EM schedule/lifestyle

[nightshift]

I'm a first year med student. I decided to go pre-med kind of outta the blue midway through college, and all that really ever interested me was surgery. The technical challenge and being able to provide such definitive treatment made it seem it seem like the ultimate shining path to glory and a worthy life-long commitment.

Now that I've started med school and have begun studying like never before (that is, A LOT), I feel like I've developed a more realistic appreciation of what a 60-70hr work week actually entails and frankly am having doubts about whether I could hack that for the rest of my career. I've also been getting pretty pissed off in the anatomy lab during dissections and don't know if I'd even have the right temperament for surgery.

So the question is: what is the lifestyle of the emergency physician like? I know it's shift work, but can that mean working three 12 hour shifts a week? I mean, that just sounds incredible. Working as a tech I've had plenty of ED exposure and really enjoyed the work environment. I like the fast pace, the pressure, the collaborative interaction, the short amount of time you spend with patients and the large volume of patients you see in a shift. And I think the more time I have to myself and to pursue my other interests, the more happy I'll be on the job and in general. There are so many things I'm interested in and I just think I might regret selling my soul to an excessively time-consuming specialty (despite not too long ago thinking the exact opposite, haha). I just want to make sure I'll be able to practice medicine while still having time for my own life, hobbies, family, etc.

So out of all the lifestyle-friendly specialties, emergency medicine just seems like the most fun/rewarding/suited for my personality. So what kind of scheduling options are there to further entice me? Is it possible to be full time by doing three twelve hour turns a week? And do those who do that still make ~200k? How does vacation time work (i.e. how much uninterrupted time off can you get)? How does on-call scheduling work? Do you have to be on call?

Thank you to whoever pitches in!

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[deleted65604]

I make over 200,000 per year, with 12 12 hour shifts per month. I'm on call about 3 times per month for 8 hours per day and get $20 per hour to be on call. If I get called in, which happens about 1/2 the time, I get my normal hourly wage added to the $20.

 

[gutonc]

I've also been getting pretty pissed off in the anatomy lab during dissections and don't know if I'd even have the right temperament for surgery.

This is the perfect temperament for surgery. All you have to do now is start yelling at the people standing around you trying to help out and you've got it nailed.

 

[EM_Rebuilder]

This is the perfect temperament for surgery. All you have to do now is start yelling at the people standing around you trying to help out and you've got it nailed.

I was going to say the same thing...

EM is the best kept secret, but its slowly getting out.

You can work as much or as little as you want. There are places in the country you can work 12 12 hour shifts and make 400K+.

Hourly wages range probably from 100-250+ depending on what you want. You can work 1-2 days a week with the right gig and make well into a 6 figure income.

Good Luck.

 

[docB]

I'm a first year med student. I decided to go pre-med kind of outta the blue midway through college, and all that really ever interested me was surgery. The technical challenge and being able to provide such definitive treatment made it seem it seem like the ultimate shining path to glory and a worthy life-long commitment.

Now that I've started med school and have begun studying like never before (that is, A LOT), I feel like I've developed a more realistic appreciation of what a 60-70hr work week actually entails and frankly am having doubts about whether I could hack that for the rest of my career. I've also been getting pretty pissed off in the anatomy lab during dissections and don't know if I'd even have the right temperament for surgery.

So the question is: what is the lifestyle of the emergency physician like? I know it's shift work, but can that mean working three 12 hour shifts a week? I mean, that just sounds incredible. Working as a tech I've had plenty of ED exposure and really enjoyed the work environment. I like the fast pace, the pressure, the collaborative interaction, the short amount of time you spend with patients and the large volume of patients you see in a shift. And I think the more time I have to myself and to pursue my other interests, the more happy I'll be on the job and in general. There are so many things I'm interested in and I just think I might regret selling my soul to an excessively time-consuming specialty (despite not too long ago thinking the exact opposite, haha). I just want to make sure I'll be able to practice medicine while still having time for my own life, hobbies, family, etc.

