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ever feel like you will burn out?

Discussion in 'Emergency Medicine' started by poloace, Aug 8, 2006.

  1. poloace

    poloace Senior Member
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    yo crew-

    its coming down to the wire- i'm trying to decide between EM and radiology. i love both for two completely different reasons. with EM its that patient interaction thing that i've always wanted without the chronic BS that i came to despise in medical school.... i feel like between mid 20's and 45 or so... i'd really enjoy it. on your feet, thinking quickly, hands on stuff- awesome.

    at the same time... i start to wonder if at the age of 45 (or even sooner- like 32) if i'll start to get really tired of what comes through that door. right now its all fun and new- but, do you get burned out? or, are those individuals burning out the ones that were grandfathered into the field that never went through an EM residency?

    with radiology - in a similar sense- each case is a puzzle - like the 'where's waldo' books we used to thumb through years ago. also, the idea of interventional brings back that patient interaction that would have to be sacrificed up front. i don't know... just looking for some input from people who are in the field of EM right now. hope all is well.

    p
     
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  3. DrQuinn

    DrQuinn My name is Neo
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    both specialties are completely different, but that is up to you. I'll answer your question.

    I just started my first "real job" out. Love it. Don't mind the switching to evenings/nights/weekends. (Wife has to get used to it but I warned her in med school). The patients are awesome, the pathology is GREAT, the nurses kick ass (and like to hang out), the other staff is cool, basically its an awesome job and I love it. Some of the older guys that work here (20 years plus) end up working part time or just in the "fast track" area. Honestly, its a pretty sweet gig. They're probably making 100-140k a year working maybe 20 hours a week. Not a bad way to ride off into the sunset.

    Q
     
  4. DropkickMurphy

    DropkickMurphy Membership Revoked
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  5. Febrifuge

    Febrifuge Grizzled Old Newcomer
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    I shadowed a guy for ten weeks while I was out east for my post-bac. He's an old crusty EM guy from way back, and did a couple nights a week in the Urgent Care, which is where we hung out. He gave some sage-sounding advice on this topic:

    "If ya start to burn out, the trick is to burn through." In other words, accept that there will be a waxing and waning to your ability to endure the BS. Take a break when you can, and just remember that this too will pass. Sounds like a plan to me.
     
  6. bartleby

    bartleby Senior Member
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    Burnout is not a major issue for EM grads. The bigger issue for you is if you want a therapeutic or non-therapeutic career path. Even if you do interventional, it is the rare group where you spend more than 50% of your time doing interventional. The rest of the time you're locked in a dark room with your films. If you don't want to deal with patients and their BS directly or get your hands dirty, sounds like you'll make a good radiologist. If you fall asleep when left alone in a dark room (like I do), you'd best avoid radiology, as it's a long residency before you get to your interventional fellowship.
     
  7. p53

    p53 ****** for F******
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    What a bunch of crock.

    If you go through a radiology residency you will be trained to do more different procedures than a ED physician. I guess all procedures are done in the dark :rolleyes:

    Don't you just love it when a medical student, resident, or attending comes into a reading room for a couple minutes for a consult and they have pinned down what a radiologist does all day?
     
  8. Apollyon

    Apollyon Screw the GST
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    "A bunch of crock"?

    Bartleby is an attending.

    I don't know if radiology residency trains you to do more procedures. Moreover, how many of those procedures will a general radiologist (not VIR-fellowship trained) be credentialed for or use in practice? You'd have to be pretty gutsy (and there's a fine line between balls and stupidity) to be embolizing arteries or coiling aneurysms, if you've only done them in residency.

    Any procedure EM residents learn, they use in practice (from central lines to ultrasound to chest tubes to LPs to I&D, and on and on).
     
  9. p53

    p53 ****** for F******
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    I don't care if Bartleby is John Carter, MD. If he believes a radiologist sits in a dark room all day he is CLUELESS. This is alarming if he/she is an attending. Furthermore, if an ED attending makes a broad generalization about another specialty he is in over his head.

    As for the procedures, the point is that a general radiologist is trained for many procedures during their residency. If all they do is read images why is radiology residency 5 years?

