How do you avoid burnout? - M3 interested in EM, but wary about longevity & toll of the unpleasant aspects

[Doctor_Strange]

I was a scribe in a community ED for one year before matriculating to an osteopathic medical school. So far during my third year, I've been thinking a lot more about longevity in a few different specialties that interest me, namely emergency medicine, anesthesiology, and perhaps even neurology. As it stands, based off my own reading of this thread, reddit, and other sources, it seems that burnout is more prevalent in EM than perhaps any other specialty outside of general surgery. It has me very anxious if I decide to pursue emergency medicine. I know that the first 10-15 years will be relatively okay, at least if I had to predict my own future. I feel that as years go on my body simply won't take the toll of shift-work. It seems docs either go part-time past (starting at 50, 55, or 60), go the urgent care route, or leave the field altogether (probably rarely occurs). When I was a scribe, I think we had maybe 3 or 4 docs in their late 50s or older still working. Frankly, I also worry about how I would change as a provider after all the year of the negative aspects of EM wearing on me, i.e. narcotic seekers, malinger-types, etc, decreased pay/less autonomy, more CMGs. Perhaps at odds, but all (or most) of the negatives of EM are absent in anesthesiology as far I know, but then I think I would then miss out on the positives of EM (jack-of-all-trade skillset, the enjoyable patient encounters, the ED environment) that anesthesiology lacks.

I welcome any advice or insight -- I'm kinda all over the place right with how I feel!

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[deleted709753]

Did you have your EM rotation yet?

 

[Doctor_Strange]

Did you have your EM rotation yet?

Not yet. Our school doesn't offer it third year so I've been shadowing and doing a few shifts with a doc that has agreed to let me hang with him during a shift. I do the H&P and present but haven't done any procedures just yet. I'm using these intermittent shifts I can squeeze in during my third year to see if I like it enough to go all-in. It's not ideal of course, but it's what I can work with at the moment.

 

[deleted709753]

My opinion is that you will get burnt out doing anything. EM doesn’t appear to be significantly different than other specialties.

Medscape National Physician Burnout, Depression & Suicide Report 2019
www.medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056

 

[GonnaBeADoc2222]

negatives of anesthesiology >>> negatives of em

cut losses and go into finance.

 

[TooMuchResearch]

Easier to do pain from anesthesia than EM...

negatives of anesthesiology >>> negatives of em

cut losses and go into finance.

 

[Birdstrike]

“How do you avoid burnout in EM?”

You can’t.

There are all kinds of things people will tell you and tell themselves, to convince you (and them) otherwise, but they’re all wrong. Those platitudes and rationalization are all 100% necessary for recruitment in EM and them for survival in EM as defense mechanisms, but they’re all false, sometimes intentional, but more often, not.

 

[Tenk]

I’ve avoided burn out by paying off all my debt and then working the bare bones minimum for full time at my shop. I also work at a smaller place full time which is nice because I know everyone well. I was working 17-18 shifts a month and moonlighting at other places. It definitely takes its toll if you do it long term. All the docs who I know that are happy are free of debt and work as little as possible. The most unhappy docs I know are deep in debt and work extra. There are very few other specialties in medicine that allow you to work 14 days a month and make well over 300k.

 

[GonnaBeADoc2222]

Yoga, positive thinking, meditation, wellness days

 

[Rekt]

I’ve avoided burn out by paying off all my debt and then working the bare bones minimum for full time at my shop. I also work at a smaller place full time which is nice because I know everyone well. I was working 17-18 shifts a month and moonlighting at other places. It definitely takes its toll if you do it long term. All the docs who I know that are happy are free of debt and work as little as possible. The most unhappy docs I know are deep in debt and work extra. There are very few other specialties in medicine that allow you to work 14 days a month and make well over 300k.

Not for long.

Anyways, the term burnout is essentially just a meme nowadays like wellness. All specialities cause burnout because medicine sucks in general. Pick the specialty you hate the least and can tolerate the mundane portion of.

