Dammit

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If you can live without operating don’t be a surgeon.
If the OR is in your blood you made the wrong call and need to switch.

Listen2Savage said:
Was hanging out with a couple ortho bros for Superbowl and now I'm thinking Surgery would have been a better fit for me.

Have always been interested in surgery and EM, now I think all the doom and gloom on here has me wishing I went the other direction.

Dammit fml
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Dr Mantis Toboggan said:
If you can live without operating don’t be a surgeon.
If the OR is in your blood you made the wrong call and need to switch.
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i think i would be happy in either field

just makes me sick reading all this cmg takover doom and gloom on here when surgery is going the opposite direction with free standing surgical centers.
 
Dr Mantis Toboggan said:
If you can live without operating don’t be a surgeon.
If the OR is in your blood you made the wrong call and need to switch.
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I think the same can be said for EM. If you can live without being in the ED then don’t go into EM. Ortho will leave you very miserable inside and outside of work, but mainly in your 20s-30s. You should be established and coasting after that. Not saying the job is easy, but when you can pull 500k+ in any city working normal hours it’s the good life.

EM is a slow misery for your entire working career unless you build on a (lucrative) academic or administrative niche. This is one piece of advice I wish I had when I was a student. I got wrapped up into doing a (relatively easy) 3 year residency and enjoying my 20s-30s. Little did I know family stuff happens and it’s more important to have stability and a normal schedule in your 40s and beyond.
 
GatorCHOMPions said:
I think the same can be said for EM. If you can live without being in the ED then don’t go into EM. Ortho will leave you very miserable inside and outside of work, but mainly in your 20s-30s. You should be established and coasting after that. Not saying the job is easy, but when you can pull 500k+ in any city working normal hours it’s the good life.

EM is a slow misery for your entire working career unless you build on a (lucrative) academic or administrative niche. This is one piece of advice I wish I had when I was a student. I got wrapped up into doing a (relatively easy) 3 year residency and enjoying my 20s-30s. Little did I know family stuff happens and it’s more important to have stability and a normal schedule in your 40s and beyond.
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This.

I'm early in my career post residency. Thankful that I've become interested in FI right before graduation. I think it's important in EM to take advantage of the early career high salaries by investing more. Gives you more options in your 40s than if you had 0 savings.
 
As miserable as doing nights, weekends, holidays in your 60s sounds for EM, I can still remember scrubbing in with an orthopod in his 60s to do a total hip and he was grunting, covered in sweat, throwing equipment down, and altogether did not look like he was having very much fun.
GatorCHOMPions said:
I think the same can be said for EM. If you can live without being in the ED then don’t go into EM. Ortho will leave you very miserable inside and outside of work, but mainly in your 20s-30s. You should be established and coasting after that. Not saying the job is easy, but when you can pull 500k+ in any city working normal hours it’s the good life.

EM is a slow misery for your entire working career unless you build on a (lucrative) academic or administrative niche. This is one piece of advice I wish I had when I was a student. I got wrapped up into doing a (relatively easy) 3 year residency and enjoying my 20s-30s. Little did I know family stuff happens and it’s more important to have stability and a normal schedule in your 40s and beyond.
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Lucrative academic/administrative niche....isn't that an oxymoron?
 
Academics spend more time less pay and often still have to do nights
 
Groove said:
As miserable as doing nights, weekends, holidays in your 60s sounds for EM, I can still remember scrubbing in with an orthopod in his 60s to do a total hip and he was grunting, covered in sweat, throwing equipment down, and altogether did not look like he was having very much fun.


Lucrative academic/administrative niche....isn't that an oxymoron?
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Of course there may be anecdotes of unhappy and/or financially struggling orthopods but that isn’t the norm.

As for the second part, if you grind and slurp your way to the top of academia, Chairs often make a hefty living for working very little clinically. Same can be said for some of these podcast rockstars we have in EM, or if you choose to do something like Tox and go into private pharmaceuticals or legal work. These examples are the outliers, of course, but is one of the potential ways to do EM into your 60s. However, the ortho example you gave above is the outlier for that field.
 
