If there were more FM and EM joint residencies (like EM/IM) options available would you do both?

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KeikoTanaka

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I ask because obviously America is facing a healthcare crisis of not having enough PCPs and access to quality healthcare as a primary option for many citizens. If you are competitive for EM, I assume you’re also competitive for FM and IM, but it seems like the thing deterring people from pursuing this option is simply lack of programs and lack of a clear goal (are you doing IM or EM?). If you did a joint program like this with the promise of working 1-2 clinic shifts a week and like 2 ED shifts a week, would you do it? I feel like this would be great for ED physicians who complain of burnout and great for the country by filling a need.

Obviously something that would be a deterrent would be a 5 year residency, but maybe you can throw in some loan forgiveness afterwards if you commit to working in a clinic 2 times a week? Let me know what you all think
 
FM/EM and IM/EM residencies already exist, albeit in very limited numbers.
They are five years long. That's a deterrent.
The reason your proposed arrangement of "1 or 2 clinic days a week + EM shifts" doesn't work is because nobody will hire you to do that. Someone else will post on here as to why it's not economically viable; I'm too tired to get into it right now, and I'm not the most articulate person with money/business-related issues.

I know it makes "sense" to you, just like it did to me. Don't feel bad. This is a common cognitive error that a lot of premeds and MS1-2s make. I thought that I "really wanted to do them both" and could be really good at it.
 
RustedFox said:
FM/EM and IM/EM residencies already exist, albeit in very limited numbers.
They are five years long. That's a deterrent.
The reason your proposed arrangement of "1 or 2 clinic days a week + EM shifts" doesn't work is because nobody will hire you to do that. Someone else will post on here as to why it's not economically viable; I'm too tired to get into it right now, and I'm not the most articulate person with money/business-related issues.

I know it makes "sense" to you, just like it did to me. Don't feel bad. This is a common cognitive error that a lot of premeds and MS1-2s make. I thought that I "really wanted to do them both" and could be really good at it.
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I'll take the FM part of that, and will apply somewhat to EM as well.

For every physician there are certain fixed costs - malpractice, EMR access, benefits, and so on. Those are usually the same whether you work 2 days a week or 7. The cost/workday is significantly less when talking 5 days/week versus 2-3.

For FM in particular, your patients generally expect you to be available every working day. If you're not, then your partners end up having to cover your acute visits for the days you don't work. This makes both your patients and your partners angry, generally speaking.
 
No, but I wish I had done EM/IM or EM/Peds. Better to cope with burnout and absurd working situations.
 
miacomet said:
No, but I wish I had done EM/IM or EM/Peds. Better to cope with burnout and absurd working situations.
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I really don't understand these dual certifications. What do you do with an EM/IM degree? I know of only one, and he strictly does IM hospitalist b/c he is not competent to work in the ED.

Do you do EM and open an IM practice/hospitalist job? What is the points of Em/Peds? To work in the peds clinic for 1/3 the pay?
 
emergentmd said:
I really don't understand these dual certifications. What do you do with an EM/IM degree? I know of only one, and he strictly does IM hospitalist b/c he is not competent to work in the ED.

Do you do EM and open an IM practice/hospitalist job? What is the points of Em/Peds? To work in the peds clinic for 1/3 the pay?
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The point is that if you are burnt out on nights etc you can leave and do private practice. Great for longevity!
 
KeikoTanaka said:
How competitive are EM/IM programs? For a DO?
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Very. Downstate seems to accept a lot of DOs to both their EM and EM/IM programs. Northwell used not to. Which programs are you looking at?
 
miacomet said:
The point is that if you are burnt out on nights etc you can leave and do private practice. Great for longevity!
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Invest the salary difference for those extras years of residency, don't go crazy on spending throughout your career, and you will not need the "longevity" of working in IM.

Also, lets flip this around: I wouldn't hire an EM physician - even if he completed a residency - if he had spent the last 20 years working in a primary care practice, and I don't think our IM guys would hire someone who has spent 20 years working as an EM physician, even with a residency.

