EM docs that left medicine

[miacomet]

---

Members don't see this ad.

Reality is if you want to get out the more typical ways will work, start a side business (I have one) though this will take a lot of time and effort and training. The beauty is you can pick and choose.

I know guys doing laser hair removal, farming, urgent cares, and real estate. We all make enough where we can invest some startup capital and make money, we are all smart enough to read books and understand them. It can all be done. You will get a better ROI on this than getting an MBA or doing another residency. Can’t comment on fellowship as the spread is too wide.

My goal from day 1 was financial freedom by age 50, I should be there even earlier.

This is very true. But for those of us who want to be docs until our sixties, EM remains a poor choice. If you want out early, do CRNA, nursing, or just don't go into medicine.

 

[BoardingDoc]

This is very true. But for those of us who want to be docs until our sixties, EM remains a poor choice. If you want out early, do CRNA, nursing, or just don't go into medicine.

Meh, only if you plan poorly. Granted, I'm not there yet, but I plan on continuing to work a few shifts a month as an ED attending into my 60s. I think the poor choice would be to do such a poor job of financial planning to the point that you need to continue to work FULL TIME into your 60s. I plan to do a few a month as a hobby and justification for bumping my vacation airfare to first class.

 

[miacomet]

Reducing your workload mitigates it a lot. The problem I had was getting my employer to let me cut back my hours. The response was always, "We're understaffed. Most ERs are understaffed. Everyone wants to cut back. If I let you cut back your hours, everyone will want to, then we're even more short staffed, wait times go up and we lose our contract." But, yes, if you can find and keep a job that allows you to work 120 hours per month or less, your stressors will be reduced greatly. Just make sure you don't get into a situation where your first year or two out, you get used to a lifestyle that requires you to work 180. Or, like I recommend to people starting out in EM, do a fellowship. Even the ones you don't think you'd be interested in give you options down the road, other people won't have.

Not too long ago I ran into a few guys I had done residency with. One guy did a hyperbarics fellowship and now only works 2 general EM shifts a month. Another did a EM cardiovascular fellowship and works only 8 general EM shifts per month. Another went into EMS and cut his general EM shifts in half. Another did a Pain fellowship and works zero general EM shifts per month (that's me). If you think you'll be happy working EM full time until you're 60, and you bounce back easily after those post night shifts, then don't plan for any need for a mid career change. But if you doubt you will be, diversify your skills so you have other options. It doesn't mean you have to abandon EM. But it may mean you'll be able to maintain your income easier, without having to work a full-time general-EM schedule at (or above) your maximum capacity.

When I was going into EM, the older folks told me "EM burnout is a myth." It was a lie.

This I do not understand.

The doc response can always be "I hear you, but right now I can only work x number of hours a month. I understand the hospital needs me to work 2x, and I'm willing to consider working 3x in the future, but right now all I can do is x for personal reasons." Places that are understaffed hate losing docs. Admittedly, you have to be willing to walk away, but who wouldn't be from such a shop? And as long as you are well-liked you can say you will be happy to come back as long as the hours are what you need.

 

[Birdstrike]

This I do not understand.

The doc response can always be "I hear you, but right now I can only work x number of hours a month. I understand the hospital needs me to work 2x, and I'm willing to consider working 3x in the future, but right now all I can do is x for personal reasons." Places that are understaffed hate losing docs. Admittedly, you have to be willing to walk away, but who wouldn't be from such a shop? And as long as you are well-liked you can say you will be happy to come back as long as the hours are what you need.

I was willing to walk away. And I did. I haven't worked an EM shift there, or anywhere else, since.

 

[miacomet]

I was willing to walk away. And I did. I haven't worked an EM shift there, or anywhere else, since.

Which is outstanding. Curious- did you insist you needed to cut down or quit?

 

[Birdstrike]

Which is outstanding. Curious- did you insist you needed to cut down or quit?

I insisted I needed to cut down repeatedly, but being right out of residency, wasn't willing or ready to get fired over it or walk. The director would cut my shifts down a little, enough to pacify me (and others), but gradually turn the heat up slowly over time. It was the perfect system to burn people out with constant chaos, while making them think stability & improvement are just around the corner, just one hire or one tweek from giving us all that life we were told was attainable in pre-med, medical school and residency . I watched many people leave that job. I saw, maybe 14-16 docs leave over the better part of a decade. Just when you thought you were burned out for good, they'd add a couple night docs, or increase staffing and it would be better for a while, until someone else got chewed up and spit out of the doctor grinder. Improvement was frequent enough to give hope, but not lasting enough to prevent burnout. As I contemplated my exit, I watched those 14-16 docs leave and every single one of them left for "the perfect job," or at a minimum, "drastically better" than the one we suffered in. By the time I was ready to make my own exit, all but one of those docs who left for the perfect job, were on to their second, third or fourth "perfect" job. Either the jobs ended up being not as advertised or they were great, but the contracts blew up shortly thereafter and the perfect job was no more. Even the one guy that stayed at his "perfect job" eventually got burned out and moved heavily into EMS so he could cut his ED shifts by at least half.

It became clear to me that it was going to be the same song and dance most everywhere, and moving around from job to job, state to state, uprooting my family multiple times, learning new EMRs, new systems and never really changing anything. That was not going to work for me. I decided I deserved better and worked too hard for too long to settle for that. That's when I decided to get out completely and make a change drastic enough that I could have a normal life. What that was going to be, almost didn't matter. Whether leaving Medicine altogether, changing specialties or doing a fellowship, I was dead set on having a normal life and leaving the "life has to suck because you decided to go to medical school" mentality behind. I decided that constantly being sleep deprived, stressed to the max, circadian-rhythm jet-lag mind-***ked all the time, and working an insane bonkers, bat***t crazy schedule was no longer a sane or sustainable option. It was full on, "Get out, before ya stroke out." So I embarked on my quest to find something that would allow me to find stability, sleep at night, be awake during the day, and have a normal life.