    Sure, I'll grant you that an ED physician does more routine procedures such as (chest tubes, central lines etc), however a private radiologist does many procedures.

    Please don't post idiotic comments such as practicing radiologists do not do procedures as part of their practice. This makes you sound like an uneducated simpleton.
     
  10. Apollyon

    Apollyon Screw the GST
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    Wow...how quickly you become abusive. I didn't say radiologists don't do procedures. I said general radiologists don't do VIR or neurorads (and probably aren't credentialed to).

    Please don't post idiotic comments that don't address the post you are replying to. This makes you sound like a simpleton.
     
  11. p53

    p53 ****** for F******
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    Let me inform you since you are uneducated on general radiology.

    A general radiologists does the following.

    1. Biopsies of neck, lung, breast, mediastinum, liver, kidney, adrenal glands, chest or abdominal masses, or other soft tissue masses. Majority of them CT guided or US guided.

    2. Arthrograms is an invasive procedure of the knee, shoulder, and hip.

    3. Angiograms, Cystograms, IVPs, Retrograde uretrograms, hystosalpingograms, swallow studies, barium swallows

    4. Central lines that the ED physicans can't get are sent to the radiologists for image guided.

    5. Spinal Taps that the ED physicians can't get are sent to the radiologists.

    These are the ones I can think of from the top of my head. Go to any community hospital in the U.S. and you will see general radiologists do these procedures.

    Just because you are in an academic institution DO NOT assume general radiologists just sit in the dark room all day.

    I will repeat radiology residencies are 5 years because they are trained to read images, and do procedures. In private practice, all radiologists do procedures.
     
  12. DropkickMurphy

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    Actually I've worked in numerous hospitals and I've only seen a few radiologists do these procedures. There's too much variability in regional practices and personal preferences to say that at any hospital you will see general radiologists doing these things.

    We all have our niches, I certainly wouldn't want to be resuscitated by the average radiologist and I wouldn't want an average EP trying to coil a pelvic bleeder. So drop the attitudes- and this goes for everyone on both sides of the issue.
     
  13. Apollyon

    Apollyon Screw the GST
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    You sound REALLY defensive.

    In reality, radiologist and EM docs work together, but each does their own thing, because that is what each is interested in.

    Certainly, LPs we can't get, we send to radiology. However, I've never sent a patient to rads for a central line I couldn't get. If rads has to do it, the patient has to be added to the schedule. By that time, they've been admitted. Central dialysis access that has to be replaced doesn't count, because I don't do that in the first place.
     
  14. p53

    p53 ****** for F******
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    I'm glad I had a chance to inform you on procedures that a general radiologist is qualified to do. As long as you remember interventional radiologists are not the only ones that do procedures you will be okay.

    Ask me any more questions if you need to learn more about radiology.
     
  15. p53

    p53 ****** for F******
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    Really? Who else in a hospital would be qualified to do procedures that I listed? Do you think pathologists do the image guided biopsies? Nope. Do you think Ob does hystosalpingograms? Nope. Do you think GI docs do barium studies, esophograms, or swallow studies? Nope. Do you think Orthopods do arthograms? Nope.

    Every image guided biopsies are done by radiolgists. Just because you don't see them done doesn't mean it doesn't happen.

    All I am saying is that ED docs should not overgeneralize and piss on radiologists by saying all they do is sit in dark rooms. This is untrue. They do many procedures. It looks like we have finally established this fact so let's bury this debate.
     
  16. Apollyon

    Apollyon Screw the GST
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    One of my best friends is a radiology chief resident, and I have more than 10 people in radiology at Duke that I can contact with my questions. If I need to learn more about radiology, I will continue to use these resources.

    I hope you relax a bit. You might burn out.
     
  17. p53

    p53 ****** for F******
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    Now who's defensive? Ask your chief resident or any of the "10 people in radiology at Duke" if Mallinckrodt is a better program than Duke. :idea:

    Can we just drop this debate? You have learned that radiologists do not just "sit in the dark" so the discussion is getting old.
     
  18. Apollyon

    Apollyon Screw the GST
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    You missed the point. I have real-world alternatives that I 100% prefer to anonymous online people with an agenda.

