Happiness, "doctoring", & EM

[frikarika]

Hey EM folks,

Long time lurker here. I'm an MSIV at a midwestern state school, currently going through a crisis regarding my future, residency, ect. I was IM most of med school, but basically could not stand the rounding, the discharge reports, and the constant dumping of CLUSTERF*$* patients, I was thoroughly miserable most days. So for the past several months, I have explored EM. I've search through tons of threads, sought guidance from others, and rotated a bit. I just completed my home school's EM rotation (16, 8 hr shifts, level 1 academic center), and I am now working out in BFE at an ER run by FM docs. I found I enjoyed many aspects of EM, the shift work, the rapid pace, the excitement, intubations, procedures, trauma ect. I really like the critical care, sick patients. But I have found myself turned off by many negatives. I think every ER deals with the politics, the defensive med nature, the "urgent care/uninsured" pts, the chronic pain seekers. For the most part I can deal with these folks, but the "soul sucking, lose faith in humanity" type patients are taking their toll. I think I could even deal with these folks, so long as I'm not working too much.

So here is my deal, I like EM, but really dislike some parts, and I think I could do it as a "job" so long as I work fewer hours. I don't plan on being rich, I've been middle class my whole life, and I like it that way. I want to know if it is feasible to work 100hrs or less per month in EM. I figure I could tolerate 10 x 10hr shifts per month, or maybe 8 x12hr shifts. Would most groups laugh me out of the interview room?

I would like to have a rich life outside of medicine, spend time with my wife, children, go fishing, canoeing enjoy my limited time on this earth. At the same time have a somewhat fulfilling career. I think I've gathered THERE IS NO PERFECT FIELD in medicine, sans maybe derm (too boring for me)

BTW the other field I am considering is anesthesia, mostly because they do not deal with the primary/urgent care component much. I like the idea of airway management and lines, procedures, ect. I have found it to be a little slow in the OR however.

Thanks, Sorry that was all over the place.

Much love

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[EM_Rebuilder]

Hey EM folks,

Long time lurker here. I'm an MSIV at a midwestern state school, currently going through a crisis regarding my future, residency, ect. I was IM most of med school, but basically could not stand the rounding, the discharge reports, and the constant dumping of CLUSTERF*$* patients, I was thoroughly miserable most days. So for the past several months, I have explored EM. I've search through tons of threads, sought guidance from others, and rotated a bit. I just completed my home school's EM rotation (16, 8 hr shifts, level 1 academic center), and I am now working out in BFE at an ER run by FM docs. I found I enjoyed many aspects of EM, the shift work, the rapid pace, the excitement, intubations, procedures, trauma ect. I really like the critical care, sick patients. But I have found myself turned off by many negatives. I think every ER deals with the politics, the defensive med nature, the "urgent care/uninsured" pts, the chronic pain seekers. For the most part I can deal with these folks, but the "soul sucking, lose faith in humanity" type patients are taking their toll. I think I could even deal with these folks, so long as I'm not working too much.

So here is my deal, I like EM, but really dislike some parts, and I think I could do it as a "job" so long as I work fewer hours. I don't plan on being rich, I've been middle class my whole life, and I like it that way. I want to know if it is feasible to work 100hrs or less per month in EM. I figure I could tolerate 10 x 10hr shifts per month, or maybe 8 x12hr shifts. Would most groups laugh me out of the interview room?

I would like to have a rich life outside of medicine, spend time with my wife, children, go fishing, canoeing enjoy my limited time on this earth. At the same time have a somewhat fulfilling career. I think I've gathered THERE IS NO PERFECT FIELD in medicine, sans maybe derm (too boring for me)

BTW the other field I am considering is anesthesia, mostly because they do not deal with the primary/urgent care component much. I like the idea of airway management and lines, procedures, ect. I have found it to be a little slow in the OR however.

Thanks, Sorry that was all over the place.

Much love

Minus a huge change in compensation (which is possible the way things are going), I assure you that RIGHT NOW I could point you to several jobs where you could work as much or as little as you want and make well into a six figure income...

With that said, I think you are doing a disservice to yourself if you really do not love the speciality. In other words, do not go to residency with plans of working as little as possible.

Its a great field, but it certainly has its negatives. You listed one of the biggest. Personally, I cope by trying my best to have a 'give a crap' switch that I can turn on/off easily. If its a genuine person with genuine complaints, etc... I think I have a bit more compassion. If its a narcotics abuser here for the 6th time this month, even though I feel for there situation and know the spot they are in sucks, you just have to sort of 'not care' in order to not let it get to you... If that makes any sense...