Right around the time I made that decision, I joined SDN as Birdstrike and started posting to tell pre-meds and medical students what I thought was the difference between what I was lead to believe EM would be, and what it turned out to be for me. But it's just n of one. Do with it what you will.

 

[miacomet]

I insisted I needed to cut down repeatedly, but being right out of residency, wasn't willing or ready to get fired over it or walk. The director would cut my shifts down a little, enough to pacify me (and others), but gradually turn the heat up slowly over time. It was the perfect system to burn people out with constant chaos, while making them think stability & improvement are just around the corner, just one hire or one tweek from giving us all that life we were told was attainable in pre-med, medical school and residency . I watched many people leave that job. I saw, maybe 14-16 docs leave over the better part of a decade. Just when you thought you were burned out for good, they'd add a couple night docs, or increase staffing and it would be better for a while, until someone else got chewed up and spit out of the doctor grinder. Improvement was frequent enough to give hope, but not lasting enough to prevent burnout. As I contemplated my exit, I watched those 14-16 docs leave and every single one of them left for "the perfect job," or at a minimum, "drastically better" than the one we suffered in. By the time I was ready to make my own exit, all but one of those docs who left for the perfect job, were on to their second, third or fourth "perfect" job. Either the jobs ended up being not as advertised or they were great, but the contracts blew up shortly thereafter and the perfect job was no more. Even the one guy that stayed at his "perfect job" eventually got burned out and moved heavily into EMS so he could cut his ED shifts by at least half.

It became clear to me that it was going to be the same song and dance most everywhere, and moving around from job to job, state to state, uprooting my family multiple times, learning new EMRs, new systems and never really changing anything. That was not going to work for me. I decided I deserved better and worked too hard for too long to settle for that. That's when I decided to get out completely and make a change drastic enough that I could have a normal life. What that was going to be, almost didn't matter. Whether leaving Medicine altogether, changing specialties or doing a fellowship, I was dead set on having a normal life and leaving the "life has to suck because you decided to go to medical school" mentality behind. I decided that constantly being sleep deprived, stressed to the max, circadian-rhythm jet-lag mind-***ked all the time, and working an insane bonkers, bat***t crazy schedule was no longer a sane or sustainable option. It was full on, "Get out, before ya stroke out."

Right around the time I made that decision, I joined SDN as Birdstrike and started posting to tell pre-meds and medical students what I thought was the difference between what I was lead to believe EM would be, and what it turned out to be for me. But it's just n of one. Do with it what you will.

That's horrific. What poor management, and what an accurate description of how awful EM is.

 

[Groove]

As an AFMD who does the scheduling at my shop, I'll give you the skinny on part time docs. Yes, it is very doable....in the right market (assuming you are not doing locums, in which case...anything is possible). However, nobody likes using PRN docs more than needed. Why?

1) They have limited schedule availability (assign themselves weekends and holidays off...and if they don't, they want 2x the FTE rate).
2) They are unreliable in that they may be available 6 shifts one month, 2 the next, none the next, 8 the month after that, etc.. It's a pain in the ass negotiating with these guys, as anytime they are not available and are needed, they want to negotiate increased rates. Also, their schedule availability is many times dependent on the other ERs finishing their schedule which many times is delayed, hence delaying yours.
3) They are not invested in the department/hospital. Always with one foot out the door, they don't particularly feel invested enough to comply with any/all departmental/hospital policies because hey....they've got 3 other ERs where they work and don't absolutely need yours.
4) Did I mention that they're a pain in the ass to schedule?

So, although ongoing PRN in a local market is doable, it's oftentimes more difficult than you think. You have to rely on local shops always having a need. As soon as they can fill their slots with FTE docs, then you are gone. Many times, there is no warning, simply an email saying "hey, we don't need you next month....and for the foreseeable future".

Now, that being said, ongoing PRN is VERY doable in the right market. As long as the local market isn't saturated, then you can many times have your cake and eat it too. In my market, even though we are fully staffed with FTE docs at my local shop, there is always a huge need at others nearby. Staffing is always cyclical and so I no doubt expect us to have a need for PRN docs again in the future. I have plenty of friends in the area that have worked PRN consistently and successfully over the years and have just gotten used to needing to re-credential at another hospital nearby in order to maintain their PRN lifestyle (fewer hours).

Your best and hassle free bet is to just be up front and frank with your new employer about your goals. Any SDG/CMG/HEM is going to try and insist that all docs are required to work a minimum hourly for full time status. In general, this turns out to be 14 shifts/mo or 144 hours give or take. This is virtually always negotiable. Just remember that negotiating less has pros and cons. The advantage of negotiating fewer hours into your contract has the distinct disadvantage of not guaranteeing you more hours/mo when you decide that you need to work 2-3 extra shifts Sept-Nov to pay for little Johnny's new braces and the car you got for your daughter's 16th birthday.

I doubt you could successfully pull off PRN@6 shifts per month in a place like NYC. ( I could be wrong.) However, it's very doable where I'm located. You just have to pick your area carefully. This is all assuming that you don't want to work locums and are looking to avoid travel. If you don't mind travel, then locums is the easiest because you literally dictate everything. (Hey, I'm available for 6 shifts/mo during the next 3 months and then I'm taking a 2 month vacation and there's nothing you can do about it. Find me some work! phone"Yes, master!")