The final point is that a residency is fine, but board certification is more important: How are you going to maintain the IM certification? I know for some of them if you are not involved in the active practice of the specialty, you have to take the full certification-exam every time.

There are better ways to deal with burnout.

(Postscript: I can see the value of this residency combination for pure (e.g., tenure-track) academics. In practice, the problem is that the personalities are very different. I don't know of many EM physicians who will be happy trying to convince someone to lose weight, or spending their time mediating among family members as to how to care for an elderly family member. "Real" internal medicine is very different from the ward-work that most experience in residency. Or so I am told...)
 
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emergentmd said:
I really don't understand these dual certifications. What do you do with an EM/IM degree? I know of only one, and he strictly does IM hospitalist b/c he is not competent to work in the ED.

Do you do EM and open an IM practice/hospitalist job? What is the points of Em/Peds? To work in the peds clinic for 1/3 the pay?
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The theoretical point of dual residencies is to manage conditions that don't fit neatly into either category. IM/Peds manages chronic diseases of childhood that are now surviving into adulthood like congenital heart disease or Cystic Fibrosis. IM/Psych runs a psych ward for medically complicated patients, such as dialysis patients. EM/Peds barely exists because the Peds ED fellowship does the same thing, but it makes you more of an expert in the resuscitation of medically complicated children and neonates who are rarely seen outside of a Pediatric ER.

Of course the actual point of dual residencies, at least from the learner's perspective, is to give you the option to jump ship. EM/FM gives you a clinic to go to when ER burns you out. IM/Peds is FM for people who aren't willing to commit to never doing a fellowship, and for Pediatricians who aren't ready to commit to a low salary. IM/Psych is Psych for people who worry that they'll eventually get sick of dealing with crazy people. It seems like its a minority of dual residency grads actually go into a job that requires both board certifications.
 
I was considering EM/IM or EM/FM initially. Some of the more rural hospitals around here have EM Hospitalists. They split their time between the floor and ED. Frankly, I didn't want to do 5 years of residency. One hospital adamantly told me "We won't hire you for the ER, you'd see patients in clinic and cover the ER when one of the Nurse Practitioners have an open shift"- yeah, not for me....
 
The EM/IMs I know are variously in hospital administration, residency administration, academics, and critical care. One left EM and did an allergy fellowship and is the happiest of all. A few are practicing EM in the community. The dual certification definitely helped with administration and academics.

I don't know as many Peds/EM folks, but the ones I do know are working in EM, although one also alternates with working as a peds hospitalist.
 
I get that its most likely a tract towards academia, although I think a true fellowship in EM would be better.

And for those who says you can jump ship, this is what makes no sense.

1st, its almost impossible to do both at the same time. You can't "moonlight" and be good at either.
2nd, Doing both would be a Pay cut. Stick to EM, and if you did the 7 on 7 off = 168hrs * $225/hr = 450K which is more way more than just doing IM alone or doing both
3rd, good luck finding a job where you can schedule both easily. Also good luck getting someone to hire you on in either field in a decent city hospital
4th, You are adding 2 more years.
5th, Avoid burnout by doing 1/2 of each? Really? Seriously. Really?
 
emergentmd said:
What is the points of Em/Peds? To work in the peds clinic for 1/3 the pay?
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Vandalia said:
Invest the salary difference for those extras years of residency, don't go crazy on spending throughout your career, and you will not need the "longevity" of working in IM.
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We get it, guys. EM is very well-paid. It's not a secret anymore. Everyone in medicine realizes that. Money is good. More money is better. Money can be exchanged for goods and services. More money can be exchanged for more goods and more services. More is better. Money is awesome. Who doesn't love money? I love money. You love money. Why would anyone ever want less money? Money.