So out of all the lifestyle-friendly specialties, emergency medicine just seems like the most fun/rewarding/suited for my personality. So what kind of scheduling options are there to further entice me? Is it possible to be full time by doing three twelve hour turns a week? And do those who do that still make ~200k? How does vacation time work (i.e. how much uninterrupted time off can you get)? How does on-call scheduling work? Do you have to be on call?

Thank you to whoever pitches in!

I surgery is really the only thing that ever interested you and you are looking at EM as a fall back because you think it will be less work then you are setting yourself up for unhappiness. You're likely to be a few years down the road regretting that you didn't follow your true passion. Lump in the fact that while EM does work less hours it's still hard work.

 

[nightshift]

.

 

[nightshift]

I make over 200,000 per year, with 12 12 hour shifts per month. I'm on call about 3 times per month for 8 hours per day and get $20 per hour to be on call. If I get called in, which happens about 1/2 the time, I get my normal hourly wage added to the $20.

Wow, that just sounds too good to be true...

 

[nightshift]

EM is the best kept secret
Good Luck.

Starting to look like it!

 

[It'sElectric]

Starting to look like it!

I hate to be Captain Obvious, but here's the thing. While EM is THE best kept secret in medicine (may be an overstatement at this point, however), it's not without it's cons. It seems like a lot of people overlook the fact that you will work a lot of nights (with frequent changes between days and nights), weekends, and holidays. Not to mention the simple fact that you will work your ass off every shift you work. If you enjoy the work (it doesn't have to be a "calling"), and you're ok with the above facts of the job, then EM may be for you.

In my opinion, the best part of it is you get to work up undifferentiated patients, you do a number of procedures, and you work you're ass off while you're there. When you're not working...YOU'RE NOT WORKING. Do an EM rotation or 2. I personally found a number of negatives with pretty much every other rotation I did. EM is the only field that speaks to me. Is it my calling? Eh. But I definitely I enjoy working hard, then having my time off to do what I want.

Best of luck to you. Bear in mind, this is all from an MS4...who has had a little to drink tonight, since I'm not on until Saturday.

 

[nightshift]

I surgery is really the only thing that ever interested you and you are looking at EM as a fall back because you think it will be less work then you are setting yourself up for unhappiness. You're likely to be a few years down the road regretting that you didn't follow your true passion. Lump in the fact that while EM does work less hours it's still hard work.

That's a great point, and thanks for bringing it up. What I'm really questioning now is whether I'm the kind of guy who was a singular "true passion" for which the pursuit justifies the sacrifice of other lesser passions. I mean, the concept of surgery is fascinating and seductive, but I feel like the day-to-day realities of the job and the effect it would have on my life as a whole would be devastating and totally taints its appeals. It would basically demand that I become a different kind of person--the workaholic I've never really been. What I find incredibly appealing about emergency medicine is that you work hard--sometimes very, very hard-- three or four shifts a week and then bam, you punch out and you've got a huge chunk of time to do your own thing. The nature of the work itself obviously interests me as well. I feel like surgery would just crush my freedom to do the other things I enjoy and that make me a more complete person. But maybe I'm just being a bitch.

This is probably something I'll be chewing over hard over the next couple years. Thank you to everyone who has contributed.

I'd love to hear more words of wisdom from attendings and residents!

 

[nightshift]

Is it my calling? Eh. But I definitely I enjoy working hard, then having my time off to do what I want.

EXACTLY.


Also, I don't have a problem with the night shift, weekends, or holidays. I'm pretty flexible when it comes to that. What's important to me is the actual number of days I have to show up on the job.

Thanks for posting--it's great to hear from an MS4.

 

[Apollyon]

I hate to be Captain Obvious, but here's the thing. While EM is THE best kept secret in medicine (may be an overstatement at this point, however), it's not without it's cons. It seems like a lot of people overlook the fact that you will work a lot of nights (with frequent changes between days and nights), weekends, and holidays. Not to mention the simple fact that you will work your ass off every shift you work. If you enjoy the work (it doesn't have to be a "calling"), and you're ok with the above facts of the job, then EM may be for you.

