EM's Fatal Design Flaw (How To Use This Knowledge To Your Benefit)

[GonnaBeADoc2222]

EM physicians should be trained in a way that they’re equally capable of earning a living outside of an Emergency Department as they are in one.

Exit plans shouldn’t be an afterthought, like a pilot hitting the eject button as a last ditch effort. It should be part of the plan and training.

EPs should be able to seamlessly move from ED-based careers to non-ED based careers. If EPs could easily do this, they’d have leverage, as opposed to now, where they’re at the mercy of the whims of administrators, CMGs and contract gain/loss.

If this was the case, EPs would have the leverage to easily walk away. They wouldn’t be at the mercy of contract loss, hospital based politics or administrators whims.

It would also be an incredible Insurnace policy against burnout if those non-ED based options avoided circadian-disruption dysphoria.

This should be a part of normal EM training. EPs should not be forced to reinvent the wheel, mid career in a scattered way or out of desperation.

EM training should take as much responsibility for the EPs exit from EM, as they it does entry into EM.

You can.

There's UC, Sports Medicine, CCM (medical, surgical and neurologic), Pain. Some of these are paycuts some are not. Some take time.

You can go out on your own and do direct or concierge stuff, offering UC, limited primary care, cosmetics. Takes business acumen and hard work. What you think these IM PCPs do who go out on their own and open a practice?

Or you can put up, and take your 300k minimum and move on.

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[emergentmd]

What specialty can move away from their core job and still make the same amount?

A NSG making $1M a yr operating wants to stop operating. What options does he have to make $1M?
A anesthesiologist stops working in the operating room, what are they going to do to make 500k?
A Cardiologist stops doing heart caths/procedures, what are they going to do to make 600K?

There is very little fields that can move away from their core specialty without a pay cut.

I would say EM has more options than most. I have done telemedicine, workers comp, Chart reviews. All take a good pay cut b/c any PCP can do this job.

 

[CoolDoc1729]

EM physicians should be trained in a way that they’re equally capable of earning a living outside of an Emergency Department as they are in one.

Exit plans shouldn’t be an afterthought, like a pilot hitting the eject button as a last ditch effort. It should be part of the plan and training.

EPs should be able to seamlessly move from ED-based careers to non-ED based careers. If EPs could easily do this, they’d have leverage, as opposed to now, where they’re at the mercy of the whims of administrators, CMGs and contract gain/loss.

If this was the case, EPs would have the leverage to easily walk away. They wouldn’t be at the mercy of contract loss, hospital based politics or administrators whims.

It would also be an incredible Insurnace policy against burnout if those non-ED based options avoided circadian-disruption dysphoria.

This should be a part of normal EM training. EPs should not be forced to reinvent the wheel, mid career in a scattered way or out of desperation.

EM training should take as much responsibility for the EPs exit from EM, as they it does entry into EM.

Not being snarky here, honestly curious: what would this look like? I feel like there was plenty enough to do in 3 years of residency to learn how to manage the emergency department patients as well as the department … and not everyone wants to do the same thing as an exit plan - many do pain, EMS, sports med etc, many do nonclinical things like real estate or options trading. How should an EM residency incorporate an introduction into these things?

 

[ShockIndex]

I agree with @emergentmd. EM offers more options for a comfortable lifestyle outside of traditional clinical practice than most other specialties. The common thread is that most of these career options involve a pay sacrifice at least in the beginning on the transition. In addition, EM is uniquely able to place physicians in niche fields in federal law enforcement, aerospace industry, military special operators, private security, and professional athletics.

 

[ShockIndex]

Not being snarky here, honestly curious: what would this look like? I feel like there was plenty enough to do in 3 years of residency to learn how to manage the emergency department patients as well as the department … and not everyone wants to do the same thing as an exit plan - many do pain, EMS, sports med etc, many do nonclinical things like real estate or options trading. How should an EM residency incorporate an introduction into these things?

It looks like an EM/IM or EM/Peds residency. They are 5 years because that is how long it takes become competent at EM and primary care.

 

[Siggy]

I agree with @emergentmd. EM offers more options for a comfortable lifestyle outside of traditional clinical practice than most other specialties. The common thread is that most of these career options involve a pay sacrifice at least in the beginning on the transition. In addition, EM is uniquely able to place physicians in niche fields in federal law enforcement, aerospace industry, military special operators, private security, and professional athletics.

Hyperbaric and dive medicine is another option for EM, but you’re going to have to live in an area with a lot of dive operations.

 

[Apollyon]

Hyperbaric and dive medicine is another option for EM, but you’re going to have to live in an area with a lot of dive operations.

Not really. UPMC Hamot, in Erie, PA, has (or had) a program. Knew a guy that did it. He did hyperbarics, only. Even if someone got bent in Lake Erie, he couldn't dive them.

 

[DeadCactus]

Hyperbaric and dive medicine is another option for EM, but you’re going to have to live in an area with a lot of dive operations.

The majority of hyperbarics is wound care. Many chambers won't even dive emergent things like CO and decompression illness because they don't reimburse and aren't worth maintaining 24/7 availability. You don't need a fellowship to do it but, like many things, the fellowship lubricates the path to leadership and academic positions.

 

[Birdstrike]

The conventional “wisdom” of the past 50 years of Emergency Medicine has failed. The “lifestyle specialty” manages to accomplish a seemingly impossible feat: To work the least hours, yet continuously rank at the top of surveys of physician burnout and depression, year after year, decade after decade.

The old and tired platitudes and quick “fixes” suggested above have failed for 50 years. The old paradigm and traditional thinking of a career in Emergency Medicine needs to be ripped up, thrown out, and rewritten.

 

[RustedFox]

The conventional “wisdom” of the past 50 years of Emergency Medicine has failed. The “lifestyle specialty” manages to accomplish a seemingly impossible feat: To work the least hours, yet continuously rank at the top of surveys of physician burnout and depression, year after year, decade after decade.

The old and tired platitudes and quick “fixes” suggested above have failed for 30 years. The old paradigm and traditional thinking of a career in Emergency Medicine needs to be ripped up, thrown out, and rewritten.

Oh, I agree.
We have a staffing crisis at my current shop. Locums in and out all day long.
ALL of them have a side hustle.
Because I am the gregarious person that I am, I talk to them.
They all say the same thing:

"Bro, I'm getting out of this nonsense and this is how I'm trying to do it."

 

[BoardingDoc]

this is how I'm trying to do it

The locums is how they're trying to do it? Or different side hustles? If the latter, details?

 

[RustedFox]

The locums is how they're trying to do it? Or different side hustles? If the latter, details?

Locums + [ x ]

and [ x ] is like, running storage units, a men's health clinic, a whatever.