How much more stressful is EM over IM hospitalist job?

[ccmonopolies]

---

Members don't see this ad.

I read that hospitalists do 7 on, 7 off, 12 hour shifts, with an average of 14 12-hour shifts a month.

EM seems to average 12 12-hour shifts a month.

There does seem to be more rounding in IM and thus a few more hours of less stressful work. For the non-downtime work, would you say that EM is more stressful than IM hospitalist work? Can you help me gauge how much more fast paced EM work is compared to IM work?

Thanks.

 

[Rendar5]

I read that hospitalists do 7 on, 7 off, 12 hour shifts, with an average of 14 12-hour shifts a month.

EM seems to average 6 12 hour shifts a month.

There does seem to be more rounding in IM and thus a few more hours of less stressful work. For the non-downtime work, would you say that EM is more stressful than IM hospitalist work? Can you help me gauge how much more fast paced EM work is compared to IM work?

Thanks.

EM is 12-14 12hour shifts a month, but some places do 8 or 10 hour shifts. EM is more fast-paced, but as to which is more stressful, you'll just have to wait until 3rd year to get a sense of what the two fields are like. What's stressful for one person is perfectly normal/fine for another.

 

[gutonc]

The one you don't like doing is more stressful regardless of the hours.

Hour for hour EM is more stressful than being a hospitalist but you can't really compare them that way. I'd look at it over the course of a month, or a year, or a career.

 

[deleted109597]

I want to work at the place where you only work 6 twelves a month. And still get paid full time.

Hell, I'd have to make like $400 an hour for that to work out.

 

[alreadylernd]

Some people get stressed out when an acute stroke and trauma role in simultaneously. I personally jump at that - it's a great shift. Some doctors hate noisy, crowded, constantly-interrupted situations or working with exremely limited patient information. Others thrive on it and they're called ER physicians. On the other hand, I'd get stressed out cross covering a patient census of 50+, rounding for hours on end, being a slave to my pager and constantly fighting with paperwork/beaurocracy etc. It's the proverbial different strokes (pun?) for different folks. But to over generalize - is the EMERGENCY department more hectic and stressful than a med/surg floor? Absolutely. But it's a different kind of stress. And I've never heard of any significant "downtime" in anything but the sleepiest of EDs (you can assume that a 10 hour ED shift is 10 hours of non-downtime work). If you're thinking about emergency medicine and "downtime" simultaneously, you've already chosen the wrong field.

I would recommend avoiding over generalization about hours of work and using that to determine what field of medicine you go into. Sure, some hospitalists work the schedule you describe, some work exclusive nights, some only do admissions from the ED. Hospitalist medicine is as variable in schedule as the ED I would imagine - it's the nature of shiftwork that affords it flexibility. And where did you get your ER schedule information from? Only smaller EDs work 12s, and 6/month is certainly not full time. When I was interviewing out of residency, the place that did 12s still had you doing at least 12/month. Most places are 8,9,10s with variable start times etc.

 

[tima]

How many breaks does an ER physician get in a 12 shift? With lunch breaks and other breaks, is it about 1-2 hours?

 

[NERDY]

How many breaks does an ER physician get in a 12 shift? With lunch breaks and other breaks, is it about 1-2 hours?

No official breaks in my area. Maybe a few minutes here and there to use the restroom or eat something.

 

[dchristismi]

Breaks? What are breaks?

Nurses get breaks.
When I was a resident working 12s, we generally tried to sneak away for 20-30 min at some point around 8 hours to eat something.

I work 8s now, and there are many shifts where I don't make it to the bathroom or get to eat anything (aside from a swiped ginger ale or package of graham crackers.) Part of the job. Sucky part of the job, but part of the job.