In my opinion, the best part of it is you get to work up undifferentiated patients, you do a number of procedures, and you work you're ass off while you're there. When you're not working...YOU'RE NOT WORKING. Do an EM rotation or 2. I personally found a number of negatives with pretty much every other rotation I did. EM is the only field that speaks to me. Is it my calling? Eh. But I definitely I enjoy working hard, then having my time off to do what I want.

Best of luck to you. Bear in mind, this is all from an MS4...who has had a little to drink tonight, since I'm not on until Saturday.

I'm an attending 3+ years out of residency, and I agree with everything you've stated (and I have NOT been drinking tonight).

 

[It'sElectric]

I'm an attending 3+ years out of residency, and I agree with everything you've stated (and I have NOT been drinking tonight).

Apollyon - you're one of my favs...but no drinking? at 0248 EST??? Tell me you're at work. Otherwise, let's start drinking.

 

[Apollyon]

Hehehe...it's 2146HST right now, and I have to go to bed soon, to work in the morning!

 

[pagemmapants]

Coming from an ex-EMT MS4 who was thisclose to doing Ortho and made an eleventh-hour switch back.

As I see it...

Cons:
Blood smells weird
Vomit smells worse
Crack-heads
Suicide attempts and psychiatry patients
Shifts where you don't sit down for 12 hours
Shifts where you don't get anything but runny noses for 12 hours
Unpredictability: you don't know walking in if you'll save a life or declare a death.
Specialists looking down their noses
No "office"
Malpractice
Telling people bad news, often suddenly (MVA, ACS, CVA)
Nights, weekends
Possibility of it turning into "algorithmic medicine"
No "getting to know" your patients (except the FF crackheads and homeless)

Pros:
Flexibility
Free time (hobbies, anyone?)
Compensation (in some parts of the country)
Diagnostics! ("undifferentiated patients")
Procedures! ("no body cavity that can't be reached with an 18g needle and a strong arm")
Get to diagnose and treat head to toe (except the disgusting eye... thank god for opthalmologists)
Get to consult if you know you're in over your head
Possibility to make it as academic as you want it to be
Possibility to avoid academics as much as possible
Toxicology = key to godliness because nobody else (exception: anesthesia) knows anything about toxidromes
Possibility to do wilderness and do medicine IN THE JUNGLE
Possibility to do international and do medicine EVERYWHERE
Neat toys (ultrasound, defibrillator, fluoro machine...)
Security is always around
NO ROUNDS
NO PAGERS
NO SUITS

 

[It'sElectric]

Well put.

 

[deleted65604]

I recently had the worst shift as far as frequent fliers. I'm talking 5 different people with over 50 ER visits each in the past 2 years (over 50 negative work-ups each).

I'd love to go into details, but I think I'd break HIPAA.

It is the single most negative thing about ER in my opinion...that we can't choose our patients.

Having 5 different borderline personality disorders yelling at you from various parts of the ER for their preferred narcotic can really suck the compassion out of you. Each patient interaction is a drama worthy of the big-screen. Doctors in the office can simply say, "Listen, I won't be manipulated by you, either stop this behavior or be discharged from the practice. You decide."

The unfunded mandate of EMTALA is an irritating law. I guess I see how the public thinks its necessary, but in reality, some of these people need to be banned from the ER.

Remember the fable of the Boy Who Cried Wolf? Try crying wolf 50 times and see if anyone cares anymore.

We need a CT-scan, narcotic Nazi security guard at the entrance that is alerted to the presence of frequent fliers and can come out and say, "No CT scan for you!! No narcotic for you!! You go home!! You whine like a mule!! You are still alive!!"

