I have spent some time working in the ED as a premed student and love it. Many people on here say that although the lifestyle seems great at first, that it is really draining and somewhat miserable in the long run. I have read through the FAQ, etc. However, assuming your wife doesn't work, the specialty just seems so ideal to me. You only work 4 days a week, and sure you have to work some nights, but on those days you can take your kids to school and go out to breakfast with your wife. How many people can do that? Furthermore, the career seems flexible enough that you can take less shifts once your loans are paid off. Every career out there has negatives. EM seems like the best overall by far. For those who have grown to dislike the field( I know at least a few of you are on here) what am I missing? Thank you.
EM and Family Time
- Thread starter chrisski
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I'm 8 years out of med school, 3 small kids, and am married to a stay at home mother.
First off, why work 4 days a week? Barring a spending problem or ridiculous loans, 3 eight-hour shifts a week is plenty. I mean, at $200 an hour, that's $230K. Trust me, making $300K won't make you any happier than making $230K. I have a nice big house, no debt, the cars I want, money to do whatever I want, and don't have to think about whether I can afford something (at least something that costs less than a grand) before I buy it. I'm also able to invest a lot each year toward an early retirement. But if you want to make $300K, fine, work 4 days a week. But this is the key to it all. If you want to last a long time in community EM, you have to keep the total hours down. The only way to make up for working all those nights, weekends, and holidays is to feel like you have ridiculous amounts of time off. Otherwise you WILL get burnt out. I don't know any attendings working more than 18 shifts a month, and most of my group is working 10-13. Some work 6. These are 8 hour shifts mind you.
Second- The last thing you feel like doing after a long night shift is going out to breakfast. I'm lucky if I can make it to the house without crashing the car, at least on the first night shift. Take the kids to school? You want me to risk their lives too? The night shifts aren't so bad, it's the constant jet lag transitioning between days and nights. Also, EDs are busier in the evenings. That means MOST of your shifts will be evening shifts. Typical time to get home from my shifts is 3:30 pm, 8:30 pm, 11:30 pm, 3 am (I leave home at 6:30 pm for this one), and 6:30 am. So 3 of the 5 shifts mean I'm not home with the family in the evenings. I miss a lot of ball games, concerts, activities etc. So sure, you're at home during the day, but when the kids don't come home from school until 3 or 4, you might not see them awake for several days depending on the shift you're on. Also, since you're working lots of evenings and weekends, there's a real drag on your social life. It is hard to go do things with your friends because every time they're off, you're working. Likewise, all your pals are working during the multitude of weekday mornings you have off. So I do a lot of stuff by myself just because I can't find anyone to go with-mountain biking, skiing, golfing etc. All solo. I can do that stuff with my wife in a few years, but not with a 2 year old at home. Someone has to watch the kid. So I watch the kid while she plays and she watches the kid while I play. Kind of lonely sometimes.
So yea, it's good, and it's bad. If you can content yourself with living off $200K it's much more good than bad. If you try to make a killing in EM, it can be kind of miserable.
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my take on the lifestyle thing is a little different. I agree that frequent shift hr changes are tough to do, that's why I work all nights.
put the kids to bed, go to work, come home, take them to school, nap for a bit, pick them up and repeat. whenever my kids are home and awake so am I. the key to this is to work somewhere slow enough that you don't get totally wiped out at work. during my 11 hr night shifts at a small facility I generally see 12-20 pts/shift(range 8-45), leaving me time to take a nap during the shift in a call room right outside the dept.
having time off during the week in the middle of the day is great. no lines anywhere for anything. also getting paid more/hr to see fewer and generally sicker pts is great. 3 codes on night shift in the last week. 2 still in icu, 1 d/c nl. not typical, but a nice stretch.
put the kids to bed, go to work, come home, take them to school, nap for a bit, pick them up and repeat. whenever my kids are home and awake so am I. the key to this is to work somewhere slow enough that you don't get totally wiped out at work. during my 11 hr night shifts at a small facility I generally see 12-20 pts/shift(range 8-45), leaving me time to take a nap during the shift in a call room right outside the dept.
having time off during the week in the middle of the day is great. no lines anywhere for anything. also getting paid more/hr to see fewer and generally sicker pts is great. 3 codes on night shift in the last week. 2 still in icu, 1 d/c nl. not typical, but a nice stretch.