Every time someone brings up some non-traditional EM practice route you don't have to bring up the obvious pay cut as if it was some automatic deal-breaker. I'm sure these posters realize that. Maybe the change of pace and practice will increase their happiness more than another million in their bank account. Maybe they would rather work until they are 60 at a job they really really love rather than retire at 40. Doing something other than 100% clinical EM is not the end of the world; people won't go bankrupt. Essentially all physicians working clinically make enough money to live comfortably, even while accounting for loans. If someone goes bankrupt doing 100% outpatient pediatric medicine then they have a spending issue, not an income issue.

There are many reasons why some of these career paths are a bad idea. Money is one of them, but you don't have to make it sound like it's the single most important thing every time this comes up.
 
enalli said:
We get it, guys. EM is very well-paid. It's not a secret anymore. Everyone in medicine realizes that. Money is good. More money is better. Money can be exchanged for goods and services. More money can be exchanged for more goods and more services. More is better. Money is awesome. Who doesn't love money? I love money. You love money. Why would anyone ever want less money? Money.

Every time someone brings up some non-traditional EM practice route you don't have to bring up the obvious pay cut as if it was some automatic deal-breaker. I'm sure these posters realize that. Maybe the change of pace and practice will increase their happiness more than another million in their bank account. Maybe they would rather work until they are 60 at a job they really really love rather than retire at 40. Doing something other than 100% clinical EM is not the end of the world; people won't go bankrupt. Essentially all physicians working clinically make enough money to live comfortably, even while accounting for loans. If someone goes bankrupt doing 100% outpatient pediatric medicine then they have a spending issue, not an income issue.

There are many reasons why some of these career paths are a bad idea. Money is one of them, but you don't have to make it sound like it's the single most important thing every time this comes up.
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Agreed.
 
enalli said:
There are many reasons why some of these career paths are a bad idea. Money is one of them, but you don't have to make it sound like it's the single most important thing every time this comes up.
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I believe the subject under discussion is burnout.

miacomet said:
The point is that if you are burnt out on nights etc you can leave and do private practice. Great for longevity!
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With respect to burnout there are several documented ways to help prevent or reduce this phenomenon. As discussed in a separate thread, the vast majority of conditions that increase or reduce burnout are financial. Complaining about financial issues being discussed wrt to burnout is a bit like complaining about too much talk about money in a thread about retirement planning.

As I believe I mentioned, there are some valid reasons for a combined residency. However, doing one because you are worried about burnout 20 years down the road is a very poor one, in my opinion. There are far more effective solutions.
 
Vandalia said:
I believe the subject under discussion is burnout.



With respect to burnout there are several documented ways to help prevent or reduce this phenomenon. As discussed in a separate thread, the vast majority of conditions that increase or reduce burnout are financial. Complaining about financial issues being discussed wrt to burnout is a bit like complaining about too much talk about money in a thread about retirement planning.

As I believe I mentioned, there are some valid reasons for a combined residency. However, doing one because you are worried about burnout 20 years down the road is a very poor one, in my opinion. There are far more effective solutions.
Click to expand...

I have to disagree- I don't think it's all financial, at least not in my personal experience. Sure, if you are financially independent, then you don't have to work, but then your field is irrelevant because you don't have to work. While I'm not (quite) financially independent, I have seven figures in the bank and a paid off house, and I don't work more than 100 hours a month. Sometimes I work 60, and I do have some nonclinical income. And I'm still burnt out. I'm not sure exactly how much better a financial situation I could be in yet still be working, so how can burnout be entirely financial? I'm honestly mystified.

So what can a person who saves most of their paycheck, has a bunch of savings, a paid off house, a bit of nonclinical income, and a very flexible and limited schedule do to stave off burnout? And no, I don't work at a toxic place. It's actually a unicorn place. I just have stopped enjoying and started hating the work. I don't actually want to work less, but I do want to work at something that doesn't have nights, swings, or weekends, has continuity of care, is less beholden to admin (even unicorns are beholden to the man in their own way), that isn't as stressful, and that I enjoy and find meaning in. Clearly, for some folks, EM has an expiration date, and a combined program may well be a long-term answer for them.
 
Finances are important...but not the most important.