    I don't have any need to say who is better or worse, because (like in EM), I believe rads programs to be essentially equal - once again, you are defensive.

    Once again, you need to relax before you burn out.
     
  19. p53

    p53 ****** for F******
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    Once again you missed the point. The point is that you or (an ED attending) should not make blanket generalizations of something you know little about such as "radiologists just sit in the dark" or "Rad programs are essentially equal". If you need information you can contact your buddies or you may ask me. I'll be happy to educate you.

    Keep your focus on ER and do not talk about radiology since you are clearly ignorant on the subject.
     
  20. Apollyon

    Apollyon Screw the GST
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    Ironically, you make blanket statements...while deriding blanket statements.

    You MUST be a resident, because you obviously lack social graces, collegiality, or any modicum of good manners. Beyond that, you could use a liberal dose of humility.

    By the way, I, too, am an EM attending, and you seem to miss the point that you are in the EM forum. Clearly, if you think that a few posts on a message board make me "clearly ignorant" of your field, you are narrow minded and an insult to your collegial, professional colleagues. Fortunately, the radiologists on SDN that are your polar opposite greatly outnumber you, since they are indeed colleagues, and are 1. more humble 2. more polite and 3. more helpful.

    Finally, your stabbing of your fellow residents in the back by outright stating tht programs are not essentially equal is demoralizing and reflects poorly on you.

    Don't go away mad - just go away.
     
  21. southerndoc

    southerndoc life is good
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    Man, talk about striking a nerve. I haven't seen someone get so pissed about their specialty. p53 is correct that radiologists do perform a lot of procedures in places where IR-fellowship trained specialists aren't available, but in these settings, there isn't a great deal of frequency of the procedures.

    p53 may receive requests for line placement by medicine physicians who cannot place central lines, but no recently trained emergency medicine physician should ever need to have IR or radiology place a line. I think our familiarity with ultrasound makes line placement more successful.

    So to avoid hurting anyone's feelings, we should probably refrain from stating that radiologists sit in a dark room all day long (even though they do this the majority of their day), just as we get aggravated when other specialists call us "triage docs" (even though we do this the majority of our day).
     
  22. JkGrocerz

    JkGrocerz Member
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    back to the topic at hand...

    there is burn out in every field...Do you think that 60 yearold internist who's been dealing with primary care shi* for the past 30+ years isnt sick of it? same goes for radiology, EM, surg, etc. If you do the same thing dayin and day out for years and years without expanding your horizons, you will get sick of it. The key is to pick what you enjoy DOING and don't let the "crap" that comes with every field sway you from it. you're gonna run into crap everywhere so it's inevitable.
     
  23. ERMudPhud

    ERMudPhud Back for a visit
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    Even after rereading it I can't see what Bartleby said that got p53 so wound up. The original poster clearly stated that what he liked was hands on patient contact without long term continuity of care and was considering Rads with the idea that interventional would eventually give the patient contact component. Bartleby was just pointing out that even if you eventually become an interventionalist you will still spend plenty of time away from patients reading studies. He never said we did more procedures or that diagnostic radiologist never do procedures. That being said, in many community settings virtually all procedures are done by the interventionalists with the general radiologist doing very few of them. At several of the community hospitals I've worked at that includes things as basic as an LP, something all the radiologist have done plenty of as residents but choose not to do after they are in practice. Even with all the procedures going to the interventionalists there may still not be enough volume in community practices to fill up their time. I have a friend who is a neurointerventionalist in a community group practice who admits she spends a good bit of her time reading studies, including studies that aren't even of the nervous system. So, if you are interested in radiology you have to realize that you will spend a good deal of time reading studies and not seeing patients. For some people that is a plus but not for everyone. Before p53 gets all upset again, I'm an attending with 9 years in the field and I've worked at university, county, HMO, and community hospitals and the only places I saw where the interventionalists did nothing but procedures was the academic centers. In the community some of them even have to take general radiology call.

    As an aside with all the digitial imaging and bright monitors with adjustable contrast do the rooms still need to be dark?

    To the original question about burnout. Sure there are times that I pick up a chart and discover it is another LOL WADAO and cringe only to discover they are a totally delightful patient, or here with a great family, or that they have an interesting diagnosis that I'm the first to figure out. Then I remind myself not to dread the next chart.
     
