Female EM physicians leave the field about 12 years earlier than their male counterparts

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Brigade4Radiant

Brigade4Radiant

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Female emergency physicians leave EM workforce >12 years b/f male EPs

Also: Two-thirds of 55 y/o+ EPs have been sued, TeamHealth’s debt, ED psych boarding is unconstitutional, & residents on strike.
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I wonder what the numbers will be after the pandemic

I plan do only do part time by 45.
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It’s hard to be a parent when you are flipping from 6am, to 8pm, to 2pm, leaving at 2 am to be back at 4pm etc…
We also miss holidays, birthdays, weekends etc…
 
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Men leave EM at age 53.

Women leave at 43.

I left at 38.

What does that make me?
 
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Those who leave, do they retire from the workforce altogether or pivot to other careers, do we know?
 
I would venture to guess that more female physicians are married to docs and other high wage earners than vice versa. I know of 2 EM docs whose husbands basically dont work. The rest are employed in white collar work or are docs. On the other hand I know a ton of docs whose wives dont work.

Much easier to quit if you have 2 incomes.
 
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I am a woman who left EM completely at 42, but I'd begun phasing out about 4 years prior to that. I changed specialties, though.
My husband is a nurse - who talks more and more about early retirement every day, it seems.

His children are grown and out of the proverbial nest and I fall into the happily child-free category. I am now Nonna. Nonna has another grandchild on the way, and yes, I give them sugar and send them home and it's much easier than raising them I hear, but that is not why I left. I left pre-pandemic for the same reasons Birdstrike left. Well, right as the pandemic hit because I didn't need those shifts and my EM colleagues did, so I gave my last ones away and jumped ship to my not-quite-full-time hospice gig.
 
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I don't think leaving sooner, means I'm smarter than anyone else here. I'm not.

Perhaps I wasn't tough enough to stay and didn't have the coping mechanisms to withstand it any longer. Or perhaps it's because my wife was very supportive and encouraged me by saying, "Do this now. Why wait until it's too late to make a difference?" And she was willing to suffer with me for that fellowship year with an 80% pay cut and a move to an overwhelmingly massive, expensive and crazy city with a cat, dog, child starting school for the first time and another in diapers.

Some of it is luck or fate. What if that one (out of 40 fellowship directors I emailed) hadn't replied with, "Of course Emergency Physicians can do Pain Fellowships?"

What if that one program out of the dozens I applied to hadn't offered me a spot? None of the others were willing to give me a shot.

Would I have given up, or would I have found some other way out?

I don't know.

But I don't think any of it is because I'm "smarter" or know anything, others don't. I'm not and I don't.

I do think there is a sore of brainwashing, a haze of doubt that sets in upon us in Medicine, especially in Emergency Medicine, that you can't leave. You can't change. You MUST do this everyday, every year until the day you retire (or die). My wife helped snap me out of that brainwashed haze. "Of course you can change careers. Of course you don't have to do this anymore if you don't want to. People change careers all the time." My brain just couldn't accept the idea that I didn't have to be that same ER-guy-til-I-die, until I finally allowed myself to accept the idea. Then once I did, I felt like I was given a new lease on life. It was the most refreshing, invigorating, battery recharging feeling I had felt in my whole life. Then, once I realized EM would always be there for me to go back to (at least for the first year or two), if the new reinvention of myself didn't workout, then there was no stopping me.
 
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Not surprising women leave earlier since they get leaned on to do more child/family care than men (plus the actual pregnancies!)

Sad state of affairs that we as a society / specialty can’t find a way to support them in modified or part time work, considering their training and skill… but hey it seems like all genders of EPs are running for the hills ASAP. Childcare is insanely expensive, etc etc.

A couple of the absolute best pit docs I’ve ever known transitioned entirely out of the ED while still under 40… to completely non-clinical work (one more WHO stuff, the other out of medicine entirely). I’m sure part of the reason was motherhood, family, hours… but I think the general state of EM played a big role.

I’ve known another couple that are excellent (I can think of 1-2 that are fellowship trained as well) that basically work daytime UC or other similar lower-acuity, lower-pay, lower-stress jobs largely for scheduling reasons.
 
