Do you suffer from depression associated with clinical work?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

Angry Birds

Angry Troll
10+ Year Member
Joined
Dec 4, 2011
Messages
1,845
Reaction score
2,515
I am using this word very non-clinically here... but I do wonder if there is a DSM term (or should be one) for like Shift Affective Disorder. I know there is something like that for sleep disorder, but I wonder if there is something related to mood. I feel down and dark during my shifts and I don't think it's normal. I wonder if people who have other jobs feel this way as well. I am not sure.

Anyone else feel the same way? Or is this just the normal feeling of someone who doesn't want to work?
This is then coupled with feeling lonely when it's the middle of the night... Maybe it's these night shifts that are really getting to me... Sigh

Members don't see this ad.
 
  • Care
  • Like
Reactions: 2 users
I don't know if feeling "down and dark" during work shifts is "normal." But it's common enough in Emergency Medicine, I'd go so far as to say it's normal in Emergency Medicine. But don't expect anyone in EM to admit that to you. If you've read my posts, you've seen me refer to Chronic Circadian Rhythm Dysphoria of EM (CCRDEM). That's a pervasive, low grade mood depression and general feeling of negativity, and just not feeling well, due to the weight of chronically disrupted circadian rhythms.

I had this condition for over ten years. I cured it 100% by leaving Emergency Medicine 100%. I got tired of the feeling bleeding into all of my non-work time "off" and I got tired of the general denial of this effect of Emergency Medicine, by those in Emergency Medicine. With essentially zero interest in solutions I've proposed (similar to those used to allow airline pilots to tolerate similar hours) I decided I had to fix it for myself.
"You're the problem...You're the 'burnout'....You weren't cut out for this...You just need to do this small thing...What's wrong with you, none of us have this, why do you? (Lie, they all do, too)....But when you're off, you're off (no you're not, you have CCRDEM when you're off)_____[insert EM gaslighting slogan of the week]______"

The extent to which you can be cured of this condition, is directly proportional to the percent you're willing to reduce you time in Emergency Departments. You want a 50% cure? Reduce your EM hours 50%. You want a 100% cure? Reduce your EM hours 100%. Of the 100 placebo-based snake-oil cures you'll be sold, this is the only one that works.
 
Last edited:
  • Like
Reactions: 5 users
In 2020, I rode the burnout express straight into clinical depression with frequent suicidal thoughts and feelings.

It took a year away and a hard look at life for me to get right.
 
  • Like
  • Care
Reactions: 16 users
Members don't see this ad :)
I don't know if feeling "down and dark" during work shifts is "normal." But it's common enough in Emergency Medicine, I'd go so far as to say it's normal in Emergency Medicine. But don't expect anyone in EM to admit that to you. If you've read my posts and don't have me on ignore, you've seen me refer to Chronic Circadian Rhythm Dysphoria of EM (CCRDEM). That's a pervasive, low grade mood depression and general feeling of negativity, and just not feeling well, due to the chronic weight of chronically disrupted circadian rhythms.

I had this condition for over ten years. I cured it 100% by leaving Emergency Medicine 100%. I got tired of the feeling bleeding into all of my non-work time "off" and I got tired of the general denial of this effect of Emergency Medicine, by those in Emergency Medicine. With essentially zero interest in solutions I've proposed (similar to those used to allow airline pilots to tolerate similar hours) I decided I had to fix it for myself.
"You're the problem...You're the 'burnout'....You weren't cut out for this...You just need to do this small thing...What's wrong with you, none of us have this, why do you? (Lie, they all do, too)....But when you're off, you're off (no you're not, you have CCRDEM when you're off)_____[insert EM recruiting gaslight of the week]______"

The likelihood of you curing yourself of this condition, is inversely proportional to the percent you reduce you time in Emergency Departments. You want a 50% cure? Reduce your EM hours 50%. You want a 100% cure? Reduce your EM hours 100%.