 

[Hercules]

I'm a 1st year attending and just wanted to add a few points. First off, I love EM and am incredibly happy with my job. I think there is a slight lifestyle misconception about EM. EM is probably the best lifestyle specialty for single people because of all the large chunks of free time. When you add a spouse and kids into the mix though it becomes much less of a lifestyle specialty. I hear lots of us comment about being flexible about nights, evenings, weekends. Me too, but you need to make sure you're family is just as flexible as you are. The peak hours for our job in terms of volume are the evening hours so lots of places are going to have extra coverage during these hours which translates into a higher number of evening shifts for you. That means missing dinner a lot of nights, not being there to put the kids to bed,having your spouse sleep alone, etc. So while we do have a ton of free time (I work 35 hrs a week and make a very nice paycheck), it may not be the time that your family and spouse would prefer to have with you. There are lots of other specialties that offer more of the 9-5 lifestyle where you'll actually be home during traditional family time.

Now on the plus side I get to do great things like take my kids to the Zoo on a Wednesday morning with no one else there. I get to drop my kids off at school more than most docs. I get to coach my daughter's 3 year old soccer team which is hilarious. I get to take the family on week long beach trips that don't involve any vacation time, just moving my shifts around.

Lengthy post to just remind people that what is a great lifestyle as a single person in your mid-twenties has some challenges to it once you have a family and children to take care of. You can make it work, but make sure everyone involved in the decision is on board with it.

 

[Phledge]

We need a CT-scan, narcotic Nazi security guard at the entrance that is alerted to the presence of frequent fliers and can come out and say, "No CT scan for you!! No narcotic for you!! You go home!! You whine like a mule!! You are still alive!!"

AHAHAHAHAHAHA!

This person would, in my book, be heretofore known as Fairy Godperson. I would do his or her taxes. I would wash his or her car. I would bring homemade baked goods for this person. I would go out of my way to bring this person comfort and joy.

 

[docB]

I'm a 1st year attending and just wanted to add a few points. First off, I love EM and am incredibly happy with my job. I think there is a slight lifestyle misconception about EM. EM is probably the best lifestyle specialty for single people because of all the large chunks of free time. When you add a spouse and kids into the mix though it becomes much less of a lifestyle specialty. I hear lots of us comment about being flexible about nights, evenings, weekends. Me too, but you need to make sure you're family is just as flexible as you are. The peak hours for our job in terms of volume are the evening hours so lots of places are going to have extra coverage during these hours which translates into a higher number of evening shifts for you. That means missing dinner a lot of nights, not being there to put the kids to bed,having your spouse sleep alone, etc. So while we do have a ton of free time (I work 35 hrs a week and make a very nice paycheck), it may not be the time that your family and spouse would prefer to have with you. There are lots of other specialties that offer more of the 9-5 lifestyle where you'll actually be home during traditional family time.

Now on the plus side I get to do great things like take my kids to the Zoo on a Wednesday morning with no one else there. I get to drop my kids off at school more than most docs. I get to coach my daughter's 3 year old soccer team which is hilarious. I get to take the family on week long beach trips that don't involve any vacation time, just moving my shifts around.

Lengthy post to just remind people that what is a great lifestyle as a single person in your mid-twenties has some challenges to it once you have a family and children to take care of. You can make it work, but make sure everyone involved in the decision is on board with it.

This is a great post and is very true. I work a lot of 3p to 12a shifts and I usually get home at about 2a. My kids still get up at 0630 no matter what time I get to bed so I frequently have to go on 4-5 hours of sleep for a few days at a time.

 

[It'sElectric]

I'm a 1st year attending and just wanted to add a few points. First off, I love EM and am incredibly happy with my job. I think there is a slight lifestyle misconception about EM. EM is probably the best lifestyle specialty for single people because of all the large chunks of free time. When you add a spouse and kids into the mix though it becomes much less of a lifestyle specialty. I hear lots of us comment about being flexible about nights, evenings, weekends. Me too, but you need to make sure you're family is just as flexible as you are. The peak hours for our job in terms of volume are the evening hours so lots of places are going to have extra coverage during these hours which translates into a higher number of evening shifts for you. That means missing dinner a lot of nights, not being there to put the kids to bed,having your spouse sleep alone, etc. So while we do have a ton of free time (I work 35 hrs a week and make a very nice paycheck), it may not be the time that your family and spouse would prefer to have with you. There are lots of other specialties that offer more of the 9-5 lifestyle where you'll actually be home during traditional family time.