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I left, but I have to say that I haven't found any other paid work. It's OK, I don't want, in any way, to go back, but there does seem to be a lack of remunerative options out there, at least for me,
 
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The only reason(s) I'm still doing this is (are):

-Pay is still good for a classically lower pay region
-No overnights
-Department structure that makes it easier to slack off while still being a rockstar compared to most

If any of these change, I'll be out the door.

I'm already signed up for obesity medicine boards for later this year. I have no idea what I will do with that merit badge but hipefully something useful.
 
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Janders said:
Not surprising women leave earlier since they get leaned on to do more child/family care than men (plus the actual pregnancies!)

Sad state of affairs that we as a society / specialty can’t find a way to support them in modified or part time work, considering their training and skill… but hey it seems like all genders of EPs are running for the hills ASAP. Childcare is insanely expensive, etc etc.

A couple of the absolute best pit docs I’ve ever known transitioned entirely out of the ED while still under 40… to completely non-clinical work (one more WHO stuff, the other out of medicine entirely). I’m sure part of the reason was motherhood, family, hours… but I think the general state of EM played a big role.

I’ve known another couple that are excellent (I can think of 1-2 that are fellowship trained as well) that basically work daytime UC or other similar lower-acuity, lower-pay, lower-stress jobs largely for scheduling reasons.
Click to expand...

The issue in EM is that nobody really gets special treatment. I'm sure we'd all love to work just day shifts during the normal work week. If you go part time then you still work a proportionate number of holidays, evenings, nights, weekends, etc. You also get paid proportionately less. If you don't work then you don't make money. I'm all for supporting new parents and families (I think we need to do more to provide everyone childcare so the parents can continue to be productive members of society) but they also shouldn't expect to get paid for work that isn't done.
 
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NYEMMED said:
It’s hard to be a parent when you are flipping from 6am, to 8pm, to 2pm, leaving at 2 am to be back at 4pm etc…
We also miss holidays, birthdays, weekends etc…
Click to expand...
Totally agree, the sleep schedule flipping in particular is horrible. Being post-nights zombie mode makes it hard to be a fun parent.
 
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I wrote a post a long time ago called, "EM Physician Bill of Rights & Responsibilities and 'The Big Lie' of EM." It had a list of things that I thought would make EM a livable specialty, over a career. It was mostly work quality-of-life rules, limits and requirements, as opposed to ACEP's which is mostly contractual, full of legalese, ignoring the original sin, the poison pill within EM. My post also detailed how the most lifestyle-destructive speciality in all of Medicine was, and still is, brilliantly and successfully marketed as Medicine's easiest and cushiest "lifestyle specialty" akin to part-time/part-vacation work.

My ideas gained very little traction, as they were seen as unrealistic, "impossible to implement," or perhaps even unneeded. I've since deleted the post.

However, I still think you shouldn't be able to work so much that you get so burned out you're begging for release from your career-prison by age 35. If there can be workable limits on the hours, schedule, and occupational hazards faced by airline pilots and nuclear power plant workers, there can be on EM physicians. But since the hazards faced by Emergency Physicians are very hard to define, since they often times subclinical (chronic shift-work depression), psychological or emotional, no one is willing to acknowledge their existence, let alone their severity and importance.

It's hard to measure and limit how "soul-crushed" you feel, how much empathy you've lost, how depressed, depleted or apathetic your job is making you and how much those feelings tarnish every moment of your "off" time. After all you "signed up" to wear a cape and do, face, react to things others can't even imagine doing.

But you can take the cape off.
 
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JacobMcCandles said:
The issue in EM is that nobody really gets special treatment. I'm sure we'd all love to work just day shifts during the normal work week. If you go part time then you still work a proportionate number of holidays, evenings, nights, weekends, etc. You also get paid proportionately less. If you don't work then you don't make money. I'm all for supporting new parents and families (I think we need to do more to provide everyone childcare so the parents can continue to be productive members of society) but they also shouldn't expect to get paid for work that isn't done.
Click to expand...

That's true and it's the correct way of doing the business. Until ER's are 18/7 and not 24/7, if one only wants to work weekday shifts, they have to pay for that right to do that. They need to support those who are working nights and weekends. And that will cost one $$$.