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Birdstrike,
I've been seeing your posts about leaving the specialty, but I have not come across the post where you actually tell us what you are switching to. Maybe cause I missed it on one of the earlier threads? Anyways, out of curiosity, what specialty are you switching to? Is it a smooth transition or was it difficult to make the switch now that you have been practicing as an attending for a while? Are you redoing a residency? or pursuing a fellowships?
I just don't see how you can switch into anything else and have a better life. If you seriously just cut half of your hours, I'm sure you can still bank in the 100K/year and be happy, right? I think you'll still make more than an Family Practice physician by doing that, and work several less hours per week.
The other career change I can only think of are consulting or Expert Witness, and by dear god...I hope you have not explored the darker side. If do do thing, go and nail all those jacka** that gave you a hard time for weak admission first 🙂
My buddy is holding two part time jobs, working a total of 4 days (9hrs shift) per week, only weekdays, no weekends, no nights, and banking in the 250K. I just can't imagine a better life than that. I mean, we all have to work to survive (except our welfare patients, of course).
Maybe I'm a PGY-I and still have tunnel vision? I do feel burn out everyday, up until I hang out with other services and listening to the sound of pagers going off like fire alarms, hehehe, then I rest my case.
I've been seeing your posts about leaving the specialty, but I have not come across the post where you actually tell us what you are switching to. Maybe cause I missed it on one of the earlier threads? Anyways, out of curiosity, what specialty are you switching to? Is it a smooth transition or was it difficult to make the switch now that you have been practicing as an attending for a while? Are you redoing a residency? or pursuing a fellowships?
I just don't see how you can switch into anything else and have a better life. If you seriously just cut half of your hours, I'm sure you can still bank in the 100K/year and be happy, right? I think you'll still make more than an Family Practice physician by doing that, and work several less hours per week.
The other career change I can only think of are consulting or Expert Witness, and by dear god...I hope you have not explored the darker side. If do do thing, go and nail all those jacka** that gave you a hard time for weak admission first 🙂
My buddy is holding two part time jobs, working a total of 4 days (9hrs shift) per week, only weekdays, no weekends, no nights, and banking in the 250K. I just can't imagine a better life than that. I mean, we all have to work to survive (except our welfare patients, of course).
Maybe I'm a PGY-I and still have tunnel vision? I do feel burn out everyday, up until I hang out with other services and listening to the sound of pagers going off like fire alarms, hehehe, then I rest my case.
I am nearing the 5th mark as an attending. I agree that working less hrs does help. When I first finished residency, 16 to 18 eight hr shifts per month seemed like a vacation compared to residency. BUT, it wasn't long before I started to hate the job and the hospital and the pts. Cutting down shifts helped tremendously, but now I feel like I need to cut down the shifts even more. This tells me that it's more than just the hours and day-night effects.
Working in the ER is HARD WORK. But it's more than that. It's very draining. There's tremendous pressure to see pts fast, think in terms of customer service, and not admit too many pts or order too many diagnostic studies but at the same time make everyone happy and never miss any diagnosis. You are the safety net of the healthcare system or more bluntly, you are the dumping ground. You deal with problems that other healthcare providers couldnt or didn't want to deal with. Pts expect you to fix things that fix themselves or have no cure. Because you are open 24/7, pts just show up
and demand answers and tests that are unrealistic.
If i go on vacation or have several days off in a row, i tell myself that i make good money, get to travel more than most, and my family is relatively stable financially. But it takes usually 1 or 2 hrs into my shift before i start telling myself i am switching careers. I would have switched already if i just didnt get paid so much for working less hrs than most.
Now I am just rambling and complaining. Sorry.
Working in the ER is HARD WORK. But it's more than that. It's very draining. There's tremendous pressure to see pts fast, think in terms of customer service, and not admit too many pts or order too many diagnostic studies but at the same time make everyone happy and never miss any diagnosis. You are the safety net of the healthcare system or more bluntly, you are the dumping ground. You deal with problems that other healthcare providers couldnt or didn't want to deal with. Pts expect you to fix things that fix themselves or have no cure. Because you are open 24/7, pts just show up
and demand answers and tests that are unrealistic.
