which was too low for the location. It still amazes me that the admin there was willing to cough up the $ for locums rather than pay their regulars $225-$250 an hour.)

5. They are understaffed.

 

[Arcan57]

Also keep in mind that most shops that are having to use locums or a regular basis are having to do so for a reasaon. That reason usually involves some combination of:

1. An undesirable location
2. A problem patient population
3. A difficult environment to move the meat (consultant/admissions/charting issues)
4. The compensation for their regulars is too low.

(I once interviewed at a shop for a locums position at a quoted rate of $300 (to me, which means they were probably on the hook to the locums company for $330-360 an hour). It seemed like a reasonable department so I asked them about the potential of a full time transition and what the rate would be. Answer: $150 - $175 which was too low for the location. It still amazes me that the admin there was willing to cough up the $ for locums rather than pay their regulars $225-$250 an hour.)

5. They are understaffed.

Typically hospitals pay for locums costs while group has to pay salary. Now most hospitals will drop a group if they’re still paying heavily after a certain time period.

 

[Brahnold Bloodaxe]

Typically hospitals pay for locums costs while group has to pay salary. Now most hospitals will drop a group if they’re still paying heavily after a certain time period.

Do you foresee the demand for locums becoming greatly reduced eventually?

 

[Arcan57]

Do you foresee the demand for locums becoming greatly reduced eventually?

The drivers of locums are largely entrenched in the system so on a global scale, no. On a local level it may. Houston needed a ton of locums due to aggressive expansion and loss of experienced docs to the FSEDs. Hundreds of EPS have been hired here in the last two years and now a lot of the locums positions are drying up in the metro area. If you’re willing to drive an hour outside the city there’s still a fair amount out there.

 

[Brahnold Bloodaxe]

The drivers of locums are largely entrenched in the system so on a global scale, no. On a local level it may. Houston needed a ton of locums due to aggressive expansion and loss of experienced docs to the FSEDs. Hundreds of EPS have been hired here in the last two years and now a lot of the locums positions are drying up in the metro area. If you’re willing to drive an hour outside the city there’s still a fair amount out there.

Could you elaborate a bit on what these drivers are? I'm an M2 and a significant part of what attracts me to EM is the feasibility of doing full time locums that currently exists. I'm 5 years away from becoming an attending so I'd like to understand whether the abundance of locums opportunities is likely to persist in the long term or is largely do to a "phase" EM as a specialty is currently in and will decline as the the field and the labor market matures over the coming years.

 

[gamerEMdoc]

Academics. Less shifts, and the students/residents keep you interested in medicine again. And you can't beat the team environment of working in a residency program.

 

[dchristismi]

Less shifts all the way.

I was really, really struggling with burnout about 2-3 years ago... to the point that I nearly left medicine altogether. I ended up (partly though my own choices and partly because my group lost the contract) quitting all of the administrative duties I was doing. Slashed my hours considerably. Discovered that I really had lost pretty much my entire life outside of medicine. (Note that I also bought a house, was remodeling said house and planning a wedding. Not a stressful time at all. Ha.)

It's been an interesting couple of years since that breaking point. Something else that the others have mentioned is that a change of scenery is often very helpful. For the last (gulp) 10 years I've been at a really high acuity disaster shop. Yeah, I love critical care, but when you only discharge 25% of your patients... I came home exhausted and demoralized and dreaded going in.

So anyway, I credentialled at a couple other hospitals to see what's out there, and it was definitely eye opening. I also formally went part-time at my main gig. I still chip in weekends and holidays for now, but thanks to nocturnalists, the nights are rare. I got a formal letter from the CMG that they were cancelling my contract a couple of weeks ago, but if I wanted to stay on PRN, sure. While I have my own AAEMish opinions about that, ultimately I don't need to work there - I had a gig dropped in my lap by a residency buddy that I'll be checking out in the coming months. Because, to quote Cartman: "screw you guys. I'm goin' home."

And if I don't have the shifts, I'll take a sabbatical. There is plenty of work out there. I live somewhat frugally and have little debt, which is honestly, a huge thing. Hospital #2 (and its sister hospitals) have 3 docs going on maternity leave this summer, so hey, yeah, there's work. There will always be work. But that is not all there is to life.

 

[SterlingMaloryArcher]

Hi All,

I am looking for some help/advice. I am ~5 years out of residency ABEM certified. I enjoy my day to day work and the medicine involved. The requirements of the specialty have started to become a drag.

I knew this was a 24/7, 365 job when I signed up for EM as a career. At that time I was single and was attracted to the medicine and the total hours worked. I figured when I got married and had children the extra days off would offset the issues.

Now I find it very difficult to work 2/4 weekends per month every month along with 1/3 afternoon shifts (which I don't see my wife or children). Days and nights really don't bother me. If days and nights and one weekend a month were possible I wouldn't have these issues.

I am looking for some way to transition out. I know I am not going to make $375-400k/year doing other things but I think for my sanity it needs to happen.