If one chooses to be an ER doctor, they are signing up for nights and weekends.
 
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You can also do part time in ER also while ER you work nights and weekends you also work 12-14 days and make significantly more than most
 
Anyone know the historical context as to why insurance has the same reimbursement no matter the day of the week or time of day? One big fix to EM would be a X% pay bump for evening and weekend hours and X++% bump for overnight charges/collections to disincentivize patients off hours or at least make it worth our while.

Some private practice dentists I know have a surcharge fee if you call the on call number off hours and mega fee if they come in and open the practice for you in the rare situation it’s needed. Seems like a sensible program that limits the BS but keeps a needed service available for a fair price in the rare situations it’s needed.
 
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Brigade4Radiant said:
You can also do part time in ER also while ER you work nights and weekends you also work 12-14 days and make significantly more than most
Click to expand...

I envision a future (no pun intended) where most EM docs do part-time EM and part-time something else, to retain their humanity.
 
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RustedFox said:
I envision a future (no pun intended) where most EM docs do part-time EM and part-time something else, to retain their humanity.
Click to expand...

Plan on going down to 8 shifts month
 
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Birdstrike said:
I don't think leaving sooner, means I'm smarter than anyone else here. I'm not.

Perhaps I wasn't tough enough to stay and didn't have the coping mechanisms to withstand it any longer. Or perhaps it's because my wife was very supportive and encouraged me by saying, "Do this now. Why wait until it's too late to make a difference?" And she was willing to suffer with me for that fellowship year with an 80% pay cut and a move to an overwhelmingly massive, expensive and crazy city with a cat, dog, child starting school for the first time and another in diapers.

Some of it is luck or fate. What if that one (out of 40 fellowship directors I emailed) hadn't replied with, "Of course Emergency Physicians can do Pain Fellowships?"

What if that one program out of the dozens I applied to hadn't offered me a spot? None of the others were willing to give me a shot.

Would I have given up, or would I have found some other way out?

I don't know.

But I don't think any of it is because I'm "smarter" or know anything, others don't. I'm not and I don't.

I do think there is a sore of brainwashing, a haze of doubt that sets in upon us in Medicine, especially in Emergency Medicine, that you can't leave. You can't change. You MUST do this everyday, every year until the day you retire (or die). My wife helped snap me out of that brainwashed haze. "Of course you can change careers. Of course you don't have to do this anymore if you don't want to. People change careers all the time." My brain just couldn't accept the idea that I didn't have to be that same ER-guy-til-I-die, until I finally allowed myself to accept the idea. Then once I did, I felt like I was given a new lease on life. It was the most refreshing, invigorating, battery recharging feeling I had felt in my whole life. Then, once I realized EM would always be there for me to go back to (at least for the first year or two), if the new reinvention of myself didn't workout, then there was no stopping me.
Click to expand...
You’ve mentioned before that your pay is in the same ballpark as above-average EM attendings. Would you still have done pain if the income was 25%, 33%, or even 50% lower than EM?
 
JacobMcCandles said:
The issue in EM is that nobody really gets special treatment. I'm sure we'd all love to work just day shifts during the normal work week. If you go part time then you still work a proportionate number of holidays, evenings, nights, weekends, etc. You also get paid proportionately less. If you don't work then you don't make money. I'm all for supporting new parents and families (I think we need to do more to provide everyone childcare so the parents can continue to be productive members of society) but they also shouldn't expect to get paid for work that isn't done.
Click to expand...

As a parent of a little one, I agree.

No one else should be responsible for the decision I made to have children. Everyone works the same distribution of shifts.

That Goes for financially too. I'm in a state that started mandatory payroll deductions for state sponsored maternity leave. Ridiculous. No one should have to foot the bill for other peoples childcare. Children are a luxury item in 2023, not a farmhand like they were on 1875. When my kid was born i budgeted money to take a month off unpaid time off. If you can't afford children, you shouldn't have them.
 
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GonnaBeADoc2222 said:
As a parent of a little one, I agree.

No one else should be responsible for the decision I made to have children. Everyone works the same distribution of shifts.