EM/FM just doesn't make a lot of sense for the reasons explained above: hard to be good at both, places not going to hire you for both, etc.

Even if you get hired for both, you become kind of an orphan...you don't really belong to EM and you don't really belong to FM.

Combined residencies exist to provide hospitals with an increased supply of low cost labor.

Even most IM/Peds people end up choosing one or the other.

I also never understood the training time differential between these combined programs and traditional programs. Categorical EM and FM are both 3 years long, but EM/FM is 5 years. Categorical IM and Peds are both 3 years long as well, but IM/Peds is 4 years. So we are saying that you can achieve competence in both EM and FM in 2.5 yrs and IM and Peds in 2 years now? Kind of a slap in the face of those in a traditional categorical residency.
 
miacomet said:
I have to disagree- I don't think it's all financial, at least not in my personal experience. Sure, if you are financially independent, then you don't have to work, but then your field is irrelevant because you don't have to work. While I'm not (quite) financially independent, I have seven figures in the bank and a paid off house, and I don't work more than 100 hours a month. Sometimes I work 60, and I do have some nonclinical income. And I'm still burnt out. I'm not sure exactly how much better a financial situation I could be in yet still be working, so how can burnout be entirely financial? I'm honestly mystified.

So what can a person who saves most of their paycheck, has a bunch of savings, a paid off house, a bit of nonclinical income, and a very flexible and limited schedule do to stave off burnout? And no, I don't work at a toxic place. It's actually a unicorn place. I just have stopped enjoying and started hating the work. I don't actually want to work less, but I do want to work at something that doesn't have nights, swings, or weekends, has continuity of care, is less beholden to admin (even unicorns are beholden to the man in their own way), that isn't as stressful, and that I enjoy and find meaning in. Clearly, for some folks, EM has an expiration date, and a combined program may well be a long-term answer for them.
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If you don't need to work financially, go 4 days/week at the free clinic. It's basically the same thing as a family medicine clinic, but they don't care what your residency was in.
 
miacomet said:
I have to disagree- I don't think it's all financial, at least not in my personal experience. Sure, if you are financially independent, then you don't have to work, but then your field is irrelevant because you don't have to work. While I'm not (quite) financially independent, I have seven figures in the bank and a paid off house, and I don't work more than 100 hours a month. Sometimes I work 60, and I do have some nonclinical income. And I'm still burnt out. I'm not sure exactly how much better a financial situation I could be in yet still be working, so how can burnout be entirely financial? I'm honestly mystified.

So what can a person who saves most of their paycheck, has a bunch of savings, a paid off house, a bit of nonclinical income, and a very flexible and limited schedule do to stave off burnout? And no, I don't work at a toxic place. It's actually a unicorn place. I just have stopped enjoying and started hating the work. I don't actually want to work less, but I do want to work at something that doesn't have nights, swings, or weekends, has continuity of care, is less beholden to admin (even unicorns are beholden to the man in their own way), that isn't as stressful, and that I enjoy and find meaning in. Clearly, for some folks, EM has an expiration date, and a combined program may well be a long-term answer for them.
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You got seven figures in the bank!? I got seven figures in debt.
 
GonnaBeADoc2222 said:
Finances are important...but not the most important.

EM/FM just doesn't make a lot of sense for the reasons explained above: hard to be good at both, places not going to hire you for both, etc.

Even if you get hired for both, you become kind of an orphan...you don't really belong to EM and you don't really belong to FM.

Combined residencies exist to provide hospitals with an increased supply of low cost labor.

Even most IM/Peds people end up choosing one or the other.

I also never understood the training time differential between these combined programs and traditional programs. Categorical EM and FM are both 3 years long, but EM/FM is 5 years. Categorical IM and Peds are both 3 years long as well, but IM/Peds is 4 years. So we are saying that you can achieve competence in both EM and FM in 2.5 yrs and IM and Peds in 2 years now? Kind of a slap in the face of those in a traditional categorical residency.
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Rural hospitals will hire EM/FM to work both and pay them VERY well. They run the ED and see patients on the floor.

