Does this get better?

[whatisthisstuff]

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Intern, really like my program. But I'm very unhappy. Residency is hard and we work alot but I'm not sure if its normal for me to be as unhappy as I am. I have good days and bad days but the days I leave completely depressed and hopeless are probably close to 80% at this point. The constantly flipping schedule, weekends is definitely way harder than I imagined. I've had alot of second thoughts about EM (and medicine) for a while now, chalked it up to not liking being a rotating student (which did suck in a different way), now trying to chalk it up to "intern year is hard." But I'm having alot of doubts that it will actually get better. Working less will help no doubt. But the constant chaos, resources always stretched to the maximum makes me think this is a place I'll never really be happy in. And I work in a pretty good health system I think. Doesn't seem like the future of EM is very bright in this regard either. CMGs, pay decreasing. I feel like I'm on a race to retirement and I'm just starting. I think taking care of acute patients is pretty fun but the constant pressure of volume combined with the BS complaints and being at the funnel of everything wrong with our society is so f'ing draining. I've thought about switching into something else but I don't know what. Most days I just want to leave healthcare completely. I'm definitely "burned out" but I'm pretty early in my career to be at this point no? I'm doing therapy, I do all the wellness things (and I'm a believer in these things too) which help me get through the days sometimes. But I struggle with this idea that daily happiness should be quite such a battle. Thanks for listening.

 

[gamerEMdoc]

Intern, really like my program. But I'm very unhappy. Residency is hard and we work alot but I'm not sure if its normal for me to be as unhappy as I am. I have good days and bad days but the days I leave completely depressed and hopeless are probably close to 80% at this point. The constantly flipping schedule, weekends is definitely way harder than I imagined. I've had alot of second thoughts about EM (and medicine) for a while now, chalked it up to not liking being a rotating student (which did suck in a different way), now trying to chalk it up to "intern year is hard." But I'm having alot of doubts that it will actually get better. Working less will help no doubt. But the constant chaos, resources always stretched to the maximum makes me think this is a place I'll never really be happy in. And I work in a pretty good health system I think. Doesn't seem like the future of EM is very bright in this regard either. CMGs, pay decreasing. I feel like I'm on a race to retirement and I'm just starting. I think taking care of acute patients is pretty fun but the constant pressure of volume combined with the BS complaints and being at the funnel of everything wrong with our society is so f'ing draining. I've thought about switching into something else but I don't know what. Most days I just want to leave healthcare completely. I'm definitely "burned out" but I'm pretty early in my career to be at this point no? I'm doing therapy, I do all the wellness things (and I'm a believer in these things too) which help me get through the days sometimes. But I struggle with this idea that daily happiness should be quite such a battle. Thanks for listening.

Does it get better? Yes and no. You work less days, but have more responsibility. I feel way more stressed out as an attending on shift than I ever did as a resident. But I work way less shifts as an attending than I did as a resident. So that part is offset. Less shifts makes adjusting to the constant schedule changes more bearable, but in the end, shift work sleep disorder is very real and one of the biggest reasons in my opinion that people burn out in EM. Dealing with the circadian rhythm disruption gets harder and harder as you get older. Not having a regular sleep schedule just creates havoc with your physiology and mental health.

I do think it may get better, but I also don't think its going to get soooooo much better that its a completely different job for you if you dislike the constant interuptions, the BS complaints, the chaos, the shift work, etc. Basically everything you dislike is the entire field of EM.

I'd definitely EITHER seek out some counceling to help you cope with some of this, or really consider changing fields while it's still early on. Or, as an alternative, plan to gut it out and finish, but start gearing your career towards a fellowship that will allow you to do something completely different when you are done (palliative, pain, sports med, etc).

Best of luck! I hope you find your way out of the burnout cycle.

 

[namethatsmell]

I'm sorry you're going through this.

Like gamer, I think it WILL get better for you. How much better? No one can say.