  24. totalbodypain

    totalbodypain banana bag in hand
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    yawn.....zzzz....snort. huh what? :sleep:
     
  25. poloace

    poloace Senior Member
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    wow-

    there were like 4 replies when i checked on this thing last night. i asked a very simple question. do the ER docs ever feel like they see so much crap interspersed with all the cool stuff that they actually have the priveledge of seeing (and, i know- they see a lot of both) that makes their feel worthwhile.

    in addition, p53, do you ever feel like what you do may be monotonous? or, is there enough diversity in what you see to keep you interested the whole day?

    i really love both fields for different reasons. in the ER- i look up at the clock and its time to go home... in radiology... its like art history. where did this come from - what do you think about this picture... any abnormalities that you can point out, etc.

    p
     
  26. Apollyon

    Apollyon Screw the GST
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    You might want to post this question in the radiology forum. Some people may be less "highly excitable" there.

    I can tell you, though, that any field by people that are not in it could be seen as "monotonous", but people in the field don't agree - that's why they're in it.
     
  27. bartleby

    bartleby Senior Member
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    This isn't actually a sentence, but I'll take it to mean that you're attempting to take issue with my original post.


    When I was a resident on the surgical service, I scrubbed in on appendectomies and cholecystectomies, so I was "trained" to do those too, but I'm doing about as many of those on a daily basis as you're going to do cerebral angiograms straight out of a diagnostic radiology residency.

    Neither I nor any other physician I've ever met has ever "consulted" a radiologist. But I'll admit..I've never actually met a radiologist in person. I've just seen them on TV.
     
  28. p53

    p53 ****** for F******
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    For an attending, I'm very surprised by your response. Once again, these procedures are ALL done by a freshly minted general radiologist. In fact, these are required to receive accreditation from the ABR (American Board of Radiology) .

    Let me inform you since you are uneducated on general radiology.

    A general radiologists does the following.

    1. Biopsies of neck, lung, breast, mediastinum, liver, kidney, adrenal glands, chest or abdominal masses, or other soft tissue masses. Majority of them CT guided or US guided.

    2. Arthrograms is an invasive procedure of the knee, shoulder, and hip.

    3. Angiograms, Cystograms, IVPs, Retrograde uretrograms, hystosalpingograms, swallow studies, barium swallows

    4. Central lines that the ED physicans can't get are sent to the radiologists for image guided.

    5. Spinal Taps that the ED physicians can't get are sent to the radiologists


    For the last time, Interventional Radiology is not the same as general radiology. Once you do an interventional radiology fellowship. One is trained to do IVC filters, chemoembolization, stents, embolization, CT guided thermal ablation of liver, lung, kidney, etc.

    Why is it so hard for the ER attendings here to figure out that interventional radiology procedures are NOT the same as General Radiology Procedures? Is this a difficult concept?

    Let me use an analogy. General Radiology is like General Surgery. Interventional Radiology is like.....

    Nevermind, I will have to take the time to explain what a fellowship means to your guys.
     
  29. SoCuteMD

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    To be fair - your #4 is a bit off. If the ED physicians can't get central venous access, the patient is either a) screwed or b) accessed using two peripheral veins (in the ED in which I've spent most of my time). Option b, according to the attendings I work with, is considered equal to having central venous access (especially for volume repletion, because those triple lumens SUCK at moving volume...). Thus, if they can't get a central line in the ED (and in the ED I spend time in, all central lines are done utilizing u/s) then they just don't get one during their time with us. They may get one if they go up to the floor, but that's medicine, not EM.

    I think you'd be hardpressed to find a residency-trained ED physician with u/s at their disposal who would have to turf a patient to rads to place a central line.
     
  30. fuegorama

    fuegorama Senior Member
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    Thanks for the clarification. By your example I now know that radiologists are actually short-fused, very angry people sitting in the dark.
     
  31. BKN

    BKN Senior Member
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    fatty . . .
     
