EM practice: disgruntled vs. reality

[dotcb]

I just wanted to write a thread because a lot of posters on this board seem to skew the perception of EM practice in a negative way, which I don't think accurately portrays what EM practice is like most of the time.

Messages you get from this board:
EP's don't earn enough money
Our work isn't appreciated
Do the right thing for patients - and you'll get screwed
Don't practice good medicine - you should instead cover your a-s

Instead, what most people I'm around experience: You'll use everything you learned in residency. You'll work hard. You'll encounter difficult patients and consultants and administrators. Most of them will be reasonable. You'll be compensated for your hard work, or you'll find a better job. You'll have a lot of flexibility in your schedule and a lot of time off. You'll be able to do the things you prioritize, whether it's family, travel, academics, etc.

This is not to say that you shouldn't strive to improve your group, your hospital, reimbursement, ridiculous policies, US healthcare, etc.

It's important to get as much information as you can, and to make informed decision. The horror stories may be true, but they are not the norm. If your situation stinks, change it. Most docs are just busy living their lives. Most EP's are quite happy and basically satisfied.

95% of the time I think I have the best job.

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[RustedFox]

Yeah, my gig is pretty good on some days. I'll chime in again later with the spoils of a good shift.

Ballgame on now, laters.

 

[Bojack Horseman]

Puckgame on now, laters.

Fixed

 

[southerndoc]

EP's don't earn enough money
Our work isn't appreciated
Do the right thing for patients - and you'll get screwed
Don't practice good medicine - you should instead cover your a-s

I definitely get paid very, very well and do not complain about my pay.

I believe my work is appreciated. Patients frequently thank me in person, send thank you cards, etc., and I am lucky enough to work at a place where everyone gets along (including the specialists).

I'm also very thankful to practice in a state that has a tort reform law that sets the standard for malpractice at gross negligence instead of just standard of care. Very few attorneys will even consider cases against EP's now.

 

[emergentmd]

I have been out for 12 years, am a director/partner in a private group. I think I have one of the best EM jobs and would not trade this with almost any of my fellow specialists.

1. EM docs get paid well for how many hours they work. I work 23-25 clinical hours a week. It is close 28 hours if you include cleaning up/charting before going home. I usually work 8-8.5 hours a shift from the time I walk in to walk out. I don't think there is many other fields with this kind of hours
2. Over the past 10 years, I have averaged about 400k/yr if you include Partner income + Pay + funded retirement. I don't think there are many fields where you can average this much working less than 30 hrs a week
3. Yes it sucks to do shift work and it sucks to go back and forth. Lucky for me, our group has docs that do all the nights. I have not done an overnight shift for 8 years. The good about shift work is vacation is easy to take. Before Kids, Wife&I took 8-9 week long trips a year with 1-2 overseas. Family life is very flexible.
4. You can slow down anytime you want. If you have enough $$ saved and want to slow down, its easy to cut back on your shifts. Our group has partners working 6 shifts, some 10, some 12. Its easy to slow down without hurting your partners.
5. When you are done, then you are done. No matter how difficult the day is or difficult a patient is, I know that I am done in 7 hrs. I know that once I hit the "admit" button, that difficult/sick patient is another person's responsibility. This makes medicine for us very Clean.
6. Residency is 3 Years. Yes only 3 Years. I made 380K with benefits my first year out after 3 years in residency. Not many can say this. I only worked 15 days/month at that time.
7. I am lucky that I have a supportive administration. I don't get everything I want, but they atleast listen and try to work with me
8. I am lucky that our hospitalist are easy to work with and will admit anything with a pulse. Want to admit a 40 yr old with chest pain? Sure why not. Want to admit and elderly with "weakness"... sure why not. Call it dehydration. In my 12 years, I have never had a hospitalist tell me that they will not admit the patient. They have come down, seen the pt, and decided to discharge them in rare cases.
9. Tort reform in texas is great. Our large group of doctors have had very little lawsuits in the years have been here. To be sued, it appears that you have to really screwed up. Knock on wood, I have not had a lawsuit filed against me.
10. I don't care a pager. I don't get calls from patients. I an NEVER ON CALL!!!!!!
11. The medical staff appreciates our ED group. We are always well rated by other specialists. I get "thank You" very often from specialists b/c they don't have to leave their house b/c I am working. The ortho chief a month ago told me how much he appreciated our ED group. It makes his life easier. He rarely needs to leave his house b/c I can reduce almost anything that doesn't require the OR.
12. I have great job security. Yes, our private group can be extinct tomorrow but I know that I will always have a job in a place where I want to live. There are open jobs all over the place.