Of the 100 placebo-based snake-oil cures you'll be sold, this is the only one that works.
I usually read, benefit from, and enjoy your posts* although I missed this term you coined. It sounds right to me!
I think you might be right. I think I'm feeling this way as I just went back from part-time to full-time clinical work. I'm still on the low end of hours per month (120), but it's really affected my mood.

I have been working towards a non-EM career although it's a gamble if it will work out.



*excluding the ones that are page to a book length long.
In 2020, I rode the burnout express straight into clinical depression with frequent suicidal thoughts and feelings.

It took a year away and a hard look at life for me to get right.
Oh man, so I guess it's felt a lot in our field.
A year away .. as in a year away from EM ??
 
A year away from EM.
I did a few other things, which I still do and are viable income streams.
 
  • Like
Reactions: 4 users
I am using this word very non-clinically here... but I do wonder if there is a DSM term (or should be one) for like Shift Affective Disorder. I know there is something like that for sleep disorder, but I wonder if there is something related to mood. I feel down and dark during my shifts and I don't think it's normal. I wonder if people who have other jobs feel this way as well. I am not sure.

Anyone else feel the same way? Or is this just the normal feeling of someone who doesn't want to work?
This is then coupled with feeling lonely when it's the middle of the night... Maybe it's these night shifts that are really getting to me... Sigh

It's probably the nights. I can get pretty foul, crusty and cynical on my first couple of night shifts until I get transitioned as well as for a few days after my night shifts. I'm probably borderline burnt out or maybe I'm just sick of the post COVID dire lack of ED resources combined with ridiculous expectations placed on us by hospital/CMG admin as well as patient expectations. However, I wouldn't say I feel dark or lonely. More like a storm cloud crackling with seething anger and frustration finding macabre humor from most things in the ED. I don't think I ever really feel true clinical depression and I can't ever remember being suicidal. That being said....make sure to get a good physical to rule out any medical issues going on. If you're a guy, check your T levels. I did feel somewhat like you describe when I was back in med school combined with an acute fatigue syndrome and got worked up only to reveal I had T levels around 75 (low FSH/LH with a normal sperm count, so it couldn't have been 75 for more than 6 months or so). Got a massive work up by endo and once they ruled out prolactinoma/pituitary adenoma, they thought I somehow got transient hypothalamitis (from reactivated EBV?) resulting in a hypogonadal state. I've been on testosterone ever since for more years than I can count and it obliterated my "depression" and fatigue.
 
I don't know if feeling "down and dark" during work shifts is "normal." But it's common enough in Emergency Medicine, I'd go so far as to say it's normal in Emergency Medicine. But don't expect anyone in EM to admit that to you. If you've read my posts and don't have me on ignore, you've seen me refer to Chronic Circadian Rhythm Dysphoria of EM (CCRDEM). That's a pervasive, low grade mood depression and general feeling of negativity, and just not feeling well, due to the chronic weight of chronically disrupted circadian rhythms.

I had this condition for over ten years. I cured it 100% by leaving Emergency Medicine 100%. I got tired of the feeling bleeding into all of my non-work time "off" and I got tired of the general denial of this effect of Emergency Medicine, by those in Emergency Medicine. With essentially zero interest in solutions I've proposed (similar to those used to allow airline pilots to tolerate similar hours) I decided I had to fix it for myself.
"You're the problem...You're the 'burnout'....You weren't cut out for this...You just need to do this small thing...What's wrong with you, none of us have this, why do you? (Lie, they all do, too)....But when you're off, you're off (no you're not, you have CCRDEM when you're off)_____[insert EM recruiting gaslight of the week]______"

The likelihood of you curing yourself of this condition, is inversely proportional to the percent you reduce you time in Emergency Departments. You want a 50% cure? Reduce your EM hours 50%. You want a 100% cure? Reduce your EM hours 100%.

Of the 100 placebo-based snake-oil cures you'll be sold, this is the only one that works.
I think that’s the best description of the main issue facing physicians that work nights (shifts/call) that I’ve ever read. I’m not in EM but I am in a heavy call burden specialty on q3-4 (cards). It’s really hard to describe how sleep deprivation alters your mood, personality, life, clinical judgement… and I agree the complicity and endorsement of such sleep deprivation. from colleagues is frustrating and mind boggling to me.
 