The things that came to mind were admin, urgent care, medical consulting or others. Administration interests me but I feel that takes quite some time to make roads into and to some extent is based on right time right place. Some of the other pathways I am just not really even sure how to get into.

What are your thoughts? I'm sure I am not the only one who is burnt out this way. My wife is very supportive but I can tell how all the nights and weekends by herself affect her.

Get in the trade lives machine with me. You'll step out 20 and not too far committed into anything yet.

 

[Old_Mil]

Get in the trade lives machine with me. You'll step out 20 and not too far committed into anything yet.

If such a machine existed I would imagine half the doctors in America would line up to do the swap,

 

[gro2001]

If such a machine existed I would imagine half the doctors in America would line up to do the swap,

And then almost immediately regret the decision. We have things pretty good. The median household income in the US is about $59,000 or about $24/hour. Yes, to get our $200/hour paychecks we had to work hard, take on lots of debt, suffer opportunity cost due to our long years of training, and work very hard for our money every day. But the end result is pretty good. We get well paid for interesting work. Despite all the lamenting on this forum, I think if such a machine existed, MDs would very quickly realize that the grass was not in fact greener.

May 2016 National Occupational Employment and Wage Estimates
How Does Your Income Stack Up Against the Average American's?
Middle-class Americans made more money last year than ever before

 

[ballinsncbirth]

i have a solution, and it may sound counterintuitive , but her me out

become a night doc. I found that switching back and forth between days and nights, the randomness of shifts, the uncertainty of your schedule is a killer.

however if you do all nights, and schedule your nights in a row, you have significant leverage on the shifts you work. For example. I work sunday , Monday and teus every week . I get a 4 days weekend EVERY WEEK . It is a game changer. I can go to all my sons weekend events (and weekday events if needed) You get to sleep while your kids are at school and other spouse is at work (if they work )


Not only do I not switch back and forth which makes it much easier to stomach . I have a stable schedule . you will also have significant leverage over your group ( ie I usually take priority in days off , vacation requests etc) Even the holidays aren't bad as I can work Christmas or thanksgiving night and still have a full dinner with my family.

another bonus is YOU CAN negotiate significant hourly pay Increase . allowing you to do less shifts .

Also the nights at most shops tend to be less crazy , less administrative folks hanging around ,less stressful ( I am currently writing this post coming of a night shift)

I have been doing it for 5 years and its a life changer.

 

[Groove]

I work 18 shifts/mo so I'm not the best person to give you advice, but....

I really see no reason to get out of the specialty. You can't work 6 shifts/mo, at whatever hours and still maintain adequate family/personal time? If not, then it's not work that's your problem...it's something else. I doubt you would earn as much FT in an urgent care with regular hours. 6 shifts would net you about 180K a year if you worked in the right spot.

It sounds like it's the swing shifts that are getting to you. As others have said, nocturnist is an option but I would just scale back to PT for awhile to get centered. Reassess in a few months. That's a much better option than a high altitude ejection shortly after career liftoff.

 

[jaeida8]

What state do you live in? I live in Texas. I am the primary caretaker of a 3 y/o who doesn't like to sleep and I was a partner in a single hospital democratic group with increased patient load and acuity without an increase in physician staffing. My solution was to go part-time with the group because part-timers make their own schedule (like locums) and to invest/work in a local freestanding ED. I am much happier and less tired now. If you're not in Texas, you could still work and/or invest in a freestanding, and because they are so low volume, you can fly in and do a bunch of hours over a few days. I'm in the southernmost part of Texas and we have someone who flies in from Kansas City.

 

[hundreddaysoff]

i have a solution, and it may sound counterintuitive , but her me out

become a night doc. I found that switching back and forth between days and nights, the randomness of shifts, the uncertainty of your schedule is a killer.

however if you do all nights, and schedule your nights in a row, you have significant leverage on the shifts you work. For example. I work sunday , Monday and teus every week . I get a 4 days weekend EVERY WEEK . It is a game changer. I can go to all my sons weekend events (and weekday events if needed) You get to sleep while your kids are at school and other spouse is at work (if they work )


Not only do I not switch back and forth which makes it much easier to stomach . I have a stable schedule . you will also have significant leverage over your group ( ie I usually take priority in days off , vacation requests etc) Even the holidays aren't bad as I can work Christmas or thanksgiving night and still have a full dinner with my family.

another bonus is YOU CAN negotiate significant hourly pay Increase . allowing you to do less shifts .

Also the nights at most shops tend to be less crazy , less administrative folks hanging around ,less stressful ( I am currently writing this post coming of a night shift)

I have been doing it for 5 years and its a life changer.

Do you keep the same night-owl schedule 7 days a week with this setup? Or do you switch to diurnal on the 4 days you aren't working?

In theory this setup is pretty appealing to me but I still haven't found a way to sleep more than 4 hours at a time when I'm pulling nights (usually 3-4h nap in AM then another nap in the evening). Also, my shop already has a few nocturnists, so I might not have as much leverage as you do.

 

[gro2001]

Do you keep the same night-owl schedule 7 days a week with this setup? Or do you switch to diurnal on the 4 days you aren't working?