 

[deleted941485]

If burn out is really what you wanna focus on, then please pick another specialty or go into industry. Honestly, there are plenty of M4 sheep we can send off to the slaughter that is 21st century medicine. Why be one of them?

 

[RustedFox]

The number one cause of burnout is....

... the patient.

 

[RustedFox]

If burn out is really what you wanna focus on, then please pick another specialty or go into industry. Honestly, there are plenty of M4 sheep we can send off to the slaughter that is 21st century medicine. Why be one of them?

C'mon man.

It's a legit question. Could be said about any other field in medicine.

I'd have burned out years ago if I were in OBGYN, Gen.surg, or whatever.

 

[thegenius]

Look...

every field in medicine has positives and negatives and I would argue that it's very difficult to absolutely say, with profound confidence, that one field is much better than another.

Wanna talk burnout? Every single doctor who works as an outpatient, whether it's medicine or surgery, has to deal with the insufferable weight of the insurance industry either 1) getting permission do to testing and treatment, or 2) deal with insurance companies not paying for what you do. It is an endless nightmare of constant phone calls and haggling on the phone to get what you want done. At least we don't have to deal with that in the ER (yet).

This madness of constantly having insurance say "no" to what you want to do magnifies burnout to such a degree that it drives well-intentioned and excellent doctors away from their fields.

The only way to avoid this is to be an all cash business - which is fine but basically you are treating the wealthy. A small percentage of the population, probably 10-20%.

The single biggest problem with EM is the hours and shift cycle. It hasn't bothered me yet, but I've been only doing this for 5 years. So far my kids and wife are understanding of this. Who knows how it will be in 5 or 10 years?

EM is great for other reasons. You've probably seen them as a scribe. Only a few other specialties can boast our achievements of actually saving a person's life RIGHT NOW (intensivists, neurosurgeons). General surgeons save lives but they often get to wait when it's convenient. The appendicitis or gallbladder can wait 6-12 hours. You can sleep during that time.

People can malinger in any specialty...it's just harder to kick them out of the ER. But it can be done.

 

[GonnaBeADoc2222]

Look...

every field in medicine has positives and negatives and I would argue that it's very difficult to absolutely say, with profound confidence, that one field is much better than another.

Wanna talk burnout? Every single doctor who works as an outpatient, whether it's medicine or surgery, has to deal with the insufferable weight of the insurance industry either 1) getting permission do to testing and treatment, or 2) deal with insurance companies not paying for what you do. It is an endless nightmare of constant phone calls and haggling on the phone to get what you want done. At least we don't have to deal with that in the ER (yet).

This madness of constantly having insurance say "no" to what you want to do magnifies burnout to such a degree that it drives well-intentioned and excellent doctors away from their fields.

The only way to avoid this is to be an all cash business - which is fine but basically you are treating the wealthy. A small percentage of the population, probably 10-20%.

The single biggest problem with EM is the hours and shift cycle. It hasn't bothered me yet, but I've been only doing this for 5 years. So far my kids and wife are understanding of this. Who knows how it will be in 5 or 10 years?

EM is great for other reasons. You've probably seen them as a scribe. Only a few other specialties can boast our achievements of actually saving a person's life RIGHT NOW (intensivists, neurosurgeons). General surgeons save lives but they often get to wait when it's convenient. The appendicitis or gallbladder can wait 6-12 hours. You can sleep during that time.

People can malinger in any specialty...it's just harder to kick them out of the ER. But it can be done.

Hours and shift cycle don't really bother me. What bothers me is pretty much all the factors that rustedfox has discussed.

 

[Splenda88]

I’ve avoided burn out by paying off all my debt and then working the bare bones minimum for full time at my shop. I also work at a smaller place full time which is nice because I know everyone well. I was working 17-18 shifts a month and moonlighting at other places. It definitely takes its toll if you do it long term. All the docs who I know that are happy are free of debt and work as little as possible. The most unhappy docs I know are deep in debt and work extra. There are very few other specialties in medicine that allow you to work 14 days a month and make well over 300k.