GatorCHOMPions said:
Of course there may be anecdotes of unhappy and/or financially struggling orthopods but that isn’t the norm.

As for the second part, if you grind and slurp your way to the top of academia, Chairs often make a hefty living for working very little clinically. Same can be said for some of these podcast rockstars we have in EM, or if you choose to do something like Tox and go into private pharmaceuticals or legal work. These examples are the outliers, of course, but is one of the potential ways to do EM into your 60s. However, the ortho example you gave above is the outlier for that field.
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EM Chair in an academic center is not a realistic attainable goal for most EM docs. There's a lot of luck, back stabbing, schmoozing and innate charisma/politic that's involved. Even then, most of those guys are making the same amount that a busy community doc in a decent paying region would be making. Yes, decreased clinical time but I wouldn't say they have an easy job. Lots of politics, meetings, administrative duties, etc..

In general though, most academic docs make a far cry less than community docs. The exception is far less common than the norm. Administration in the community is an option, and that's certainly less clinical time but usually not by a lot and if you're working for a CMG, the total compensation is still about what your pit docs are making minus 4-6 clinical shifts/mo.
 
Listen2Savage said:
Was hanging out with a couple ortho bros for Superbowl and now I'm thinking Surgery would have been a better fit for me.

Have always been interested in surgery and EM, now I think all the doom and gloom on here has me wishing I went the other direction.

Dammit fml
Click to expand...
While you were hanging out with your ortho-bros at the Superbowl Party, what did they tell you that made you wish you had chosen Ortho over EM?
 
Groove said:
EM Chair in an academic center is not a realistic attainable goal for most EM docs. There's a lot of luck, back stabbing, schmoozing and innate charisma/politic that's involved. Even then, most of those guys are making the same amount that a busy community doc in a decent paying region would be making. Yes, decreased clinical time but I wouldn't say they have an easy job. Lots of politics, meetings, administrative duties, etc..

In general though, most academic docs make a far cry less than community docs. The exception is far less common than the norm. Administration in the community is an option, and that's certainly less clinical time but usually not by a lot and if you're working for a CMG, the total compensation is still about what your pit docs are making minus 4-6 clinical shifts/mo.
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People are misunderstanding me. My whole point is the exception I’m painting for EM is the same exception you mentioned for Ortho. Would you rather the EXCEPTION be a miserable surgeon doing a total hip or the successful academician/administrator/private industry person. The “rule” for Ortho is far superior than the EM counterpart.

I think it says something about a field where a large portion of its members are trying to attain FIRE as their sole goal of working.
 
I'd hate to be ortho. Can you imagine being on call and having to argue with all those EM goons about sending home unstable bimal/trimal fxs that I don't want to admit for ORIF because I know they don't have insurance and I'm trusting they won't make it through screening to the clinic because they can't afford the office visit?
 
Birdstrike said:
While you were hanging out with your ortho-bros at the Superbowl Party, what did they tell you that made you wish you had chosen Ortho over EM?
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they weren't trying to dissuade me from em or anything

they were just talking about negotiating with different private groups which made me think damn thatd be nice to actually have skin in something.

then on top of that they seem to be pretty well insulated from mlp creep and residency expansion

seems like every effing thing i read on hear for the future of em is negative

like not one effing thing is gonna break my way as a rising em doc

doggydog said:
Wow.

Another thread that devolved into the doom-and-gloom money conversation.

Shocking.
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to be fair $ was at the crux of my OP
 
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I don't find EM "miserable" as so many here do. I view it as a job. There's a reason it's called "work" and not "super happy fun time". I go to work, get through my shift with the minimum effort and as little friction as I can, then go home and forget about work. I'd much rather work the 3-4 days per week I currently do, than be stuck in a 5-day work week at some office or administrative job. Sure ortho sounds great, but almost any of these surgical specialties you are up almost every day at 5AM to do early morning procedures, then have to see obnoxious clinic patients, and then take ED call and calls about other patients all day. Sounds simply awful.
 