Now on the plus side I get to do great things like take my kids to the Zoo on a Wednesday morning with no one else there. I get to drop my kids off at school more than most docs. I get to coach my daughter's 3 year old soccer team which is hilarious. I get to take the family on week long beach trips that don't involve any vacation time, just moving my shifts around.

One of the things that I think is so super sweet about EM - the ability to get involved with your kids' sports/extracurriculars. No kids as of now, but I look forward to having this opportunity...unlike many other docs in other fields.

 

[Painter1]

i'm a first year attending.

some days i love my job, other days i hate it.

what i hate?

1. i hate *****hole consultants.
2. i hate family members displaying their hospital badges expecting special treatment.
3. i hate painful sign-outs.
4. i hate when i have a legit sign-out and the incoming doc gives me their dissaproval with thier body language
5. i hate the medico-legal climate
6. i hate when pmds or consulants don't call back
7. i hate patients that fake illnesses
8. i hate drug-seekers (allergic to everything but dilaudid, ivp)
9. i hate nurses that think they know more than you

with that said,

i can write a list with the things i love and in the end, as a whole, i can't see myself doing anything other than em. weird, i know.

 

[RandomAttending]

How many 60 - 70 year olds do you see practicing EM and doing evening/night/weekend shifts? And don't say you will be retired then -- you don't what is in store and 200K doesn't go far unless you live in Iowa (nothing against Iowa. Just picked it.)

Longevity is the issue here. An EM career in academics is the best solution if you want to be in this for the long haul and decrease the clinical load and keep it interesting. My friends from residency in community practice are complete toast.

 

[WilcoWorld]

How many 60 - 70 year olds do you see practicing EM and doing evening/night/weekend shifts? And don't say you will be retired then -- you don't what is in store and 200K doesn't go far unless you live in Iowa (nothing against Iowa. Just picked it.)

Longevity is the issue here. An EM career in academics is the best solution if you want to be in this for the long haul and decrease the clinical load and keep it interesting. My friends from residency in community practice are complete toast.

200K doesn't go far? Forget about a lifestyle specialty, you might need a lifestyle adjustment.

Then again, my main vices are used records and beer... much cheaper than sports cars and mistresses.

 

[WilcoWorld]

The above sounds harsher then it was meant to...but I'm going to leave it as is - WW's feelin' feisty.

 

[Jeff698]

Apollyon - you're one of my favs...but no drinking? at 0248 EST??? Tell me you're at work. Otherwise, let's start drinking.

Since it's a tradition on this forum that all good threads eventually turn to EtOH, let me say that I've got Apollyon's back here. I'm having a Dogfish Head 60 Minute IPA for him.

Just 'cause I'm that kind of warm, caring guy.

Take care,
Jeff

 

[Apollyon]

Since it's a tradition on this forum that all good threads eventually turn to EtOH, let me say that I've got Apollyon's back here. I'm having a Dogfish Head 60 Minute IPA for him.

Just 'cause I'm that kind of warm, caring guy.

Take care,
Jeff

And a Frito pie and Big Red tomorrow night!

 

[badasshairday]

Is it common for older ED doctors to switch to say Urgent Care when they are burnt out and done with those over nights?

 

[docB]

Is it common for older ED doctors to switch to say Urgent Care when they are burnt out and done with those over nights?

