EM Salary?

[versace]

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How does EM make as much salary as other specialties when they work far fewer hours?

 

[235009]

Not all hours are created equal. This is what pre-meds and preclinical med students have trouble understanding. There's a big difference between seeing 6-12 new undifferentiated demanding patients per hour vs seeing a panel of clinic patients or taking care of 20 hospitalized patients over 12 hours.

 

[Tri4thlete]

High stress environment requires a higher salary. 1 hour in the clinic == 1.5 hours in the ED.

 

[Stagg737]

Additionally there aren't a lot of other fields where people regularly work night shifts or such odd schedules.

 

[pathologyDO]

They order a lot of tests and do procedures.

 

[masaraksh]

I'd want a higher salary too if I was treating the shallow end of the gene pool all day

 

[username456789]

High stress environment requires a higher salary.

That's not how reimbursement works at all.

 

[Doctor Bob]

EM charges more for their hours because they can.
If FP could bill more for the office visit they would.

The EM "lifestyle" takes its toll after a while. There aren't a lot of 60yr old EM docs still working full time. It isn't 36 hours a week of 9a-5p shifts. It's 36 hours of 7a-3p, then 5p-2a, then 7p-7a, then repeat. You miss a lot of kids' birthdays, Christmas mornings, etc etc. But we don't (shouldn't) complain; we knew what we were signing up for.

 

[Tri4thlete]

That's not how reimbursement works at all.

I was referring to the fact that ED docs have crazy hours and can have precipitous patient loads at any given time. I think this is ONE reason why ED docs get paid higher than primary care specialties, or some other sub specialties. Sitting in an office all day seeing patients would be cake (I mean, in a good way. I was an ED tech, I can attest to being on my feet running around all day). I think FM can be high stress too, but not in the way ED docs have it.

 

[username456789]

I was referring to the fact that ED docs have crazy hours and can have precipitous patient loads at any given time. I think this is ONE reason why ED docs get paid higher than primary care specialties, or some other sub specialties. Sitting in an office all day seeing patients would be cake (I mean, in a good way. I was an ED tech, I can attest to being on my feet running around all day). I think FM can be high stress too, but not in the way ED docs have it.

I don't think you understand at all how physicians are reimbursed or how it is calculated.

 

[Tri4thlete]

I don't think you understand at all how physicians are reimbursed or how it is calculated.

I don't think you understand what I'm saying.... Not a big deal. I digress 🙂

 

[el_duderino]

I don't think you understand what I'm saying.... Not a big deal. I digress 🙂

He does.. he just realizes that what you're saying doesn't correspond to reality in any way. Pay structures for physicians are not based on how "stressful" their job is.

 

[Winged Scapula]

Sitting in an office all day seeing patients would be cake (I mean, in a good way. .

Hmmm...no. Sounds like you've never done it then. FM is not "cake".

 

[JimmyB123]

He does.. he just realizes that what you're saying doesn't correspond to reality in any way. Pay structures for physicians are not based on how "stressful" their job is.

Do RVUs take into account the "stress" or "value" of a case, procedure, situation, etc?

 

[Winged Scapula]

Do RVUs take into account the "stress" or "value" of a case, procedure, situation, etc?

The "stress" involved is not included (frankly I should be paid more for some patients because of the stress they cause me, but I digress).

Medicare bases RVUs on the following:
1) Physician work, which takes into account the physician’s expertise, the time and technical skill spent in performing the entire service including the mental effort and judgment expended by the physician prior to, during and after the patient encounter terminates, including documentation of the service; THIS HAS BEEN WIDELY CRITICIZED AS SOME VALUES ARE OVERVALUED AND MANY UNDERVALUED IN TERMS OF THE EXPERTISE AND SKILL REQUIRED
2) Practice expense, which accounts for the cost to operate a medical practice; APPARENTLY CMS THINKS OUR EXPENSES ARE NIL BECAUSE THESE KEEP GOING UP AND THE CMS REIMBURSEMENT DOES NOT MATCH THAT;
3) Professional liability insurance expense, which estimates the relative risk of services/cost to insure against the risk of loss in providing the service.

