As others have stated, ultimately it's about obtaining maximal happiness. For some, that's a 9-5 job after a pain fellowship. For me, if I had to go to pain clinic, you would find me at 8:30AM in the garage with the car running and a hose hooked up to the tailpipe. No amazing schedule could make me enjoy it. I think it's important to differentiate the trade off between "great schedule + doing what I hate" and "horrible schedule + doing what I love". For me, trying to find a balance between those two ends of the spectrum has always been challenging. Derm was appealing to me for many reasons, but I would do what I hate. Surgery was appealing to me for many reasons, but I wouldn't have lasted through the residency. For me, I think EM is more leaning towards the horrible schedule + doing what I love part of the spectrum. I think the constant goal is to find a way to pull you more towards the middle. Pain management/palliative care are definitely viable options, IF and only if you actually like the medicine. An overnight 12 hour shift in our resuscitation area for me flies by in the equivalent of 4 hours. A 9-5 in a pain clinic would be slow and painful torture for me.
For me, I see the appeal to academics. Many faculty in their 50s or 60s are working 6 clinical shifts a month (and no nights in our academic group). Sure, they work an additional 20 days a month. But depending on what they do, those days are a 9-5 job. Roll into the office at 9am, go to some meetings, do some research, give some lectures. Travel to some conferences. Grab lunch with your colleagues, go on an evening bike ride and then relax at home for the evening. Sure, there are pressures to publish, to get promoted, etc, so it's definitely not all rainbows and unicorns in the academic world.
Unlike the above poster, I would rather have 7 hectic clinical shifts and 20 days of work, than 7 hectic clinical shifts and 23 days off. I know that makes me crazy, but overall, I like medicine, I like the workplace, I like working with residents, students, etc. If I hate it after awhile, I'll leave and do something else.
I am also horrible at rock climbing. I mean what else do EM docs do outside of work? I would be bored out of my mind.
Critical care called to me awhile ago, but I don't think working in an ICU with mechanically ventilated patients of which roughly 1 in 3 will never leave your ICU is the key to solving the burnout problem. It's a phenomenal subspecialty that we have access to, but go into it for the right reasons. Nobody should be saying, "I'm going into CCM for the lifestyle".
Whatever you do, don't fall into the trap of making EM "just a job that pays the bills". While financial success is, IMO one of the many pillars of happiness and stability, it is only one pillar. If you hate your job, it won't be worth it. Strive for something within EM that makes you happy and gives meaning to your work.
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