 

[miacomet]

As an AFMD who does the scheduling at my shop, I'll give you the skinny on part time docs. Yes, it is very doable....in the right market (assuming you are not doing locums, in which case...anything is possible). However, nobody likes using PRN docs more than needed. Why?

1) They have limited schedule availability (assign themselves weekends and holidays off...and if they don't, they want 2x the FTE rate).
2) They are unreliable in that they may be available 6 shifts one month, 2 the next, none the next, 8 the month after that, etc.. It's a pain in the ass negotiating with these guys, as anytime they are not available and are needed, they want to negotiate increased rates. Also, their schedule availability is many times dependent on the other ERs finishing their schedule which many times is delayed, hence delaying yours.
3) They are not invested in the department/hospital. Always with one foot out the door, they don't particularly feel invested enough to comply with any/all departmental/hospital policies because hey....they've got 3 other ERs where they work and don't absolutely need yours.
4) Did I mention that they're a pain in the ass to schedule?

So, although ongoing PRN in a local market is doable, it's oftentimes more difficult than you think. You have to rely on local shops always having a need. As soon as they can fill their slots with FTE docs, then you are gone. Many times, there is no warning, simply an email saying "hey, we don't need you next month....and for the foreseeable future".

Now, that being said, ongoing PRN is VERY doable in the right market. As long as the local market isn't saturated, then you can many times have your cake and eat it too. In my market, even though we are fully staffed with FTE docs at my local shop, there is always a huge need at others nearby. Staffing is always cyclical and so I no doubt expect us to have a need for PRN docs again in the future. I have plenty of friends in the area that have worked PRN consistently and successfully over the years and have just gotten used to needing to re-credential at another hospital nearby in order to maintain their PRN lifestyle (fewer hours).

Your best and hassle free bet is to just be up front and frank with your new employer about your goals. Any SDG/CMG/HEM is going to try and insist that all docs are required to work a minimum hourly for full time status. In general, this turns out to be 14 shifts/mo or 144 hours give or take. This is virtually always negotiable. Just remember that negotiating less has pros and cons. The advantage of negotiating fewer hours into your contract has the distinct disadvantage of not guaranteeing you more hours/mo when you decide that you need to work 2-3 extra shifts Sept-Nov to pay for little Johnny's new braces and the car you got for your daughter's 16th birthday.

I doubt you could successfully pull off PRN@6 shifts per month in a place like NYC. ( I could be wrong.) However, it's very doable where I'm located. You just have to pick your area carefully. This is all assuming that you don't want to work locums and are looking to avoid travel. If you don't mind travel, then locums is the easiest because you literally dictate everything. (Hey, I'm available for 6 shifts/mo during the next 3 months and then I'm taking a 2 month vacation and there's nothing you can do about it. Find me some work! phone"Yes, master!")

Way too much schooling, time and headaches for the ROI. Ridiculous to go into a field that requires this much song and dance. How do people not see this?

 

[Birdstrike]

That's horrific. What poor management, and what an accurate description of how awful EM is.

Well, it is what it is. I think the value in reading about my (and others') experience for EM residents and pre-meds, is they get to see some things they may not be told by the people that are in the business of marketing, selling and promoting EM as a specialty, specifically, those interviewing them, residency directors, ED directors and the Big Organization crew. It may allow them to have a smoother ride by making the right choices. One thing I've recommended recently is, if you're hell bent on doing EM (as I was) then consider doing a fellowship. It seems those happiest in EM long term, are those that have a niche that allows them to reduce their EM shifts a lot at some point, as opposed to those locked into whatever their specific EDs needs happen to be over time. When you're personally asked to solve the Emergency Physician shortage and ED overcrowding crisis yourself, one shift at a time, that's a no win situation. Have a niche as use it to your advantage. Mine just happened to be Interventional Pain, by sheer luck. It could have been finding that perfect job, EMS, administration, running a hyperbarics fellowship & program, or saving 50% of income and leaving clinical Medicine enitirely very early. But whatever it is, you don't have to be locked in to something miserable because you feel you put yourself on certain track and you feel you've failed if you don't stay on it forever. That's the sunshine behind the clouds.

 

[WilcoWorld]

As an AFMD who does the scheduling at my shop, I'll give you the skinny on part time docs. Yes, it is very doable....in the right market (assuming you are not doing locums, in which case...anything is possible). However, nobody likes using PRN docs more than needed. Why?

1) They have limited schedule availability (assign themselves weekends and holidays off...and if they don't, they want 2x the FTE rate).
2) They are unreliable in that they may be available 6 shifts one month, 2 the next, none the next, 8 the month after that, etc.. It's a pain in the ass negotiating with these guys, as anytime they are not available and are needed, they want to negotiate increased rates. Also, their schedule availability is many times dependent on the other ERs finishing their schedule which many times is delayed, hence delaying yours.
3) They are not invested in the department/hospital. Always with one foot out the door, they don't particularly feel invested enough to comply with any/all departmental/hospital policies because hey....they've got 3 other ERs where they work and don't absolutely need yours.
4) Did I mention that they're a pain in the ass to schedule?

So, although ongoing PRN in a local market is doable, it's oftentimes more difficult than you think. You have to rely on local shops always having a need. As soon as they can fill their slots with FTE docs, then you are gone. Many times, there is no warning, simply an email saying "hey, we don't need you next month....and for the foreseeable future".