  • Like
Reactions: 4 users
To preface and in full disclosure, I work all nights by preference due to the positive tradeoffs in my opinion. I think people inaccurately and frequently blame nights and circadian rhythm disruption as the primary reason EM is tough instead of other negative aspects. You can always pay someone more to work your nights. The reality is though that most aren't willing to give up income to do so. If that's the case, then I think that it's important to admit to yourself that you might value money over avoiding circadian rhythm disruption. Some will find themselves really enjoying EM without nights, but I suspect many will also find that the job continues to be demanding and draining. Cutting hours alleviates some of the burden, but the reality is the job is hard no matter how sliced.
 
  • Like
Reactions: 5 users
To preface and in full disclosure, I work all nights by preference due to the positive tradeoffs in my opinion. I think people inaccurately and frequently blame nights and circadian rhythm disruption as the primary reason EM is tough instead of other negative aspects. You can always pay someone more to work your nights. The reality is though that most aren't willing to give up income to do so. If that's the case, then I think that it's important to admit to yourself that you might value money over avoiding circadian rhythm disruption. Some will find themselves really enjoying EM without nights, but I suspect many will also find that the job continues to be demanding and draining. Cutting hours alleviates some of the burden, but the reality is the job is hard no matter how sliced.

1. Not always, bro.

2. Yep. I have a "hard ceiling" on my hours now; and even those hours make me hate humanity at large, which is antithetical to why I got into medicine.
 
  • Like
Reactions: 1 users
To preface and in full disclosure, I work all nights by preference due to the positive tradeoffs in my opinion. I think people inaccurately and frequently blame nights and circadian rhythm disruption as the primary reason EM is tough instead of other negative aspects. You can always pay someone more to work your nights. The reality is though that most aren't willing to give up income to do so. If that's the case, then I think that it's important to admit to yourself that you might value money over avoiding circadian rhythm disruption. Some will find themselves really enjoying EM without nights, but I suspect many will also find that the job continues to be demanding and draining. Cutting hours alleviates some of the burden, but the reality is the job is hard no matter how sliced.
To add to this point, I work nights exclusively because the patient volume is way lower and I occasionally get some downtime to do the academic work I actually get enjoyment out of.

So, the issue is:
1) Work mornings and get burnt out from the sheer volume.

OR

2) Work nights and get burnt out due to being awake when your body is telling you to sleep.

It's a no win situation.
I totally agree with your last sentence: "the reality is the job is hard no matter how sliced." A statement of fact.
 
  • Like
Reactions: 1 user
Can't pay me enough to work straight nights. Not even for 1M/year because I'd be too miserable to enjoy the money.
 
  • Like
Reactions: 1 user
Members don't see this ad :)
I agree that although nights suck, it's more than that. It's all of the things we deal with on a daily basis from patients, admin, etc. that are impossible to explain to anyone who's never done the job. And the impossibility of having anyone to commiserate with aside from other ER docs is part of the problem.

I quit EM after 10 years as an attending (FIRE-ish, with a happily working spouse) in late 2019. (Still cannot believe how lucky I got to miss Covid, and can't imagine how awful it's been for all of you.) Everyone (non-medical) assumes it's because I got tired of the blood and guts. Nope. As any other EP knows, I would have preferred more super-sick patients to care for and less of all the other BS (not that I wish serious illness or injury on anyone, but it happens). There's an old post here in which I was looking for advice on what to do because for my very last shift ever (single coverage), there was no one scheduled to relieve me... until just hours before the shift. It was just confirmation that I was doing the right thing.