Ortho is one of my favorite parts about EM. Reducing a shoulder in two seconds w/o sedation is the best way to feel better after seeing a drug seeking/psych patient. I still prefer EM though and wouldn't want the lifestyle or daily work of a typical surgeon. I would say our hourly rates are probably pretty similar and possibly in some cases better in EM.

Around here ortho groups are more often employed by hospitals and EM is still contracted/independent, due to state law.

The upside of EM is being one of the few physicians who can walk into any situation and know exactly how to manage the patient. Whether that gives the professional satisfaction to make up for the downsides depends on you. Also like Veers said, it's a job and honestly I would say our work is in many ways easier than what our nurses and medics go through, while paying >10x as much.

I would again caution against taking too much stock in the doom and gloom. I do not see ABEM physicians being in a significantly different situation than most other specialties. Anesthesia, FM, gen surg even subspecialties etc all have their issues with CMGs/legislation/APPs etc.
 
GeneralVeers said:
I don't find EM "miserable" as so many here do. I view it as a job. There's a reason it's called "work" and not "super happy fun time". I go to work, get through my shift with the minimum effort and as little friction as I can, then go home and forget about work. I'd much rather work the 3-4 days per week I currently do, than be stuck in a 5-day work week at some office or administrative job. Sure ortho sounds great, but almost any of these surgical specialties you are up almost every day at 5AM to do early morning procedures, then have to see obnoxious clinic patients, and then take ED call and calls about other patients all day. Sounds simply awful.
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Same, I actually like my job. Sure, there are downsides, the worst being working nights for me. Even then, I do 3-4 a month tops. If pay and working conditions remained the same as they are now, I'd be very satisfied. The issue is that we know it won't...
 
I haven't seen that movie, but what about this thread reminds you of it?
 
e30ftw said:
Ortho is one of my favorite parts about EM. Reducing a shoulder in two seconds w/o sedation is the best way to feel better after seeing a drug seeking/psych patient.
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If you like reducing dislocations, I wouldn't go into ortho. How many shoulder dislocations do you think your average orthopod does? In almost 15 years in EM, I've seen an Orthopod one time in the ED for a shoulder dislocation. I was in the Navy and my EM colleague couldn't get it so they came in. They couldn't get it and flat out said, "we never do shoulder reductions, the ED always does, so he asked me to do it and I promptly popped it in.
 
I'm not going to sound particularly insightful, but with only one exception the happiest orthopods I've met have either been at the very start or the very end of their career. Not all that glitters is gold.
 
e30ftw said:
... it's a job and honestly I would say our work is in many ways easier than what our nurses and medics go through, while paying >10x as much...
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I don't understand why some physicians say this. It's just not true or youre seeing 0.25pts an hour or seeing only urgent care garbage. These statements only hurt all of us with no gain.
 
Rekt said:
I don't understand why some physicians say this. It's just not true or youre seeing 0.25pts an hour or seeing only urgent care garbage. These statements only hurt all of us with no gain.
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I respect nurses and medics and feel blessed and happy in EM.

I post here in an attempt to share that energy.

You are free to find what you seek.
 
I'm one of the most negative people around. I really don't like my job most days. That said I think EM is one of the better places to be. The vast majority of the problems we are all facing aren't with EM but with medicine as an industry. Pay, autonomy, metrics, job insecurity, med mal, etc. They hit everyone, not just the EPs. When you're a student don't worry so much about whose got it better. It's like trying to find the best bite of a poop sandwich. Just figure out what you like doing most and go for that.
 
honestly that's the only reason I've started posting a bit more recently; to combat the negativity.

Interestingly just posting positive comments seems to entice others to negativity.. reviewing the forum shows most of such posts are from non-ABEM folks.

Seems contrary to the ultimate goal of the forum.
 