Now, that being said, ongoing PRN is VERY doable in the right market. As long as the local market isn't saturated, then you can many times have your cake and eat it too. In my market, even though we are fully staffed with FTE docs at my local shop, there is always a huge need at others nearby. Staffing is always cyclical and so I no doubt expect us to have a need for PRN docs again in the future. I have plenty of friends in the area that have worked PRN consistently and successfully over the years and have just gotten used to needing to re-credential at another hospital nearby in order to maintain their PRN lifestyle (fewer hours).

Your best and hassle free bet is to just be up front and frank with your new employer about your goals. Any SDG/CMG/HEM is going to try and insist that all docs are required to work a minimum hourly for full time status. In general, this turns out to be 14 shifts/mo or 144 hours give or take. This is virtually always negotiable. Just remember that negotiating less has pros and cons. The advantage of negotiating fewer hours into your contract has the distinct disadvantage of not guaranteeing you more hours/mo when you decide that you need to work 2-3 extra shifts Sept-Nov to pay for little Johnny's new braces and the car you got for your daughter's 16th birthday.

I doubt you could successfully pull off PRN@6 shifts per month in a place like NYC. ( I could be wrong.) However, it's very doable where I'm located. You just have to pick your area carefully. This is all assuming that you don't want to work locums and are looking to avoid travel. If you don't mind travel, then locums is the easiest because you literally dictate everything. (Hey, I'm available for 6 shifts/mo during the next 3 months and then I'm taking a 2 month vacation and there's nothing you can do about it. Find me some work! phone"Yes, master!")

Way too much schooling, time and headaches for the ROI. Ridiculous to go into a field that requires this much song and dance. How do people not see this?

I didn't read this post as saying you have to do the song and dance, rather, it was giving advice should you choose to do so, while ultimately recommending against it with the following:

"Your best and hassle free bet is to just be up front and frank with your new employer about your goals. "

 

[Groove]

Way too much schooling, time and headaches for the ROI. Ridiculous to go into a field that requires this much song and dance. How do people not see this?

All relative my friend. I had the advantage of working in corporate america for a few years and can't imagine anything more soul sucking than that old office job. Endless, monotonous, brain crushing, 9-5 M-F, living for the weekend, counting the hours each day, never really making a difference other than to contribute ever so slightly to the corporate efficiency machine, always worried about job security, living paycheck to paycheck.

I think being a doctor is infinitely more cool and, at least for me, I have a lot more fun doing it. Women also seem find me way more interesting and attractive for some reason. I haven't quite figured that one out yet. 🙄 It also pays much better than my old job.

Stressful? You betcha. Perfect? Not by a long shot. But...in general, I think it's way better than some people on here make it out to be. I've never really been part of this "doom and gloom", "the sky is falling", "EM is the ass crack of specialties", "OMG my new employer asked me to do 4 overnights/mo...this is the end of me! Goodbye cruel world!", "I work 6 shifts/mo and I'm suffering from the dreaded burnout! Help!"

Hehe, I'm not trying to make light of anyone else's disillusionment with the specialty or with medicine for that matter. I guess I just have always seen it based on my own personal experiences and feel that a lot of general complaints are very applicable to other fields and other specialties though I don't personally think most people realize this because many times they haven't really worked out in the real world doing anything other than medicine.

Also, a lot of us are type A, ambitious, perfectionistic, OCD, and idealistic which doesn't translate very well to having a very rational, realistic, contented or grateful view of our job, ourselves, or the world for that matter.

 

[namethatsmell]

As an AFMD who does the scheduling at my shop, I'll give you the skinny on part time docs. Yes, it is very doable....in the right market (assuming you are not doing locums, in which case...anything is possible). However, nobody likes using PRN docs more than needed. Why?

1) They have limited schedule availability (assign themselves weekends and holidays off...and if they don't, they want 2x the FTE rate).
2) They are unreliable in that they may be available 6 shifts one month, 2 the next, none the next, 8 the month after that, etc.. It's a pain in the ass negotiating with these guys, as anytime they are not available and are needed, they want to negotiate increased rates. Also, their schedule availability is many times dependent on the other ERs finishing their schedule which many times is delayed, hence delaying yours.
3) They are not invested in the department/hospital. Always with one foot out the door, they don't particularly feel invested enough to comply with any/all departmental/hospital policies because hey....they've got 3 other ERs where they work and don't absolutely need yours.
4) Did I mention that they're a pain in the ass to schedule?

So, although ongoing PRN in a local market is doable, it's oftentimes more difficult than you think. You have to rely on local shops always having a need. As soon as they can fill their slots with FTE docs, then you are gone. Many times, there is no warning, simply an email saying "hey, we don't need you next month....and for the foreseeable future".

Now, that being said, ongoing PRN is VERY doable in the right market. As long as the local market isn't saturated, then you can many times have your cake and eat it too. In my market, even though we are fully staffed with FTE docs at my local shop, there is always a huge need at others nearby. Staffing is always cyclical and so I no doubt expect us to have a need for PRN docs again in the future. I have plenty of friends in the area that have worked PRN consistently and successfully over the years and have just gotten used to needing to re-credential at another hospital nearby in order to maintain their PRN lifestyle (fewer hours).