I was more angry than depressed at work, and I hated humanity. I think in my case, it was anger more than sadness because it seemed like none of it had to be the way it was. Better staffing, better hospital/ED systems, better general public understanding of health and self-care for basic issues, etc. would resolve so many of the frustrations we encounter daily. I'm not sorry I had the career I did, as I learned more about humans than I ever thought possible (both medically and socially), and I had some incredible experiences, but when people ask if I miss it, I tell them no, not for a second.
 
  • Like
Reactions: 7 users
I agree that although nights suck, it's more than that. It's all of the things we deal with on a daily basis from patients, admin, etc. that are impossible to explain to anyone who's never done the job. And the impossibility of having anyone to commiserate with aside from other ER docs is part of the problem.

I quit EM after 10 years as an attending (FIRE-ish, with a happily working spouse) in late 2019. (Still cannot believe how lucky I got to miss Covid, and can't imagine how awful it's been for all of you.) Everyone (non-medical) assumes it's because I got tired of the blood and guts. Nope. As any other EP knows, I would have preferred more super-sick patients to care for and less of all the other BS (not that I wish serious illness or injury on anyone, but it happens). There's an old post here in which I was looking for advice on what to do because for my very last shift ever (single coverage), there was no one scheduled to relieve me... until just hours before the shift. It was just confirmation that I was doing the right thing.

I was more angry than depressed at work, and I hated humanity. I think in my case, it was anger more than sadness because it seemed like none of it had to be the way it was. Better staffing, better hospital/ED systems, better general public understanding of health and self-care for basic issues, etc. would resolve so many of the frustrations we encounter daily. I'm not sorry I had the career I did, as I learned more about humans than I ever thought possible (both medically and socially), and I had some incredible experiences, but when people ask if I miss it, I tell them no, not for a second.

How'd you get out? Retire? Or moved to something else?
I always love to live vicariously through others who managed to get out...
 
After many long years of work in a side gig, I am now at the point where I can see the time I can take a jump and move laterally to another line of work... The problem is that the offer I have been provisionally given is on the high end for what that work is, but it's still peanuts compared to what I make in the ER (despite all the gloom and doom on the board with regard to pay). Golden handcuffs, especially due to my poor financial planning, debt, and high costs of being alive in an expensive city. All of my own doing but I feel crushed nonetheless...
 
  • Like
Reactions: 1 user
After many long years of work in a side gig, I am now at the point where I can see the time I can take a jump and move laterally to another line of work... The problem is that the offer I have been provisionally given is on the high end for what that work is, but it's still peanuts compared to what I make in the ER (despite all the gloom and doom on the board with regard to pay). Golden handcuffs, especially due to my poor financial planning, debt, and high costs of being alive in an expensive city. All of my own doing but I feel crushed nonetheless...

For the record, I didn't "thumbs up" your frustrations. I "thumbs'ed up" your "I can make a leap" position.
 
  • Like
Reactions: 1 user
For me, it’s much less depression and more unfathomable rage and general disappointment with a large percentage of humanity. Also lazy consultants piss me the F off. It’s sad that another doctor can make or break my whole day/mood.
 
  • Like
  • Love
Reactions: 10 users
After many long years of work in a side gig, I am now at the point where I can see the time I can take a jump and move laterally to another line of work... The problem is that the offer I have been provisionally given is on the high end for what that work is, but it's still peanuts compared to what I make in the ER (despite all the gloom and doom on the board with regard to pay). Golden handcuffs, especially due to my poor financial planning, debt, and high costs of being alive in an expensive city. All of my own doing but I feel crushed nonetheless...

Maybe this is me living vicariously through you now, but I think you should just go for it. EM has one of the highest realistically-obtainable hourly salaries out there, so if you keep looking at it this way, you'll never leave and will always be a wealthy, unhappy guy.

How much are we talking about, anyways? I would look at it as "is my happiness/sanity worth $x per hour?" (Where x is the hourly differential in compensation). Based on your posts, I would say that's likely a resounding yes.
 
  • Like
Reactions: 1 user
Maybe this is me living vicariously through you now, but I think you should just go for it. EM has one of the highest realistically-obtainable hourly salaries out there, so if you keep looking at it this way, you'll never leave and will always be a wealthy, unhappy guy.