 

[frikarika]

Yeah, makes sense. Perhaps I didn't explain my rationale very well though, it's not that I want to work the least amount of hours, it's just that I do fear the "burn out " syndrome, and I'd like to practice medicine for at least 25yrs. I enjoy EM, I really do, but perhaps like anything in life there are things that I do not enjoy, but I am a realist it's not all sunshine and I get that. I think its hard to find your "true love", with the few rotations 3rd and 4th yr its hard to decide the rest of your life with minimal experience. I'm sure I could find something in every field that I don't like. That said, I can see myself doing EM, I just hope I'm not a burn out casualty.

BTW one of your recent Chief residents (initials LA) was my attending on his first shift last month...(might give you a hint as to where I am). Great guy, knows his stuff, someone I'd like to be like in the future.

 

[ptarmigan]

If you are getting tired of patients already just on your medical student rotation, I would say that is a bad sign. Do not go into EM if you don't love it - there are signifigant down sides that will pile ontop of the fact that the patients are driving you crazy. You are going to have to get through 3-4 years of residency getting worked like a dog, and if you are already getting burned out when the expectations are low then the outlook is not good for success with an increased workload. If you are seeing more than the isolated patient that is "sucking the life out of you," you will not be happy working any number of shifts - low or high. Even as a resident, there are very few patients that get under my skin. Which patients are sucking the life out of you??? This does not sound like an ideal fit.

 

[Pinner Doc]

I think in terms of the "soul sucking, lose faith in humanity" patients that you describe, we do a pretty good job of weeding them out before they get to you on Internal Medicine.

EM is, for sure, the front line. The beauty is that every day is new, however. Someone above mentioned an on/off switch; I've (similarly) learned from working in the ED that the BS isn't about you, but mostly about the patient and his/her inability to cope (very vague, but I think it fits most situations).

Anyway... I'm a new attending, fresh out of residency, and I am working 96 hours/month... 12 8 hour shifts, to be exact. This is pretty standard at my practice. For full disclosure, I am probably taking a couple of extra shifts a month at another group that is closer to my home and is more academic/less-community oriented. 12 shifts/month isn't a ton, and I'm young, and have no kids, etc.

So yeah, to answer your question above, it's possible to work < 100 hrs a month. But like others said, don't do yourself a disservice... do something you love. You're in the thick of it, you're tired, you're probably a bit burned out... keeping in mind that every job has its BS, you have to picture what life will be as an ATTENDING, and not as a student or resident. That's the best advice I can give to you.

 

[gman33]

The things you said you didn't like about IM are pretty much all unique to inpatient general IM.

Most people don't end up working in that environment.
If you did outpt, or subspecialty, those issues really wouldn't exist post residency (for the most part).

The things you said you don't like about EM, they would be around for your whole career.

I'm not saying one is better than the other for you, just try to envision your future career, not just the med student or resident part.

 

[frikarika]

Thanks for the advice folks.

I think some of my post was reactionary, just came off a 12hr night shift, and while most of it was interesting I just had one pt that put me in a bad mood. It was this 30 something F who comes in weekly with severe vague abdominal pain, often times RLQ, labs are always wnl, she has had an extensive GI workup, and she's had 7 abdominal/pelvic CT's in the past year (all neg for anything abnormal), and the pain only gets better with dilaudid. Basically she c/o of such excruciating pain crying and screaming, that we seem forced to do something, despite knowing its probably all BS. On top of it her enabling boyfriend is there screaming at us to "do something now, she's never like this" So she got her fix, pain went away, we ended up only doing a flat and upright abd xray, and basic labs, ua, ect. Anyway, left me feeling sour.

But I'm better today, had a good shift, saw some MVA action, a STEMI. Overall I think I can do EM, I enjoy a lot it. I'm just not 100% gung ho, and love every aspect of it. But I'm more happy doing EM than I have been on other rotations, I'll hopefully officially decide here in the next couple weeks.

 

[gro2001]

Thanks for the advice folks.

I think some of my post was reactionary, just came off a 12hr night shift, and while most of it was interesting I just had one pt that put me in a bad mood. It was this 30 something F who comes in weekly with severe vague abdominal pain, often times RLQ, labs are always wnl, she has had an extensive GI workup, and she's had 7 abdominal/pelvic CT's in the past year (all neg for anything abnormal), and the pain only gets better with dilaudid. Basically she c/o of such excruciating pain crying and screaming, that we seem forced to do something, despite knowing its probably all BS. On top of it her enabling boyfriend is there screaming at us to "do something now, she's never like this" So she got her fix, pain went away, we ended up only doing a flat and upright abd xray, and basic labs, ua, ect. Anyway, left me feeling sour.