Just remember that a career as Ortho? Just doing Ortho? I like all the Ortho guys I work with, but remember all you do is fix bones. Along with occasional tendon stuff and joint repairs. It is such a very small part of medicine. A TINY PART. And that's all you do day in and day out? Look at xray after xray after CT after xray, the same old thing all the freaking time.

The nice thing about being an EM doctor is you feel so useful to so many patients that come in. Remember we discharge 85% of all patients we see. Any single thing that comes into the ER, we can usually handle. Of course I know we sometimes discharge patients and say "sorry you came to the wrong doctor", but for the most part we can help ANYTHING that comes in that door. And we usually admit patients because we need specialists to fix them. We don't admit patients because all they need is a hospitalist. I'd say 3/4 of all the patients I admit get consults from other specialties.
 
Is there a diarrhea part and more of a dessicated part? I think if I have to take a bite, at least I won't have to chew the diarrhea part as much.
docB said:
I'm one of the most negative people around. I really don't like my job most days. That said I think EM is one of the better places to be. The vast majority of the problems we are all facing aren't with EM but with medicine as an industry. Pay, autonomy, metrics, job insecurity, med mal, etc. They hit everyone, not just the EPs. When you're a student don't worry so much about whose got it better. It's like trying to find the best bite of a poop sandwich. Just figure out what you like doing most and go for that.
Click to expand...
 
e30ftw said:
honestly that's the only reason I've started posting a bit more recently; to combat the negativity.

Interestingly just posting positive comments seems to entice others to negativity.. reviewing the forum shows most of such posts are from non-ABEM folks.

Seems contrary to the ultimate goal of the forum.
Click to expand...
Renaissance Man said:
FFS, this sub-forum has really just become an echo chamber of negativity. All recent threads have been 90% doom and gloom.
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There are a lot of people who picked EM because they liked the idea of taking care of sick people while enjoying an excellent standard of living. Well, the signal to noise ratio on sick people may not be all that great after a 3-year residency, and now the whole lifestyle side of the equation is threatened as the labor supply swells. That leads to some butthurt.

Don’t get me wrong, there are still plenty of tree hugging, true believers who genuinely enjoy pounding out 130 hrs/month helping people...with their routine problems...at off hours. They are still pretty happy but are too busy with their woodworking and home brewing to post about it on SDN.

On the other hand, there is a significant minority of happy, well-adjusted people who completed EM residency...they just don’t practice traditional EM all that much. Some are people in academics or administration with significant clinical buy-down. Others are entrepreneurs and business people who leveraged EM against other skill sets and talents. A few do fellowships in interventional pain mgmt, CCM, etc. Then, there is a small handful who don’t give a crap about money or lifestyle and use EM for their adrenaline rush, sense of purpose, or desire to treat a highly select population (Professional or Collegiate Sports Medicine, Special Forces Group Surgeons, Ranger Bn Surgeons, FBI Operational Medical Program, NASA, WHMU, DOS Foreign Service/CIA, etc.). This last group often had very alternative backgrounds before medical school, were and continue to be hardcore athletes, or have compliant patient populations that are actually a pleasure to treat. Despite making peanuts, most are as happy as a pig in stink provided that their families can handle the pressures.

Having said that, if you really want to take care of sick patients, EM residency is one of the fastest and most efficient means to that ends. However, the price of admission is often 2 years of fellowship and you need to enjoy the in-patient ICU (or be able to get a job at one of the few EC3s). Community EM rarely has the acuity to satisfy most people who want to spend the majority of their time treating sick patients.
 
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docB said:
I'm one of the most negative people around. I really don't like my job most days. That said I think EM is one of the better places to be. The vast majority of the problems we are all facing aren't with EM but with medicine as an industry. Pay, autonomy, metrics, job insecurity, med mal, etc. They hit everyone, not just the EPs. When you're a student don't worry so much about whose got it better. It's like trying to find the best bite of a poop sandwich. Just figure out what you like doing most and go for that.
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Hey, man! Glad to see you back. I had posted a thread a long time ago asking around if @docB was "still around," if you know what I mean. I wasn't sure if you had taken a break, something bad happened, or if you just had gone incognito with a different screen name. You've always been one of the best posters on this forum. Awesome you're back.
 