One question to ask yourself: as an attending, could you tolerate working 4-6 shifts/month? If the answer is yes, you can make ~100-150k/yr and then use the rest of month do work/other things you find more palatable. Ponder this question for another 2 years as you gain more experience and insight to better answer this question. By then you'll almost be done with residency. If the answer turns out to be yes, then congrats you've made a good choice. If the answer is no, you'll still finish residency and can become board-certified which will make you far more marketable for non-clinical jobs than not having done a residency. Again, you'll have made a good choice. Either way, you'll get a serious ROI on your time in residency if you finish. If you are certain you want to do another field more than EM than try to switch now. But whatever you do, finish a residency if at all possible. I'd only advise not finishing a residency if it's putting your health at risk.

Do search this forum as this question has been asked many times and has received many good answers.

PS: Big props for entering therapy. It takes a lot of self-awareness and honesty to do so. Do not hesitate to see a psychiatrist if you don't feel you're making headway in therapy. I have a few colleagues who have reaped massive rewards by getting help for their untreated depression. On the flip side, I've also had a few colleagues who unfortunately didn't get help. Taking care of yourself is paramount.

 

[RuralEDDoc]

I strongly disliked residency. Many aspects were bothersome - always being a fish out of water on random rotations, too many night shifts, lack of respect from house staff and always fighting with consultants. Most of those issues were fixed by becoming an attending. Like an above poster said, actual shift work is harder, by a substantial degree. The first year out I went into each shift highly anxious about what would happen. That’s gone now and life is pretty good.
I can’t say what will happen in the future (reimbursement/volume etc) but, currently, I don’t regret the choice, and life is much better than residency.

 

[miacomet]

I actually enjoyed residency more. Fun off service rotations, guaranteed month of vacation, less responsibility.

 

[thegenius]

The shift work isn't going to change for the most part.

What changes is that at some point you only work with attendings, and you work in a community of other ER docs and Hospitalists, Cardiologists, General Surgeons, Gynecologists, Ophthalmologists who all more or less are also burned out and they come to work, they do their job, and they help you out. Just as you help them out. You help them out when they ask you to call a consult for them. They help you out when you want them to see a questionable nec fasciitis in the ED. By the time you are an attending and out for 3-4 years it becomes a job. J-O-B. Just like all the other docs you work with. Occasionally they get testy and you will get testy too. But 29 out of 30 days a month it's fine. You come to work, you listen to the same story from patients time and time again...
"I'm having chest pain"
"I'm feeling dizzy and having diarrhea for the past 3 days, is it related to the McDonalds I ate?"
"I have some pain in my calf, is it a DVT? Why am I having pain?"
"I've got this electrical feeling going from my head down to my feet, been going on for at least a month. It's getting worser. I think I'm having a stroke."
"I just want to confirm that I'm pregnant"
"I bleeding and I'm pregnant."
"I have the sniffles and I'm pregnant"
"I have the sniffles"
"I just had my appendix removed yesterday and I'm having real bad pain in my abdomen"
the list goes on an on

For most people on this forum, they will read the above lines and they will know what to do without blinking. That that accounts for 95% of what we see. Very rarely do we have a patient encounter where we don't know what's going on AND they are really sick.


I think it all gets easier because you end up having a J-O-B. You go to work, do you work, then go home. All J-O-B-S sometimes have bad days. Doesn't matter what you go into.

I have a feeling though based on what you wrote above, that you might not like any residency. All residencies have crappy hours

 

[gamerEMdoc]

I'm sorry you're going through this.

Like gamer, I think it WILL get better for you. How much better? No one can say.

One question to ask yourself: as an attending, could you tolerate working 4-6 shifts/month? If the answer is yes, you can make ~100-150k/yr and then use the rest of month do work/other things you find more palatable. Ponder this question for another 2 years as you gain more experience and insight to better answer this question. By then you'll almost be done with residency. If the answer turns out to be yes, then congrats you've made a good choice. If the answer is no, you'll still finish residency and can become board-certified which will make you far more marketable for non-clinical jobs than not having done a residency. Again, you'll have made a good choice. Either way, you'll get a serious ROI on your time in residency if you finish. If you are certain you want to do another field more than EM than try to switch now. But whatever you do, finish a residency if at all possible. I'd only advise not finishing a residency if it's putting your health at risk.