I know in EM/FM there is a lot of overlap in the training so that helps in cutting down the hours. You only need 21 months of EM. I bet the rest are rotations are in common with FM. There was even talk of making it 4 years, where all your FM electives are just EM months but FM accreditation didn’t want to do that.




Sent from my iPhone using Tapatalk
 
VA Hopeful Dr said:
If you don't need to work financially, go 4 days/week at the free clinic. It's basically the same thing as a family medicine clinic, but they don't care what your residency was in.
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I don't think you read my post fully. My point is that even with that money, I still need to work.
 
miacomet said:
I don't think you read my post fully. My point is that even with that money, I still need to work.
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VA Hopeful Dr said:
If you don't need to work financially, go 4 days/week at the free clinic. It's basically the same thing as a family medicine clinic, but they don't care what your residency was in.
Click to expand...

Why would I want to work for free when I can sit on a beach for free? What's the point? Insane, IMHO.
 
VA Hopeful Dr said:
Then do urgent care. Isn't that what EM folks do when they get sick of nights and really sick patients?
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Urgent care is still weekends and holidays. This is why I think a combined residency is worth it- you can segue into something that doesn't involve a horrible schedule and where you do something aside from dispensing Z-packs and sending patients to the ER.

YMMV, but our UC docs still work holidays and weekends, and also many evenings. Also, I don't really see EM docs burning out on sick, but on not sick, which UC doesn't solve.

I really think students need to think carefully about EM with the scheduling and burnout issues. A combined residency certainly is one of several paths to an exit.
 
Vandalia said:
the vast majority of conditions that increase or reduce burnout are financial
Click to expand...

If someone out there is working 20 12-hour shifts per month because they are at imminent risk of financial ruin, that would be a financial cause of burnout. I don't think that's what we're seeing in EM. A lot of the causes of burn out have a financial root for the healthcare system, not for the physician: having a high pph expectation because the hospital/CMG wants to increase their bottom line, expecting high PG scores because the hospital wants more repeat customers and higher reimbursement, "supervising" mid-levels because the CMG wants to decrease their costs. This isn't to mention the non-financial causes: power-tripping administrators, the risk of lawsuits, irregular hours. None of these things would go away by increasing the hourly rate paid to emergency physicians, but working less shifts might lessen their impact.

Now, you may be asking "why not just maximize your hourly salary and cut down to part time?" Well, that's exactly what a lot of these guys want to do! They just want to fill part of their other time with another clinical (or non-clinical) job for personal satisfaction. Think of it as a hobby. You wouldn't rag on someone cutting down to half-time to have more time for their travels or wood-working.
 
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enalli said:
If someone out there is working 20 12-hour shifts per month because they are at imminent risk of financial ruin, that would be a financial cause of burnout. I don't think that's what we're seeing in EM. A lot of the causes of burn out have a financial root for the healthcare system, not for the physician: having a high pph expectation because the hospital/CMG wants to increase their bottom line, expecting high PG scores because the hospital wants more repeat customers and higher reimbursement, "supervising" mid-levels because the CMG wants to decrease their costs. This isn't to mention the non-financial causes: power-tripping administrators, the risk of lawsuits, irregular hours.
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Agreed. There is real abuse causing real problems with EM docs. I don't understand why folks seem so resistant to addressing or even seeing it.
 
enalli said:
We get it, guys. EM is very well-paid. It's not a secret anymore. Everyone in medicine realizes that. Money is good. More money is better. Money can be exchanged for goods and services. More money can be exchanged for more goods and more services. More is better. Money is awesome. Who doesn't love money? I love money. You love money. Why would anyone ever want less money? Money.

Every time someone brings up some non-traditional EM practice route you don't have to bring up the obvious pay cut as if it was some automatic deal-breaker. I'm sure these posters realize that. Maybe the change of pace and practice will increase their happiness more than another million in their bank account. Maybe they would rather work until they are 60 at a job they really really love rather than retire at 40. Doing something other than 100% clinical EM is not the end of the world; people won't go bankrupt. Essentially all physicians working clinically make enough money to live comfortably, even while accounting for loans. If someone goes bankrupt doing 100% outpatient pediatric medicine then they have a spending issue, not an income issue.