If i go on vacation or have several days off in a row, i tell myself that i make good money, get to travel more than most, and my family is relatively stable financially. But it takes usually 1 or 2 hrs into my shift before i start telling myself i am switching careers. I would have switched already if i just didnt get paid so much for working less hrs than most.
Now I am just rambling and complaining. Sorry.
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Oh it's so nice to think that!
First, as a resident, you may in fact work every weekend (or at least a part of every weekend). It's called residency. When you're in the ED, you could be looking at 22-23 shifts/month. On ICU, trauma months, you'll probably have a brutal call schedule.
As an attending, most groups probably have some weekend/holiday schedule, but I would expect to work every-other weekend and every other holiday (that's what I do now). Unless your group has some different scheduling for weekends (like fewer number of shifts but each shift is longer), then remember, someone's got to be working for anyone who isn't. And weekends usually have higher volume since doctors offices aren't open. Sure, you will have more overall time off (16-18 shifts/month), but everyone in your group will probably want that same extra time off (no one is clamoring for tuesdays in February off).
I would think that EM docs actually work more nights, weekends, holidays than most other specialties because office-based practices can have reduced staffing during these periods, the ER generally doesn't.
Thanks for all the great replies. I was under the impression that you were always pressured into working 4 shifts a week at the start, but if one can do less, that would be great. I want to live in a small house and have a simple life style, spending time with my family, but doing a career that I am passionate about. Its sounding like part time is completely viable, so once my loans are paid off could I even work 1 or 2 shifts a week (I imagine this would still make 80-100K)? Thanks again.
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I'm soon to graduate, and will be working 96 scheduled hours/month (12 8-hour shifts/month).
To answer your question, there is a critical number of shifts/month, below which you will be considered part-time and may not qualify for benefits.
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There are also cut-offs for malpractice. Depending on how your policy is structured, you might get a break for working less. Or, you might pay the same malpractice premiums no matter how few shifts you work. Every policy is a little different.
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Kind of reminds me of Office Space:
STAN
I need to talk about your flair.
JOANNA
Really? I have 15 buttons on. I, uh, (shows him
STAN
Well, ok, 15 is minimum, ok?
JOANNA
Ok.
STAN
Now, it's up to you whether or not you want to just do the bare
minimum. Well, like Brian, for example, has 37 pieces of flair. And a
terrific smile.
JOANNA
Ok. Ok, you want me to wear more?
STAN
Look. Joanna.
JOANNA
Yeah.
STAN
People can get a cheeseburger anywhere, ok? They come to Chotchkie's
for the atmosphere and the attitude. That's what the flair's about.
It's about fun.
JOANNA
Ok. So, more then?
STAN
Look, we want you to express yourself, ok? If you think the bare
minimum is enough, then ok. But some people choose to wear more and we
encourage that, ok? You do want to express yourself, don't you?
As for me, I'm a fourth year headed for internship and I'm already kind of wondering the same question. I would think that doing minimal hours would make becoming a partner more difficult. Would you also in general get crappier shifts and holiday schedules if you're pulling bare minimum? Do you really get looked down upon by colleagues by working less?
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"Holiday Schedules" - that's the thing - (No disrespect meant to above poster), but neither me nor wifey celebrate any sort of 'holiday' except for our anniversary, or family things (we're both agnostics teetering on the brink of atheism), so we don't care about "Christmas" and "Easter" and all of that.
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If you are hired as part time and do the minimum, then no, you're not a slacker; you're doing the job they hired you to do. Plus, doing "extra" shifts (such as holidays) might get you more $$$.
The essential part of not being labeled as a "slacker" is to be just that - not a slacker. See your patients, make sure you're meeting your PPH or RVU goals (can ask your department administrator/chief to provide these numbers), and don't dump procedures or complicated dispositions on your relief.
Oh, and I've always found that punctuality carries a lot of weight... you could be the second coming of Dr. Osler, but if you're late, you're a slacker. My take: if I'm not 10-15minutes early, then I'm already late for my shift. Gives me time to get coffee and take the temperature of the ED, so I know what I'm getting into.