Do search this forum as this question has been asked many times and has received many good answers.

PS: Big props for entering therapy. It takes a lot of self-awareness and honesty to do so. Do not hesitate to see a psychiatrist if you don't feel you're making headway in therapy. I have a few colleagues who have reaped massive rewards by getting help for their untreated depression. On the flip side, I've also had a few colleagues who unfortunately didn't get help. Taking care of yourself is paramount.

Also remember too, that EM is not a cookie cutter job. Yes many people go work in jobs seeing 2+ patients an hour. But if you are willing to work rurally, you can work in a place that sees less than a 15-20 patients in 24hrs. Where overnight you'll see 0-5 in 12 hours. You may make a little less per hour, but your quality of life and stress will be immensely better.

 

[TooMuchResearch]

Or be like me and work in a high acuity (though under 2 pph) referral center some of the time and rural other times, all same group, all same schedule.

Also remember too, that EM is not a cookie cutter job. Yes many people go work in jobs seeing 2+ patients an hour. But if you are willing to work rurally, you can work in a place that sees less than a 15-20 patients in 24hrs. Where overnight you'll see 0-5 in 12 hours. You may make a little less per hour, but your quality of life and stress will be immensely better.

 

[gamerEMdoc]

Or be like me and work in a high acuity (though under 2 pph) referral center some of the time and rural other times, all same group, all same schedule.

Sounds familiar. Our hospital has 3 rural critical access hospitals under its wing that will pay our mother ship faculty their normal hourly rate to pick up shifts at the rural sites. It’s very enticing for those that want to work extra to get paid to sleep most of the night. At the busiest site, you may see 1/hr overnight. At the slowest if you see 0.5 it was a busy night. Not a bad change of pace as a side gig.

 

[deleted547339]

Intern, really like my program. But I'm very unhappy. Residency is hard and we work alot but I'm not sure if its normal for me to be as unhappy as I am. I have good days and bad days but the days I leave completely depressed and hopeless are probably close to 80% at this point. The constantly flipping schedule, weekends is definitely way harder than I imagined. I've had alot of second thoughts about EM (and medicine) for a while now, chalked it up to not liking being a rotating student (which did suck in a different way), now trying to chalk it up to "intern year is hard." But I'm having alot of doubts that it will actually get better. Working less will help no doubt. But the constant chaos, resources always stretched to the maximum makes me think this is a place I'll never really be happy in. And I work in a pretty good health system I think. Doesn't seem like the future of EM is very bright in this regard either. CMGs, pay decreasing. I feel like I'm on a race to retirement and I'm just starting. I think taking care of acute patients is pretty fun but the constant pressure of volume combined with the BS complaints and being at the funnel of everything wrong with our society is so f'ing draining. I've thought about switching into something else but I don't know what. Most days I just want to leave healthcare completely. I'm definitely "burned out" but I'm pretty early in my career to be at this point no? I'm doing therapy, I do all the wellness things (and I'm a believer in these things too) which help me get through the days sometimes. But I struggle with this idea that daily happiness should be quite such a battle. Thanks for listening.

It will get better. It may get worse before it gets better, but it will get better. The ratio of competence to responsibility is not in your favor currently.

Remember why you did medicine and EM. Continue to do your best to get some sleep, exercise, family time and time to pray.

As an attendings, there are still days I’m down, but there are also days when I can’t believe I get paid (much less this much) to so this job. Those days usually come after a string of days off.

