Don't Let It Take Everything

[docB]

I recently mentioned in another thread that I was upset about something. I didn’t want to derail that thread so I deflected the questions. I’ve been thinking about whether or not to post this and what to say. I think it’s important so here it goes.

I was cleaning out my hard drive and I found a letter of recommendation I wrote for someone years ago. They were successful and got into emergency medicine. Once they were practicing they had some problems. They really weren’t supported through these issues and things got worse. They committed suicide.

I don’t feel responsible so that’s not what this is about. I’ve been doing EMS and working in EDs for 30 years now and I’m appalled at the body count. I’ve known too many people who couldn’t drag themselves back from the darkness. I don’t draw too much distinction between the ones who ate a gun or went out with a needle in their arms. This industry and this specialty can be toxic.

I will say that for the ones I know who got to that point and were able to turn it around things always got better. Not perfect, but better. For the ones who killed themselves it never got better.

If you’re getting there reach out. Don’t let this mess of a system take everything.

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[dchristismi]

Damn DocB. That would derail just about any thread (although it doesn't take much around here.)
I'm so sorry to hear that. They always joke about nurses eating their young, but I think docs just don't think they can even ask. And the "system" is not just unsupportive, but egregiously unsupportive.

I'm glad I got out of the ED when I did...
Agreed - if anyone out there is in a dark place, please say something. Sure doesn't feel simple when you're in that hole, but you aren't alone.


...edited to add that one of my grief colleagues just posted something about not asking people grieving to "reach out" because when that hole is so deep you can't see the light, "reaching out" is damn near impossible. So just pm an me emoji if you need and that might start a conversation.
(Hospice and Palliative Care Touchy-Feels to the rescue!)

 

[GeneralVeers]

Hospital admin and medical directors don't realize the repercussions of what they do to us. We are highly skilled, trained, intelligent people with egos to match. The constant smackdowns, like bringing up every patient complaint and bad survey result negatively impacts mental health. Especially in the current environment, the anxiety from being disciplined and not knowing if there's another job out there could be life-ending.

 

[bravotwozero]

I think they realize it, they just don't care, because they don't have to.

 

[Frazier]

Hospital admin and medical directors don't realize the repercussions of what they do to us. We are highly skilled, trained, intelligent people with egos to match. The constant smackdowns, like bringing up every patient complaint and bad survey result negatively impacts mental health. Especially in the current environment, the anxiety from being disciplined and not knowing if there's another job out there could be life-ending.

I don't recall ever seeing this brought up before, but damn it sure does make a lot of sense!

 

[GeneralVeers]

I don't recall ever seeing this brought up before, but damn it sure does make a lot of sense!

I felt severely depressed for two weeks after my last "annual evaluation". Demotivating doesn't being to describe it.

 

[Birdstrike]

I'll tell you, @docB, the ED sure broke me. Here's my first ever post on SDN ten years ago, from the brink:

I'm done. Gonna do something else. Done with the ED. Got lots of great stories. But had enough.

They broke me. I'm much better now. But I'll tell ya, they broke me.

So, I get it. And I get PMs often, from people who feel the same and are looking for a way out. No, they need a way out; don't have a choice anymore.

I came through it okay. And everyone reading will, too. Because there are people our there (and here) who get it.

 

[GeneralVeers]

I'll tell you, @docB, the ED sure broke me. Here's my first ever post on SDN ten years ago, from the brink:



They broke me. I'm much better now. But I'll tell ya, they broke me.

So, I get it. And I get PMs often, from people who feel the same and are looking for a way out. No, they need a way out; don't have a choice anymore.

I came through it okay. And everyone reading will, too. Because there are people our there (and here) who get it.

I used to be able to shrug off most of the criticism and bad reviews. In the past with the shortage, it was too hard to recruit new docs to a site, so you had to really mess up to get fired, and usually with patient care. Even if fired there were plenty of jobs to be had.

Now with nowhere to go, it's stressful having to be extra careful and mind everything you say in order to hold onto a job. That stress is going to lead to burnout among our physicians like we've never seen before.

 

[docB]

I'll tell you, @docB, the ED sure broke me. Here's my first ever post on SDN ten years ago, from the brink:



They broke me. I'm much better now. But I'll tell ya, they broke me.