Just my $0.02 (actual value = 1/20th of a penny)
-t
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I think you're getting ahead of yourself too much until you are looking at a specific job.
One group who offered me a position is a small independent group in a desirable location, where I was offered essentially two shifts/month until more space opened up (with help finding moonlighting on the side if wanted). My 12 eight's at my current job is pretty standard for that location - and I can always add on more shifts if I want to (which I don't, right out of residency, with boards coming up). Another job I looked at had sixteen eights/month. Every place is pretty different, so I don't think you can worry about looking like a slacker at this point in the game, without looking at specific jobs. Besides, every place I looked at has part-timers anyway.
One group who offered me a position is a small independent group in a desirable location, where I was offered essentially two shifts/month until more space opened up (with help finding moonlighting on the side if wanted). My 12 eight's at my current job is pretty standard for that location - and I can always add on more shifts if I want to (which I don't, right out of residency, with boards coming up). Another job I looked at had sixteen eights/month. Every place is pretty different, so I don't think you can worry about looking like a slacker at this point in the game, without looking at specific jobs. Besides, every place I looked at has part-timers anyway.
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what about the jobs, as december07 alluded to one, where you work only during the week, no nights no weekends? I'm sure there has to be places where you can work more during the week so you don't have to work nights and weekends. Or you can works nights and have weekends off...I'd totally do that.
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one disadvantage is that my buddy will never make partner because both of his jobs are part-time. He doesn't care too much about partnership, tho.
The mystery remains, what is Birdstrike switching to?
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Anyone have any more positive perspectives on balancing EM and family life? It seems that if the stereotype of EM docs seeing EM as a job, not a lifestyle, rings true, then that would play itself out in meshing well with family life. Maybe not. Just curious.
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I'm curious, does anyone solve the burnout issue by taking sabbaticals, practicing in vacation locales, or going on service missions?
I love the notion of an urban practice half the year, working in the mountains during their 'busy' season, and going abroad for a month a year. And no, I dont need to make the big bucks.
I love the notion of an urban practice half the year, working in the mountains during their 'busy' season, and going abroad for a month a year. And no, I dont need to make the big bucks.
What are some benefits of partnership?
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I entirely agree with the above posts from active duty especially.
One thing I will add is that the shifts are more taxing when you work in a setting with more difficulties...no in house rads, no access to MRI, inpatient residents frequently dodging work, etc. The fewer the ancillary headaches and the better your nursing staff, EMR, and admission process, the longer your practice life.
Also the attending shelf life is different between academics and community practices.
Small additions to the conversation...
One thing I will add is that the shifts are more taxing when you work in a setting with more difficulties...no in house rads, no access to MRI, inpatient residents frequently dodging work, etc. The fewer the ancillary headaches and the better your nursing staff, EMR, and admission process, the longer your practice life.
Also the attending shelf life is different between academics and community practices.
Small additions to the conversation...
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More job security, more control over practice environment, but mostly more money.
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I know what birdstrike is going into, but I do not know if I am at liberty to divulge such information.
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Then why say anything here?
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I'm not bashing on Birdstrike by any mean, I actually appreciate that he has accurately spilled out the dark side of Emergency Medicine.
My only problem is that his posts WILL deters many curious students from ever consider EM as an option. Oddly enough, those candidates that frequent SDN forums are typically the bright ones.
So just to be fair, if Birdstrike has a better career choice and leaving EM altogether, at the very least tell the students (and us) what it is so that some can follow suit. Like I mentioned earlier, I just can't figure out another career in MEDICINE where you don't have to work weekends, nights, and NOT be on call at some point.
again, I do appreciate his contribution to this board as he repeated point out the negatives of this career choice that I failed to recognize as a student.
My only problem is that his posts WILL deters many curious students from ever consider EM as an option. Oddly enough, those candidates that frequent SDN forums are typically the bright ones.
So just to be fair, if Birdstrike has a better career choice and leaving EM altogether, at the very least tell the students (and us) what it is so that some can follow suit. Like I mentioned earlier, I just can't figure out another career in MEDICINE where you don't have to work weekends, nights, and NOT be on call at some point.
again, I do appreciate his contribution to this board as he repeated point out the negatives of this career choice that I failed to recognize as a student.