Each component of the relative value unit (work, practice expense and professional liability) assigned to each CPT Code, is then multiplied by the Geographic Practice Cost Index (GPCI) for each Medicare locality, which takes the cost of delivery of health care services based on locale into account, and which is further adjusted by a conversion factor that is set by the Centers for Medicare and Medicaid Services (“CMS”) on an annual basis. The Medicare Conversion Factor (CF) is a national value that converts the total RVUs into the dollar amounts paid by Medicare to physicians for the services they provide. Thus a general surgeon practicing in Philly will make more than one practicing in Tyler, Tx because the malpractice is significantly greater in the former community, as is the cost to run a practice.

Assigning "value" is going to inherently difficult. Some would claim that Orthopedics is overvalued. But grandma's new hip is pretty valuable to her. I would claim that the time I spent taking someone's breast cancer out is worth more than $400 (which includes the 90 day global) but others apparently have felt it is not so the arguments continue.

Every speciality wants more for themselves and tries to argue that others deserve less if the pie is to be distributed amongst everyone. EM will argue that they deserve more per hours worked because they have more "stress" but as @Doctor Bob points out: they do it to themselves and as he's posted before, that doesn't mean that others don't have stressful jobs as well (its been claimed more than once on SDN before that EM is more difficult than any other specialty, hence my comment).

 

[Atmosphere123]

Do you think the current salaries are sustainable?
I worked as an ED scribe and I saw lots of docs trying to see as many patient's as possible to make more money. They loved working the "Fast Track" area because they could see like 30 urgent care type patients in an 8 hour shift and make more money than seeing fewer higher acuity patients the main ED. It seems to me like as more people get insured and learn how to use insurance with ACA, there will be fewer lower acuity patients and therefore less money...

 

[arkdoc]

Do you think the current salaries are sustainable?
I worked as an ED scribe and I saw lots of docs trying to see as many patient's as possible to make more money. They loved working the "Fast Track" area because they could see like 30 urgent care type patients in an 8 hour shift and make more money than seeing fewer higher acuity patients the main ED. It seems to me like as more people get insured and learn how to use insurance with ACA, there will be fewer lower acuity patients and therefore less money...

Some recent articles have shown that ED visits have actually gone up since ACA. Also, many of the people who will now have insurance are still not going to be able to have a cash flow to even pay a copay. Because of this, many people will still go to the ED in order to not have to pay the copay. This same population usually works hours which will not allow them to go to urgent care clinics or FP clinics during "normal" hours. This also results in people still coming to the ED.

 

[Esquire]

How does EM make as much salary as other specialties when they work far fewer hours?

Economics 101: supply & demand.

EMTALA more or less demands that hospitals must have EM docs, but there aren't enough. Hospitals in ghetto areas are overflowing and desperately need EM docs to avoid getting fined by EMTALA, while hospitals in non-ghetto areas make a lot of money from the ED. Those $50 Tylenols are profitable.

EM docs are employees or independent contractors, so they are used by hospitals to bypass Stark laws and drive revenue toward the hospital-owned lab and imaging center that would otherwise be idle from 5 pm to 8 am. One patient with "chest pain" can generate tons of money via inhouse tests, imaging, and referrals to medical and surgical subspecialists, who then generate even more facility fees for the hospital. EM docs also admit patients, which generates more fees.

If you don't have enough EM docs, the longer the wait time and the more likely patients are going to go to another hospital. Hence all the ads from hospitals touting their under 30 minute wait times and great "customer" service. So the ED is basically a "have it your way" Burger King that the franchisor/owner/CEO keeps open 24/7 to generate revenue, complete with free sandwiches and cab rides home.

 

[JimmyB123]

The salary of an ED attending is competitive because while not a specialist, the knowledge and skills of an average emergency physician would put those of most specialists to shame. Who else can properly use a slit lamp, deliver a baby, properly dose children's medications, interpret an EKG, reduce a dislocated shoulder, insert a chest tube, resuscitate a coding patient, and manage violent psychiatric patient encounters?