So, I get it. And I get PMs often, from people who feel the same and are looking for a way out. No, they need a way out; don't have a choice anymore.

I came through it okay. And everyone reading will, too. Because there are people our there (and here) who get it.

I agree. We've all been there. And even if we endeavor to persevere we don't come out whole.

I've noticed something troubling recently. Displays of emotion make me angry. We had someone in the ED the other day who was grieving over a loved one's death but they were wildly inappropriate, screaming, running into other patient rooms, flinging themselves on the body, the floor and so on. I felt outraged, like I could feel my blood pressure going up. I get the same reaction when fictional characters get emotional on TV.

I think it's because when patients or their families get irrational, demanding and accusatory I feel threatened. It's those situations that generate complaints, bad Yelps or just bring administration into the fray. And that always ends badly for me with lost time off, difficult meetings and a tarnished reputation. And of course all of this is independent of any action or error on my part. That's if I did everything appropriately. It's really soul crushing to think I can't feel anything but fear anymore and I can't tolerate anyone else feeling anything either.

I do think that this board provides solace and community for these issues. You can come here and feel like you're not alone. I could never mention how I'm feeling at work or to anyone in the group. Maybe that's just where we are. This isn't a really nurturing environment for the young idealists. It is a crutch for the war weary docs trying to limp toward retirement.

 

[WilcoWorld]

I think it's because when patients or their families get irrational, demanding and accusatory I feel threatened. It's those situations that generate complaints, bad Yelps or just bring administration into the fray.

We have a patient experience rep or some such Title. Now, when patients or families start actin a fool I offer to have administration speak with them, and then have the patient experience rep come down. It really helps:
1 - it takes me out of the room
2 - they're almost always upset because they're boarding in the ED, have admin explain this to them
3 - once admin has met these people in their aggrieved state, they always see my side of things and that gets me out of meeting with Monday Morning Quarterbacks

This doesn't solve the bigger problem that @docB highlights, but it helps me.

 

[RustedFox]

We have a patient experience rep or some such Title. Now, when patients or families start actin a fool I offer to have administration speak with them, and then have the patient experience rep come down. It really helps:
1 - it takes me out of the room
2 - they're almost always upset because they're boarding in the ED, have admin explain this to them
3 - once admin has met these people in their aggrieved state, they always see my side of things and that gets me out of meeting with Monday Morning Quarterbacks

This doesn't solve the bigger problem that @docB highlights, but it helps me.

This isn't pointed at you; so don't take it personally.

A "patient experience rep"? Great; so another unnecessary position suckling at the teat. The real answer here is patients and their families need to act like adults and not throw tantrums. If admin understood that (they don't), then there wouldn't be a need for Monday Morning QB'ing.

Once again, it comes back to this:
The number one cause of burnout is the patient.

 

[GeneralVeers]

This isn't pointed at you; so don't take it personally.

A "patient experience rep"? Great; so another unnecessary position suckling at the teat. The real answer here is patients and their families need to act like adults and not throw tantrums. If admin understood that (they don't), then there wouldn't be a need for Monday Morning QB'ing.

Once again, it comes back to this:
The number one cause of burnout is the patient.

It demonstrates the malignancy that is growth of administration. Why can't they have a physician experience rep?

 

[VA Hopeful Dr]

It demonstrates the malignancy that is growth of administration. Why can't they have a physician experience rep?

I'm sure your hospital will set up a "physician burnout seminar" that will solve all of your problems very soon...

 

[Arcan57]

There’s different definitions of burnout, but here’s mine. For a couple of months, I hated every patient I saw. I hated the worried well because they were wasting my time. I hated the sick because it meant I had to interact with other docs that I hated, and that I needed to order labs being run by technicians that I despised and wait too long for radiology reads for images that took too long to acquire. I hated the nurses that didn’t do anything I asked in a timely fashion and I hated when they were disregarding a patient I thought was sick or were feeding into drama created by the entitled not-sick.

I hated that my wife didn’t understand why I was so angry all the time and I hated that she’d withdrawal emotionally to protect herself from my relentless negativity. I hated that I had nothing to offer my kids except being a chauffeur since I was too exhausted to interact in a reasonable manner with them.