There are many reasons why some of these career paths are a bad idea. Money is one of them, but you don't have to make it sound like it's the single most important thing every time this comes up.
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Obviously money is not the most important thing for most. But the question was

"If you did a joint program like this with the promise of working 1-2 clinic shifts a week and like 2 ED shifts a week, would you do it? I feel like this would be great for ED physicians who complain of burnout and great for the country by filling a need. "

And I am giving my opinion and as you can see all of my points, only ONE pointed out money. You must have missed the other 4.

If you think EM = big burnout, then I also disagree. The last Medscape article had FM with higher rate of Burnout (or atleast that is what I read)

Doing 1/2 FM + 1/2 EM has a Greater burnout potential. Being 1/2 EM still obligates you (for most groups) to do weekends, holidays, night shifts with potentially less benefits. Do you think 1/2 FM or 1/2 EM jobs will give you full benefits?

How are you going to get any decent job to hire you for 1/2 time? You would be stuck with the worse/desperate jobs of both worlds.

Imagine working 9-5 in FM clinic then going in for a EM night shift. Or doing an EM night shift and going to your 9-5 clinic.

Who are you going to schedule 1st? If you schedule FM first, no EM job is going to let you back fill whatever you want. You would be stuck with many night shifts when you take Mondays&Tuesday off your EM schedule.

If you schedule EM first, how are you going to schedule your FM shifts? So you are going to work two different days every week and have the practice ensure that you have nurses/techs available to care for your patients?

Good luck doing both.

I don't know of ANYONE who does 1/2 in two different specialty!!!!!! Its because there is a Reason.
 
Everyone I know who did med/peds or EM/IM has ended up only sticking with one after residency. I think it'd be cool for me to do EM/FM because I like volunteering at free clinics and helping underserved areas. But I'd rather being doing EM as work, and I'm sure my FM knowledge would quickly become outdated within a few years. Much better to just uptodate stuff as needed for FM type work than spend an extra two years learning a lot that I'd never really use.
 
miacomet said:
Urgent care is still weekends and holidays. This is why I think a combined residency is worth it- you can segue into something that doesn't involve a horrible schedule and where you do something aside from dispensing Z-packs and sending patients to the ER.

YMMV, but our UC docs still work holidays and weekends, and also many evenings. Also, I don't really see EM docs burning out on sick, but on not sick, which UC doesn't solve.

I really think students need to think carefully about EM with the scheduling and burnout issues. A combined residency certainly is one of several paths to an exit.
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I do prn UC work. No weekends, no nights (getting off at 8pm isn't a night to my reckoning), no holidays. I pick up maybe 5-7 shifts/month.
 
Just to chip in, burnout in EM is high, buts only as high as Internal Medicine. So I am struggling to understand why running from EM to IM to avoid burnout is a good idea.
fig3.png

Courtesy: Medscape National Physician Burnout & Depression Report 2018

Also, some of us are trying for EM not just because it pays a lot. Sure, the paycheck will be a nice motivating factor to get out of bed and go to work every morning. But I really wish people see EM as something beyond the "nice paying lifestyle branch" tag which is incorrectly associated with it.
 
DocRPP said:
Just to chip in, burnout in EM is high, buts only as high as Internal Medicine. So I am struggling to understand why running from EM to IM to avoid burnout is a good idea.
fig3.png

Courtesy: Medscape National Physician Burnout & Depression Report 2018

Also, some of us are trying for EM not just because it pays a lot. Sure, the paycheck will be a nice motivating factor to get out of bed and go to work every morning. But I really wish people see EM as something beyond the "nice paying lifestyle branch" tag which is incorrectly associated with it.
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I initially asked this because I’m not a student yet, I was just accepted, but I’ve scribed for PCPs, EM Docs, and surgeons. I love the knowledge and skills that go into EM but I love the continuity of care with PCPs and seeing the benefit of your work. I really wish there was a way to do both haha but people really make it seem impossible. Also, after speaking with many physicians, I found that burnout is more so due to people who maybe aren’t cut out for the intensity of work of medicine going into medicine for reasons such as money or family influence or prestige... the same people who are burnt out would probably get just as burnt out answering telephones for 40 hours a week...
 