 

[qwerty89]

I was referring to the fact that ED docs have crazy hours and can have precipitous patient loads at any given time. I think this is ONE reason why ED docs get paid higher than primary care specialties, or some other sub specialties. Sitting in an office all day seeing patients would be cake (I mean, in a good way. I was an ED tech, I can attest to being on my feet running around all day). I think FM can be high stress too, but not in the way ED docs have it.

The salary of an ED attending is competitive because while not a specialist, the knowledge and skills of an average emergency physician would put those of most specialists to shame. Who else can properly use a slit lamp, deliver a baby, properly dose children's medications, interpret an EKG, reduce a dislocated shoulder, insert a chest tube, resuscitate a coding patient, and manage violent psychiatric patient encounters?

Dear God. Did you guys even read what Winged Scapula wrote?

 

[Winged Scapula]

Dear God. Did you guys even read what Winged Scapula wrote?

Seriously.

Can we stop with the dick measuring contest here?

(and the answer is that a FM physician can do all of those things; love that it's a pre med writing those comments as well)

 

[qwerty89]

Its that kind of thinking that leads some med students to look down on primary care. After all they get paid less cause they do "simple" stuff.

 

[Doctor Bob]

Seriously.
Can we stop with the dick measuring contest here?

This is SDN, so... no.


















#satisfiedwife

😎

 

[stop2stop]

The "stress" involved is not included (frankly I should be paid more for some patients because of the stress they cause me, but I digress).

Medicare bases RVUs on the following:
1) Physician work, which takes into account the physician’s expertise, the time and technical skill spent in performing the entire service including the mental effort and judgment expended by the physician prior to, during and after the patient encounter terminates, including documentation of the service; THIS HAS BEEN WIDELY CRITICIZED AS SOME VALUES ARE OVERVALUED AND MANY UNDERVALUED IN TERMS OF THE EXPERTISE AND SKILL REQUIRED
2) Practice expense, which accounts for the cost to operate a medical practice; APPARENTLY CMS THINKS OUR EXPENSES ARE NIL BECAUSE THESE KEEP GOING UP AND THE CMS REIMBURSEMENT DOES NOT MATCH THAT;
3) Professional liability insurance expense, which estimates the relative risk of services/cost to insure against the risk of loss in providing the service.

Each component of the relative value unit (work, practice expense and professional liability) assigned to each CPT Code, is then multiplied by the Geographic Practice Cost Index (GPCI) for each Medicare locality, which takes the cost of delivery of health care services based on locale into account, and which is further adjusted by a conversion factor that is set by the Centers for Medicare and Medicaid Services (“CMS”) on an annual basis. The Medicare Conversion Factor (CF) is a national value that converts the total RVUs into the dollar amounts paid by Medicare to physicians for the services they provide. Thus a general surgeon practicing in Philly will make more than one practicing in Tyler, Tx because the malpractice is significantly greater in the former community, as is the cost to run a practice.

Assigning "value" is going to inherently difficult. Some would claim that Orthopedics is overvalued. But grandma's new hip is pretty valuable to her. I would claim that the time I spent taking someone's breast cancer out is worth more than $400 (which includes the 90 day global) but others apparently have felt it is not so the arguments continue.

Every speciality wants more for themselves and tries to argue that others deserve less if the pie is to be distributed amongst everyone. EM will argue that they deserve more per hours worked because they have more "stress" but as @Doctor Bob points out: they do it to themselves and as he's posted before, that doesn't mean that others don't have stressful jobs as well (its been claimed more than once on SDN before that EM is more difficult than any other specialty, hence my comment).

This is a great post, thank you. In your opinion, what future reimbursement changes do you anticipate occurring, particularly with respect to the ACA? Might some of the money at the top be redistributed downward to other specialities?

 

[DetectiveAlonzo]

.