That’s happened to me twice during my career. Getting back from that place was the standard package (cutting back in workload, therapy, self-care) and has been described more eloquently by others. But it’s possible to stay in the game after burning out, you just can’t keep playing it the same way that caused you to burn out it the first place.

 

[namethatsmell]

It demonstrates the malignancy that is growth of administration. Why can't they have a physician experience rep?

You know why.

In EM, 99.9% of us can only interact with admin as renters, not owners. We’re currently suffering the consequences of this power dynamic.

Unless you have the potential to own where you work, in the current environment the only leverage a typical physician has over admin is 1) how much revenue the doc creates (or saves) within the system and/or 2) how difficult he/she is to replace.

 

[RustedFox]

There’s different definitions of burnout, but here’s mine. For a couple of months, I hated every patient I saw. I hated the worried well because they were wasting my time. I hated the sick because it meant I had to interact with other docs that I hated, and that I needed to order labs being run by technicians that I despised and wait too long for radiology reads for images that took too long to acquire. I hated the nurses that didn’t do anything I asked in a timely fashion and I hated when they were disregarding a patient I thought was sick or were feeding into drama created by the entitled not-sick.

I hated that my wife didn’t understand why I was so angry all the time and I hated that she’d withdrawal emotionally to protect herself from my relentless negativity. I hated that I had nothing to offer my kids except being a chauffeur since I was too exhausted to interact in a reasonable manner with them.

That’s happened to me twice during my career. Getting back from that place was the standard package (cutting back in workload, therapy, self-care) and has been described more eloquently by others. But it’s possible to stay in the game after burning out, you just can’t keep playing it the same way that caused you to burn out it the first place.

Hello. Are you me?

 

[GeneralVeers]

There’s different definitions of burnout, but here’s mine. For a couple of months, I hated every patient I saw. I hated the worried well because they were wasting my time. I hated the sick because it meant I had to interact with other docs that I hated, and that I needed to order labs being run by technicians that I despised and wait too long for radiology reads for images that took too long to acquire. I hated the nurses that didn’t do anything I asked in a timely fashion and I hated when they were disregarding a patient I thought was sick or were feeding into drama created by the entitled not-sick.

I hated that my wife didn’t understand why I was so angry all the time and I hated that she’d withdrawal emotionally to protect herself from my relentless negativity. I hated that I had nothing to offer my kids except being a chauffeur since I was too exhausted to interact in a reasonable manner with them.

That’s happened to me twice during my career. Getting back from that place was the standard package (cutting back in workload, therapy, self-care) and has been described more eloquently by others. But it’s possible to stay in the game after burning out, you just can’t keep playing it the same way that caused you to burn out it the first place.

The trick for me was to just detach at work. I've mentioned the widgets before, and I still stick to that. It has let me avoid a lot of the previous burnout. I generally ignore the lazy nurses, slow techs, etc and focus on the part of my work I control. Keep patient interaction to a minimum to avoid hating them.

Unfortunately it's led to complaints of "not being empathetic" and burnout due to criticism.

 

[Arcan57]

The trick for me was to just detach at work. I've mentioned the widgets before, and I still stick to that. It has let me avoid a lot of the previous burnout. I generally ignore the lazy nurses, slow techs, etc and focus on the part of my work I control. Keep patient interaction to a minimum to avoid hating them.

Unfortunately it's led to complaints of "not being empathetic" and burnout due to criticism.

I detached so far I couldn’t really feel anything else and I still hated them. In addition to what I mentioned above, I made a pact with myself that I would find one positive thing to connect with in each patient I saw. I now use the inability to do that as a warning sign that I’m going back down that path.

 

[NITRAS]

@RustedFox, you need to quit and do something for 6 months or so. I mean, like anything. One of my mentors does a weight loss clinic that basically is Adkins with BS vitamin shots. Something to get some distance and decide on a career.

 

[RustedFox]

@RustedFox, you need to quit and do something for 6 months or so. I mean, like anything. One of my mentors does a weight loss clinic that basically is Adkins with BS vitamin shots. Something to get some distance and decide on a career.

See my other post in "The Rural Job Myth".