  32. phillyfornia

    phillyfornia Member
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    i have a feeling that i'd burn out pretty quickly in ER. that's why i'm considering doing something else.

    btw, what exactly are the "cool" things that you think ER docs do? personally, i like the small things like I&Ds, suture lacs, and LPs right now, but i have a feeling that those things get old really fast. in fact, the attendings and senior residents don't seem to be interested in those things at all anymore. as far as trauma goes, it's kind of cool seeing these people come in, but it seems like the surgeons get to do the real cool stuff with these patients (needle decompressions, chest tubes, etc). maybe it's just the institution where i'm at.

    also, isn't p53 an ms-iv? that's always the impression i got. also, is what s/he saying true? that's pretty cool if general radiologists get to do those procedures (biopsies, arthrograms, etc.)
     
  33. st0rmin

    st0rmin Unregistered User
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    [​IMG]
     
  34. Jeff698

    Jeff698 EM/EMS nerd
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    Man, I just love that image!

    Take care,
    Jeff
     
  35. drsutter

    drsutter Junior Member
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    i am 3 years out of my EM residency and already burned out.
     
  36. phillyfornia

    phillyfornia Member
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    lol. i wish i was trolling. the truth is that i'm on my second EM rotation (i was almost certain that i'd go into EM at the beginning of the year) and i'm already getting a bit sick of being in the ER. the things that i thought were cool aren't that cool anymore; the crappy things about EM ended up being crappier than i thought they'd be.

    for the OP, i'd suggest doing a rotation in EM. see if you would be happy working in the ED for the next 20 years of your life. personally, i think that it would be fun working there for 3-4 years, then i'd be sick of it. it's one of those fields that requires a certain type of personality. i've realized that it's just not my cup of tea. i know a lot of cool people that really like it though. give it a try.
     
  37. Jeff698

    Jeff698 EM/EMS nerd
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    Philly,

    What a great post. You're absolutely right. Just like any other specialty, EM isn't for everyone. The single best way to discover if it is for you is to do as you suggest...do it. Try a rotation.

    I'm a big believer that, for those docs who seem like the perfect match, the specialty chooses them. Again, you're right. It's like a high-stakes personality test. Each specialty has it's own personality. Docs with that personality type 'fit' best in a that specialty.

    Thanks again for a great post.

    Take care,
    Jeff
     
  38. st0rmin

    st0rmin Unregistered User
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    I have a friend from school in your same situation. He thought that he would be very happy in EM, rotated, and discovered it really wasn't what he thought it would be (no, he wasn't brainwashed by ER the TV show or anything, he just had different expectations). He ended up choosing something different and is now happy (I think) doing what is best for him.

    Great suggestion on doing a rotation. If you haven't been there how can you really make an informed decision?

    **slowly takes down the don't feed the troll sign**
    :)
     
  39. p53

    p53 ****** for F******
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    This talk about burnout is really a non-issue. It is not exclusive to ED physicians. It is found in every specialty. The key is a well balanced life.

    How about increasing your extracurricular activities. Don't put all your energy into work. Have a balance. For me that is taking girls out and NOT talking about medicine. There is nothing like playing the field.

    What things do you like? Golf? Hiking? Traveling? Use your hobbies to replenish your energy.

    If you are working nonstop chasing $$$$ you will be miserable in and outside the hospital.
     
  40. leorl

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    So out of curiousity, what kind of personality types go into ER?
     
  41. doctawife

    doctawife Rocephin is for wimps
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    Well, most of the folks I know that are happy in ER land are somemix of the following:

    - slightly ADHD
    - manic as all hell
    - smart
    - relatively low tolerance for BS
    - energetic (this ain't no place for a lazy lout!)
    - forceful personality
    - funny, yet sarcastic (kinda like the long term posters here)

    People who don't do well in the EC:

    - slow. Here I mean the pace of his or her work; I know some very bright people who are perfect for genetics or endocrinology or whatever, but they just move through the day at a pace that makes a snail look fast. These folks are NOT good in the EC.
     
  42. NEMC

    NEMC Junior Member
    7+ Year Member

    Joined:
    Aug 17, 2006
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    Looking back to my ER friends, all fit. :) And I count myself as only-- ADHD and manic (but not as hell), maybe half smart.. so I stay with IM.

     

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