 

[Birdstrike]

Intern, really like my program. But I'm very unhappy. Residency is hard and we work alot but I'm not sure if its normal for me to be as unhappy as I am. I have good days and bad days but the days I leave completely depressed and hopeless are probably close to 80% at this point. The constantly flipping schedule, weekends is definitely way harder than I imagined. I've had alot of second thoughts about EM (and medicine) for a while now, chalked it up to not liking being a rotating student (which did suck in a different way), now trying to chalk it up to "intern year is hard." But I'm having alot of doubts that it will actually get better. Working less will help no doubt. But the constant chaos, resources always stretched to the maximum makes me think this is a place I'll never really be happy in. And I work in a pretty good health system I think. Doesn't seem like the future of EM is very bright in this regard either. CMGs, pay decreasing. I feel like I'm on a race to retirement and I'm just starting. I think taking care of acute patients is pretty fun but the constant pressure of volume combined with the BS complaints and being at the funnel of everything wrong with our society is so f'ing draining. I've thought about switching into something else but I don't know what. Most days I just want to leave healthcare completely. I'm definitely "burned out" but I'm pretty early in my career to be at this point no? I'm doing therapy, I do all the wellness things (and I'm a believer in these things too) which help me get through the days sometimes. But I struggle with this idea that daily happiness should be quite such a battle. Thanks for listening.

Everyone is different, but I remember feeling exactly this way at times during internship and residency. It did get significantly better as the workload & stress decreased later in residency and post residency. Then it went away completely when I went and did my Interventional Pain fellowship, and hasn't returned. Whether you stay on your current path which is likely to improve or choose another path which will make thinks improve differently, is your choice. But it will get better for you.

 

[GatorCHOMPions]

Intern year is rough on most people. If it's not rough, you are probably doing it wrong and either not working hard enough or have too much confidence. As others have said, it will likely get a little worse before it gets better because you should gradually obtain more responsibility and with that comes increased pressure and stress. However, after you're out as an attending over a year, it will become a job just like anything else. And unlike residency, you have immense freedom to pick up and leave (with the exception of personal issues keeping you somewhere) if you're at a job you don't like and want to try something new.

I would caution the use of "burnout" in your case, as you are still pretty fresh and new to everything relatively speaking. We are quick to label unhappiness fatigue, and stress as being burned out. This is called working hard during residency. I think your expectations when choosing the field have not met the reality, as is the case for many of us. The easiest path to getting through is reworking these expectations you set for yourself that an EM residency would be. Try not to extrapolate to your career as an attending because the job you take then could be vastly different. You may also be in a much different part of your life personally.

I'm a few years out of residency now and enjoy the actual work while I'm on shift, but still cannot get over the shift fluctuations and deviations from a "normal" life in society with my friends and family. As EM docs we miss out on so many experiences to share with our loved ones. A full-time job has become less and less worth it to me over time. I'm going for a fellowship and if I don't make it or enjoy my career change, I will probably switch to part-time and/or per diem to take control of my schedule. As one of the posters alluded to, I think even the crispiest burned out EM doc can work 4-6 shifts per month, make 150k and be happy.

 

[ShockIndex]

It gets different, but not necessarily better.

However, you will feel better if you stop airing your self doubts over the internet and instead do what the rest of us do when we regret life’s choices - go to a bar...🙂

All kidding aside, make sure you are not on this road alone. Be a good friend to others so that you have people outside of the hospital that will help you keep it all in perspective.

 

[psychapp121]

The shift work isn't going to change for the most part.

What changes is that at some point you only work with attendings, and you work in a community of other ER docs and Hospitalists, Cardiologists, General Surgeons, Gynecologists, Ophthalmologists who all more or less are also burned out and they come to work, they do their job, and they help you out. Just as you help them out. You help them out when they ask you to call a consult for them. They help you out when you want them to see a questionable nec fasciitis in the ED. By the time you are an attending and out for 3-4 years it becomes a job. J-O-B. Just like all the other docs you work with. Occasionally they get testy and you will get testy too. But 29 out of 30 days a month it's fine. You come to work, you listen to the same story from patients time and time again...
"I'm having chest pain"
"I'm feeling dizzy and having diarrhea for the past 3 days, is it related to the McDonalds I ate?"
"I have some pain in my calf, is it a DVT? Why am I having pain?"
"I've got this electrical feeling going from my head down to my feet, been going on for at least a month. It's getting worser. I think I'm having a stroke."
"I just want to confirm that I'm pregnant"
"I bleeding and I'm pregnant."
"I have the sniffles and I'm pregnant"
"I have the sniffles"
"I just had my appendix removed yesterday and I'm having real bad pain in my abdomen"
the list goes on an on

For most people on this forum, they will read the above lines and they will know what to do without blinking. That that accounts for 95% of what we see. Very rarely do we have a patient encounter where we don't know what's going on AND they are really sick.