How much are we talking about, anyways? I would look at it as "is my happiness/sanity worth $x per hour?" (Where x is the hourly differential in compensation). Based on your posts, I would say that's likely a resounding yes.
Thanks for this. I needed to hear this.
I will almost certainly take it and then cut my shifts in half. Then titrate to effect...

But, I haven't yet been made the firm offer... It's in the works still. Fingers crossed. Thanks again!
 
I agree that although nights suck, it's more than that. It's all of the things we deal with on a daily basis from patients, admin, etc. that are impossible to explain to anyone who's never done the job. And the impossibility of having anyone to commiserate with aside from other ER docs is part of the problem.

I quit EM after 10 years as an attending (FIRE-ish, with a happily working spouse) in late 2019. (Still cannot believe how lucky I got to miss Covid, and can't imagine how awful it's been for all of you.) Everyone (non-medical) assumes it's because I got tired of the blood and guts. Nope. As any other EP knows, I would have preferred more super-sick patients to care for and less of all the other BS (not that I wish serious illness or injury on anyone, but it happens). There's an old post here in which I was looking for advice on what to do because for my very last shift ever (single coverage), there was no one scheduled to relieve me... until just hours before the shift. It was just confirmation that I was doing the right thing.

I was more angry than depressed at work, and I hated humanity. I think in my case, it was anger more than sadness because it seemed like none of it had to be the way it was. Better staffing, better hospital/ED systems, better general public understanding of health and self-care for basic issues, etc. would resolve so many of the frustrations we encounter daily. I'm not sorry I had the career I did, as I learned more about humans than I ever thought possible (both medically and socially), and I had some incredible experiences, but when people ask if I miss it, I tell them no, not for a second.
I think I remember this thread. If I recall, the general consensus was that you should inform the CEO / whoever else that if no one came to relieve you, you would close the ED waiting room, go on diversion, see no new patients, finish caring for anyone who needed acute medical care and admit/discharge the rest and then go home. The alternative would be to work indefinitely, growing more and more fatigued until it caused patient harm.
 
  • Like
Reactions: 1 user
I think I remember this thread. If I recall, the general consensus was that you should inform the CEO / whoever else that if no one came to relieve you, you would close the ED waiting room, go on diversion, see no new patients, finish caring for anyone who needed acute medical care and admit/discharge the rest and then go home. The alternative would be to work indefinitely, growing more and more fatigued until it caused patient harm.
I think every state has a different protocol by which an ED can close. Ours is shockingly easy, I believe all you have to do is notify the state and EMS and put signage directing people to the closest open ED. Obviously that’s just the letter of the rule and to close any ED in such a manner would cause a giant ****storm, state inspectors and feds to come sniffing around etc. I would honestly in such a scenario just work myself to exhaustion to the point where I would syncopize, and direct my nurses to call 911 and have EMS take me to an staffed ER. Don’t know how they could really fault you for doing that.
 
  • Like
Reactions: 1 users
I think I remember this thread. If I recall, the general consensus was that you should inform the CEO / whoever else that if no one came to relieve you, you would close the ED waiting room, go on diversion, see no new patients, finish caring for anyone who needed acute medical care and admit/discharge the rest and then go home. The alternative would be to work indefinitely, growing more and more fatigued until it caused patient harm.

I agree with the sentiment...but in reality I'm not closing down my entire ER. I'm calling the hospital CEO and ER Chief every 10 minutes saying I need some relief.
 
Last edited:
I'm honestly considering selling my house, quitting my job, and moving in with my parents for 1-2 years while I try to make this side gig work out.
Doubt my wife would go for it though.
 
  • Like
Reactions: 1 user
How'd you get out? Retire? Or moved to something else?
I always love to live vicariously through others who managed to get out...

Just lived below my means (but still had plenty of fun and plenty of nice things), paid off my student loans, paid off the mortgage, and invested in index funds. Boring, simple, effective.