Every group has complainers that like to magnify problems. Yes, EM has problems. But when I look around and see the hospitalist with 10 admission in 2 hrs working their 24 hr shifts, I am happy. When I see our OB hospitalist at the end of their 24 shifts having to take a person to the OR, I am happy. When I see our cardiologist have to come in at 2am from sleep for a STEMI, I am happy. I have realized that I have one of the best jobs in the hospital.

I am so lucky to have a job that puts me in the top 1% of wage earners, working less than 30 hrs a week, have a flexible schedule doing a job that I love. I go to work everyday excited to see patients and work with the ED staff.

 

[RustedFox]

Fixed

Haaaa Ha! Actually, I was watching the hockey game on my TV - AND - I was watching the baseball game on my tablet. All I needed was a cold beer, and it was a regular sportsbar up in this mah.

 

[jkfallin]

I never actually post on here, but thank you for the pro EM post, from someone who is a little worried about his future plans by all the negativity recently

 

[WakeTheNation]

This positive attitude toward EM is much appreciated. While there is always some negativity out there, I can honestly say in the 8 months or so since I've decided to pursue EM i've heard many more positive than negative things from people about the field. Call me an optimist but I believe EM has a bright future as a field, or at least a brighter than average future among all medical specialties.

 

[emergentmd]

This positive attitude toward EM is much appreciated. While there is always some negativity out there, I can honestly say in the 8 months or so since I've decided to pursue EM i've heard many more positive than negative things from people about the field. Call me an optimist but I believe EM has a bright future as a field, or at least a brighter than average future among all medical specialties.

No Problem. Everyone, especially doctors, need to take a step back and take a deep breath sometimes. I can safely say that 90% of this world would trade income + hours worked with doctors. I can safely say that all docs would not trade jobs with 90% of the workforce.

When I see a roofer or yard guy working their 12 hr job in the 95+ degree heat of texas while I am driving to a 70 degree ED to work 8 hrs, my job is a piece of cake. And I make more in 2 hours than they do the WHOLE day. I come home mentally tired sometimes but that beats being Physically tired.

I was never given anything growing up. We were Poor on food stamps. I did not have any luxuries of life. My first job at age 14 was working in a paper factory, unairconditioned, in the 100 degree heat some days. Back then, I thought that was the best job b/c i was making money.

Now I am making a great deal of money, have a great family life, have alot of time on my hands helping people.

I think all physicians should be ashamed when they think their jobs are so tough, how unfair life is, etc. 99% of the people in this world would trade their life for yours in a second. Funny that they can complain and then drive off in their Mercedes to their 600K+ homes.

I am happy that I grew up poor. It makes you realize how good doctors (Myself included) have it.

Alittle off topic, but I believe that EM docs as a whole are among the happiest. I do not know if this is true b/c it takes a laid back personality to be an ED doc. Med students run by my ED all the time and I am lucky enough to work with some. There are countless times when they remark to me that EM docs seem to be the happiest. I think this is very telling.

 

[The White Coat Investor]

Just the nature of an internet forum.

 

[Hercules]

Just the nature of an internet forum.

Absolutely. A lot of docs come here to vent. Several of us had posts similar to the OP's a while back expressing our happiness with our jobs. I love my job.

 

[fiznat]

What about the medicine aspect?

I know EPs can generate a good salary while also maintaining flexibility for a life outside of work. That's great-- in fact it is ideal -- but it seems so rare that I hear anyone say that they enjoy this work for the intellectual challenge of it. Do you feel like you are shifting meat and running protocol all day, or is there still room for clinical acumen? Do you feel like an expert in your field, or a glorified triage/gateway for the specialties? I like a lot of what I see in emergency medicine, but sometimes I worry that being ",,,master of none" might at some point get to me.

(Please don't take offense. I was a medic for 10 years, currently MSIII, just weighing options based on my experiences and what little I've seen thus far. It's pretty scary that I have to make this decision so soon, so I appreciate every titbit I can pick up from here and elsewhere.)

 

[Zanegray]

What about the medicine aspect?

I know EPs can generate a good salary while also maintaining flexibility for a life outside of work. That's great-- in fact it is ideal -- but it seems so rare that I hear anyone say that they enjoy this work for the intellectual challenge of it. Do you feel like you are shifting meat and running protocol all day, or is there still room for clinical acumen? Do you feel like an expert in your field, or a glorified triage/gateway for the specialties? I like a lot of what I see in emergency medicine, but sometimes I worry that being ",,,master of none" might at some point get to me.

- It seems your two points are contradictory, in EM you never know what will walk in, thus you are challenged daily, always a twist... if you become a specialist at say, for example, cardiology, you may only see post-MI or afib or chf all day, you may be "master" of a field, but where is the challenge?