 

[Groove]

Look, I know med students analyze specialties first and foremost based on "lifestyle", "stress level" and other such cortisol suppressed metrics these days but there really is a lot of truth to just spending some time in the ED and see if it fits you. You can make the schedule as easy or as hard as you want to make it after residency. I find comparing hospitalist medicine to EM very difficult to do. The only thing they have in common is the shift work IMO. Completely different specialties and arenas of practice. If you don't like stress, then don't work in the ED, because EM is stressful. We love the environment though and the specialty which is why we do what we do. Personally, being bored is more stressful to me. Spend some time in the ED and you'll know if it's for you or not. It's a love/hate environment. I find very few people that are "on the fence" about EM. When I was a med student, it was my fav place in the hospital and I found excuses to spend as much time down there as possible. Some of my fellow classmates felt the exact opposite. Ya know what? They didn't go into EM.

 

[docB]

How many breaks does an ER physician get in a 12 shift? With lunch breaks and other breaks, is it about 1-2 hours?

I frequently go 8 hours as a time without peeing and 12 without eating. My break happens after my shift once I'm no longer responsible for seeing new patients before I spend a few hours after my shift dispoing people.

 

[Groove]

As for bathroom breaks...don't know what you tell you. You grab then when you can and sometimes you can't. I work 12's and I've gone more than a few times for 12-14 hrs without peeing or eating. It sucks and doesn't happen too often, but it does happen. It's just part of the job. I try not to drink very much water and yes, getting dehydrated is the only way to do that.

As for 1 hr lunch breaks...eh...you're not working in a cubicle man, this is an ER. Not gonna happen for you if you go into this specialty.

 

[RustedFox]

B-b-b-breaks ?

Ha!

 

[dotcb]

Yeah, generally no breaks. I am lucky if I stop 5-10 min to inhale something I brought.

These 2 fields are extremely different - you ought to try them both and the differences will be obvious.

And I would recommend you not think - which is easier or less stressful, but which if more FUN.

You know how people say "the time flies when you're having fun?" To me - that's EM. Others see it as glorified triage, babysitting drunks, narc seekers, but it's where you work, and different strokes for different folks. I see a ton of these patients but hardly notice them.

You can always control your work volume (work more or less shifts), you can't change the role itself.

 

[Cerberus]

Breaks? What are breaks?

Nurses get breaks.
When I was a resident working 12s, we generally tried to sneak away for 20-30 min at some point around 8 hours to eat something.

I work 8s now, and there are many shifts where I don't make it to the bathroom or get to eat anything (aside from a swiped ginger ale or package of graham crackers.) Part of the job. Sucky part of the job, but part of the job.

20-30min to eat? Slacker! I usually inhale a meal while I type notes.

 

[otacon88]

Yeah, generally no breaks. I am lucky if I stop 5-10 min to inhale something I brought.

These 2 fields are extremely different - you ought to try them both and the differences will be obvious.

And I would recommend you not think - which is easier or less stressful, but which if more FUN.

You know how people say "the time flies when you're having fun?" To me - that's EM. Others see it as glorified triage, babysitting drunks, narc seekers, but it's where you work, and different strokes for different folks. I see a ton of these patients but hardly notice them.

You can always control your work volume (work more or less shifts), you can't change the role itself.

I think the ED was the ONLY place where I felt time flew. Every other field I would look at the clock and be like wtf only 2 min passed? In the ED, i look up and it's like holy **** 4 hours have passed. one of the main reasons I picked the field...among other things of course!

 

[jbar]

I don't know why this culture of "I don't need breaks" has taken hold. I know the ED is busy but I'm convinced that if 6 hours into a 12 you get 30 minutes to pee, drink some water, eat some food and walk around outside, you are way more productive for the last 6 hours of the shift. It think it would be a good study, randomize residents into breaks or no breaks and look at their RVUs. I know it feels like you are getting more done by not taking breaks, but I just don't think it's true.

 

[docB]

I don't know why this culture of "I don't need breaks" has taken hold. I know the ED is busy but I'm convinced that if 6 hours into a 12 you get 30 minutes to pee, drink some water, eat some food and walk around outside, you are way more productive for the last 6 hours of the shift. It think it would be a good study, randomize residents into breaks or no breaks and look at their RVUs. I know it feels like you are getting more done by not taking breaks, but I just don't think it's true.

