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

[Birdstrike]

Isn't it great?

It's actually pretty, pretty, good.

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[CoolDoc1729]

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).

Omg I’m dying 🤣 🤣 🤣

As a mom of 4 who almost never asks for any trades because I work weekend nights for the sole reason of not being at work during the weekday days. No one asks me for trades anymore because no one wants my shifts. But some of the requests I hear. Can you work my Christmas morning? I’ll pick up your Tuesday in mid January

I’d be like GTFOOH

 

[Ubba]

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.

It's hard to say no to a colleague when they guilt-trip you by bringing child-bonding time into the equation. It is always up to the person asking a favor to both explicitly give the other party permission to decline and to sweeten the pot. Could be cash or, in EM's case, maybe a deal to switch 2 weekends for 2 weekdays or 2 night shifts for 2 day shifts in the future so that the person doing the parent a time-specific favor kind of comes out "ahead" on net.

 

[hoot504]

Asking for a bad trade is one thing, but we actually have call outs for "child care" in our group, and not infrequently, either.

 

[DetroitERDO]

Omg I’m dying 🤣 🤣 🤣

As a mom of 4 who almost never asks for any trades because I work weekend nights for the sole reason of not being at work during the weekday days. No one asks me for trades anymore because no one wants my shifts. But some of the requests I hear. Can you work my Christmas morning? I’ll pick up your Tuesday in mid January

I’d be like GTFOOH

Wow how old are your kids? You are a superwoman with 4

As a mom of 2 the missing nights and weekends when they still want me around (my kids are 3 and 1) is really getting to me since I didn’t have them till I was 35 and 38. And my husband who is an engineer is around during those times . I’m jealous of that time he has with the kids since I see how precious it is

I feel blessed too since many of my friends are at the same stage ( both doctors and non medical) had to go to the IVF route which took a lot of time/money/ emotional/physical/mental toll on them. I think that might also be why women are leaving. 1 in 4 women physicians has infertility issues so they might be leaving as last chance to have a kid

Infertility in Women in Medicine - American Medical Women's Association

www.amwa-doc.org

 

[beebermd]

I personally think that we are victims of our own making in regards to EM. My own personal belief is that you can be perfectly happy in this specialty if you have can be happy with part time work and less money. Politics and future changes aside, many times I question, "why in the world cant I live well doing 6 12s/mth. At my current scale @ 275/hr, 6 12/mth = $237600/year........for.......6......days......of......work a month. Even with "a fair share" of nights/holidays/weekends, thats pretty insane compared to most people in this country. Early on, I could mentally never do this, as I felt like I was losing out on my "PRIME" earning years and felt like if I worked more now, I could save more and work even less later.

This would be my dream EM set up. The dirty little secret with all this, is that I have found that the less you work, the more expendable you become. Most places I know of arent even hiring for part time providers, and if they are, they wont guarantee shifts. If someone new comes in and wants full time, 15 shifts/month, the part time guy is going to be the first one kicked out to make room.

 

[hoot504]

I personally think that we are victims of our own making in regards to EM. My own personal belief is that you can be perfectly happy in this specialty if you have can be happy with part time work and less money. Politics and future changes aside, many times I question, "why in the world cant I live well doing 6 12s/mth. At my current scale @ 275/hr, 6 12/mth = $237600/year........for.......6......days......of......work a month. Even with "a fair share" of nights/holidays/weekends, thats pretty insane compared to most people in this country. Early on, I could mentally never do this, as I felt like I was losing out on my "PRIME" earning years and felt like if I worked more now, I could save more and work even less later.

This would be my dream EM set up. The dirty little secret with all this, is that I have found that the less you work, the more expendable you become. Most places I know of arent even hiring for part time providers, and if they are, they wont guarantee shifts. If someone new comes in and wants full time, 15 shifts/month, the part time guy is going to be the first one kicked out to make room.

I don't know if that's a dirty little secret. More like staffing fundamentals 101. Why would they give preference to someone only working 6 shifts a month?

 

[EctopicFetus]

I personally think that we are victims of our own making in regards to EM. My own personal belief is that you can be perfectly happy in this specialty if you have can be happy with part time work and less money. Politics and future changes aside, many times I question, "why in the world cant I live well doing 6 12s/mth. At my current scale @ 275/hr, 6 12/mth = $237600/year........for.......6......days......of......work a month. Even with "a fair share" of nights/holidays/weekends, thats pretty insane compared to most people in this country. Early on, I could mentally never do this, as I felt like I was losing out on my "PRIME" earning years and felt like if I worked more now, I could save more and work even less later.

This would be my dream EM set up. The dirty little secret with all this, is that I have found that the less you work, the more expendable you become. Most places I know of arent even hiring for part time providers, and if they are, they wont guarantee shifts. If someone new comes in and wants full time, 15 shifts/month, the part time guy is going to be the first one kicked out to make room.