That Goes for financially too. I'm in a state that started mandatory payroll deductions for state sponsored maternity leave. Ridiculous. No one should have to foot the bill for other peoples childcare. Children are a luxury item in 2023, not a farmhand like they were on 1875. When my kid was born i budgeted money to take a month off unpaid time off. If you can't afford children, you shouldn't have them.
Click to expand...

Yeah I really get upset when my colleagues that need to do something with their children try to ask me to do a crappy trade like work Saturday for a Thursday and then guilt me by saying man “I would love to do x and y with my daughter”

I already get taxed enough! I won’t do any crappy trades. If you want time off with your kid just give up the shift but they dont want to do that
 
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Brigade4Radiant said:
Yeah I really get upset when my colleagues that need to do something with their children try to ask me to do a crappy trade like work Saturday for a Thursday and then guilt me by saying man “I would love to do x and y with my daughter”

I already get taxed enough! I won’t do any crappy trades. If you want time off with your kid just give up the shift but they dont want to do that
Click to expand...
That’s quite douchey of them.
 
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dchristismi said:
I am a woman who left EM completely at 42, but I'd begun phasing out about 4 years prior to that. I changed specialties, though.
My husband is a nurse - who talks more and more about early retirement every day, it seems.

His children are grown and out of the proverbial nest and I fall into the happily child-free category. I am now Nonna. Nonna has another grandchild on the way, and yes, I give them sugar and send them home and it's much easier than raising them I hear, but that is not why I left. I left pre-pandemic for the same reasons Birdstrike left. Well, right as the pandemic hit because I didn't need those shifts and my EM colleagues did, so I gave my last ones away and jumped ship to my not-quite-full-time hospice gig.
Click to expand...
What did you switch to?
 
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RustedFox said:
We have a few of these.
They're invariably female.

"But if you will make this four way swap then I can take my kids to breakfast with Santa."

Eff you.
Click to expand...

Yeah they are always the moms
 
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MechEDoc said:
What did you switch to?
Click to expand...
Hospice and Palliative. Except I just do Hospice; and within that, I negotiated a gig where I just do inpatient-level hospice at a freestanding facility. But I'm kinda touchy feely. Fox knows me IRL and can attest to that. But I swear a lot, which is actually helpful because a lot of times, my families need debriefing from really traumatic ICU experiences. And since I used to inflict those things on people, well, you know.

So if you're dying and terribly symptomatic, or critically ill and need something deescalated... like you have a perfed bowel, or intractable cancer pain perhaps from a cord compression and can't tolerate lying on the table for radiation, or are dying with the sensation you can't breathe from your end stage MS/ALS and want to be gracefully liberated from your life support... you can come to my hospice house and I will gently manage your symptoms whist you ease your way to the other side. I can make it easier, but the patient has to do the work. Or maybe you just need your symptoms (pain/anxiety/dyspnea/nausea) managed because you aren't dying quite yet (but probably in the next 6 months) and your old doctor (or the VA) won't touch methadone because it's scary and this is Florida.

If you're dying relatively peacefully and serenely, you don't need me. Pretty niche.
 
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TooMuchResearch said:
We do this all the time, for lots of reasons. Kid stuff, adult stuff, you name it, we swap around for it.
Click to expand...

I'm okay with it when the swap is reasonable, and its not every month, from the same people, for the same reasons (Kensleee can show me her pottery class or whatever).
 
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Brigade4Radiant said:
Yeah I really get upset when my colleagues that need to do something with their children try to ask me to do a crappy trade like work Saturday for a Thursday and then guilt me by saying man “I would love to do x and y with my daughter”

I already get taxed enough! I won’t do any crappy trades. If you want time off with your kid just give up the shift but they dont want to do that
Click to expand...
I don't understand feeling guilty in that scenario. It sounds like your group is hungry for shifts and someone will be willing to simply pick up the shift if given up. In that case, I don't think that the other party asking is inappropriate, provided they aren't a dick if you say no.

This is, of course, unless they're habitually asking for weekends off and not offering something of similar value (a different weekend / overnight / whatever) in return. In that case this isn't a "parent" thing, this is a "mooch" thing.
 
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Crappy trades are crappy trades.