Your best and hassle free bet is to just be up front and frank with your new employer about your goals. Any SDG/CMG/HEM is going to try and insist that all docs are required to work a minimum hourly for full time status. In general, this turns out to be 14 shifts/mo or 144 hours give or take. This is virtually always negotiable. Just remember that negotiating less has pros and cons. The advantage of negotiating fewer hours into your contract has the distinct disadvantage of not guaranteeing you more hours/mo when you decide that you need to work 2-3 extra shifts Sept-Nov to pay for little Johnny's new braces and the car you got for your daughter's 16th birthday.

I doubt you could successfully pull off PRN@6 shifts per month in a place like NYC. ( I could be wrong.) However, it's very doable where I'm located. You just have to pick your area carefully. This is all assuming that you don't want to work locums and are looking to avoid travel. If you don't mind travel, then locums is the easiest because you literally dictate everything. (Hey, I'm available for 6 shifts/mo during the next 3 months and then I'm taking a 2 month vacation and there's nothing you can do about it. Find me some work! phone"Yes, master!")

Working as pure PRN definitely has swings like you mention. When I signed on at once place they reliably had 10-20 open shifts a month open. Now there are 0 for the next few months.

So I'm currently living a quasi-PRN life and I've found it a good way to balance flexibility and stability while still being of value to employers. I picked one shop and favor them over the other places. We agreed to a minimum amount of shifts per month and some specific scheduling mechanics so I can accommodate my other gigs. So while I'm PRN there it functions more like baby-PT. It works for them because they know I'm a constant factor and the place is big enough that there's always something that reliably "comes up" with staffing but not to the extent that they need another FTE. So it's win-win. At the same time the promised amount of shifts is so small there's plenty of time to work at other places and on non-clinical stuff. Or I could head to a random corner of the world for a medical mission anytime I feel like it.

There are of course downsides to splitting yourself up between different jobs, but in the right situation the pros can outweigh the cons.

 

[Birdstrike]

All relative my friend. I had the advantage of working in corporate america for a few years and can't imagine anything more soul sucking than that old office job. Endless, monotonous, brain crushing, 9-5 M-F, living for the weekend, counting the hours each day, never really making a difference other than to contribute ever so slightly to the corporate efficiency machine, always worried about job security, living paycheck to paycheck.

I think being a doctor is infinitely more cool and, at least for me, I have a lot more fun doing it. Women also seem find me way more interesting and attractive for some reason. I haven't quite figured that one out yet. 🙄 It also pays much better than my old job.

Stressful? You betcha. Perfect? Not by a long shot. But...in general, I think it's way better than some people on here make it out to be. I've never really been part of this "doom and gloom", "the sky is falling", "EM is the ass crack of specialties", "OMG my new employer asked me to do 4 overnights/mo...this is the end of me! Goodbye cruel world!", "I work 6 shifts/mo and I'm suffering from the dreaded burnout! Help!"

Hehe, I'm not trying to make light of anyone else's disillusionment with the specialty or with medicine for that matter. I guess I just have always seen it based on my own personal experiences and feel that a lot of general complaints are very applicable to other fields and other specialties though I don't personally think most people realize this because many times they haven't really worked out in the real world doing anything other than medicine.

Also, a lot of us are type A, ambitious, perfectionistic, OCD, and idealistic which doesn't translate very well to having a very rational, realistic, contented or grateful view of our job, ourselves, or the world for that matter.

You love what you do. Keep doing it. It doesn't matter what anyone else says.
I do Interventional Pain now and most people think that's s**t, but I don't care cause I'm happy. So, whatevs.

"Haters gonna hate" -Proverbs 9:8

 

[namethatsmell]

Also, a lot of us are type A, ambitious, perfectionistic, OCD, and idealistic which doesn't translate very well to having a very rational, realistic, contented or grateful view of our job, ourselves, or the world for that matter.

This is SO true.

My first full-time job involved dissembling and cleaning toilets. My current job is much, much better.

But one thing that just sucks is that physicians are held to a super-human standard, both externally and many times internally.

I recently had a specialist come to me--twice--begging for forgiveness regarding a case. The patient did fine and there was no change in outcome but the specialist wouldn't let it go and I was close to asking if he needed to talk with psych. I had an EM colleague leave medicine over a bad case. And I admit I have a few cases a year where I loose sleep over a patient having an adverse outcome that was extremely unlikely or unexpected. I run these cases by my colleagues and they always say they'd have done the same thing but it still sucks and I still irrationally kick myself for not being clairvoyant.

Somewhere between childhood, schooling, and training it seems like many docs develop an expectation of having an amazing job handed to them and being clinically perfect 100% of the time. I'm not sure where along the line these expectations develop, but it drives me nuts that med schools don't at least devote one lecture to: "Welcome to reality: you and your life are not perfect. And that's OK."

 

[chudat]

I use to deliver fast food for a living.... Everythings in perspective.

 

[miacomet]

There are plenty of docs who expect a fancy house etc, but I don't think it's unreasonable, or at least it shouldn't be unreasonable, for any human being to expect a job where they are treated with respect; allowed to have adequate time off for personal, family, and health needs; ensured a safe and comfortable working environment; and ensured adequate compensation. Sadly, I see too many EM jobs that meet only the last qualification.

 

[Psai]

You love what you do. Keep doing it. It doesn't matter what anyone else says.
I do Interventional Pain now and most people think that's s**t, but I don't care cause I'm happy. So, whatevs.

"Haters gonna hate" -Proverbs 9:8

haha omg proverbs 9:8 really does say that

 

[Birdstrike]

I use to deliver fast food for a living.... Everythings in perspective.