KeikoTanaka said:
I initially asked this because I’m not a student yet, I was just accepted, but I’ve scribed for PCPs, EM Docs, and surgeons. I love the knowledge and skills that go into EM but I love the continuity of care with PCPs and seeing the benefit of your work. I really wish there was a way to do both haha but people really make it seem impossible. Also, after speaking with many physicians, I found that burnout is more so due to people who maybe aren’t cut out for the intensity of work of medicine going into medicine for reasons such as money or family influence or prestige... the same people who are burnt out would probably get just as burnt out answering telephones for 40 hours a week...
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There is a reason almost NO ONE can play two pro sports.

Also, I agree that most people I know get burned out b/c they are just unhappy in general or have a crappy personal life.

There is a reason why medscape shows the majority of specialists are in the high 30's-40's. Seems to me most fields are similar to burn out rates.
 
emergentmd said:
Obviously money is not the most important thing for most. But the question was

"If you did a joint program like this with the promise of working 1-2 clinic shifts a week and like 2 ED shifts a week, would you do it? I feel like this would be great for ED physicians who complain of burnout and great for the country by filling a need. "

And I am giving my opinion and as you can see all of my points, only ONE pointed out money. You must have missed the other 4.

If you think EM = big burnout, then I also disagree. The last Medscape article had FM with higher rate of Burnout (or atleast that is what I read)

Doing 1/2 FM + 1/2 EM has a Greater burnout potential. Being 1/2 EM still obligates you (for most groups) to do weekends, holidays, night shifts with potentially less benefits. Do you think 1/2 FM or 1/2 EM jobs will give you full benefits?

How are you going to get any decent job to hire you for 1/2 time? You would be stuck with the worse/desperate jobs of both worlds.

Imagine working 9-5 in FM clinic then going in for a EM night shift. Or doing an EM night shift and going to your 9-5 clinic.

Who are you going to schedule 1st? If you schedule FM first, no EM job is going to let you back fill whatever you want. You would be stuck with many night shifts when you take Mondays&Tuesday off your EM schedule.

If you schedule EM first, how are you going to schedule your FM shifts? So you are going to work two different days every week and have the practice ensure that you have nurses/techs available to care for your patients?

Good luck doing both.

I don't know of ANYONE who does 1/2 in two different specialty!!!!!! Its because there is a Reason.
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I agree that most folks pick one or the other, and that practicing EM with IM or Peds is almost impossible.
emergentmd said:
There is a reason almost NO ONE can play two pro sports.

Also, I agree that most people I know get burned out b/c they are just unhappy in general or have a crappy personal life.

There is a reason why medscape shows the majority of specialists are in the high 30's-40's. Seems to me most fields are similar to burn out rates.
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Huh. Then why are doctors burning our more and more every year? Administration loves to blame us, but we shouldn't be blaming ourselves; if we are, then they have truly won.

Don't underestimate the circadian issues in EM.
 
miacomet said:
I agree that most folks pick one or the other, and that practicing EM with IM or Peds is almost impossible.


Huh. Then why are doctors burning our more and more every year? Administration loves to blame us, but we shouldn't be blaming ourselves; if we are, then they have truly won.

Don't underestimate the circadian issues in EM.
Click to expand...
As the son of a high school teacher, I can tell you burnout is even higher working with ungrateful little brats haha. But at least doctores are making 4x their salary.
 
miacomet said:
I agree that most folks pick one or the other, and that practicing EM with IM or Peds is almost impossible.