I think it all gets easier because you end up having a J-O-B. You go to work, do you work, then go home. All J-O-B-S sometimes have bad days. Doesn't matter what you go into.

I have a feeling though based on what you wrote above, that you might not like any residency. All residencies have crappy hours

can you post the answers to those complaints? Particularly the appendix one? Is it like post op ileus or infection or what

 

[TheSingularity]

It gets different, but not necessarily better.

However, you will feel better if you stop airing your self doubts over the internet and instead do what the rest of us do when we regret life’s choices - go to a bar...🙂

All kidding aside, make sure you are not on this road alone. Be a good friend to others so that you have people outside of the hospital that will help you keep it all in perspective.

Different.

More money.

In many ways worse.

Sent from my Pixel 3 using SDN mobile

 

[BoardingDoc]

can you post the answers to those complaints? Particularly the appendix one? Is it like post op ileus or infection or what

There aren't "answers." There are workups or lack thereof. The appendix one ranges from a nontender abdomen in a neurotic person who doesn't understand that surgery will hurt the next day to the nicked colon who is now septic from all the **** that's filling their abdomen. Depending on your exam/gestalt you get labs and/or imaging or just a pat on the head and some discharge papers.

 

[RustedFox]

Intern, really like my program. But I'm very unhappy. Residency is hard and we work alot but I'm not sure if its normal for me to be as unhappy as I am. I have good days and bad days but the days I leave completely depressed and hopeless are probably close to 80% at this point. The constantly flipping schedule, weekends is definitely way harder than I imagined. I've had alot of second thoughts about EM (and medicine) for a while now, chalked it up to not liking being a rotating student (which did suck in a different way), now trying to chalk it up to "intern year is hard." But I'm having alot of doubts that it will actually get better. Working less will help no doubt. But the constant chaos, resources always stretched to the maximum makes me think this is a place I'll never really be happy in. And I work in a pretty good health system I think. Doesn't seem like the future of EM is very bright in this regard either. CMGs, pay decreasing. I feel like I'm on a race to retirement and I'm just starting. I think taking care of acute patients is pretty fun but the constant pressure of volume combined with the BS complaints and being at the funnel of everything wrong with our society is so f'ing draining. I've thought about switching into something else but I don't know what. Most days I just want to leave healthcare completely. I'm definitely "burned out" but I'm pretty early in my career to be at this point no? I'm doing therapy, I do all the wellness things (and I'm a believer in these things too) which help me get through the days sometimes. But I struggle with this idea that daily happiness should be quite such a battle. Thanks for listening.

Hello, RustedFox of 2009.

This is a message from FutureYOU!

1. I remember those days! I really, really, really do. The whole "this thing is completely unsustainable and I can't be a part of this problem" thing? YeeeEEEAH! I spent 90% of my intern year b!tching about how the vast majority of these people shouldn't be in the ER.

2. Yep. The future of EM is certainly in question. Nobody knows where the chips may fall.

3. Yep. I want to leave healthcare completely a lot of the time. But then, I realize that I'm one of the better docs in my group. And if I weren't here, and DocMcFatFaceAndSkinnyBeard had to do this job all alone; then people would die, for realsies.

4. It gets better when you realize that you don't really have to do a ROS an full PE on 99.99% of patients. Sure; you do all that (S1/S2+, no murmurs, gallops, or rubs) thing now because you're an intern; and you were trained to. I get it; ** I USED TO DO THE SAAAME THING **. But when drunk homeboy is drunk, and on the monitor... you skip the HPI/ROS/PE pretty much altogether... you push the buttons... you chart defensively... and bye-byeeee!