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It's his business. Maybe he's in the process of finalizing it and doesn't want someone close to the situation to be reading about it online. Or perhaps he just doesn't want to discuss it. It doesn't matter.
Also I can help you out with your list...
Family
Peds
Outpatient Medicine
Pretty much any of the IM subspecialties
PM&R
Pysch
Pain
Derm
Optho
All of these (and more) could easily have no nights/weekends/call after residency. Any student could do a simple search and find out the possibilities of life after residency in any field of medicine. They don't need their hand held by someone.
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Just out of curiosity, for all the attendings/residents who have spouses out there, do you feel like they truly understand your schedule and work demands? Mine flips out if I say... come off days and want to stay up later and later the next 2 nights off in order to transition to nights getting ready for 6 night shifts coming up. I mean, I can't tell you how brutal the flip flopping can be on my body and it's the only way I know how to get ready. I sleep by myself in a separate room about 1/3 of the time just because of the drastic differences in times that we both go to bed and it's always a big issue with her. Most of the time I feel bad because I'm usually working when she's off, or vice versa and when I'm off after a string of shifts I just don't feel like doing anything that very next day. I always feel like the bad guy who can't give her a "normal" life/schedule. I think that's the worst part of EM for me, is how the schedule affects those around you, friends included. However, I really wouldn't pick anything else. I love the craziness of it, partly because I love the intensity of the work and then the immediate downtime, (along with loving EM in general...) and honestly... I like working nights, almost feel bad saying that. I'd work all nights if I could, even after residency. Everyone around me would hate me for it though...except my partners!
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Residency and attendinghood are different, but the flipflopping is generally a part of EM life. If she doesn't *get* this, you're in for more misery.
I don't know how else to put it.
My ex-husband dealt with it very well, but I think he understood what I was doing and why I had to do it. I'm happily single now, but honestly, that would be a dealbreaker now. Good luck, man. That sucks.
Fox, seriously, come work with me. We understand work and play. Think about it. 🙂
Danielle
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atkinsje said:
For all of these there is someone on call for when patient's call the clinic with questions or emergencies. As to IM, most of the subspecialties have some sort of hospital component, which includes call (Cardiac, pulm, nephro, heme, onc etc)
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I agree with dc - if your SO doesn't understand & support the sleep needs that EM imposes on you, it ain't gonna work. Either you bend to the SO's will, and you're an irritable, under-rested companion on your days off, or you honor your sleep needs and your partner is angry with you for neglecting him/her. Fortunately my wife is understanding, I make sure to be attentive when I am awake and it all works out well. Also, I often sleep in a separate bed, but we both recognize that this doesn't reflect a lack of affection, so it's not a problem. This way we do spend a bit less time together, but we really enjoy the time we do spend together.
Kids however...they're a lot less understanding.
Kids however...they're a lot less understanding.
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I think it's highly variable. Most of the docs in this area don't take call. Mine included. If I call after hours I get a polite message telling me to leave a message to make an appointment but if its urgent to head to the ED. And yeah, I could have been more specific with the subspecialties but there are many that could easily have no call/weekends (allergy, endo, rhum, pulm only practices GI).
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Allergy, Endo and Rheum I'll agree with, but pulmonologists take call (unless they're running a sleep center) and GI definitely takes call. We have GI come in all the freaking time for acute bleeders, peds foreign bodies, etc. There are probably some exceptions to this, but from what I've seen it's the norm.
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exactly how many EM rotations have you been on? I'm curious of the level of interaction you have had with various attendings and other disciplines while doing an EM rotation. You may not realize how often we call attendings at home until you actually become a resident and start doing the dirty work. (correct me if i'm wrong, but you're currently a 2nd year med student, right?)
Like JBar said, every discipline, there is someone covering for you when you're not taking call. If you're in a big group, then you take less call, but you do take calls.
Almost all IM subspecialties have some sort of tie to the hospital. As a matter of fact, they rely on the hospital to refer patients to them. In return, they are our resources when we need to consult.
"Also I can help you out with your list... "
Family--> take calls, many FM admit there own patients
Peds--> take calls
Outpatient Medicine--> IM without hospital work? huh?