On my own, I'd have been lean-FIRE when I quit, but about halfway through the path to FIRE, I met my spouse, so together we're coast-FIRE, meaning we live on one income, don't touch our retirement savings, and don't add any more to retirement savings aside from what's necessary to get the 401(k) employer match.

As for what I DO on a daily basis... whatever I want. And there's plenty to do. I don't know how I ever had time to work before.
 
  • Like
Reactions: 2 users
I'm honestly considering selling my house, quitting my job, and moving in with my parents for 1-2 years while I try to make this side gig work out.
Doubt my wife would go for it though.

I daydream about this exact scenario. Though in this case my wife would probably be in favor of it since it comes with built-in child care!
 
  • Like
Reactions: 1 user
I work 7 on 7 off nights (luckily get an additional 320 hours (32 shifts) of PDO).
But I completely agree with the feeling. I have done it for 4 years, and am going to transition off. I have a child just starting school and moving from every other to every 4th weekend will be a big deal with spending time with her (now I have all the time I want on my off week.
But I do get the general low level of just not feeling right, it is hard to put into words. I enjoy the actual work, but I am just coming off a stretch of 21 days in a row off- and feel so much more myself, and this is what cemented me to wanting to go back to days.
 
  • Like
Reactions: 1 user
I work 7 on 7 off nights (luckily get an additional 320 hours (32 shifts) of PDO).
But I completely agree with the feeling. I have done it for 4 years, and am going to transition off. I have a child just starting school and moving from every other to every 4th weekend will be a big deal with spending time with her (now I have all the time I want on my off week.
But I do get the general low level of just not feeling right, it is hard to put into words. I enjoy the actual work, but I am just coming off a stretch of 21 days in a row off- and feel so much more myself, and this is what cemented me to wanting to go back to days.
I am using this word very non-clinically here... but I do wonder if there is a DSM term (or should be one) for like Shift Affective Disorder. I know there is something like that for sleep disorder, but I wonder if there is something related to mood. I feel down and dark during my shifts and I don't think it's normal. I wonder if people who have other jobs feel this way as well. I am not sure.

Anyone else feel the same way? Or is this just the normal feeling of someone who doesn't want to work?
This is then coupled with feeling lonely when it's the middle of the night... Maybe it's these night shifts that are really getting to me... Sigh
I feel exactly the same way. I feel “uncoupled from time and society”. I never know what day it is. The difference between a weekend and week day means nothing to me now. Day time and nights all blur together. There are days I work and days I am off, nothing else. I am tired of seeing the river of hell that runs through society that only we know about. It is isolating. And slowly maddening at the same time. My emotional tolerance to feel anything increase with every horrid shift. Nothing makes me feel anything now, except for a bloody gsw or a difficult intubation and even then only a tempid and anemic feeling of some autistic like urgency. I didn’t used to be like this. That is the worse part. This job f’n sucks.
 
  • Like
  • Care
Reactions: 11 users
I feel exactly the same way. I feel “uncoupled from time and society”. I never know what day it is. The difference between a weekend and week day means nothing to me now. Day time and nights all blur together. There are days I work and days I am off, nothing else. I am tired of seeing the river of hell that runs through society that only we know about. It is isolating. And slowly maddening at the same time. My emotional tolerance to feel anything increase with every horrid shift. Nothing makes me feel anything now, except for a bloody gsw or a difficult intubation and even then only a tempid and anemic feeling of some autistic like urgency. I didn’t used to be like this. That is the worse part. This job f’n sucks.

Duuuude. And on top of that; you go out into society to hang out with the normies and try and remember what its like to be a normie and you want to squeeze them and scream for one of several hundred very good reasons.
 
Last edited:
  • Like
Reactions: 1 users
I feel exactly the same way. I feel “uncoupled from time and society”. I never know what day it is. The difference between a weekend and week day means nothing to me now. Day time and nights all blur together. There are days I work and days I am off, nothing else. I am tired of seeing the river of hell that runs through society that only we know about. It is isolating. And slowly maddening at the same time. My emotional tolerance to feel anything increase with every horrid shift. Nothing makes me feel anything now, except for a bloody gsw or a difficult intubation and even then only a tempid and anemic feeling of some autistic like urgency. I didn’t used to be like this. That is the worse part. This job f’n sucks.