- Incidentally, I do love my job too, despite the frustrations.
This week had a 40 something collapse in registration. No other medical history, CP for an hour and diaphoresis. Got them on a stretcher, started bagging, CPR, shock for vfib, 2 minutes more, and the patient thanked us BEFORE going to the cath lab. That's a save.

 

[J ROD]

Over the years I have shadowed and talked to EM docs mostly and did a ton of volunteering in the ER............

Most of the time I hear them complaining about the patients, stress, shiftwork, the other specialities, the damn lawyers, etc....etc....all the stuff we hear about on here...........

at the same time when I asked would you do EM again......almost all of them say....

yeah, I would do again......so I think the grass is just greener.

Each specialty has pros and cons. And we all have those days.

For example, rounding in IM is hell to me. Will it ever end?

Just know yourself and what you want and do that. It will be all good!

 

[emergentmd]

What about the medicine aspect?

I know EPs can generate a good salary while also maintaining flexibility for a life outside of work. That's great-- in fact it is ideal -- but it seems so rare that I hear anyone say that they enjoy this work for the intellectual challenge of it. Do you feel like you are shifting meat and running protocol all day, or is there still room for clinical acumen? Do you feel like an expert in your field, or a glorified triage/gateway for the specialties? I like a lot of what I see in emergency medicine, but sometimes I worry that being ",,,master of none" might at some point get to me.

(Please don't take offense. I was a medic for 10 years, currently MSIII, just weighing options based on my experiences and what little I've seen thus far. It's pretty scary that I have to make this decision so soon, so I appreciate every titbit I can pick up from here and elsewhere.)

This is always brought up with EDs. There are fields that are masters of none suchs as FP, IM. Every fields has their issues.

If you think EDs has protocols, look at ALL of the hospital protocols that the cardiologist, hospitalists, etc have to follow.

Medicine has become protocol driven, metric driven and we all are caught up in this. The freedom to truly practice your own medicine is slowly eroding.

There are fields for everyone and everyone's personality.

I, along with all of my EM friends, would never be a hospitalists. I have a dual boarded IM/EM guy that does hospitalists work and he could never do ED eventhough he would work 30 compared to 60 hours. Make 300K+ vs his 200K.

If you really feel like you need to be a master of something, then we are masters of running codes. All specialists are masters of very small part of medicine.

 

[Arcan57]

Part of the disgruntlement expressed on this board is designed to give a counterpoint to the pre-clinical med student view of the ED. On paper, ED looks like a no brainer for someone that doesn't have a strong interest in another area of medicine already. High pay, short hours, cool procedures. What's not to like?

People that settle on EM for the high pay/short hours part of the gig tend to be profoundly unhappy in their choice of profession within a couple of years of practice. So part of the tone on the board is a deliberate counterpoint to the image that people in their early 20s (usually without kids) have of EM. When you're young and have no fixed time commitments, EM is F%^$ing amazing. Some people are going to avoid those time commitments (kids being the major one) and until you're body starts betraying you on night shifts EM will remain F%$&*ing amazing. A lot of people are going to have someone that they have to take care of (kids, elderly parents, etc) and EM is significantly less amazing then. I enjoy what I do most days but it's not the "I'm happy driving to my shift everyday" that it was when I was a resident or first year attending. Still, enjoying what you do most days while being paid what we get paid is not a bad gig at all.

 

[Apollyon]

I have a dual boarded IM/EM guy that does hospitalists work and he could never do ED eventhough he would work 30 compared to 60 hours. Make 300K+ vs his 200K.

I keep reading and re-reading this, and can't make heads or tails of it. Could you restate this?

 

[Brigade4Radiant]

Part of the disgruntlement expressed on this board is designed to give a counterpoint to the pre-clinical med student view of the ED. On paper, ED looks like a no brainer for someone that doesn't have a strong interest in another area of medicine already. High pay, short hours, cool procedures. What's not to like?

People that settle on EM for the high pay/short hours part of the gig tend to be profoundly unhappy in their choice of profession within a couple of years of practice. So part of the tone on the board is a deliberate counterpoint to the image that people in their early 20s (usually without kids) have of EM. When you're young and have no fixed time commitments, EM is F%^$ing amazing. Some people are going to avoid those time commitments (kids being the major one) and until you're body starts betraying you on night shifts EM will remain F%$&*ing amazing. A lot of people are going to have someone that they have to take care of (kids, elderly parents, etc) and EM is significantly less amazing then. I enjoy what I do most days but it's not the "I'm happy driving to my shift everyday" that it was when I was a resident or first year attending. Still, enjoying what you do most days while being paid what we get paid is not a bad gig at all.