Apollyon said:
Every time someone on SDN mentions "echo chamber", I wonder what is their agenda. Every time.
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Isn't every group of people, dare I say "friends," who get together to chat about thoughts, experiences and attitudes they have in common, an "echo chamber" in some form?

I find it funny that people use that term "echo chamber" as an pejorative, then they go an have coffee with their friends who totally agree with them about echo chambers. Are they suggesting people purposefully seek out social and online interactions only with people who only disagree with them, challenge everything they say, argue, and never agree? Isn't that what we call "trolls"?
 
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Renaissance Man said:
FFS, this sub-forum has really just become an echo chamber of negativity. All recent threads have been 90% doom and gloom.
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Once you figure out that life is all about wading through that 90% and bringing that other 10% into clear focus, life gets immeasurably easier.
 
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Apollyon said:
Every time someone on SDN mentions "echo chamber", I wonder what is their agenda. Every time.
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Birdstrike said:
I mean, seriously. Are they suggesting people purposefully seek out social and online interactions only with people who only disagree with them, challenge everything they say, argue, and never agree? Isn't that what we call
marriage?
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FIFY.
 
One thing I've learned (after posting way too much "doom and gloom") is that if you're going to contribute to an online forum (or any other social situation) that you think is too negative, just adding one more negative post about how negative everyone is being, doesn't help the situation. Instead of simply adding another negative post to a thread you think is too negative, try posting something positive to counter the negativity. That works very well and is much more persuasive.

What's the positive spin on burnout?

It's that it's preventable and can be fixed. For me the solution to EM burnout, was doing an EM sub-specialty fellowship. I think the various fellowships help a lot of people and I've posted about these positive solutions and will continue to. Reducing shifts, attaining financial independence and finding job arrangements that allow more flexibility also help. Other people have suggested other solutions. I think there's some great advice you can get here (for free).
 
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whats the most lucrative fellowship out of EM?

ive got like 450k in loans so now im thinking ill hedge my bets against all this doom and gloom and do fellowship then go for PSLF
 
Listen2Savage said:
whats the most lucrative fellowship out of EM?

ive got like 450k in loans so now im thinking ill hedge my bets against all this doom and gloom and do fellowship then go for PSLF
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I don't know all the data on this. What you need to get from someone is the most recent MGMA surveys on salaries. That's the industry standard on this. Your ED directors and residency directors will have this, or can get it.
 
Birdstrike said:
I don't know all the data on this. What you need to get from someone is the most recent MGMA surveys on salaries. That's the industry standard on this. Your ED directors and residency directors will have this, or can get it.
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what do you think affords the best lifestyle/pay ? pain? just straight EM?
 
Listen2Savage said:
what do you think affords the best lifestyle/pay ? pain? just straight EM?
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Lifestyle: Definitely Pain. By a mile, at least for me.

Pay?

I'm not sure. I make more than I did in EM, but I've been out 9 years now and these things change year to year. The last time I looked at an MGMA survey, Pain averaged more than EM and it has every time I've looked since I left to do my fellowship. But again, you have to look at the most recent data.
 
Listen2Savage said:
what do you think affords the best lifestyle/pay ? pain? just straight EM?
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Define lifestyle?

If the dollar amount per hour is paramount to what you define as a lifestyle, then community EM is very hard to beat. You had just better make damn sure that you have embraced the customer service driven, protocolized-out-the-ass, cookie cutter models of care delivery that have become so prevalent in EM.