As mentioned below why would someone prioritize the doc doing 6/month over the one doing 15/ month. Losing the doc working 6/month is not nearly as painful as losing the one doing 15. Keep those docs happier.

 

[beebermd]

As mentioned below why would someone prioritize the doc doing 6/month over the one doing 15/ month. Losing the doc working 6/month is not nearly as painful as losing the one doing 15. Keep those docs happier.

I never said they should. They absolutely wouldn't, nor does it make sense to do so from a business perspective. Trust me, I've worn about every hat from an director/administrative side. It was more of a commentary on how ironic it is that quantitavily low volume EM work for resistance against burnout and extending career longevity, while technically possible, is difficult to find and suffers the improbable aspect of consistent job security. I mentioned the "dirty little secret" because I work with a lot students and quite a few of them have an inclination to enter EM. One of the big selling points to them I hear about is how "you can work as much or a little as you want". While true, either direction has its own issues of practicality. It is relevant to this thread as I hear this more so from female students who think they can just cut back if/when they want to start a family, etc. They just have never considered the nuances of doing so. I am always happy to educate any prospective EM physician about the current climate of our specialty.

 

[alpinism]

I still think the biggest problem with EM is how it continues to be sold as this lifestyle specialty in medical school.

It's been almost 12 years now but I can vividly remember talking to applicants on the interview trail and nearly everyone I met seemed to have the most ridiculous expectations for life after graduation. Lots of "You make your own schedule" and "You choose your own shifts" not to mention "You know I think I want to work for 6 months then not work for 6 months and live on a sailboat and sail around the world."

People literally believed that working nights meant 1 million salaries and was totally optional for attending physicians.

 

[dchristismi]

When I cut back, I knew I'd have to voluntarily pick the weekend overnights, so that's what I did. And yeah, my main gig eventually did exactly the above - let me go. Which was hilarious 6 months later when the guy who took my assistant director position had to call me and ask if I'd "come out of retirement and pick up a few shifts." Um, no. (It was a horrible team un-health takeover. I had gracefully bowed out to "pursue my other passion, HPM" and BSed my way out the door so I didn't burn bridges since I'd still be in the community.)

But I'd also made EM schedules for years and knew what groups would be needing... so I could make my own schedule, but it would be when no one else would want to work, and since I had enough contacts to do my own locumsy-legwork, I offered my weekend-night services to some sites via friends and they jumped.

 

[Birdstrike]

… I work with a lot students and quite a few of them have an inclination to enter EM. One of the big selling points to them I hear about is how "you can work as much or a little as you want".

I was told this same lie as a premed. But the economics of it just don’t work out. While most large groups can absorb one part-timer, no EM group can have a majority of part timers, without a drastic increase in overhead per physician, and the necessary collapse in salary.

Much of physician overhead is fixed and doesn’t reduce when you reduce hours.

Do to that simple economic fact having the majority of EM physicians work part time isn’t a workable solution, in the current state of EM reimbursement. And for it to work, it would have to extend to the majority, since in survey after survey, over 50% of EPs report burnout.

True for 0.1% of EM physicians, but a lie, for the other 99.9%.

 

[HemorrhagicShock]

I've been saying this for years. Part-time work in EM is an overall pipedream if that's the goal going into it.

Are there people who find their way into an 8-shift/month gig that's actually stable? Sure.

Can somebody going into EM or even working full-time currently expect they'll be able to find this as a means to offset burnout? Absolutely not

 

[GatorCHOMPions]

I still think the biggest problem with EM is how it continues to be sold as this lifestyle specialty in medical school.

It's been almost 12 years now but I can vividly remember talking to applicants on the interview trail and nearly everyone I met seemed to have the most ridiculous expectations for life after graduation. Lots of "You make your own schedule" and "You choose your own shifts" not to mention "You know I think I want to work for 6 months then not work for 6 months and live on a sailboat and sail around the world."

People literally believed that working nights meant 1 million salaries and was totally optional for attending physicians.

Guilty as charged. I was naive like this back in med school. Fortunately I wised up, was inspired by Birdstrike’s posts, and got out.

One additional facade of EM to point out. Most students don’t rotate, interact with, and/or talk to the community ER grunt workers. A lot of the rose colored glasses outlook was borne out of academic EM departments. Clerkship Directors and PDs, Vice Chairs of Basket Weaving and the like working 60 hours clinically perpetuated the belief that EM is a lifestyle specialty to students. This coupled with the relatively competitive nature of the field until recently created the illusion that EM was highly desirable. Remember those SLOEs you just had to get 2 or even 3 of to have the privilege to apply to 40 programs to give you the hope of matching?

One of the biggest perks of finding a well paying job anywhere anytime is starting to fade. Now that the curtain has been raised we’re seeing a different story play out.