 

[docB]

There’s different definitions of burnout, but here’s mine. For a couple of months, I hated every patient I saw. I hated the worried well because they were wasting my time. I hated the sick because it meant I had to interact with other docs that I hated, and that I needed to order labs being run by technicians that I despised and wait too long for radiology reads for images that took too long to acquire. I hated the nurses that didn’t do anything I asked in a timely fashion and I hated when they were disregarding a patient I thought was sick or were feeding into drama created by the entitled not-sick.

I hated that my wife didn’t understand why I was so angry all the time and I hated that she’d withdrawal emotionally to protect herself from my relentless negativity. I hated that I had nothing to offer my kids except being a chauffeur since I was too exhausted to interact in a reasonable manner with them.

That’s happened to me twice during my career. Getting back from that place was the standard package (cutting back in workload, therapy, self-care) and has been described more eloquently by others. But it’s possible to stay in the game after burning out, you just can’t keep playing it the same way that caused you to burn out it the first place.

I detached so far I couldn’t really feel anything else and I still hated them. In addition to what I mentioned above, I made a pact with myself that I would find one positive thing to connect with in each patient I saw. I now use the inability to do that as a warning sign that I’m going back down that path.

Wow! You really nailed it here. I've been in and out of that for 10 years. I don't think I really understood why I can hate everyone including the sick ones but you're right. It's because they do need to be here but they're forcing me through a process I hate.

 

[Arcan57]

Wow! You really nailed it here. I've been in and out of that for 10 years. I don't think I really understood why I can hate everyone including the sick ones but you're right. It's because they do need to be here but they're forcing me through a process I hate.

So many of us work in environments where most things fail most of the time, and that accumulates over time. Eventually it corrodes everything. It’s why you can be on the overnight and see a pt at 2am when you’ve got 1-2 other active patients and be furious at their very existence, even if they’re pleasant and in genuine need of help.

 

[WilcoWorld]

This isn't pointed at you; so don't take it personally.

A "patient experience rep"? Great; so another unnecessary position suckling at the teat. The real answer here is patients and their families need to act like adults and not throw tantrums. If admin understood that (they don't), then there wouldn't be a need for Monday Morning QB'ing.

Once again, it comes back to this:
The number one cause of burnout is the patient.

Oh yeah, I am not advocating for more money spent on non-clinical positions. But if there's a non-clinical problem that's really unpleasant, it's extra satisfying to hand that sack of poop to an administrator.

 

[WilcoWorld]

The trick for me was to just detach at work. I've mentioned the widgets before, and I still stick to that. It has let me avoid a lot of the previous burnout. I generally ignore the lazy nurses, slow techs, etc and focus on the part of my work I control. Keep patient interaction to a minimum to avoid hating them.

Unfortunately it's led to complaints of "not being empathetic" and burnout due to criticism.

I've had the opposite experience. Viewing my patients as widgets burned me to a crisp. Now that I practice Palliative Med half the time I'm doing the opposite, allowing patients stories to really impact me (and this spills into my EM practice) and I'm much happier in and outside of work.

But my approach, and Palliative Med are clearly not for everyone.

 

[Birdstrike]

The Two Signs On The Door

We’re taught Medicine. We’re taught how to save lives and make lives better. We’re taught that’s 99% of what’s most important. We’re told we’re going to help people, and when we can’t, we’ll help find someone to help those. We start out on a noble path, full of goals and good intentions.

Then, we arrive at our destination. On the door is a sign. We fully expect it to say,

“Here’s where you help people for the next thirty years. Welcome, and thanks for coming.”

But the sign doesn’t say that. Instead, it says,

“You’re not good enough. You’re not nice enough. You’re not fast enough. You’re patients aren’t happy enough. YOU’RE not happy enough. You made a mistake. Or maybe you didn’t. But it doesn’t matter because you’re going to pay. You must be a bad doctor. And if you’re not, it doesn’t matter. You’re going to be dragged through the mud. And you’re name, what’s left of it will be happy it wasn’t your ego. Because that’s been stomped flat. Don’t ask for it back.

You’re the bastard of the medical world. Crap rolls down hill straight to you. Don’t call me. I hate you, because you make work for me. I hate you, because I know I’m going to get a bill with your name on it. You cost too much. You’re not worth your salary. If only you were a specialist, then maybe, just maybe, you’d be special. I’ll let you know when that happens, but don’t hold your breath.