I agree with the sentiment with this...AND...I still find enjoyment that when I do find patients who want to be helped, and who are willing to listen and do as I instruct. These are fulfilling encounters. I will spend extra time with them. It's what being a doctor is all about.

I'm sorry you feel this way. Probably time for a change.
 
  • Like
Reactions: 1 user
I agree with the sentiment with this...AND...I still find enjoyment that when I do find patients who want to be helped, and who are willing to listen and do as I instruct. These are fulfilling encounters. I will spend extra time with them. It's what being a doctor is all about.

I'm sorry you feel this way. Probably time for a change.
Agreed - life is still full of opportunities for delight. The trick is to be in such a state that you can actually recognize and receive them when they come along. It ain't easy though it's definitely worth it.
 
  • Like
Reactions: 1 users
I am tired of seeing the river of hell that runs through society that only we know about. It is isolating. And slowly maddening at the same time.

I felt this part way too much.
 
  • Like
Reactions: 2 users
Agreed - life is still full of opportunities for delight. The trick is to be in such a state that you can actually recognize and receive them when they come along. It ain't easy though it's definitely worth it.

Yes I agree. I've been an attending for 8 years. Admittedly my enjoyment is very slowly getting worse...like a 1-3%/year. What keeps me going is when I do have patients who are grateful for what I do. It does seem like these are slowly becoming more infrequent. Maybe happens now less than once per shift.

I grumble a lot at work and it probably keeps me going. I vent, let it out, and continue on.
 
  • Like
Reactions: 1 users
Yes I agree. I've been an attending for 8 years. Admittedly my enjoyment is very slowly getting worse...like a 1-3%/year. What keeps me going is when I do have patients who are grateful for what I do. It does seem like these are slowly becoming more infrequent. Maybe happens now less than once per shift.

I grumble a lot at work and it probably keeps me going. I vent, let it out, and continue on.
A mere 1-3% rate of pit-happiness decay is actually stupendous. For some people its more like a turbo-charged, oil-burning, El Camino surging off a cliff in flames. So says a 'friend.'
 
  • Like
Reactions: 1 users
I mean, I moved 7500 miles around the world to escape the acute craziness of 2020 – and discovered emergency medicine can be fun again.

It can still be hard, and it's work, but it doesn't have to ruin your life.

I think this thread is describing the transformation of the actual practice of EM into something no one can stomach beyond a certain number of hours a month, rather than being a physician delivering emergency care somehow a non-viable career option.
 
I feel exactly the same way. I feel “uncoupled from time and society”. I never know what day it is. The difference between a weekend and week day means nothing to me now. Day time and nights all blur together. There are days I work and days I am off, nothing else. I am tired of seeing the river of hell that runs through society that only we know about. It is isolating. And slowly maddening at the same time. My emotional tolerance to feel anything increase with every horrid shift. Nothing makes me feel anything now, except for a bloody gsw or a difficult intubation and even then only a tempid and anemic feeling of some autistic like urgency. I didn’t used to be like this. That is the worse part. This job f’n sucks.
This is very timely - I am meeting with mgmt and I will be very likely moving back to days. I am taking a 15k a pay cut (I make 170k - so not quite 10%) and losing the extra 10 hours a week (work 80 get paid for 70), plus I will work 10 days a pay period vs 7 (8 hour days vs 10) and will take less desirable job with increased teaching responsibilities, and it is well worth it. Like I said, 21 days off made me realize how normal I felt, and that first rotation back I was just miserable. So ya - well worth it
 
  • Like
Reactions: 2 users
I don’t wanna start a whole new thread, but Jesus Christ is anyone else’s group dealing with BS callouts from everybody. The quality life becomes exponentially horrible we have people calling out all the freaking time. We have a back up schedule but it seems like as if everyone’s getting called up all the time and no one is getting held accountable for all these BS callouts. If you’re not dying you go to work I don’t get this mentality of I’m not going to work.
 