It happens. But I've seen EPs go into all kinds of weird stuff like real estate, pain medicine, weight loss medicine, beauty clinics (dermabrasion, botox, etc.) and administration. I think it's more common to see EPs change their practice environment, switching to lower volume, lower acuity EDs. I have found that it's not as common that they are burnt on the nights as that they're burnt on the high volume. Not that nights aren't hard and they do get harder as you get older but a night of high volume is a different animal from the night where you work a sleepy ED, see 12 people with colds and get a nap.

 

[pagemmapants]

And a Frito pie

... wth is a Frito pie? I hope it is not a corn-chip-related dessert?

 

[Kris1]

... wth is a Frito pie? I hope it is not a corn-chip-related dessert?

It's the closest one can get to heaven while on this earth.

 

[MSTigER]

It happens. But I've seen EPs go into all kinds of weird stuff like real estate, pain medicine, weight loss medicine, beauty clinics (dermabrasion, botox, etc.) and administration. I think it's more common to see EPs change their practice environment, switching to lower volume, lower acuity EDs. I have found that it's not as common that they are burnt on the nights as that they're burnt on the high volume. Not that nights aren't hard and they do get harder as you get older but a night of high volume is a different animal from the night where you work a sleepy ED, see 12 people with colds and get a nap.

docB, is it common that EPs staff urgent care-type clinics? Or is that the realm of FPs? I get asked by alot of my classmates what an EP can do when they get "burnt out" working night shifts as they get older, and I never have a good answer. What opportunities would you suggest are available? Thanks.

 

[Powdermonkey]

 

[Apollyon]

... wth is a Frito pie? I hope it is not a corn-chip-related dessert?

Clearly, the most important SDN thread in some time.

And it's now officially "late November", so it's perfect season!!

 

[Jeff698]

And it's now officially "late November", so it's perfect season!!

And lest anyone miss the opportunity to turn this thread back toward that final resting place of all SDN EM threads (good ones, anyway), I present the perfect accompaniment to frito pie:

BTW, It is clearly written in all holy texts that thou must enjoy frito pie in the stands at a Texas high school football game. Truly, a moral imperative.

Take care,
Jeff

 

[Apollyon]

Ah, hell - 3 years ago, you said the beverage of choice was a Big Red!

 

[crewmaster1]

For all the people on this forum who are all about the lifestyle of EM (work only your scheduled shifts and have the rest of the time off), how does academic practice change this? I have always looked forward to this same lifestyle of shiftwork, but as I get closer to residency ending and start considering academics it seems as though this is only the lifestyle in community EM. In academics you have grand rounds, med student responsibilities, department meetings, committees, and research. I'd love to hear from some academic EM docs about how much they feel this impacts the whole lifestyle of EM.

 

[docB]

docB, is it common that EPs staff urgent care-type clinics? Or is that the realm of FPs? I get asked by alot of my classmates what an EP can do when they get "burnt out" working night shifts as they get older, and I never have a good answer. What opportunities would you suggest are available? Thanks.

Many guys do the Urgent Care thing. It pays less but it's less stress.

The best answer back to people who ask about burnout in EM is that it was a much more prevelent issue back in the 80s and 90s when the docs who were doing it had not trained in it. Many of those docs didn't really choose EM, they sort of found themselves doing it and after so many years got burnt. They tended to go into it with different expectations, eg. "I'll do this for a while then open a clinic."

Burnout for EM trained people tends to be less about EM or even about the schedule and more about particular practice environments. Docs eventually switch to jobs that suit them better.

 

[roja]

Depends on what you mean by academics. Do you mean a place that has residents and medical students? Has both and is tied to a medical school? where?

I have worked two academic centers: one very 'traditional' center and one where there were residents, medicals students, and researchers, etc but maybe wasn't ivory tower academics.

Actual work load is about the same (12-14 shifts a month) with less pay. Some will get buy down time for research, admin work, educational positions. There are department meetings but they are there in private work as well. Some places will require you to do research or academic stuff, others won't.

You will definately be required to teach, which for some is a plus and others a minus. (Ie, I love it but have friends who can't stand having residents and students around)

So, it depends.....