My last job prior to being an MD was also delivering & occasionally making food. I actually liked that job. Got to drive around, jam great music in my bangin' stereo and for the most part got to be left the hell alone. I met a surprisingly diverse set of people from walks of life I hadn't interacted with prior, or since. Man, the stories. The pay was terrible though. I make 20 times more now.

 

[Birdstrike]

haha omg proverbs 9:8 really does say that

 

[miacomet]

My last job prior to being an MD was also delivering & occasionally making food. I actually liked that job. Got to drive around, jam great music in my bangin' stereo and for the most part got to be left the hell alone. I met a surprisingly diverse set of people from walks of life I hadn't interacted with prior, or since. Man, the stories. The pay was terrible though. I make 20 times more now.

What kind of food? Any good recipes?

 

[KGflyboy]

There are plenty of docs who expect a fancy house etc, but I don't think it's unreasonable, or at least it shouldn't be unreasonable, for any human being to expect a job where they are treated with respect; allowed to have adequate time off for personal, family, and health needs; ensured a safe and comfortable working environment; and ensured adequate compensation. Sadly, I see too many EM jobs that meet only the last qualification.

Although it would be nice to have these things... Why would anyone go into this field with the idea doctors have adequate time off? I knew way before starting medical school that would likely not happen.

Anyone who thought they wouldn't be overworked as a doctor is guilty of choosing a career without a basic amount of research into what the job would entail.

Sure there are always surprised, and it might be worse that many people thought, but "the sky is falling" crowd on SDN almost always falls into 2 categories.

1) People who got I to EM when being a doctor was a better gig More respect for sure. More autonomy too. But still worked their tails off and had little time to take care of themselves. Now CMGs and insurance companies have taken over and turned doctors into widgets.

2) Younger doctors without any prior career experience who think that they should be able to work 40 hrs per week, have nights, weekends, and holidays off, make $300 per hr or more, and dictate their own work environment and department policies without administrative interference. This is unreasonable and typically only happens to people who chose to be doctors without doing adequate research. They deserve most of the blame for their own frustrations, as it is a result of poor planning combined with poor perspective. The grass isn't always greener in other careers.

I can understand people in the first category much better than the second category. The first group went into their chosen fields of medicine only to have the rug pulled out from under them when medicine went corporate and the mega mergers and buyouts started to happen. It was like a bait-and-switch with doctors, patients, and everyone but the shareholders being screwed over

My residency is affiliated with a medical school that is destined to produce docs in category 2. They have a pass or fail grading system throughout all 4 years. No honors. They never work evenings or nights on 98% of their rotations. Shelf exams are optional. They have extended Christmas, Thanksgiving, and Spring breaks. They never have to work any major holidays. They are never given a class rank as far as they know.

Surprise, surprise! All the docs who have been around the hospital long enough to see the transition comment that the medical students are just not very competent or hard working anymore.

These are the same people who will be on here in 5 years complaining that no one warned them being an ER doctor will not be as good as they were led to believe.

 

[miacomet]

Although it would be nice to have these things... Why would anyone go into this field with the idea doctors have adequate time off? I knew way before starting medical school that would likely not happen.

Anyone who thought they wouldn't be overworked as a doctor is guilty of choosing a career without a basic amount of research into what the job would entail.

Sure there are always surprised, and it might be worse that many people thought, but "the sky is falling" crowd on SDN almost always falls into 2 categories.

1) People who got I to EM when being a doctor was a better gig More respect for sure. More autonomy too. But still worked their tails off and had little time to take care of themselves. Now CMGs and insurance companies have taken over and turned doctors into widgets.

2) Younger doctors without any prior career experience who think that they should be able to work 40 hrs per week, have nights, weekends, and holidays off, make $300 per hr or more, and dictate their own work environment and department policies without administrative interference. This is unreasonable and typically only happens to people who chose to be doctors without doing adequate research. They deserve most of the blame for their own frustrations, as it is a result of poor planning combined with poor perspective. The grass isn't always greener in other careers.

I can understand people in the first category much better than the second category.

My residency is affiliated with a medical school that is destined to produce docs in category 2. They have a pass or fail grading system throughout all 4 years. No honors. They never work evenings or nights on 98% of their rotations. Shelf exams are optional. They have extended Christmas, Thanksgiving, and Spring breaks. They never have to work any major holidays. They are never given a class rank as far as they know.

Surprise, surprise! All the docs who have been around the hospital long enough to see the transition comment that the medical students are just not very competent or hard working anymore.

These are the same people who will be on here in 5 years complaining that no one warned them being an ER doctor will not be as good as they were led to believe.

By "adequate time off" I mean being, at the very least, being able to take sick leave when you are sick and not losing your job. This is not an unreasonable request. It's also safer for patients. If you run your own shop, fine, but if we are employed, we should be treated as employees. This is part of the problem with docs being employed. But if we are to be employed, we should have the same benefits everyone else does (Kaiser does this very well FWIW).

 

[KGflyboy]

By "adequate time off" I mean being, at the very least, being able to take sick leave when you are sick and not losing your job. This is not an unreasonable request. It's also safer for patients. If you run your own shop, fine, but if we are employed, we should be treated as employees. This is part of the problem with docs being employed. But if we are to be employed, we should have the same benefits everyone else does (Kaiser does this very well FWIW).

I agree with that. I think we all do. But there are a lot of students going into EM right now because someone told them we have a lot of time off, can control our schedules, make tons of money, and live like rock stars. They have no insight into what an EM schedule involves, how much money they will earn, how much BS they will have to endure from patients and from employers. Many of them think they would be happy working for $180/hr, so they think anyone complaining on SDN about making $200 or more is selfish and entitled.