Huh. Then why are doctors burning our more and more every year? Administration loves to blame us, but we shouldn't be blaming ourselves; if we are, then they have truly won.

Don't underestimate the circadian issues in EM.
Click to expand...
Doctors in gen are burning out every year, not just EM.

More burnout is multifactorial including the newly minted generation of wanting a "work life balance compatible, happy hours, high pay, low stress" job.

Not Just medicine... I bet you most fields would be in the 30-40's. Go Ask any Teacher
 
emergentmd said:
Doctors in gen are burning out every year, not just EM.

More burnout is multifactorial including the newly minted generation of wanting a "work life balance compatible, happy hours, high pay, low stress" job.

Not Just medicine... I bet you most fields would be in the 30-40's. Go Ask any Teacher
Click to expand...

Teachers actually have a really low burnout rate,
 
emergentmd said:
Tell that to all of the teachers who are striking and working multiple jobs to make up for their 40-50k salary.
Click to expand...

Right on.

I could be wrong about this (as I have but a tangential understanding of the teacher's situation), but I suspect that the sources of burnout in their world are very similar to ours; administration and parents (i.e. - their version of "patients") having unrealistic expectations of their abilities while they exert ZERO power over their situation.

Parent: "Why is my son not getting good grades in your class?"
Teacher: "Because your son either has limited aptitude in this subject, has behavioral problems, or is plainly not interested."
Parent: "How dare you call my son these things! The problem must be YOU!"
Principal: "We can't have dissatisfied customers. You must change, teacher."
Teacher: "Eff both of you."

Patient: "Why am I not feeling any better at all?"
Doctor: "You're horribly noncompliant with lifestyle modifications because you don't like them or find them 'uncomfortable', or cannot be motivated to understand your own condition."
Patient: "How dare you say these things about me! The problem must be YOU!"
Administrator: "We can't have dissatisfied customers. You must change, physician."
Doctor: "Eff both of you."

...

A STRANGE GAME. THE ONLY WINNING MOVE IS NOT TO PLAY.

HOW ABOUT A NICE GAME OF CHESS?
 
Last edited:
RustedFox said:
Right on.

I could be wrong about this (as I have but a tangential understanding of the teacher's situation), but I suspect that the sources of burnout in their world are very similar to ours; administration and parents (i.e. - their version of "patients") having unrealistic expectations of their abilities while they exert ZERO power over their situation.

Parent: "Why is my son not getting good grades in your class?"
Teacher: "Because your son either has limited aptitude in this subject, has behavioral problems, or is plainly not interested."
Parent: "How dare you call my son these things! The problem must be YOU!"
Principal: "We can't have dissatisfied customers. You must change, teacher."
Teacher: "Eff both of you."

Patient: "Why am I not feeling any better at all?"
Doctor: "You're horribly noncompliant with lifestyle modifications because you don't like them or find them 'uncomfortable', or cannot be motivated to understand your own condition."
Patient: "How dare you say these things about me! The problem must be YOU!"
Administrator: "We can't have dissatisfied customers. You must change, physician."
Doctor: "Eff both of you."
Click to expand...

Administrators are certainly the cause of most burnout. Time to send them out to sea in a boat full of holes.
 
Teachers are way worse.

Uninvolved parents + Lazy kids + Admin needing everyone to pass/good standardize scored = Why aren't teachers doing enough?

Teachers are there to teach, not motivate your kids. Parents are LAZY, expect teachers to be their parents and expect to add nothing to a kids education but expect them to be Rhode scholars.

Teachers must be the worse job. Atleast we get paid 10x what they get.

Plus there are many times when I tell patients you either can listen to me or leave, but I am not dealing with their attitude. If you don't leave, you will be discharged and police called.

Good luck doing this as a teacher.
 
emergentmd said:
Did you get this from the state legislature book of salary negotiating?
Click to expand...

Some people like to mouth off about subjects that they know nothing about in a rather "authoritarian" fashion, but then criticize the forum for being "authoritarian" in climate.
Happens with increasing frequency around here.
 
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