 

[EctopicFetus]

I never said they should. They absolutely wouldn't, nor does it make sense to do so from a business perspective. Trust me, I've worn about every hat from a director/administrative side. It was more of a commentary on how ironic it is that quantitavily low volume EM work for resistance against burnout and extending career longevity, while technically possible, is difficult to find and suffers the improbable aspect of consistent job security. I mentioned the "dirty little secret" because I work with a lot students and quite a few of them have an inclination to enter EM. One of the big selling points to them I hear about is how "you can work as much or a little as you want". While true, either direction has its own issues of practicality. It is relevant to this thread as I hear this more so from female students who think they can just cut back if/when they want to start a family, etc. They just have never considered the nuances of doing so. I am always happy to educate any prospective EM physician about the current climate of our specialty.

I think it depends. A private group is often the best option. My group you can work 2 shifts per week and you will be guaranteed your spot. It’s 16 clinical hours a week. Not too shabby. I realize thats a minority.

 

[Brigade4Radiant]

It isn’t about money ERs have to be staffed 24/7 especially since most places are doing rvu the costs of having someone on are minimal compared to hiring locums or paying bonuses or having tons of turnover

 

[HemorrhagicShock]

Guilty as charged. I was naive like this back in med school. Fortunately I wised up, was inspired by Birdstrike’s posts, and got out.

One additional facade of EM to point out. Most students don’t rotate, interact with, and/or talk to the community ER grunt workers. A lot of the rose colored glasses outlook was borne out of academic EM departments. Clerkship Directors and PDs, Vice Chairs of Basket Weaving and the like working 60 hours clinically perpetuated the belief that EM is a lifestyle specialty to students. This coupled with the relatively competitive nature of the field until recently created the illusion that EM was highly desirable. Remember those SLOEs you just had to get 2 or even 3 of to have the privilege to apply to 40 programs to give you the hope of matching?

One of the biggest perks of finding a well paying job anywhere anytime is starting to fade. Now that the curtain has been raised we’re seeing a different story play out.

How has pain medicine been? Are you still working EM shifts?

I expect all the fellowships that result in work environments OUTSIDE of the ED are going to become insanely competitive over the next few years.

 

[GatorCHOMPions]

How has pain medicine been? Are you still working EM shifts?

I expect all the fellowships that result in work environments OUTSIDE of the ED are going to become insanely competitive over the next few years.

It’s not perfect, but both work and life are more manageable when you get regular sleep and aren’t dreading going back on days off. Happiness scale 6-7/10 up from 2-3/10.

I still do around 36 hours of EM per month, usually weekend days with occasional weekday days. I want to keep the door to academic EM open, actually enjoy it from time to time, and like the extra money. It makes a world of a difference when EM is optional and more under your control.

 

[HemorrhagicShock]

How are you able to balance working in a pain clinic while also doing sporadic day shifts? Does your pain clinic allow you to work effectively per diem? @GatorCHOMPions

 

[GatorCHOMPions]

How are you able to balance working in a pain clinic while also doing sporadic day shifts? Does your pain clinic allow you to work effectively per diem? @GatorCHOMPions

My pain job is hospital employed and I am lucky the admin is very hands off, but also receptive to my feedback. One of the sites they sent me to 1 day/week was very slow so I just asked to go there every other week to make my time more efficient and they obliged. My partner who has been there several years works 3.5 days per week, granted he’s seeing 35-40 ppd, but that gave me a clue before I joined. My starting salary is relatively low for Pain but the flexibility and work-life balance makes it more than worth it. And I still have the ability to make good money eventually, at my own pace.

 

[WilcoWorld]

My pain job is hospital employed and I am lucky the admin is very hands off, but also receptive to my feedback. One of the sites they sent me to 1 day/week was very slow so I just asked to go there every other week to make my time more efficient and they obliged. My partner who has been there several years works 3.5 days per week, granted he’s seeing 35-40 ppd, but that gave me a clue before I joined. My starting salary is relatively low for Pain but the flexibility and work-life balance makes it more than worth it. And I still have the ability to make good money eventually, at my own pace.

40 patients a day?

 

[CoolDoc1729]

Wow how old are your kids? You are a superwoman with 4

As a mom of 2 the missing nights and weekends when they still want me around (my kids are 3 and 1) is really getting to me since I didn’t have them till I was 35 and 38. And my husband who is an engineer is around during those times . I’m jealous of that time he has with the kids since I see how precious it is

I feel blessed too since many of my friends are at the same stage ( both doctors and non medical) had to go to the IVF route which took a lot of time/money/ emotional/physical/mental toll on them. I think that might also be why women are leaving. 1 in 4 women physicians has infertility issues so they might be leaving as last chance to have a kid

Infertility in Women in Medicine - American Medical Women's Association

www.amwa-doc.org

My kids are 9/7/5/4 .. I worked out the schedule I have so I am home and awake every night for dinner and until bedtime .. and during the week I am home and awake most of the time.