They are destined to be burnt out quickly after residency.

 

[RustedFox]

Not to mention that our scheduling is so stochastic that it wouldn't "work" in any other field.

Yesterday, I was scheduled 3-11pm - but this was a "stopgap" shift designed to meet what was a perceived high-volume day. If "productivity" fell below a certain mark, I was supposed to not come in.

It was dead, so I was told by site site medical director to "see how it goes" and plan on coming in at 5.
I logged in to look at the tracking board at 3-ish.
Dead.

Called me site medical director to say "Hey; this is stupid. Let me drive up to Orlando with my wife; its her birthday the day after tomorrow, and I have stuff planned for her."
"Okay, sounds good."

Then I get phone calls a few hours later from 2 different job sites (this one, and another) saying "Hey; can you come in to help? We're at 'surge' capacity."
I said; I got called off. I made plans. Sorry; no.

 

[RustedFox]

I love emergency medicine.
There's a lot about its that's just amazing.
But I cannot tolerate this scheduling nonsense any longer.
Stay home! Come in! Standby!
2019 is going to involve a lot of changes for me, I guarantee it.
I hope against hope that my wife and I can hatch our plan, and my workload is cut by 1/3rd, at least.
Pray for me, SDN'ers.

 

[Birdstrike]

What kind of food? Any good recipes?

Pizza. No special recipes other than we invented cheesy bread before it was a thing, and ate it on the job secretly in the back of the store.
#scandal

 

[Birdstrike]

double post

 

[bravotwozero]

I love emergency medicine.
There's a lot about its that's just amazing.
But I cannot tolerate this scheduling nonsense any longer.
Stay home! Come in! Standby!
2019 is going to involve a lot of changes for me, I guarantee it.
I hope against hope that my wife and I can hatch our plan, and my workload is cut by 1/3rd, at least.
Pray for me, SDN'ers.

That's brutal man, hope it works out for you. Are they deliberately understaffed or something? I don't understand the need for this...

 

[RustedFox]

That's brutal man, hope it works out for you. Are they deliberately understaffed or something? I don't understand the need for this...

The original idea was that we would upstaff for [snowbird/tourist] "season" so as to avoid our docs being "slammed" whenever that "10pm rush" or "4pm rush" all of a sudden came rolling in. We're normally a single-coverage shop, but its not unusual for 8-10 patients to all sign-in within an hour's time during "season". Thus, we added a "shortstop" shift from 3pm-11pm so we could be double-covered with physicians during the busy hours and not just have one physician trying to cover all high-acuity stuff while also simultaneously swatting at the two MLP "biplanes" that circled near-constantly and were picking up stuff that was clearly above their level like we had last season. It sucked, a lot - and this is how I wound up being sued for a patient that I never ever saw. Only thing is; the snowbirds and tourists aren't here yet (some blame the red tide scare, some blame the warmer winter), and our daily census is down far from where it was last year. Thus, when "productivity" fell to below 2.2 patient per "provider" (there's that accursed word again) per hour (or whatever other number the suits were comfy with), they started "benching the shortstop" on an hour-by-hour basis.

 

[RustedFox]

That's brutal man, hope it works out for you. Are they deliberately understaffed or something? I don't understand the need for this...

- and thanks for the sentiment. Once we look at some tax-related things, I may just cut down to 100 hours a month altogether so that my wife can follow her dream, too. I grossed 354 K this year, and I will totally retire my 300K+ student loan burden next month. I really don't need all that much money. Might just make me a lot happier.

 

[enalli]

My residency is affiliated with a medical school that is destined to produce docs in category 2. They have a pass or fail grading system throughout all 4 years. No honors. They never work evenings or nights on 98% of their rotations. Shelf exams are optional. They have extended Christmas, Thanksgiving, and Spring breaks. They never have to work any major holidays. They are never given a class rank as far as they know.

Surprise, surprise! All the docs who have been around the hospital long enough to see the transition comment that the medical students are just not very competent or hard working anymore.

God forbid the medical students live normal lives. You are what is wrong with the culture of medicine.

 

[VA Hopeful Dr]

God forbid the medical students live normal lives. You are what is wrong with the culture of medicine.

Yeah, curse those patients. Why can't everyone just get sick 9-5, M-F and never on holidays.

 

[miacomet]

I love emergency medicine.
There's a lot about its that's just amazing.
But I cannot tolerate this scheduling nonsense any longer.
Stay home! Come in! Standby!
2019 is going to involve a lot of changes for me, I guarantee it.
I hope against hope that my wife and I can hatch our plan, and my workload is cut by 1/3rd, at least.
Pray for me, SDN'ers.

Our group pays us for call, and it's voluntary. Are they paying you a ton? What is with this nonsense? This is not reasonable. And they should pay your for call.

 

[RustedFox]

Our group pays us for call, and it's voluntary. Are they paying you a ton? What is with this nonsense? This is not reasonable. And they should pay your for call.

185/hour for days.
200/hour for nights.
Plus RVU bonuses.
I generally make 210-220/hour after all is said and done.
1099.
No benefits besides malpractice (which doesn't need to be stated).
Its the easiest job, though. Wealthy, worried-well population.

 

[miacomet]

185/hour for days.
200/hour for nights
Plus RVU bonuses.
I generally make 210-220/hour after all is said and done.
1099.
No benefits besides malpractice (which doesn't need to be stated).
Its the easiest job, though. Wealthy, worried-well population.