In theory this setup is pretty appealing to me but I still haven't found a way to sleep more than 4 hours at a time when I'm pulling nights (usually 3-4h nap in AM then another nap in the evening). Also, my shop already has a few nocturnists, so I might not have as much leverage as you do.

I do mostly nights too, and mostly try to stack them. Here is what I do to make sure I get a decent amount of sleep:

1) Going into the first night, I don't take a nap prior to the shift. I keep the day activities pretty light, but basically do more or less what I normally would. Then I go to the night shift. With a little extra coffee and adrenaline from the shift that's not as difficult as it sounds. This ensures that when I get home from the first shift, I crash and stay asleep for a good 8 hours.

2) The devil is in the details of sleep hygiene. I make sure my room is absolutely blacked out. Black out blinds AND an eye mask. The room is cold and quiet. Phone is on the "do not disturb", not vibrate. The alarm is set to an hour prior to the start of my next shift, so if I do take time to get to sleep I am not going to wake up in the middle of a sleep cycle. All these little things add up.

The difficult part is actually switching back to days.

 

[Old_Mil]

And then almost immediately regret the decision. We have things pretty good. The median household income in the US is about $59,000

The fact that you are benchmarking our careers against median household income is telling. The people who successfully get through premed programs, medical school, and residency are in no way median. If they applied their intellect and work ethic to other fields, they would do very well.

 

[NinerNiner999]

Work less for 4 months. I''m not kidding - pick up 2/3 of your current shift volume, whatever it is. The income will be there, but your sanity will enjoy those extra days off to recharge. Your career is a marathon and not a sprint. Also - if you're burned out doing the shifts, don't consider administration until you master your issues. It is nearly impossible to lead and retain a team if they know you're cooked on the scheduled you make them work.

 

[Brigade4Radiant]

The fact that you are benchmarking our careers against median household income is telling. The people who successfully get through premed programs, medical school, and residency are in no way median. If they applied their intellect and work ethic to other fields, they would do very well.

This is only true for academic fields which doesn't equal success. Just because I got a good GPA and high MCAT doesn't mean I would be successful in the corporate world or be a tenured microbiology professor. Certain fields only higher from certain schools like Ibanking. Sure you may argue that you can work for tech but you have to live on the west coast so your high salary will be similar to a middle class lifestyle. You can't beat working 6 days a month and reliably making six figures. Not for the good student from Alabama medicine is tough and I did work hard but I've seen the life of my friends with high GPA and high MCATs who didn't get into medicine none of them are making six figs or living a life that I envy.

 

[enalli]

I've seen the life of my friends with high GPA and high MCATs who didn't get into medicine

This has always been a discussion full of hypotheticals to me because the high-achieving premeds almost always go on to medical school. What happened to your friends and what are they doing now?

 

[Brigade4Radiant]

This has always been a discussion full of hypotheticals to me because the high-achieving premeds almost always go on to medical school. What happened to your friends and what are they doing now?

One couldn't get in after three years so he did a PHD and is working as a post doc making 45k a year in Missouri he didn't want to do DO. The other one tried to work for a bio tech start up got laid off and is working with another start up.

 

[hundreddaysoff]

This is only true for academic fields which doesn't equal success. Just because I got a good GPA and high MCAT doesn't mean I would be successful in the corporate world or be a tenured microbiology professor. Certain fields only higher from certain schools like Ibanking. Sure you may argue that you can work for tech but you have to live on the west coast so your high salary will be similar to a middle class lifestyle. You can't beat working 6 days a month and reliably making six figures. Not for the good student from Alabama medicine is tough and I did work hard but I've seen the life of my friends with high GPA and high MCATs who didn't get into medicine none of them are making six figs or living a life that I envy.

Completely agree. I was a scientist before med school. You can be as smart as you want but success is by no means guaranteed. If you win the lottery of being right wrt objective reality, then sure, but that's only the 1--10% who are both smartest and luckiest. Same concept with law (similar setup to I-banking financially). The only profession I've seen with as consistent financial success as medicine is engineering, but it's probably harder to make more at the top end there.

I still like Nassim Taleb's explanation of this stuff in _The Black Swan_. Medicine is about the best you can do in Mediocristan; most of the high earners we see in other fields are living in Extremistan. You can't reliably win in Extremistan by just being smart and hardworking.

I'd love to be proven wrong about this...

 

[gro2001]

The fact that you are benchmarking our careers against median household income is telling. The people who successfully get through premed programs, medical school, and residency are in no way median. If they applied their intellect and work ethic to other fields, they would do very well.

They would probably do well. But well in most other fields, at least consistently, is much lower than in medicine. If they didn't go to medical school but instead applied themselves similarly in other fields, most MDs wouldn't be senior partners at big Manhattan law firms making $1.5 M a year or starting successful startups. Those are extremely rare exceptions. The more common outcome would be them making low 6 figures at some engineering, architecture, or software firm, with somewhat less debt, living a solid middle class life style. Not bad by any means, and arguably better in some ways, but worse in others. Our trade offs just aren't that bad, in my opinion.