It's not about not needing or wanting breaks. It's about the near impossibility of getting them. Several times a day I head for the bathroom but get intercepted by a line of nurses. I take a 1 L water bottle with me every day and try to drink it in the first 2 hours. If I do it forces me to go to the bathroom regardless of what the nurses say. If I don't I'll go at 8 hours in and realize "this is the first time I've been in here today."

 

[Interpolfanclub]

It's not about not needing or wanting breaks. It's about the near impossibility of getting them.

This. Sometimes I play this little game in my head where I sit down to chart and track how long it takes for me to get interrupted by someone. It's generally on the order of a few seconds to a few minutes. It's truly unreal. Forget about anything longer. When I'm pretty confident no one will die in my absence I usually go hide and eat for a few minutes.

Just as an example of why we don't eat/pee my shift yesterday wasn't horribly busy but the acuity involved: AMS BS >1000 needed to be intubated, me running to a code in the OR, elderly female kicked in head by horse and life-flighted in, peds abuse case, and 10 y/o s/p tonsillectomy vomiting blood. You get the idea.

There was a study done in Australia a few years ago about how often ED doctors got interrupted.

 

[EM_Rebuilder]

Getting back to the question of the thread.. I think if you have proper training, neither are stressful.

I am newly minted, well trained at a 4 year program. I've moonlit for a couple years and have a month of fulltime under my belt at a Level 1 trauma center. I would say my stress level is extremly low. Sure, there are times when you get stretched right to the limits, but you know what to do, or who to call, and quickly things get back in line.

Put me on call with 3 admits at once as an IM hospitalist, and I would be very stressed out. Likewise, I bet if the IM hospitalist did what I did at times, he would be very stressed out.

I think its all in the training.

As far as breaks... that does get 'tough' in Emergency Medicine. I think at some point, you just have to do your best to make time. A leisure stroll to the cafteria and discussion over a hamburger isn't going to happen. I think heating up your own food or a quick jog to the cafteria and eating at your work station is very doable. You might have to reheat it sometimes though.

 

[Arcan57]

I remember laying into an intern during one of our resident retreats for bitching that he didn't get to eat a hot lunch consistently during his shift. He ended up changing to another specialty.

My last couple of jobs have allowed been at least partial double coverage which allowed for running to the cafeteria then eating in the workroom while I caught up on charting. I don't know how diabetics do EM, since the ability to consume food at any given time is variable. Lunch may be anytime between 11:30 and 2:30 depending on volume and total "break" time during an 11 hr shift averages maybe 10 minutes. This work ethic is part of why we are a relatively well-compensated specialty.

 

[xaelia]

The type of activities that are stressful in the ED are different than those that are stressful for a hospitalist.

Honestly, the complex social dynamics involved with dispositioning inpatients is far more stressful to me than the rapid/uncertain medical decision-making we have in the ED. We do have our moments with social issues, but nothing like what you have to deal with in the hospital.

 

[ec2190]

In case anyone is still reading this thread...

My mom is IM trained and worked in the ED back in the day before it was a separate specialty (could have grandfathered in, chose not to). She's been doing hospital-based work for years and now works part-time with a hospitalist group. She told me that based on her experience, hospitalist and emergency work have comparable amounts of stress, just different kinds. For instance, she recently had to admit 8 patients between 7pm and 12am, without the help of any resident team (community hospital without a residency program). Not much downtime that night, I imagine.

So, in her opinion, ED work in the days before formal training was equally stressful as hospitalist work, even with her 30+ years of experience.

 

[ccmonopolies]

In case anyone is still reading this thread...

My mom is IM trained and worked in the ED back in the day before it was a separate specialty (could have grandfathered in, chose not to). She's been doing hospital-based work for years and now works part-time with a hospitalist group. She told me that based on her experience, hospitalist and emergency work have comparable amounts of stress, just different kinds. For instance, she recently had to admit 8 patients between 7pm and 12am, without the help of any resident team (community hospital without a residency program). Not much downtime that night, I imagine.

So, in her opinion, ED work in the days before formal training was equally stressful as hospitalist work, even with her 30+ years of experience.

Thanks, that was really helpful. Thanks everyone else who contributed as well.