And by the way, thanks for nothing punk. You took so damn long to read this, there’s 20 more people in the waiting room that are going to screw up of metrics. **** you. And **** you very much. Because at the next group meeting, you’re going to be fired. Or maybe worse, maybe we’ll make you think you’re going to get fired for the rest of your career.

Hope you slept well buddy. Because here’s the revised schedule. We put you back on nights with a 24 he turnaround to days, because Dr. Dipschnitzel is on leave again. Something about needing ‘me time.’ Sounds like ‘burnout’ to me. He’s not like you. You can handle anything.

Goodbye.

P.S. Don’t forget you’re replaceable. And don’t forget to smile more. You’re the face of our brand.”

The cognitive dissonance, the hurt, that comes from being sold the former idea of our future and being faced with the reality of the latter is something some of us never reconcile and never can accept or make peace with.

It eats at you every day, little by little, flesh by flesh, until the only thing left of that young idealistic, world-saver, is replaced with someone we no longer recognize.

We’re left only with hope, that there’s a way out. Or a way to figure it out. And there is. It’s just very hard to see sometimes. If you look hard enough, with help, you can see it, because its real and it’s there.

 

[RoyBasch]

So many of us work in environments where most things fail most of the time

This is so true.

I do not know why this crappy environment is tolerated in the ER but nowhere else in the hospital.

Try telling a surgeon in the OR you don't have the instrument they need, or some critical piece of machinery isn't working, or necessary ancillary staff isn't available...surgery simply doesn't happen.

But somehow "The ER will make do."

I have just worked a series of shifts where the only CT scanner was down for 5 days.

 

[GeneralVeers]

This is so true.

I do not know why this crappy environment is tolerated in the ER but nowhere else in the hospital.

Try telling a surgeon in the OR you don't have the instrument they need, or some critical piece of machinery isn't working, or necessary ancillary staff isn't available...surgery simply doesn't happen.

But somehow "The ER will make do."

I have just worked a series of shifts where the only CT scanner was down for 5 days.

Love when CT is down but admin refuses to go on EMS diversion for stroke or abdominal pain patients. Cuz reasons.

 

[Frazier]

We’re taught Medicine. We’re taught how to save lives and make lives better. We’re taught that’s 99% of what’s most important. We’re told we’re going to help people, and when we can’t, we’ll help find someone to help those. We start out on a noble path, full of goals and good intentions.

Then, we arrive at our destination. On the door is a sign. The sign does not say,

“Here’s where you help people for the next thirty years. Welcome, and thanks for coming.”

The sign on the door says is,

“You’re not good enough. You’re not nice enough. You’re not fast enough. You’re patients aren’t happy enough. YOU’RE not happy enough. You made a mistake. Or maybe you didn’t. But it doesn’t matter because you’re going to pay. You must be a bad doctor. And if you’re not, it doesn’t matter. You’re going to be dragged through the mud. And you’re name, what’s left of it will be happy it wasn’t your ego. Because that’s been stomped flat. Don’t ask for it back.

You’re the bastard of the medical world. Crap rolls down hill straight to you. Don’t call me. I hate you, because you make work for me. I hate you, because I know I’m going to get a bill with your name on it. You cost too much. You’re not worth your salary. If only you were a specialist, then maybe, just maybe, you’d be special. I’ll let you know when that happens, but don’t hold your breath.

And by the way, thanks for nothing punk. You took so damn long to read this, there’s 20 more people in the waiting room that are going to screw up of metrics. **** you. And **** you very much. Because at the next group meeting, you’re going to be fired. Or maybe worse, maybe we’ll make you think you’re going to get fired for the rest of your career.

Hope you slept well buddy. Because here’s the revised schedule. We put you back on nights with a 24 he turnaround to days, because Dr. Dipschnitzel is on leave again. Something about needing ‘me time.’ Sounds like ‘burnout’ to me. He’s not like you. You can handle anything.

Goodbye.

P.S. Don’t forget you’re replaceable. And don’t forget to smile more. You’re the face of our brand.”

This is all so true and yet so raw/gritty -- the reality is almost laughable.

 

[RoyBasch]

Love when CT is down but admin refuses to go on EMS diversion for stroke or abdominal pain patients. Cuz reasons.