Or 8-10 days/month and make 200k...

I think EM is arguably the best specialty in medicine in term of work-life balance. I worked last month with a couple of EM docs who only work 2 nights/wk and still make ~200k/yr, and it's considered full time (i.e full benefits).

Self disclosure: I am an IM resident.

 

[GonnaBeADoc2222]

Or 8-10 days/month and make 200k...

I think EM is arguably the best specialty in medicine in term of work-life balance. I worked last month with a couple of EM docs who only work 2 nights/wk and still make ~200k/yr, and it's considered full time (i.e full benefits).

Self disclosure: I am an IM resident.

Definitely good for work life balance...while you're young and maybe have no kids (or very young kids) and use all the downtime to travel etc. That's the phase I'm in and it's pretty great.

It's not so good for work life balance when you have a couple kids in grade school or older and you're on a string of evening swing shifts and haven't seen your family in a week.

Plusses and minuses.

 

[TooMuchResearch]

Hours and shift cycle are pretty much all that bothers me. I can work around everything else.

Hours and shift cycle don't really bother me. What bothers me is pretty much all the factors that rustedfox has discussed.

 

[Splenda88]

Definitely good for work life balance...while you're young and maybe have no kids (or very young kids) and use all the downtime to travel etc. That's the phase I'm in and it's pretty great.

It's not so good for work life balance when you have a couple kids in grade school or older and you're on a string of evening swing shifts and haven't seen your family in a week.

Plusses and minuses.

If you insist in making 380k, of course it is not perfect. But if you are ok with making 200k/yr while working only 2 nights/wk, there is not that many jobs in America that can beat that.

 

[TooMuchResearch]

Or when your kids start school, figure out what weekends are, and want you to stop missing them.
Plus kids do great with consistency. It's hard for them not knowing who is going to be around for dinner, who's putting them to bed, who will be home in the morning, etc.

Definitely good for work life balance...while you're young and maybe have no kids (or very young kids) and use all the downtime to travel etc. That's the phase I'm in and it's pretty great.

It's not so good for work life balance when you have a couple kids in grade school or older and you're on a string of evening swing shifts and haven't seen your family in a week.

Plusses and minuses.

 

[deleted859535]

1. Your EM rotation will help.
2. Your EM rotation will not be fully representative of how you'll handle it.
3. You pick your poison no matter what you pick.
4. Choose what will help you be happy outside of work but still like what you do enough to do it, and do it well.
5. You will get a lot of doomsday / sky falling comments about things here. Grain of salt. They don't know the future any more than I do. Some things suck about EM, it's true. Some things are great about it. Again, you pick your poison. EM reimbursement might fall. So might other specialties. Some markets already aren't what they used to be. Meanwhile, I'm still doing quite well.
6. If you love EM, do it. If you don't, read #4 again.

 

[Porfirio]

Tips to Avoid Burn Out:
1) work no more than 120 hrs per month
2) live like a resident (normal American) and save money/pay off debt
3) do not work in The Northeast (especially New York/New Jersey/Massachusetts/Connecticut/Pennsylvania) or California- the patient population is horrible
4) see tip 3 because of cost of living and quality of life
5) have affordable hobbies
6) travel twice or three times a year - nothing fancy see tip 2
7) don’t bring work home
8) bring candy (chocolate) to work - everyone loves chocolate
9) read about medicine way less than in residency (most of it is bullsh*t anyways)
10) find a shop that has a good amount of provider coverage to patient volume (when interviewing visit the waiting room on a Monday between 2:00 pm to 7:00 pm if you can)
11) if not an emergency - take 2 minutes to smile, laugh and talk with patients about something non-medical; see tip 10 because you have time to do so
12) find a shop that pays you the most while also following all the other tips
13) take time to talk to consultants about something else other than medicine when you see them
14) say positive things even in the face of negativity - because it honestly doesn’t fu*king matter most of the time
15) acknowledge the family with the patient

 

[RuralEDDoc]

All great points (except patients in California being terrible - it’s the most populous state in the country, incredible diverse, an experience in one city will be completely different than another)
Really want to hammer home on “don’t bring work home”. Finish charts at work. If you’re the scheduler or hold another admin position do most of the work away from home - if you don’t work will start to expand and take more and more of your personal time.
And don’t chart for free. Do it on the clock. See one less patient to do so if you have a choice.