 

[calvnandhobbs68]

The salary of an ED attending is competitive because while not a specialist, the knowledge and skills of an average emergency physician would put those of most specialists to shame. Who else can properly use a slit lamp, deliver a baby, properly dose children's medications, interpret an EKG, reduce a dislocated shoulder, insert a chest tube, resuscitate a coding patient, and manage violent psychiatric patient encounters?

lol let me know the last time you saw a ED attending use a slit lamp (or deliver a baby for that matter unless they're in some truly podunk hospital with no delivery room and no OB in house). Are you sure it wasn't the ophtho resident?

 

[versace]

The salary of an ED attending is competitive because while not a specialist, the knowledge and skills of an average emergency physician would put those of most specialists to shame. Who else can properly use a slit lamp, deliver a baby, properly dose children's medications, interpret an EKG, reduce a dislocated shoulder, insert a chest tube, resuscitate a coding patient, and manage violent psychiatric patient encounters?

Bad thing about medicine is everyone gets a superiority complex and starts exaggerating to make themselves seem better than others

 

[LostinLift]

lol let me know the last time you saw a ED attending use a slit lamp (or deliver a baby for that matter unless they're in some truly podunk hospital with no delivery room and no OB in house). Are you sure it wasn't the ophtho resident?

The ones I worked with used the slit lamp regularly with most eye complaints. Deliveries on the other hand... no.

 

[brewdog11]

Very high stress, some patients are a PITA, you do the work that other doctors refuse to do, etc. There's also very high burnout in EM. You have a GSW to the chest 5min out, your SOB patient is coding in trauma 2, and several other patients you're seriously worried about, and you're knee-deep in alligators only 1.5 hours into your shift. Not the easiest specialty.

 

[brewdog11]

How does EM make as much salary as other specialties when they work far fewer hours?

The "far fewer hours" part really perplexes me. lol WHICH ER do they work in!?!? The EM Physicians I work with each work around 48/week (unless they're one of the odd-balls who work a much lighter schedule), and the work in our particular ED is grueling. We might as well be a battlefield hospital.

Edit to add: I think a lot of it depends on the contract/arrangement. Some hospitals are going to have more posh contracts (and those are the ones where there are likely more paying patients, it's a nicer environment, etc.) than others. I couldn't ever see myself in one of those places, but the more hectic hospitals require their EM physicians to work more (our EM Director doesn't want "Sunday Morning EM Physicians").

 

[Winged Scapula]

The "far fewer hours" part really perplexes me. lol WHICH ER do they work in!?!? The EM Physicians I work with each work around 48/week (unless they're one of the odd-balls who work a much lighter schedule), and the work in our particular ED is grueling. We might as well be a battlefield hospital.

1) then your physicians work a lot more than most; according to several threads by EM attendings here on SDN, the average tends to be around 140 hours per month, or about 35 hours per week. YMMV but none that I could find mentioned anywhere near 200 hours per month

2) if you include paperwork and other non-clinical work, many specialties work more than 48 hrs per week. Heck I'm in a lifestyle specialty and I work more than that.

 

[Wordead]

When I hear EM people complaining about how tough their 40 hours a week is

Seriously, GTFO with that

 

[LostinLift]

When I hear EM people complaining about how tough their 40 hours a week is

Seriously, GTFO with that

8am-4pm, 2pm-10pm, 4pm-12am, off, 12am-8am, off 4pm - 12pm
Followed by
8am-4pm or off or whatever, either way not very fun.

And that is a generous circadian shift schedule for one week, it will almost never work out like that aside from some residency scheduling. Do you think the burnout in EM is because everyone in EM is a slacker?

http://www.medscape.com/viewarticle/838437

 

[versace]

My EM friend only works 3 days a week

 

[Wordead]

8am-4pm, 2pm-10pm, 4pm-12am, off, 12am-8am, off 4pm - 12pm
Followed by
8am-4pm or off or whatever, either way not very fun.

And that is a generous circadian shift schedule for one week, it will almost never work out like that aside from some residency scheduling. Do you think the burnout in EM is because everyone in EM is a slacker?

http://www.medscape.com/viewarticle/838437

6 am-10 pm for 6 days straight

Boohoo your circadian rhythm

Seriously, I respect my ED colleagues for what they do, but all this BS about their work being "way more stressful" despite being 40 hours a week is a joke. It's a good lifestyle specialty, just own up to it. Don't be like the dermies with their "oh boy, we have to see sooooo many patients in our 6 hours of clinic a day".