This has been my life the last few days.

 

[sylvanthus]

This isn't pointed at you; so don't take it personally.

A "patient experience rep"? Great; so another unnecessary position suckling at the teat. The real answer here is patients and their families need to act like adults and not throw tantrums. If admin understood that (they don't), then there wouldn't be a need for Monday Morning QB'ing.

Once again, it comes back to this:
The number one cause of burnout is the patient.

Story time.

Ive got an end stage MS patient in the unit right now with crazy family. Hospital policy is no visitors, however this changss based on who the nursing sup is. So, somehow, they were allowed in 24 hour a day, were actually living in the damn room. Meanwhile, we had a covid pt go comfort on the same floor and family was allowed a whopping 3 minutes outside the room to say goodnye. Meanwhile, this family is hanging out like they live here.

Eventually, it got tk the point they were kicked out because they were so disruptive.

Until last night.....

Almost intubated her cuz she refused bipap, family allowed in AGAIN to “discuss code status.”. Which,
of course, with end stage MS has been done nuuuummerrrroouss times, but somehow they were let in at 2 am. I walked away and said id discuss
with them on the phone but at this point they are f’ing nuts and I personally dis not feel safe around them. Theyd be the ones to shoot the place up.

End result, they were again disruptive, and escorted out by security. Had yet another meeting with admin today and were found hanging out im the hospital lobby afterward becaue they “needed wifi”. And were again booted out

The whole situation is fuxxored, medicine blows because of crap like this. Im staying as far back as I can from the whole situation. Tell me when she needs to be intubated, otherwise im in the office.

 

[sylvanthus]

I'm sure your hospital will set up a "physician burnout seminar" that will solve all of your problems very soon...

they will discuss being “resilient”.

What was the quote? Something about it not being a sign of mental health/strength being ok in a flawed system. Or something like that.

 

[d2305]

Learned helplessness damned if you do and damned if you don't.

 

[docB]

I think my point was that even though we all get pretty disgruntled some or even most of the time no one should kill themselves over this job.

 

[GeneralVeers]

I think my point was that even though we all get pretty disgruntled some or even most of the time no one should kill themselves over this job.

True, and in earlier times I would have agreed with you. Now though, loss of a job means going without income for an extended period of time and moving to 3rd tier city to take a huge pay cut. That would depress any rational human being.

 

[bravotwozero]

Things are going to be tough for EPs, and undeniably it will take its toll mentally on a lot of people. But nobody who's been on this planet long enough has gone through life without taking a few hits, in one form or another.

I'm glad you posted this, @docB Lots of people hurting right now, and I hope this will do some good.

McNinja once talked about looking into stoic philosophy. I found that helpful in putting things into perspective. I think i'll start a thread on that soon.

 

[miacomet]

Damn DocB. That would derail just about any thread (although it doesn't take much around here.)
I'm so sorry to hear that. They always joke about nurses eating their young, but I think docs just don't think they can even ask. And the "system" is not just unsupportive, but egregiously unsupportive.

I'm glad I got out of the ED when I did...
Agreed - if anyone out there is in a dark place, please say something. Sure doesn't feel simple when you're in that hole, but you aren't alone.


...edited to add that one of my grief colleagues just posted something about not asking people grieving to "reach out" because when that hole is so deep you can't see the light, "reaching out" is damn near impossible. So just pm an me emoji if you need and that might start a conversation.
(Hospice and Palliative Care Touchy-Feels to the rescue!)

You are always an inspiration...

 

[miacomet]

Thanks. Such an important thread. I had a unicorn job, but administrative changes and Covid gaslighting have done me in. I wanted to stick it out for two more years, but the unreasonable expectations, endless "feedback" and constant push to do more while they cut, cut, cut are too much, as @GeneralVeers has so succinctly noted.

I'd like to make a clean, polite break before my next abusive annual eval. I'm thinking of applying for a palliative or occ med fellowship in a year or two. I can certainly survive for a year or two without working, although I'd eventually have to work at something.

How crazy is it just to leave without a plan?

 

[bravotwozero]

Don't think it's crazy for someone in your financial position. I would also not be very polite if I knew I was going to make a break, and let them know of every abuse and malevolent behavior the ones in charge are responsible for, so I can at least have the satisfaction of watching the c clowns squirm...