By cookie cutter I’m taking about nursing triage orders, provider in triage, code stroke, code sepsis, and the protocolized way we now wipe our collective asses. For example, my last academic shop had a protocol for suspected kidney stones that mandate a CT for almost every patient to facilitate urologic follow-up. I had gatekeeper PGY2s tell me that I needed to get a BS under 300 and SBP under 170 to admit patients to the floor because...you know - patient safety. 😵

On the other hand, if lifestyle means enjoying taking care of a particular patient population (critically ill, athletes, etc.), you may find a lower per hour dollar amount acceptable. For example, I’ll probably make about $300-400k as an intensivist after fellowship and work more hours than most EM attendings. A friend of mine is the medical director for NASA and a colleague was the medical director for the FBI - they both probably work 50 hrs/week and make far less that $300K. However, none of us will be spending any time answering complaints because we didn’t work-up someone’s chronic abdominal pain or give opiates to back pain. I also no longer have to debate IM PGY2s about admissions or field ridiculous questions on why I didn’t get an ICU consult on patients with hyperglycemia, trace ketones, and a normal pH/bicarbonate. That right there is pure gold when applied across the 20 or so more years I have left ahead of me.
 
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Apollyon said:
Every time someone on SDN mentions "echo chamber", I wonder what is their agenda. Every time.
Click to expand...

It is my observation, nothing more and nothing less. I have used and read SDN for 10+ years and been sporadically active in posting. Over the last few months most threads here have devolved into "poor job market", NP/PAs, decrease in pay, etc. Not really even sure what possible "agendas" I could enact on a forum like this, but I will let you continue to wonder, sport.

Birdstrike said:
Isn't every group of people, dare I say "friends," who get together to chat about thoughts, experiences and attitudes they have in common, an "echo chamber" in some form? I find it funny that people use that term "echo chamber" as an pejorative, then they go an have coffee with their friends who totally agree with them about echo chambers.
Click to expand...

Birdstrike said:
One thing I've learned (after posting way too much "doom and gloom") is that if you're going to contribute to an online forum (or any other social situation) that you think is too negative, just adding one more negative post about how negative everyone is being, doesn't help the situation. Instead of simply adding another negative post to a thread you think is too negative, try posting something positive to counter the negativity.
Click to expand...

Aren't you the guy who deletes half of their old posts "."?

How is this? I don't regret medical school, student loans, or choosing EM. I think it is a pretty great job 75% of the time. I never dread going to work and often have a few cases that make me feel very satisfied. The time passes quickly during shifts, I enjoy keeping up with learning about the field, and during my recent job search I had multiple offers to make ~$350K a year (not to mention the benefits and retirement match).

The other 25% of time I remind myself that it is a job and I am just like Joe Insurance Guy in that way.
 
Thanks Birdstrike for the kind comments. I didn't mean to leave. I got busy and checking SDN just fell out of my routine. I continue to think SDN is a great forum and one of the places where students and residents get a lot of unfettered access to a wide array of opinions and helpful advice.

I don't mean to seem so negative that I scare people. Within the confines of medicine EM is a good place to be. It faces a lot of difficulties as do all specialties. I do a lot of EMS and admin work and I enjoy those aspects, particularly the EMS part.

It's hard to explain the way I look at the day to day of EM at the 20 year mark. There was a poster here from way back who really said it best (I'm sorry I can't recall the name but he was great and I'm paraphrasing):
When you're a young attending and you're faced with the difficult situations that arise due to administration, metrics, difficult patients and consultants and so on you overcome them because you have to. Since these are new challenges to you you feel like you've accomplished something and it is exhilarating. You bask in the glory of "I can run this whole ED through anything!" But as the years go by you begin to anticipate these challenges and dread the process of slogging through them. It's no longer exciting, just tiring.
 
Superslim11 said:
As someone waiting for match results next month I feel sick.
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Residency is a lot of work, but worlds better than medical school. Becoming an attending is then way better than residency...No one from my residency took a job somewhere they didn't want to live, and I think we are all quite financially comfortable even with student loan payments. If you want to chat, send me a private message. It is still a great field and profession.
 
Superslim11 said:
As someone waiting for match results next month I feel sick.
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EM still sucks the least of all the other specialties. You just have to be fine with making a meager salary compared to what it once was along with likely working in a location you don't really enjoy.
 
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