 

[Wordead]

8am-4pm, 2pm-10pm, 4pm-12am, off, 12am-8am, off 4pm - 12pm
Followed by
8am-4pm or off or whatever, either way not very fun.

And that is a generous circadian shift schedule for one week, it will almost never work out like that aside from some residency scheduling. Do you think the burnout in EM is because everyone in EM is a slacker?

http://www.medscape.com/viewarticle/838437

And way to put words in my mouth. No, I dont think EM people are dumb. Nor do I think circadian rhythms are the reason for burnout. I think it's because they work with the worst patient population and get yelled at by all the other services for stupid consults (which are not really their fault). They form no long term relationships with their patients so they barely even see the positive sides of medicine.

Guess what, unstable sleep schedules have been around for a long long time. What did you think people did on a postcall day?

 

[LostinLift]

6 am-10 pm for 6 days straight

Boohoo your circadian rhythm

Seriously, I respect my ED colleagues for what they do, but all this BS about their work being "way more stressful" despite being 40 hours a week is a joke. It's a good lifestyle specialty, just own up to it. Don't be like the dermies with their "oh boy, we have to see sooooo many patients in our 6 hours of clinic a day".

Aside from the multiple studies showing that night shift workers with constant circadian rhythm disturbances have increased risk of CVD, DM, obesity, depression, GI problems, fertility issues, and cancer.... Imagine dealing with the difficult patient populations in addition to everything else they have to deal with.. for example this post by the one and only BirdStrike sums it up nicely.

Many times an emergency physician is under tremendous stress and time pressure. This should be obvious, but to many it's not. Life and death decisions and events are the norm. The hours are stressful sometimes being upside down nights, holidays and everything in between. You may walk out of a room having pronounced a baby dead, or told a 29 year old new mother her scan shows cancer, all the while realizing the waiting room just filled full of twice as many patients as you can possibly see and in the morning your boss is going to insist there should have been a way you could have done the impossible by seeing them all in a pizza-delivery 30 min or less with a smile. You know the monday morning quarterbacks and specialists will always say they would done it better, more perfectly, once you have sorted the facts out of the chaotic fog of the unknown, and lined the facts up neatly for their well rested Monday morning brains.

So you gather yourself together, you try to turn your stomach right side up and forget the dead two year old in the other room whose parents don't know it yet, who you're going to have to tell when they get here. And you try to forget the ambulance radio just chirped out "rollover motor vehicle accident 10 minutes out can't get an airway!" And you try to see just one more patient so the place doesn't blow up, while trying to forget your body just isn't made to be awake a 4 am, even though you know you're kidding yourself that it's even possible to stem the tide of chaos. The nurse comes and says, "This should be quick, see this one."

And you walk into the room and what you find is a person having what they feel is the worst day of their life, with concerns that are incredibly anxiety provoking to them, with a problem that very well may be real. But you know they're not dying. You know they have no life or limb threat. Your thousand of hours of training have taught you how to be able to do this almost automatically, quicker than anyone else possibly can. You try to smile. You try to do the best you can to ease their concerns and meet their perceived needs. And then you think about the dead kid in the other room and if the parents are almost here yet. And you wonder why no one has grabbed you and pulled you to the trauma bay yet, for the trauma that's not breathing who they can't get an airway on that you're going to have to find a way to do, and you wonder how many more have piled into the waiting room while you're thinking this.

And you try to smile. But it's not always easy. Sometimes it's very hard. But none of the others waiting know about the dead kid tearing your heart out, or the impending trauma fueling your own streak of anxiety and they certainly aren't concerned with the others before them or after them in the waiting room. After all it's not their problem. It's yours.

You try to smile, knowing it's likely never to be good enough, touchy-feely enough or Disney-like enough, even though the memo from the hospital CEO to your boss says that's how it must be. But all the while you know you've done what you thought you were there for, to save those dying or losing limbs, and to make sure the others weren't losing life or limb. But to some it will never, ever be good enough.