 

[MechEDoc]

I agree re the stoic philosophy. Things aren't exactly where I would like them to be, but it is where I find myself.

 

[miacomet]

I'll need references (potentially) although I think that my career is probably toast for a number of reasons. Also, they wouldn't squirm; they would say the problem is me, of course.

It's hard to leave a job that was once good and has taken a turn for the worse, with the knowledge that an aging ER doc isn't worth much, and that getting into a fellowship, any fellowship, will be a challenge, and that I may never work again. This is a dilemma we all face right now; I realize it's not unique to me.

 

[MechEDoc]

I'll need references (potentially) although I think that my career is probably toast for a number of reasons. Also, they wouldn't squirm; they would say the problem is me, of course.

It's hard to leave a job that was once good and has taken a turn for the worse, with the knowledge that an aging ER doc isn't worth much, and that getting into a fellowship, any fellowship, will be a challenge, and that I may never work again. This is a dilemma we all face right now; I realize it's not unique to me.

How is your career toast? I can't help but imagine. Mine's not on the hottest of trajectories, but when I look around, I'm not really thrilled about the options and I'm sort of content with being a pit-doc.

 

[dchristismi]

M, I think it's high time you jumped. With EM salaries the way they are, you wouldn't be taking much of a pay cut jumping to HPM or Occ. And you might have more administrative support "following your dreams." That's exactly how I gracefully bowed out of a rapidly worsening workplace.

And I don't know... getting a fellowship might be much less of a challenge than finding a different gig. Send out some feelers. You might be surprised. (You might not be, I don't know. But rather than stew away, maybe you take the plunge. The match is in December, I think...)

FWIW, Stoic philosophy has saved me on many sleepless nights.

 

[RustedFox]

How is your career toast? I can't help but imagine. Mine's not on the hottest of trajectories, but when I look around, I'm not really thrilled about the options and I'm sort of content with being a pit-doc.

I'm going to guess that he had the cojones to say and do the right (but unpopular) things when it came down to it.

 

[GeneralVeers]

I'm going to guess that he had the cojones to say and do the right (but unpopular) things when it came down to it.

That's the quickest way to burn your career. Any square doctor who doesn't fit the round hole has to go.

 

[miacomet]

Well, maybe.
I started a fellowship right out of residency that was not for me and left after the first year; not sure how much that would affect my chances of another fellowship.

 

[RustedFox]

That's the quickest way to burn your career. Any square doctor who doesn't fit the round hole has to go.

Veers.
Bird.
Miacomet.
Arcan57.
Me.

Eleventeen other docs with hundreds of years of attending physician experience.

Where's Quailboy to tell us that we're all wrong and how it's not like that?

 

[Birdstrike]

I think my point was that even though we all get pretty disgruntled some or even most of the time no one should kill themselves over this job.

Amen

 

[Birdstrike]

This is the lowest I’ve ever seen morale on this forum in over a decade, by far. It used to be that I was by far, the gloomiest, most negative on here. I think now, roles may have reversed. The unlikeliness of this, finally hit me.

And you guys aren’t just venting. I know you well enough to tell when your okay, but venting, versus truly down.

I’m going to have to think more about this. I have something helpful to say, I just don’t know what it is yet, or how to put it into words. I know that sounds weird, but it’s true.

I don’t know when, or how, but it’s going to get better.

 

[GeneralVeers]

This is the lowest I’ve ever seen morale on this forum in over a decade, by far. It used to be that I was by far, the gloomiest, most negative on here. I think now, roles may have reversed. The unlikeliness of this, finally hit me.

And you guys aren’t just venting. I know you well enough to tell when your okay, but venting, versus truly down.

I’m going to have to think more about this. I have something helpful to say, I just don’t know what it is yet, or how to put it into words. I know that sounds weird, but it’s true.

I don’t know when, or how, but it’s going to get better.

I truly am at the lowest point in my career. It's a combination of de-motivating "evaluations", implosion of the job market, and hopelessness about the future of the specialty.

 

[RustedFox]

I truly am at the lowest point in my career. It's a combination of de-motivating "evaluations", implosion of the job market, and hopelessness about the future of the specialty.

I'm right there with you, amigo.