But I'm better today, had a good shift, saw some MVA action, a STEMI. Overall I think I can do EM, I enjoy a lot it. I'm just not 100% gung ho, and love every aspect of it. But I'm more happy doing EM than I have been on other rotations, I'll hopefully officially decide here in the next couple weeks.

I don't have an answer as to what field you should pick. What bothers me about the statement is that this mindset may be particularly dangerous in EM. I am not preaching that you should like (or even care about, beyond professional responsibility) about ALL patients, not at all. But if you approach this type of patients with a mindset of "oh god, this bs again?" you are setting yourself up for trouble. This is the type of patients we miss big things in. One day she may have a AAA. I don't think that means we should necessarily scan her every time, but its important to be able to remain alert for badness, which may be difficult if you feel they suck out your soul and make you lose faith in humanity.

So if this type of patient really bothers you that much to color you whole shift, then my advice would be to put EM a little lower on your list since working fewer hours would not protect you from being exposed to them often enough to make you miserable.

 

[tridocm]

I don't have an answer as to what field you should pick. What bothers me about the statement is that this mindset may be particularly dangerous in EM. I am not preaching that you should like (or even care about, beyond professional responsibility) about ALL patients, not at all. But if you approach this type of patients with a mindset of "oh god, this bs again?" you are setting yourself up for trouble. This is the type of patients we miss big things in. One day she may have a AAA. I don't think that means we should necessarily scan her every time, but its important to be able to remain alert for badness, which may be difficult if you feel they suck out your soul and make you lose faith in humanity.

So if this type of patient really bothers you that much to color you whole shift, then my advice would be to put EM a little lower on your list since working fewer hours would not protect you from being exposed to them often enough to make you miserable.

I agree with your first paragraph. One of my mentors had a quote, "Even squirrels get run over." By fixating on the abuse of the system perpetrated by some, you will miss diagnosing serious problems and have a miserable life within medicine. I think that can be true across multiple specialties but is especially true of EM.

Further, do not think that life will necessarily get easier with less hours once you graduate residency. I am currently working in a busy, Level 1 trauma center, academic setting, urban emergency department without emergency residents. We have over 25 full time board certified or eligible doctors in the group covering 3 departments (a total of 12 doctors a day are needed to meet staffing requirements daily). I am working at least 150 hours a month. Even with taking the last 10 days of August off to go camping in the Rocky Mountains, I am working 16 shifts of at least 9 hours each. One of my colleagues does this routinely by working hard for 2-3 weeks then going out of the country for 10 days to two weeks. This is only possible with shift work in emergency medicine. EM is a great profession if you can put the emotions aside. As the same mentor above said, "EM is like fishing, we catch them, someone else has to clean them" referring to the long-term care required.

Cheers,

M

 

[ptarmigan]

If your right upper quadrant pain patient bothers you now, just think how frustrating it will be when you are an attending and that patient slams you on a Press Ganey form because you blew her off and didn't give her enough pain medication. Or worse the chief calls you and reprimands you for not giving the patient enough opiates after she complained to the hospital administration.

If you decide on primary care, you can pick your patients. In EM, we take care of the drunks, the druggies, the homeless as well as people with every personality disorder and psychiatric disease in the DSMIV As an EP, you need to approach every patient with a healthy balance of open mindedness, paranoia, and skepticism. You have to have a thick skin. You also have to apologize a lot for people's wait when it is beyond your control and treat people like customers. In addition, we are expected to never miss anything and solve a variety of social problems. We are expected to do all this very quickly while making the patient feel they are of utmost importance even when they are not particularly ill. In fact, the less ill they are the more they are customers and the more time/TLC you have to give them. The job is very demanding. You really have to like working with people - even people you don't like.

And I'm not down on the specialty. EM is far an away the best specialty in medicine. I would make the same decision a thousand times over. I love EM. But it is definitely not for everyone. If you are someone who expects everyone to be responsible members of society and not abuse the system you will have a very difficult time.

Watch yourself over the next few weeks - if you find that every shift there is a patient or two that gets under your skin then I would take extreme caution when considering this specialty.

 

[Pinner Doc]

I agree with your first paragraph. One of my mentors had a quote, "Even squirrels get run over.

One of my mentors has a variation on that. "Squirrels hide nuts!" Hee hee.