Similar to my job, except we see a lot of trauma from outdoor activities and we see a ton of kids.
Pay is similar, but we get bennies, and we get paid for call.
If you aren't W2, I don't believe there is a legal way to compel you to take call, although obviously they can pressure you, and as a 1099 you have no worker protections. I would suggest to the bosses that you get paid for call. Even a small amount really motivates people to sign up, and it would solve their problem.
Sorry, sounds annoying.

 

[KGflyboy]

God forbid the medical students live normal lives. You are what is wrong with the culture of medicine.

Right... People like myself who work their tails off, are at the hospital on weekends and nights when patients need me, make sure I tidy up my patients at the end of my shift and dispo as many as possible in order to make things easier for the next doc, who stayed late as a student to help out, put in the extra effort to earn honors, had end of life discussions with patients' families at work on Christmas while my family was at home without their husband and father...

Yeah, you are right. I'm definitely what's wrong with the culture of medicine

 

[KGflyboy]

I love emergency medicine.
There's a lot about its that's just amazing.
But I cannot tolerate this scheduling nonsense any longer.
Stay home! Come in! Standby!
2019 is going to involve a lot of changes for me, I guarantee it.
I hope against hope that my wife and I can hatch our plan, and my workload is cut by 1/3rd, at least.
Pray for me, SDN'ers.

Exactly. You are the type of doc who is tired of being jerked around and treated poorly. You have demonstrated willingness to put in the hours, work, and sacrifice because you "love emergency medicine." If docs like you and many other regulars on this board are getting frustrated and wanting to significantly cut back, those going into EM for the wrong reasons are triple screwed.

I kid you not, I had an applicant tell me last week at his residency interview he chose EM for the awesome schedule. He went on to say he doesn't want to do anything else because he didn't want to work that hard. He said similar things to other interviewers. There are many other applicants with similar skewed perceptions of EM, but they aren't dumb enough to say it at an interview.

 

[GonnaBeADoc2222]

Exactly. You are the type of doc who is tired of being jerked around and treated poorly. You have demonstrated willingness to put in the hours, work, and sacrifice because you "love emergency medicine." If docs like you and many other regulars on this board are getting frustrated and wanting to significantly cut back, those going into EM for the wrong reasons are triple screwed.

I kid you not, I had an applicant tell me last week at his residency interview he chose EM for the awesome schedule. He went on to say he doesn't want to do anything else because he didn't want to work that hard. He said similar things to other interviewers. There are many other applicants with similar skewed perceptions of EM, but they aren't dumb enough to say it at an interview.

Ha! What a joker.

Regarding hours reduction, I'm thinking of this too, for a variety of reasons. Currently work 120 /month. Considering 100.

Sent from my SM-G928V using SDN mobile

 

[enalli]

Right... People like myself who work their tails off, are at the hospital on weekends and nights when patients need me

Rarely does a patient actually need a medical student

make sure I tidy up my patients at the end of my shift and dispo as many as possible in order to make things easier for the next doc, who stayed late as a student to help out

Med students aren't there for throughput; at that stage of their career focusing on throughput is counterproductive.

put in the extra effort to earn honors

And earning honors is the only motivator to being a good physician?

had end of life discussions with patients' families at work on Christmas while my family was at home without their husband and father...

A med student having a end-of-life discussion on Christmas has got to be one of the more unnecessary things I can think of.

Yeah, you are right. I'm definitely what's wrong with the culture of medicine

Complaining about your school's efforts to improve the life of their med students absolutely makes your part of the problem. Maybe once you get off your high horse and stop yelling at the clouds you'll realize that.

 

[KGflyboy]

Rarely does a patient actually need a medical student



Med students aren't there for throughput; at that stage of their career focusing on throughput is counterproductive.



And earning honors is the only motivator to being a good physician?


A med student having a end-of-life discussion on Christmas has got to be one of the more unnecessary things I can think of.



Complaining about your school's efforts to improve the life of their med students absolutely makes your part of the problem. Maybe once you get off your high horse and stop yelling at the clouds you'll realize that.

I'm confused. Are you suggesting I'm a med student? Or simply that med students shouldn't do those things? Either way, I feel you are getting farther off topic at this point, and nothing good will come from you trying to convince people in this thread med students shouldn't work weekends, nights, or holidays.

This thread is about EM docs, most of which actually worked some nights, weekends, or holidays as students prior to residency and full time jobs, hanging up their hats for other careers. My point addresses this problem. I think choosing any career, not just EM, without actually ever being exposed to it is a mistake and will make burnout worse. If you never work nights, weekends, and holidays as a medical student, it's not a big stretch to conclude med students just might realize EM is not what they signed up for. EM has plenty of legitimate drawbacks. People who sign up for EM having no clue what it really is and then get disappointed are a distraction from the real issues that are being discussed in this thread. If you don't want to work the schedule of an EM doc as a student, why should any residency or employer think you are going to last long working an ER doc schedule after medical school?

 

[enalli]

I'm confused. Are you suggesting I'm a med student? Or simply that med students shouldn't do those things? Either way, I feel you are getting farther off topic at this point, and nothing good will come from you trying to convince people in this thread med students shouldn't work weekends, nights, or holidays.

I originally responded to your complaints about med students, but you decided to bring in resident and attendings into it to move the goal posts.

Anyways, students should work nights and weekends when appropriate, but complaining about the lack of emphasis on competing for rankings, their *gasp* Christmas and Thanksgiving breaks, and other policies that arguably make school more bearable for the students is at best petty and at worst serving to perpetuate the often malignant medical culture.