 

[Doctor_Strange]

Thank you everyone for taking the time to provide your insights, advice, and commentary. I don't take your time for granted and it helps me organize my own thoughts and feelings.

I think what is causing me some anxiety is the fact that I will eventually need to pick a specialty with the possibility that I will miss out on some aspects that I like in other fields. I think parts of anesthesiology appeals to some aspects of my personality and interest whereas emergency medicine certainly appeals to other parts of me -- there is not too much overlap in this regard. Perhaps feeling you are missing out on other aspects of medicine is an inevitable feeling? I'm sure a hospitalist may envy some aspects of emergency medicine and vice versa. What I don't want to happen is be 45 or 50 years old, and dread coming into work -- no matter the field. I'm sure any career has peaks and valleys in this regard, and I suppose I am trying to figure out in my novice stage which specialty I could have a higher threshold of tolerance for in terms of the negatives (eg handling difficult pts versus handling difficult surgeons just as a example).

Reading the WCI forums, one poster said that the longevity of an emergency physician is less so than compared to say a surgeon. In that, while the residency of a surgeon is grueling, often times the surgeon can practice at an essentially constant pace well into their late 60s and onward. In contrast, and even supported by the comments on this thread, it would seem that EPs inevitably bring their workload down in their later years simply due to the demands of shift work that are unlike most other fields. I don't like this trend only because -- and I will be frank here -- that means such an EP would earn less despite being senior in training whereas a senior surgeon would not experience such a drop in salary. Am I thinking about this in the wrong way? I don't like involving money into my consideration, but I'd be disingenuous if I said it plays no factor. In other words, while it is good that a EP would recognize their own burnout and adjusted their workload, would their lifestyle and finances not need to be adjusted accordingly?

 

[TooMuchResearch]

You absolutely should think about money when you're considering your future job.

Thank you everyone for taking the time to provide your insights, advice, and commentary. I don't take it for granted and it helps me organize my own thoughts and feelings.

I think what is causing me some anxiety is the fact that I will eventually need to pick a speciality with the possibility that I will miss out on some aspects that I like in other fields. I think parts of anesthesiology appeals to some aspects of my personality and interest whereas emergency medicine certainly appeals to other parts of me -- there is not too much overlap in this regard. Perhaps feeling you are missing out on other aspects of medicine is an inevitable feeling? I'm sure a hospitalist may envy some aspects of emergency medicine and vice versa. What I don't want to happen is be 45 or 50 years old, and dread coming into work -- no matter the field. I'm sure any career has peaks and valleys in this regard, and I suppose I am trying to figure out in my novice stage which speciality I could have a higher threshold of tolerance for in terms of the negatives (eg handling difficult pts versus handling difficult surgeons just as a example).

Reading the WCI forums, one poster said that the longevity of an emergency physician is less so than compared to say a surgeon. In that, while the residency of a surgeon is grueling, often times the surgeon can practice at an essentially constant pace well into their late 60s and onwards. In contrast, and even supported by the comments on this thread, it would seem that EPs inevitably bring their workload down in their later years simply due to the demands of shift work that are unlike most other fields. I don't like this trend only because -- and I will be frank here -- that means such an EP would earn less despite being senior in training whereas a senior surgeon would not experience such a drop in salary. Am I thinking about this in the wrong way? I don't like involving money into my consideration, but I'd be disingenuous if I said it plays no factor. In other words, while it is good that a EP would recognize their own burnout and adjusted their workload, would their lifestyle and finances not need to be adjusted accordingly?