Have my coworkers ever asked me to cover something for a special / (or sick) kid thing? Sure.

I have kids too. We get it. But it isn’t a guilt trip or a crappy trade, its a “sorry, I really need Thursday PM off what can make that work” trade… I’ve been asked the same thing for concerts, trips to Vegas, weddings, sick dogs, whatever. Hell, I have gotten way less asks to cover weird kid stuff than I have weird academic stuff by the academic/hybrid docs I work with! But the key is… it isn’t a guilt trip? Its a group that will try to help each other and pay each other back… gotta keep the positive vibes going. And if someone asks me to cover their Friday overnight in exchange for my Tuesday AM, I just laugh and show them my upcoming weekend shifts they may be interested in.

And I agree w/ above, I wouldn’t expect groups to be able to just assign all young mothers to week day 9-5 shifts with equal pay-per-hour and no downside. But stepping back, the current situation has been tons of these physicians completely leaving the field of EM. I wonder what a better solution would be, even things like 2/3 time with a predictable, templated (but including night/weekend) schedule might help.
 
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BoardingDoc said:
I don't understand feeling guilty in that scenario. It sounds like your group is hungry for shifts and someone will be willing to simply pick up the shift if given up. In that case, I don't think that the other party asking is inappropriate, provided they aren't a dick if you say no.

This is, of course, unless they're habitually asking for weekends off and not offering something of similar value (a different weekend / overnight / whatever) in return. In that case this isn't a "parent" thing, this is a "mooch" thing.
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Agreed. I start off with the attitude that if I can help a colleague out, I will. Most of the docs in my group are great and we almost never have trouble getting even pretty undesirable shifts covered quickly. There's only one guy who never steps up when I need it, but is unafraid to ask me to pick up his Saturday 5pm shift. I just say no to his requests unless they actually benefit me, and I don't feel guilty about it.
 
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I almost left but stayed because I couldn't find anything better in terms of money/time/flexible. When I find it, I'll bail. Till then, I'll stay in shape till find a sugar mama or burn out.
 
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GonnaBeADoc2222 said:
As a parent of a little one, I agree.

No one else should be responsible for the decision I made to have children. Everyone works the same distribution of shifts.

That Goes for financially too. I'm in a state that started mandatory payroll deductions for state sponsored maternity leave. Ridiculous. No one should have to foot the bill for other peoples childcare. Children are a luxury item in 2023, not a farmhand like they were on 1875. When my kid was born i budgeted money to take a month off unpaid time off. If you can't afford children, you shouldn't have them.
Click to expand...
That fact that you're calling children a luxury item is concerning unless you want to go the way of Japan.

Purely from an economic standpoint, it makes sense to support people having children. We will need young workers so we can eventually retire and pay for the next 40 years of baby boomer SS and Medicare (plus, you know, us in another 20-30 years). My wife's hospitalist job when she had our girls gave her 3 months fully paid for maternity leave. That was on top of the 1 month of short term disability when she was on OB-ordered bed rest. It was a godsend. Having babies as stressful enough without having to significantly worry about money.
 
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VA Hopeful Dr said:
That fact that you're calling children a luxury item is concerning unless you want to go the way of Japan.

Purely from an economic standpoint, it makes sense to support people having children. We will need young workers so we can eventually retire and pay for the next 40 years of baby boomer SS and Medicare (plus, you know, us in another 20-30 years). My wife's hospitalist job when she had our girls gave her 3 months fully paid for maternity leave. That was on top of the 1 month of short term disability when she was on OB-ordered bed rest. It was a godsend. Having babies as stressful enough without having to significantly worry about money.
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Similar with education funding (and why I oppose tax credits for parents who pull their kids out of public schools). Similar with police and military funding. Just because I don't "use" the service doesn't mean I shouldn't have to pay those taxes. I live in the society that is benefitted from those taxes being paid, so I should contribute my fair share.

Medicine functions better when the doctors have decent lives. I support the policies that make doctors' lives better, even if they don't directly benefit me.
 