5. Similarly... when Old Person is Old, and the problem is that... they're OLD... you push the buttons... you chart defensively... and bye-byeeee!
When a millennial is being a millennial and is upset that he has to move out of his mommie's basement and has related abdominal pain and asks what the best "cleanse" is... you push the buttons, you chart defensively, and bye-byeeee!

6. Does it suck? Yeah. But it sucks a lot less than a lot of other jobs in teh (sic) medicines.

7. When you encounter a muggle that really wants help (and your AttendingSense will let you know who really wants/needs help and who is just here for the selfies, teh lolz, and because a nurse didn't want to do the jobz), then YOU CAN REALLY HELP THEM!

8. FUTUREyou will have a talk with FUTUREwife (or husband), and you'll say something like I said a few days ago: "Listen; thanks for listening to me complain about work a lot. I complain a lot. I get it. But you know what? I can set a broken bone. I can repair a bad laceration. I can reduce a shoulder/knee/hip. I can do magic physiologically. I make make hearts start beating again (sometimes). I can do a lot of good things... its just that the average muggle doesn't see just how lucky they are and how good they have it... and they WHINE all day about it. Worse yet; they are AMERICANS, and they can't BEAR to IMAGINE how a live with INCONVENIENCE can be lived. That's our reality here in 20xx."

9. You will [continue] to say to yourself that we need a separate "bull$hit department" alongside the Emergency Department to see things like: "my PEG tube fell out", or "My doctor sent me for admission", or "My chronicNONSENSEdisorder is acting up and I can't complain to anyone who will listen". This will never change. This will never change. Maybe someday we can have a true emergency department, and a separate "bull$hit department" next door. I would actually LOVE to run a "bull$hit department". The cognitive load would be SO LOW! Discharge. Discharge. Haldol. Discharge. Byeee

10. You will be okay. Go back to (#1) and start over.

 

[ShockIndex]

Different.

More money.

In many ways worse.

Sent from my Pixel 3 using SDN mobile

Most residents and especially interns are relatively sheltered from the most onerous parts of routine EM - dealing with unrealistic patient expectations. Seriously - putting in chest tubes, pediatric airways, pacers, and resuscitating traumas is the easy part of the job and the best part of residency. Ultimately, it falls on the faculty to be the final arbiter of “no” for those requesting dilaudid for their migraine, an MRI for their back pain, or yet another work-up of their functional abdominal pain. These are the consumers (of healthcare resources and your life) who complain, scream, yell and otherwise determine the trajectory of your shift. This part gets much, much worse if you plan to practice traditional EM.

The good news is that there is an out if you are driven and willing to put in the time and a possible pay cut. For example, almost all of the Ranger Btn Surgeons and SF Group Surgeons were EPs when I was in the sandbox. The medical directors or asst. directors for the FBI, CIA, White House Medical Unit, USSS, and NASA are EPs (with both contractor and special agent EPs under them). Organizations like RAND Corp, CATO, CDC, NTSB have or had EPs in their senior leadership. Finally, EM is the fastest way to the sickest patients in the hospital via CCM with the possibility of ZERO ward months - that is career gold.

Finally, if none of those ideas float your boat, there are OCONUS jobs that can be a blast. I’ve got acquaintances who went to Australia and New Zealand for a year. If you want something a little more “exotic”, the cartels are supposedly hiring in the mid-seven figures...😉El Chapo had doctor revive rival so he could keep torturing him, court docs claim

 

[TheSingularity]

Sure just sign me up for a senior position at Cato

....

Most residents and especially interns are relatively sheltered from the most onerous parts of routine EM - dealing with unrealistic patient expectations. Seriously - putting in chest tubes, pediatric airways, pacers, and resuscitating traumas is the easy part of the job and the best part of residency. Ultimately, it falls on the faculty to be the final arbiter of “no” for those requesting dilaudid for their migraine, an MRI for their back pain, or yet another work-up of their functional abdominal pain. These are the consumers (of healthcare resources and your life) who complain, scream, yell and otherwise determine the trajectory of your shift. This part gets much, much worse if you plan to practice traditional EM.