 

[scissors]

You can work as much or as little as you want. There are places in the country you can work 12 12 hour shifts and make 400K+.

Sounds appealing. What type of places?

Another question. Is there concern that there will be an oversupply of ED docs if they fix the system and the uninsured no longer need to use the ER?

 

[deleted65604]

I don't think insurance reform is going to cut down on ER visits. Keep in mind that much of the volume of emergency departments happens in the evenings and at night, when primary care doctors are sleeping in their beds.

There are a lot of people who don't come to the ER because they realize they will be stuck with a big bill. If all people have insurance, there will be no downside from a cost perspective of going to the ER.

Even worse, if the government-subsidized insurance public option drives other insurance out of business, and in the end, doctors are forced to choose between being a doctor and accepting the poor reimbursement from the government, they will essentially become government employees, subject to penalties, paper-work, and "standards" set by government bodies. IF this happens, physicians could become clock watching, angry individuals, unwilling to sacrifice for their patients. A lot of the courtesy, innovation, and desire to compete for patients is going to go away. The end result will be, paradoxically, a worsening of primary care.

We take care of the poor right now. We do. In my town, there is a free walk in clinic for the poor. The hospital is supplemented by a foundation that has a huge grant made by private donation from wealthy donors over the years. This foundation allows the hospital to forgive millions of dollars in patient bills per year. When everyone has insurance, or at least, has no excuse not to have insurance, do you think rich people are going to care about donating to the poor anymore? Do you think physicians are going to donate their time to a free clinic when people should have bought insurance per the government mandate and should be seeing them in their offices?

I have no crystal ball as to what is actually going to be the effect of the current legislation, but I'm not convinced that a decrease in ER visits will be the result. If anything, in general, our reimbursement as ER physicians will be increased as the percent of charity care requests decreases and there are fewer non-pays.

 

[RxnMan]

I don't think insurance reform is going to cut down on ER visits...

Great post. The only way I can think of ED visits going down as a result of universal HC / single payer / gov't insurance is that patients will be given some number of ED visits per time period. Those that habitually go over will be targeted in some manner. Maybe care will be denied (unlikely). Maybe some sort of increased taxes (unlikely to be effective). Maybe the frequent flier will be referred to social work and given a visiting nurse (more likely, more effective, more expensive).

But even this reeks of rationing.

 

[LoveandHate]

I was going to say the same thing...

EM is the best kept secret, but its slowly getting out.

You can work as much or as little as you want. There are places in the country you can work 12 12 hour shifts and make 400K+.

Hourly wages range probably from 100-250+ depending on what you want. You can work 1-2 days a week with the right gig and make well into a 6 figure income.

Good Luck.

Yo rebuilder, is this still true?

 

[Arcan57]

Yo rebuilder, is this still true?

Nice necro...

$150/hr x 2 twelve hour shifts/week x 50 weeks/yr = $180,000

Knock that down to $100/hr and you're still talking $120,000.

Definitely doable, will take some searching to find a job where you can consistently work that little. Not a lot, but some.

 

[EM_Rebuilder]

Yo rebuilder, is this still true?

Every word of it...

I have fulltime work where I do approx 144 hours per month; I then work additional at a few other places but have one spot that is my 'go to'...I have always been able to get at least 1 shift elsewhere if I wanted it; usually there are more shifts availble than I end up caring to work..

I am sure this is somewhat regional and the 'most desirable places' are less likely to work as well...however, you could live in say California and fly to a less deisrable place and work a few shfits then fly home...

 

[Pinner Doc]

I work an RVU-based system, and do 12 eight-hour shifts/month. This works out to a little shy of $200,000 (pre-tax, of course).

Of course, now that my state health care authority (Washington) has decided not to compensate physicians or hospitals for care that they arbitrarily and capriciously (as well as retrospectively) determine to be non-emergent (ie, chest pain that - AFTER the work-up - is deemed non-cardiac), I'm sure my salary will take a hit.