I don't think most people drive happy to work. It's called work for a reason. There are very few jobs which can double as hobbies such as actor, sports analyst or radio host. Really in terms of money and lifestyle I would say Derm is the only field in medicine that can give you money and lifestyle. If your time is more important to you can always work less shifts. You can work 6 days a month and still make roughly the same as a pediatrician.

 

[Iamthewarthog]

I keep reading and re-reading this, and can't make heads or tails of it. Could you restate this?

One of his friends is dual-boarded IM/EM who chooses to work as a hospitalist over EM despite the fact that he could be working half the hours and making more money in EM. It's not worth it to him to do something his heart isn't in.

 

[gutonc]

I don't think most people drive happy to work. It's called work for a reason.

Really? You need to meet more people. I love my job.

 

[RPedigo]

I drive happy to work almost every day... but I'm only done with my intern year, so we'll see when/if that changes

 

[RustedFox]

I don't think most people drive happy to work. It's called work for a reason. .

I frequently say this to friends/cowokers/etc. Work is work. Sure, I think that my job is better than way most (sic), but at any hot second... I can name at least ten things that I'd rather be doing... if it weren't for those pesky things like "money" and "bills" and all.

My favorite way of relating this is: "Work is called work for a reason. Otherwise, they'd call it 'batting practice'."

At this hot second...

1. Playing guitar.
2. Reading the history of the "Dark Ages"
3. Mega Man 4. Again.
4. Planting red peppers.
5. Sportscenter.
6. Playing catch with my Dad.
7. Learning how to 'fix an automobile' and feeling 'manly' about it.
8. Writing parody songs of easily identifiable pieces of popular music.
9. Trading sports cards on the internet.
10. Trimming my bonsai tree forest. (Well, maybe its a couple of trees, but whatev.)

I am never bored.

Your turn.

 

[Birdstrike]

I just wanted to write a thread because a lot of posters on this board seem to skew the perception of EM practice in a negative way, which I don't think accurately portrays what EM practice is like most of the time.

Messages you get from this board:
EP's don't earn enough money
Our work isn't appreciated
Do the right thing for patients - and you'll get screwed
Don't practice good medicine - you should instead cover your a-s

Instead, what most people I'm around experience: You'll use everything you learned in residency. You'll work hard. You'll encounter difficult patients and consultants and administrators. Most of them will be reasonable. You'll be compensated for your hard work, or you'll find a better job. You'll have a lot of flexibility in your schedule and a lot of time off. You'll be able to do the things you prioritize, whether it's family, travel, academics, etc.

This is not to say that you shouldn't strive to improve your group, your hospital, reimbursement, ridiculous policies, US healthcare, etc.

It's important to get as much information as you can, and to make informed decision. The horror stories may be true, but they are not the norm. If your situation stinks, change it. Most docs are just busy living their lives. Most EP's are quite happy and basically satisfied.

95% of the time I think I have the best job.

It's not black, and it's not white. It's more than shades of gray. There are as many human experiences as there are humans. It's great that you love your job, and it's refreshing to here someone make such a positive post. Thank you. But when you have a day when you can't stand it, post that to. The answer is neither "disgruntled" or "reality." It's all of the above and more. Everyone's experience matters. There's a wide range. People on this board want to hear the blood, the guts, the tears, the glory...

...and the unicorns and rainbows, too.

 

[deleted109597]

I'm not disgruntled every day.


Some days I'm gruntled.

 

[Birdstrike]

"Let your soul shine,
Oh, it's better than sunshine,
Better than moonshine...
...Got to let your soul shine,
Shine till the break of day." - Warren Haynes (Soulshine, Gov't Mule)
.
.
.
.
.
.
.

 

[Happy3nding]

I just wanted to write a thread because a lot of posters on this board seem to skew the perception of EM practice in a negative way, which I don't think accurately portrays what EM practice is like most of the time.

Messages you get from this board:
EP's don't earn enough money
Our work isn't appreciated
Do the right thing for patients - and you'll get screwed
Don't practice good medicine - you should instead cover your a-s

Instead, what most people I'm around experience: You'll use everything you learned in residency. You'll work hard. You'll encounter difficult patients and consultants and administrators. Most of them will be reasonable. You'll be compensated for your hard work, or you'll find a better job. You'll have a lot of flexibility in your schedule and a lot of time off. You'll be able to do the things you prioritize, whether it's family, travel, academics, etc.

This is not to say that you shouldn't strive to improve your group, your hospital, reimbursement, ridiculous policies, US healthcare, etc.

It's important to get as much information as you can, and to make informed decision. The horror stories may be true, but they are not the norm. If your situation stinks, change it. Most docs are just busy living their lives. Most EP's are quite happy and basically satisfied.

95% of the time I think I have the best job.

3rd year here. Thank you for this post!!!