The good news is that there is an out if you are driven and willing to put in the time and a possible pay cut. For example, almost all of the Ranger Btn Surgeons and SF Group Surgeons were EPs when I was in the sandbox. The medical directors or asst. directors for the FBI, CIA, White House Medical Unit, USSS, and NASA are EPs (with both contractor and special agent EPs under them). Organizations like RAND Corp, CATO, CDC, NTSB have or had EPs in their senior leadership. Finally, EM is the fastest way to the sickest patients in the hospital via CCM with the possibility of ZERO ward months - that is career gold.

Finally, if none of those ideas float your boat, there are OCONUS jobs that can be a blast. I’ve got acquaintances who went to Australia and New Zealand for a year. If you want something a little more “exotic”, the cartels are supposedly hiring in the mid-seven figures...😉El Chapo had doctor revive rival so he could keep torturing him, court docs claim

Sent from my Pixel 3 using SDN mobile

 

[ShockIndex]

Sure just sign me up for a senior position at Cato

....

Sent from my Pixel 3 using SDN mobile

Yeah, I think you skipped right over that part about being “driven and willing to put in the time and a possible pay cut.”

I get it. Delaying gratification is not everyone’s strong suit. 🙂

 

[Frazier]

Intern, really like my program. But I'm very unhappy. Residency is hard and we work alot but I'm not sure if its normal for me to be as unhappy as I am. I have good days and bad days but the days I leave completely depressed and hopeless are probably close to 80% at this point. The constantly flipping schedule, weekends is definitely way harder than I imagined. I've had alot of second thoughts about EM (and medicine) for a while now, chalked it up to not liking being a rotating student (which did suck in a different way), now trying to chalk it up to "intern year is hard." But I'm having alot of doubts that it will actually get better. Working less will help no doubt. But the constant chaos, resources always stretched to the maximum makes me think this is a place I'll never really be happy in. And I work in a pretty good health system I think. Doesn't seem like the future of EM is very bright in this regard either. CMGs, pay decreasing. I feel like I'm on a race to retirement and I'm just starting. I think taking care of acute patients is pretty fun but the constant pressure of volume combined with the BS complaints and being at the funnel of everything wrong with our society is so f'ing draining. I've thought about switching into something else but I don't know what. Most days I just want to leave healthcare completely. I'm definitely "burned out" but I'm pretty early in my career to be at this point no? I'm doing therapy, I do all the wellness things (and I'm a believer in these things too) which help me get through the days sometimes. But I struggle with this idea that daily happiness should be quite such a battle. Thanks for listening.

Any fellowships interest you?

EMRA Fellowship Guide Opportunities for Emergency Physicians

www.emra.org

They can drastically change your career depending on which route you choose.
If none of them interest you... try to continue to find small wins every day grinding shifts.

 

[whatisthisstuff]

Thanks for responding everyone, it really does help.

I've planned on doing a non-EM based fellowship for a while as a way to give myself options. I would definitely be ok with working parttime in the future. Even things like palliative I can imagine would be rewarding. I will say I usually feel better after a couple of days off, which gives me hope. It's just hard to gauge how much the anxiety, schedule flipping, sickness, dealing with pissed off people (patients, consultants) and seldom getting to make anyone happy or feel like I'm actually doing good for anyone wears on you at 200+ hrs a month. Some of the things I never thought would bother me really do. Its just so empathy sapping and when its 3 am and you're getting crushed everything feels a little bit different.

The skillset and flexibility of EM are probably the main reasons I chose it. I'm most passionate about health and helping people live healthier, which isn't really a job that exists in US healthcare. Thought some about switching to Family Practice but those just never seemed like my people and they have their own set of frustrations. Tough to say whose are worse. Also a number of things about EM I like I'd have to give up. I never liked the idea of working so much in a surgical specialty but not sure I wouldn't be happier on a day to day basis. I always liked the idea of entrepreneurship and EM gives me some flexibility for that as well. Just seems like we are all in such an unhappy system and doesn't seem like my non-healthcare friends aren't nearly this bitter. Though I'm sure I have a rose-colored view of this. Anyways, I'll keep trudging along for now. Trying to take it one day at a time. Thanks all