Be warned. It's happening to us in Washington. It could happen to you. But that's a whole different thread....

 

[BJJVP]

Nightshift,

I was very similar to you as a med student. I wanted to do surgery but realized I didn't have enough passion for it to work 60hrs a week and take call for the rest of my career. My GF at the time convinced me EM was for me because of lifestyle. Nights and weekends don't bother me. Also, I liked the thought of being jack of all trades, doing resuscitations and using medical treatments in addition to doing procedures. At the time, it sounded like ER doctors were the only "real doctors." Plus (I'm ashamed to admit this), telling people you're an ER doctor just sounded cool.

It's been 7 years since graduating and there are things I wish I knew:

1) Being jack of all trades is overrated. It sucks to be a smart guy with the answers your whole life only to be relegated to the role of the non-specialist people go to just because they have to. I know people will say that you are the specialist in resuscitations but really, many of these pts had no real chance for long term/meaningful survival and the fact that they made it to the ICU only to die later doesn't make me feel that good. To top it off, you often get second guessed by the ICU folks who consider themselves the real specialists in treating crashing pts.

2) I didn't realize how much I would miss out on by not doing something that provides definitive care more often. I would love to go to work everyday and walk out of the OR to tell a pts family that everything went well and that the pt will get better. Nowadays, I still love going in to sedate a pt, do a procedure and then telling the family or pt that everything went well. However, while doing that I have to worry about moving the meat and who else is crashing in the ED.

Also, nobody remembers the name of the ER doctor that reduced their shoulder, shocked them out of VF, intubated them when they had bad pneumonia, etc. On the other hand, pts always remember the name of the ortho that scoped their knee, cardiologist that rx'd amiodarone, pulmonologist that bronched them and extubated them. I get pts coming in to the ER all the time asking if Dr So and So, who did their hernia surgery 20 years ago, is still practicing.

3) All the other BS regarding press ganey, crazy pts, drug seekers, being dumped on by others, medicolegal risk, etc. You can see these topics on a weekly basis on this forum and so I will not go further.

I disagree with the statement that burnout was a thing of the past. I see it in myself and many others.

I know that #1 and #2 make me sound kind of narcissistic but I think you need to consider them. I used to tell myself that I don't need respect from other doctors or patients. I used to think getting lots of time off to do cool things, stay in shape and spend time with family was all I cared about. They are great, but I do feel like I missed out on certain things professionally by not going into surgery or some other more focused/narrow field.

If I could do it again, I probably would still do EM. In all honesty, I don't like any part of medicine enough to sacrifice my other interests just to work over 50hrs a week. And, for the hrs I work, I make really good money. BUT, having the proper expectations is extremely important and I just hope that people pursuing EM don't have the same unrealistic expectations that I did 7 yrs ago.

 

[BJJVP]

LOL. I just realized that this thread was started in 2009 and Nightshift is probably a senior student at this point. What field did you decide on?

 

[deleted109597]

I work an RVU-based system, and do 12 eight-hour shifts/month. This works out to a little shy of $200,000 (pre-tax, of course).

Of course, now that my state health care authority (Washington) has decided not to compensate physicians or hospitals for care that they arbitrarily and capriciously (as well as retrospectively) determine to be non-emergent (ie, chest pain that - AFTER the work-up - is deemed non-cardiac), I'm sure my salary will take a hit.

Be warned. It's happening to us in Washington. It could happen to you. But that's a whole different thread....

Vote with your feet. Neurosurgeons in West Virginia did.

 

[EctopicFetus]

Ninja,

While this is surely what I would do we have to be fair and understand that some people are geographically tied to their areas. What may occur is that people want to see what the pain will be. Between Obamacare and this in Washington it might be a death blow.

I do believe that once obamacare is fully implemented this would be illegal since I believe one of the provisions is that medicaid has to pay at least medicare rates. Therefore if for ICD-10 code x medicare would pay $50 i DONT see how medicare in Wash state could keep doing this.