 

[deleted859535]

Thank you everyone for taking the time to provide your insights, advice, and commentary. I don't take it for granted and it helps me organize my own thoughts and feelings.

I think what is causing me some anxiety is the fact that I will eventually need to pick a speciality with the possibility that I will miss out on some aspects that I like in other fields. I think parts of anesthesiology appeals to some aspects of my personality and interest whereas emergency medicine certainly appeals to other parts of me -- there is not too much overlap in this regard. Perhaps feeling you are missing out on other aspects of medicine is an inevitable feeling? I'm sure a hospitalist may envy some aspects of emergency medicine and vice versa. What I don't want to happen is be 45 or 50 years old, and dread coming into work -- no matter the field. I'm sure any career has peaks and valleys in this regard, and I suppose I am trying to figure out in my novice stage which speciality I could have a higher threshold of tolerance for in terms of the negatives (eg handling difficult pts versus handling difficult surgeons just as a example).

Reading the WCI forums, one poster said that the longevity of an emergency physician is less so than compared to say a surgeon. In that, while the residency of a surgeon is grueling, often times the surgeon can practice at an essentially constant pace well into their late 60s and onwards. In contrast, and even supported by the comments on this thread, it would seem that EPs inevitably bring their workload down in their later years simply due to the demands of shift work that are unlike most other fields. I don't like this trend only because -- and I will be frank here -- that means such an EP would earn less despite being senior in training whereas a senior surgeon would not experience such a drop in salary. Am I thinking about this in the wrong way? I don't like involving money into my consideration, but I'd be disingenuous if I said it plays no factor. In other words, while it is good that a EP would recognize their own burnout and adjusted their workload, would their lifestyle and finances not need to be adjusted accordingly?

1 - Virtually impossible to be 100% exposed to 100% of what's out there by the time you have to pick something. You do the best you can by being honest with yourself and looking into the top options. You appear to already be doing that.

2 - Money matters. Period. Also another place where you have to be honest with yourself. If physicians made $80k annually, the majority of us wouldn't do this. Doesn't mean we're money hungry; just means that compensation is warranted for (a) giving up most of our 20s to get into this / (b) the hours and requirements along the way / (c) the stress (telling someone their husband/wife/child is dead despite your full court press never gets easier) / (d) making the tough decisions / (e) the liability.

Speaking for some of my partners, many of our older, more senior EPs simply could afford to cut back without a major lifestyle change by that point. Another good reason to be financially savvy and make good decisions early (i.e., the key points of what folks like WCI talk about).

 

[Sushirolls]

... As it stands, based off my own reading of this thread, reddit, and other sources, it seems that burnout is more prevalent in EM than perhaps any other specialty outside of general surgery. It has me very anxious if I decide to pursue emergency medicine. ...

Go into Psychiatry. We have the sweetest Alpine mountain pastures, and our forage really is more vibrantly colored on our side of the fence.

 

[dchristismi]

Or... do it for long enough to set aside a nest egg, pay off your loans, and cut back to half time. Part timers are generally always welcome, and my own burnout lessened significantly by cutting way back. You'll burn out doing anything - might as well be something fun.

Besides, once you get to actually rotate in EM, you'll know.

Or... do it awhile and then subspecialize.

I "retired" to hospice this year and honestly, my life is pretty damn good now.
(Ok, so I do have a dedicated oncologic EM gig on the side, but it's still death and dying and lots of talking, with the occasional neutropenic fever/cord compression, etc thrown in for variety). Hospice doesn't pay as well as EM, but I could do this for a loooong time. And since my debts are paid and my retirement next egg is now 7 figures, I don't *have* to work like I did. I mean, I still want to go to Europe every year, but financial independence is pretty sweet. So I talk, and counsel, and use my EM skillz, but in a different way now. And you may decide that you love EM and want to do it For-Ev-Er, but you might not. And that's ok.