You try to smile.

 

[jw3600]

I think one of the big reasons EM burnout is high is because of constant sifting through patients with trivial, or in fact fabricated, complaints while trying to identify the true emergencies. All while working under the impossible standard of full liability and a zero-miss culture. I think the sleep issue is a factor but by no means the compelling reason. The vast majority of physicians work tough schedules and do not have great sleep cycles.

I ignored press ganey for my own sanity during finals week for now.

 

[Doctor Bob]

lol let me know the last time you saw a ED attending use a slit lamp ... Are you sure it wasn't the ophtho resident?

Keep in mind the vaaaaaaaaaaaast majority of hospitals don't have residents. And specialty attendings don't come into the ED. We have a very collegial relation with docs in other fields once residents are taken out of the picture.

I'm sorry - usually you're spot on with your posts - but slit lamp is an essential skill. By no means are we able to perform anywhere near an ophtho level retinal exam, but basic abrasions or ulcers? Possibly cell/flare if you're good? That's incredibly common. We don't call ophtho for the majority of our eye problems.

Indeed.

If you want to know about the scope of practice, or skillset of ED docs, don't ask a resident or a medical student. And I wouldn't ask an academic attending (in any field) either. Teaching hospitals are structured such that ED docs are often limited in how much or what they can do by hospital policy (so as to allow subspecialty residents to get experience in various things). At teaching hospitals, calls from the ED always represents work and not work with increased reimbursement. That just engenders animosity and animosity usually turns to disparaging comments.

 

[ED50]

Shift work is the main reason I opted against EM. 6am-4pm then 11am to 7pm then 2 back to back 10pm to 6am. No thank you sir. For me EM isn't stressful, it's draining. It's like 15 new patient encounters per shift.

 

[mmmcdowe]

8am-4pm, 2pm-10pm, 4pm-12am, off, 12am-8am, off 4pm - 12pm
Followed by
8am-4pm or off or whatever, either way not very fun.

And that is a generous circadian shift schedule for one week, it will almost never work out like that aside from some residency scheduling. Do you think the burnout in EM is because everyone in EM is a slacker?

http://www.medscape.com/viewarticle/838437

I guess neurosurgeons were too busy loving life to participate.

 

[Wordead]

Aside from the multiple studies showing that night shift workers with constant circadian rhythm disturbances have increased risk of CVD, DM, obesity, depression, GI problems, fertility issues, and cancer.... Imagine dealing with the difficult patient populations in addition to everything else they have to deal with.. for example this post by the one and only BirdStrike sums it up nicely.

That's some bleeding heart prose. You think I couldn't write one for literally every single specialty? What is that supposed to prove? Also, family med is right below EM on your chart and critical care above. Whats your explanation for that? No circadian rhythm disruptions there. They have set schedules. And is a 2-4% increase in "reported burnout" over the middle of the pack really significant? No.

And how about I cherry pick a chart from that same stupid study for you:

Maybe put down the joints and they'd stop feeling so "burnt out".

 

[TooMuchResearch]

RVU generation

/thread

 

[W19]

Why can't psych physicians make 350k+ working 36 hrs/wk just like EM docs? I would also like to be rich some day...😛

 

[PL198]

That's some bleeding heart prose. You think I couldn't write one for literally every single specialty? What is that supposed to prove? Also, family med is right below EM on your chart and critical care above. Whats your explanation for that? No circadian rhythm disruptions there. They have set schedules. And is a 2-4% increase in "reported burnout" over the middle of the pack really significant? No.

And how about I cherry pick a chart from that same stupid study for you:

Maybe put down the joints and they'd stop feeling so "burnt out".

dude you just killed it in this thread. I am literally clapping

 

[PL198]

Why can't psych physicians make 350k+ working 36 hrs/wk just like EM docs? I would also like to be rich some day...😛

you can. start your own practice.