Pretty much any of the IM subspecialties ???? like Cardio, GI, nepho? ever heard of cath lab, GI bleeding, dialysis? yep, Endo aren't protected from calls either, not often, but we'll call if we need to. Allegy/Rheu are few in between.
PM&R--> not often as acute pain are fairly easy to be managed
Pysch--> take calls
Pain-->??? like PM&R?
Derm--> ok, part of "ROAD", rarely an emergency, so no calls, lots of referrals
Optho--> are you kidding? who do you think we call for acute closed angle glaucoma?
Like always, we hi-jacked the thread and digressed. my apology to the OP 🙂
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I am not saying that we don't these specialties to take call (if thats how it came across not what I meant). I am saying that if not working weekends and not taking call is that important to you it is very doable. I can list examples from every specialty I listed (and honestly just thought of some more). Granted its all anecdotal (but real life examples of ones I've personally seen) but there is no reason it would be unique to this area (and I would be surprised if it is). Again, not saying that we don't need these people on call...just saying one can work in a field and not do it.
Edit: If you want specific examples of what I am talking about I would be more than happy to provide them...just not here. We've derailed this enough. Hit me up in PM if you're still interested.
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Fascinating. For all the internet jockeying going on there are some compelling things being written on this board.
It will probably all be different for me, however; I would just like to say that your comments are far reaching and widely read. Thanks for laying it out there. There are a lot of us percolating on these issues who would love to claim awareness "eyes wide open" so to speak.
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This is spot on advice. I came out of residency and took on too much too quickly DESPITE my directors suggesting otherwise....I regret it still. Also, I did not appreciate that the chairpersons and institutional leaders in EM are very business savvy and that they can take advantage of naive residency grads if you don't protect yourself.
I entirely endorse the idea that with thought, care, discipline and foresight many of these problems can be avoided.
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Birdstrike and ThymeLess, thanks for highlighting this point about new attending hours. I can see how it would be very easy to do this, going from essentially no salary your whole life to opportunities for more would be tempting to any new grad. Thanks for being so honest and helping out future EP's.
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A shoutout to Thymeless and Birdstrike. Thanks for the posts. Extremely informative and insightful. As a medical student, we need those types of posts from attending. The honest truth. EM is still an amazing field in my eyes, but just makes me explore my options more as a student. Thanks again🙂
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You're welcome. but...
Almost all posts here are truthful. Its kind of like if you ask about a corvette, it is truthful to say that it is fast, attractive, a status symbol but it is also truthful to say that the ride isn't smooth, its pricey, and the gas mileage is poor.
The nice thing about studentdoctor.net is that you get anonymous posts which lead to as truthful responses as possible. This applies to this thread and all the others. People don't get any kick backs for tricking medical students into anything....we all tell what we believe to be truth in response to specific questions.
I love my job, truly. I love Emergency medicine and cannot imagine a better specialty. This is truth. It is all truth.
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If you go into EM, weekends do not exist. If you consider a weekend from 5 pm on Friday to 6 am on Monday, I have worked at least one shift during 8 of the last 12 weekends. And I'm only working about 120 hours a month.
I go to church, and as a resident, I made it about once a month on average.
IF WORKING ON WEEKENDS IS A BIG DEAL TO YOU, EM IS NOT FOR YOU.
As an attending you do have a lot more free time, but it isn't necessarily on the weekends.
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My view is slightly different on this one even though I agree with almost everything else you have said ActiveDuty. My current job gives me at least two full weekends off and my next one will give me three each month. The weekend situation is very job specific and if it is important to you it is best to carefully scrutinize which job you take is my opinion on the issue.
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I agree it is job specific, and if I wanted to, I could request more weekends off than I do (and get them.) But I have other priorities with my scheduling requests, such as getting enough shifts to meet my financial needs, not pissing anyone off too much (I still have a year to make partner), and I like to take a significant block of time off each month (4-8 days) for short trips. Also, I'm counting "working weekends" as those in which I start a shift at 10 pm Sunday night or finish one at 8 pm Friday night. Also, lots of those weekends I'm only working one shift. So if you want complete weekends off, you just have to work both days on the weekends on. It's all a trade-off.
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