I don’t wanna start a whole new thread, but Jesus Christ is anyone else’s group dealing with BS callouts from everybody. The quality life becomes exponentially horrible we have people calling out all the freaking time. We have a back up schedule but it seems like as if everyone’s getting called up all the time and no one is getting held accountable for all these BS callouts. If you’re not dying you go to work I don’t get this mentality of I’m not going to work.

this x1000

I'm on call once a month and got called in five times last year. I pretty much just assume on my call day I'll be working.
 
I don’t wanna start a whole new thread, but Jesus Christ is anyone else’s group dealing with BS callouts from everybody. The quality life becomes exponentially horrible we have people calling out all the freaking time. We have a back up schedule but it seems like as if everyone’s getting called up all the time and no one is getting held accountable for all these BS callouts. If you’re not dying you go to work I don’t get this mentality of I’m not going to work.
your docs are calling out like that? I probably can count on one hand the number of times I have seen one of our docs call out (not counting mandatory covid absences).
 
  • Like
Reactions: 1 user
You guys must be employed because the IRS definition of independent contractors is that the IC determines his/her schedule. On call means your employer determines your schedule and it runs afoul of the IRS definitions of independent contractors. If you're an IC on call, you might wanna call your local IRS office. You're owed a ton of money from benefits and also they are obligated to pay a portion of your taxes (the SE portion).

Having said all that IRS mumbo jumbo, it sounds like it sucks to be on call at your facility because docs abuse it. Perhaps they need a talking to about abusing the system.
 
  • Like
  • Haha
Reactions: 3 users
I don’t wanna start a whole new thread, but Jesus Christ is anyone else’s group dealing with BS callouts from everybody. The quality life becomes exponentially horrible we have people calling out all the freaking time. We have a back up schedule but it seems like as if everyone’s getting called up all the time and no one is getting held accountable for all these BS callouts. If you’re not dying you go to work I don’t get this mentality of I’m not going to work.
Are these covid-related? I called out once a few months ago, the exact phrasing I used was "I tested positive for covid. I'm not that sick and could come to work if need be".

What's your group structure? Frankly, if it's a CMG or hospital employed I"m not surprised. When you treat people as expendable widgets w/o any personal value, that's what you get. Why should I work through a bad back or a hangover, when someone else can click the 'sepsis alert' button just as well as me?
 
  • Like
Reactions: 1 users
You guys must be employed because the IRS definition of independent contractors is that the IC determines his/her schedule. On call means your employer determines your schedule and it runs afoul of the IRS definitions of independent contractors. If you're an IC on call, you might wanna call your local IRS office. You're owed a ton of money from benefits and also they are obligated to pay a portion of your taxes (the SE portion).
How does that work then for every 1099 job out there for USACS, TH, etc etc where you are given a schedule just like any other ED job?
 
How does that work then for every 1099 job out there for USACS, TH, etc etc where you are given a schedule just like any other ED job?
Technically you're supposed to control your schedule. So you submit to them the days you're available and they schedule you. They cannot dictate to you when you work (i.e., if you say you cannot work any holiday ever, they technically can't schedule you).
 
Technically you're supposed to control your schedule. So you submit to them the days you're available and they schedule you. They cannot dictate to you when you work (i.e., if you say you cannot work any holiday ever, they technically can't schedule you).
Ahh, so technically correct but ultimately unenforceable as they can just fire you if you say you're unwilling to work holidays / a call shift / your kid's birthday / etc.
 
Ahh, so technically correct but ultimately unenforceable as they can just fire you if you say you're unwilling to work holidays / a call shift / your kid's birthday / etc.
You're correct until someone complains to the IRS and they audit the CMG. If they find out they were enforcing a schedule (i.e., they controlled IC's availability), then they're going to have a hard time defending IC status.
 
Top