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Brigade4Radiant said:
Yeah I really get upset when my colleagues that need to do something with their children try to ask me to do a crappy trade like work Saturday for a Thursday and then guilt me by saying man “I would love to do x and y with my daughter”

I already get taxed enough! I won’t do any crappy trades. If you want time off with your kid just give up the shift but they dont want to do that
Click to expand...

That is a good point - if you have a few kids it's hard to be at all of their functions (soccer games, birthday parties, etc) and not have it interfere with work. If you want to be an ER doc, you are gonna have to make some (not a lot though) sacrifices like this.

Unless you are lucky enough to enter a group where you have nocturnists and weekend docs, then you are really lucky
 
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As long as there is an even distribution of days, nights, weekends for all the full timers working at an ER, what happens afterwards is not an issue. People swap shifts all the time. If a Mom is constantly swapping/exchanging her shifts and people pick them up, it's not a problem at all!

It's only a problem is there is preferential treatment for some and not others. Like a handful of docs never work weekends. If the scheduling is fair, there is no problem (and not even douchy) if people want to swap shifts.
 
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Janders said:
And I agree w/ above, I wouldn’t expect groups to be able to just assign all young mothers to week day 9-5 shifts with equal pay-per-hour and no downside. But stepping back, the current situation has been tons of these physicians completely leaving the field of EM. I wonder what a better solution would be, even things like 2/3 time with a predictable, templated (but including night/weekend) schedule might help.
Click to expand...

As long as there is a fair distribution of shifts, there are lots of feasible solutions. Maybe a group is lucky enough to get some nocturnists. However in my opinion they don't last too long...after a few years many back out. IF there end up being gaps in a schedule...they have to be filled equitably.

It's hard to be an ER doc and expect entitlement to preferential shifts for whatever reason. If one cannot or does not want to work weekends, then find another job. Seems pretty straightforward to me
 
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VA Hopeful Dr said:
That fact that you're calling children a luxury item is concerning unless you want to go the way of Japan.

Purely from an economic standpoint, it makes sense to support people having children. We will need young workers so we can eventually retire and pay for the next 40 years of baby boomer SS and Medicare (plus, you know, us in another 20-30 years). My wife's hospitalist job when she had our girls gave her 3 months fully paid for maternity leave. That was on top of the 1 month of short term disability when she was on OB-ordered bed rest. It was a godsend. Having babies as stressful enough without having to significantly worry about money.
Click to expand...


Not entirely Japan /Korea can solve their population crisis if they allowed immigration. They don’t and they have restrictive policies on women in the workplace

While children are essential for a society it shouldn’t amount to another doctor taking in a less desirable schedule.

Society could easily make this happen and we won’t need any extra tax we can just take some of the military funds and pay more for paternity and maternity leave


BoardingDoc said:
I don't understand feeling guilty in that scenario. It sounds like your group is hungry for shifts and someone will be willing to simply pick up the shift if given up. In that case, I don't think that the other party asking is inappropriate, provided they aren't a dick if you say no.

This is, of course, unless they're habitually asking for weekends off and not offering something of similar value (a different weekend / overnight / whatever) in return. In that case this isn't a "parent" thing, this is a "mooch" thing.
Click to expand...

Yeah it’s a mooch tho g they want to work all of their shifts but no weekends lol
 
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Franzd'Epinay said:
You’ve mentioned before that your pay is in the same ballpark as above-average EM attendings. Would you still have done pain if the income was 25%, 33%, or even 50% lower than EM?
Click to expand...
My pain has varied in Pain. It's not a set "hourly rate." It varies based on how much I work, what work I do, how reimbursement is in a given year and how busy or slow a year is. There have been years I've made more than I made in EM. There have been years I've made less. On average I've made the same or slightly more. However, my stress is down 90% and my job satisfaction up 90%.

To answer your question, when I chose to make the switch out of EM, I decided that if I could find anything where I could have a normal life (work no nights, weekends or holidays) that I'd do it for as much as a 25% pay cut.

The pay at Pain jobs varies, also. I make significantly less that I could in a lot of Pain jobs because I have such a good setup currently. I'm in a physician owned group, with a lot of autonomy, growing ownership, control over things like my hours, days off, type of patients I see and how I practice from an ethical standpoint. That's worth much more than a few, or even a lot of, extra dollars
 
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