 

[LostinLift]

That's some bleeding heart prose. You think I couldn't write one for literally every single specialty? What is that supposed to prove? Also, family med is right below EM on your chart and critical care above. Whats your explanation for that? No circadian rhythm disruptions there. They have set schedules. And is a 2-4% increase in "reported burnout" over the middle of the pack really significant? No.

And how about I cherry pick a chart from that same stupid study for you:

Maybe put down the joints and they'd stop feeling so "burnt out".

It is an example of the difficulties and pressures associated in EM. Of course every specialty can express how difficult their jobs can be, but in what other specialty are the pressures so fast-paced and time dependent with death, trauma, violent patients, drug-seekers, and difficult patients that you have to see by federal law constantly around you? The point is that even if there are a few specialties that are just as stressful and burnt out as EM, they are not considered lifestyle either. Then throw in circadian disruptions for 10-20 years. Many people do not consider how these shifting schedules will affect their life 10+ years out. Sure, as a single 30 y/o straight out of residency pulling 40h/week with nights and flip flopping schedules you'll probably be fine, for a while. But when you are 45 or 55 with 2.5 kids, working that many hours in EM in a tough shop (read: most shops) is not sustainable for most people.


EM is a fast-paced, high stress field where you can get burnt out if you work too many hours, more so than other fields, which is why they work less hours on average than other specialties. Out of necessity. And even then, many are working more hours than they want. If you're able to work ~30hrs/week and cut down a bit more as you get older, in addition to limiting the sleep disturbances with shifting schedules, then yes it can be very lifestyle friendly. But go over to the EM forums and find a doc who has consistently worked 40 clinical hours per week for 10+ years and you'll find one who has now either transitioned more hours to admin/teaching, left general EM for a sub specialty, or feels burnt out and depressed.


And based on the "stupid" survey of U.S. physicians, it seems like more FM physicians should pick up a joint.

 

[PL198]

It is an example of the difficulties and pressures associated in EM. Of course every specialty can express how difficult their jobs can be, but in what other specialty are the pressures so fast-paced and time dependent with death, trauma, violent patients, drug-seekers, and difficult patients that you have to see by federal law constantly around you? The point is that even if there are a few specialties that are just as stressful and burnt out as EM, they are not considered lifestyle either. Then throw in circadian disruptions for 10-20 years. Many people do not consider how these shifting schedules will affect their life 10+ years out. Sure, as a single 30 y/o straight out of residency pulling 40h/week with nights and flip flopping schedules you'll probably be fine, for a while. But when you are 45 or 55 with 2.5 kids, working that many hours in EM in a tough shop (read: most shops) is not sustainable for most people.


EM is a fast-paced, high stress field where you can get burnt out if you work too many hours, more so than other fields, which is why they work less hours on average than other specialties. Out of necessity. And even then, many are working more hours than they want. If you're able to work ~30hrs/week and cut down a bit more as you get older, in addition to limiting the sleep disturbances with shifting schedules, then yes it can be very lifestyle friendly. But go over to the EM forums and find a doc who has consistently worked 40 clinical hours per week for 10+ years and you'll find one who has now either transitioned more hours to admin/teaching, left general EM for a sub specialty, or feels burnt out and depressed.


And based on the "stupid" survey of U.S. physicians, it seems like more FM physicians should pick up a joint.

lol so what is an acceptable amount of hours for a senior EM guy to work in a week? 20?

lol at the phrase " that many hours" being used when you're working 36 hours a week. yes I get they are tough hours and you're scrambling the entire time.

 

[LostinLift]

lol so what is an acceptable amount of hours for a senior EM guy to work in a week? 20?

lol at the phrase " that many hours" being used when you're working 36 hours a week. yes I get they are tough hours and you're scrambling the entire time.

Everyone will have a different threshold, but 160/month is considered a lot by most EPs. Full-time for EPs is usually between 120-140 hours, with of course the option to pick up more to pay off debt faster, etc.

 

[Chemdude]

I think you guys are being too harsh in criticizing LostinLift. He's right; I would choose a regular, predictable schedule over ER shift-work. Less hours=/=less stress. IMO FM/primary care is more lifestyle friendly than ER in the long run.