I feel the least like superwoman right now because I am finishing up my monthly {week-plus weekend-plus half the week off} stretch at home and I am exhausted and super ready to return to work 😂

 

[Birdstrike]

40 patients a day?

For comparison, I average about 20 per day. They vary in length from quick, 5 minute visits (suture removal, "may pain is gone after the shot," okay, bye) to others that might be as long as an hour (kyphoplasty, spinal cord stimulator). 40 would be way too much for me, but 15-20 on a procedure day and 20-25 on a clinic day, is totally manageable. It should be noted, zero of them are dying, coding, having acute violent-psychotic breakdowns or in need of a seconds-to-minutes action.

 

[Birdstrike]

... I am finishing up my monthly {week-plus weekend-plus half the week off} stretch at home and I am exhausted and super ready to return to work 😂

Been there! Lol

 

[GatorCHOMPions]

40 patients a day?

The more I think about it, it's more like 30-35. He might see 40 if he was out the previous week on vacation. He's got his flow down, and the patient population is tolerant. I don't ever plan to do that much, but it's doable especially if a lot of the patients are on low dose opioids seeing you for refills, or uncomplicated post procedural follow ups.

 

[GassYous]

This is just further proof that women are smarter than men

 

[sloh]

The more I think about it, it's more like 30-35. He might see 40 if he was out the previous week on vacation. He's got his flow down, and the patient population is tolerant. I don't ever plan to do that much, but it's doable especially if a lot of the patients are on low dose opioids seeing you for refills, or uncomplicated post procedural follow ups.

I’ve heard of some high volume pain clinics that see 60-80 per day. Crazy

 

[Birdstrike]

I’ve heard of some high volume pain clinics that see 60-80 per day. Crazy

Whole clinic with multiple providers? Sure.

80 patients per provider, per shift? Big red flag.

 

[sloh]

Whole clinic with multiple providers? Sure.

80 patients per provider, per shift? Big red flag.

Ya with some mid levels involved

 

[MechEDoc]

This is just further proof that women are smarter than men

Here's a brain teaser for you (and true): men and women have the same intelligence while simultaneously being smarter and dumber than the other gender.

 

[miacomet]

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




Yeah it’s a mooch tho g they want to work all of their shifts but no weekends lol

Where, exactly, besides a few countries in sub-Saharan Africa, is the birth rate at or above replacement? Immigration is a short term fix.

Agreed on need for more maternity and paternity leave, and also perhaps a reevaluation of our 24 hour lifestyle. Other countries (Oz, NZ, UK) don't have ER attendings on at night, and they seem to do just fine.

 

[miacomet]

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

I just quit because there didn't seem to be any other path. I'm glad you found a remunerative way out!

 

[Brigade4Radiant]

Where, exactly, besides a few countries in sub-Saharan Africa, is the birth rate at or above replacement? Immigration is a short term fix.

Agreed on need for more maternity and paternity leave, and also perhaps a reevaluation of our 24 hour lifestyle. Other countries (Oz, NZ, UK) don't have ER attendings on at night, and they seem to do just fine.

Well lets not get rid of nights that just means salary cuts. I'm fine with the option of nights

 

[RustedFox]

Where, exactly, besides a few countries in sub-Saharan Africa, is the birth rate at or above replacement? Immigration is a short term fix.

Agreed on need for more maternity and paternity leave, and also perhaps a reevaluation of our 24 hour lifestyle. Other countries (Oz, NZ, UK) don't have ER attendings on at night, and they seem to do just fine.

"Attending" means a different thing altogether in their educational system, from my understanding. Their night docs ('registrars') aren't NP/PA clowns.

 

[Frazier]

My pain job is hospital employed and I am lucky the admin is very hands off, but also receptive to my feedback. One of the sites they sent me to 1 day/week was very slow so I just asked to go there every other week to make my time more efficient and they obliged. My partner who has been there several years works 3.5 days per week, granted he’s seeing 35-40 ppd, but that gave me a clue before I joined. My starting salary is relatively low for Pain but the flexibility and work-life balance makes it more than worth it. And I still have the ability to make good money eventually, at my own pace.

I hope you guys are being paid handsomely for that clinic volume!

 

[GatorCHOMPions]

I hope you guys are being paid handsomely for that clinic volume!

It is completely by his choice and that’s the beauty of the gig, and a distinguishing feature from EM. He could spread the 120 patients per week into 5 days but he’d rather golf a couple times per week. And yes he gets paid well. No one is pressuring me to do that volume either. I’m still building up, but I expect my capacity to be around 25 ppd, spread over 4-4.5 days. If I wanted to I could cap out at 15-20 ppd but of course I wouldn’t be making as much.