If you could do it all over again, would you chose EM?

Panacea Financial Contract Review
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
M

med2928

New Member
7+ Year Member
Joined
Sep 27, 2015
Messages
9
Reaction score
2
Having a difficult time imagining what it would be like to practice EM for 20 years+. How it would impact family life (dont have kids yet). Please share your thoughts!
Members don't see this ad.
 
Yes. Absolutely. There are a few fields I could bear doing. Most I would slit my wrist. EM, I love going to work

BTW and I am gong on my 15th yr and prob could do another 15 but plan on slowing down in the next 5 yrs.

Not too bad to be retired/semi retired by 50
 
Last edited:
Of course. What was Winston Churchill's quote? Something along the lines of "Democracy is the worst form of government except for all the others." In the same way, emergency medicine is a terrible way to earn a living, except everything else is worse.
 
Members don't see this ad :)
med2928 said:
Having a difficult time imagining what it would be like to practice EM for 20 years+. How it would impact family life (dont have kids yet). Please share your thoughts!
Click to expand...

I am just at the beginning of my career, but I do love EM. It's a lot of fun and a decent income. I also question how or if I am going to be doing it 20 years from now, and my thoughts stray in part to a CC fellowship. But honestly, it's no use trying to guess that far ahead. In 20 years the healthcare system, as well as medicine itself and half the specialties could be unrecognizable.

Imagine someone trying to pick a specialty in 1995 and trying to imagine doing it 20 years from now...
-If they went into trauma surgery, they would be surprised at how a much less they operate these days, with lots of liver and spleen (!) injuries being managed non operatively
-Someone going into gen surg would be like 'WTF is acute care surgery'?
-Someone going into IM would be like 'WTF is a hospitalist?'
-Someone going into neurology would be like 'I bet in 20 years we will have treatments for all these diseases I am diagnosing with my clinical exam!' only to see no significant changes in their intervention options (except tPA) and MRI replace the clinical acumen of a generation of neurologists
-If they went into anesthesia they would see a huge spike in their income and then see their specialty in a significant part taken over by midlevels and every anesthesiologist needs a fellowship to remain competitive
-Rads would experience a surge in income followed by a crash over this time period as tele radiology begins to eat away at their job market and everyone starts doing 2 fellowships all of a sudden
-In many parts of the country independent primary care practice got gobbled up by huge hospital chains

Who knows what all these specialties, and ours, will look like in 20 years.
 
gro2001 said:
I am just at the beginning of my career, but I do love EM. It's a lot of fun and a decent income. I also question how or if I am going to be doing it 20 years from now, and my thoughts stray in part to a CC fellowship. But honestly, it's no use trying to guess that far ahead. In 20 years the healthcare system, as well as medicine itself and half the specialties could be unrecognizable.

Imagine someone trying to pick a specialty in 1995 and trying to imagine doing it 20 years from now...
-If they went into trauma surgery, they would be surprised at how a much less they operate these days, with lots of liver and spleen (!) injuries being managed non operatively
-Someone going into gen surg would be like 'WTF is acute care surgery'?
-Someone going into IM would be like 'WTF is a hospitalist?'
-Someone going into neurology would be like 'I bet in 20 years we will have treatments for all these diseases I am diagnosing with my clinical exam!' only to see no significant changes in their intervention options (except tPA) and MRI replace the clinical acumen of a generation of neurologists
-If they went into anesthesia they would see a huge spike in their income and then see their specialty in a significant part taken over by midlevels and every anesthesiologist needs a fellowship to remain competitive
-Rads would experience a surge in income followed by a crash over this time period as tele radiology begins to eat away at their job market and everyone starts doing 2 fellowships all of a sudden
-In many parts of the country independent primary care practice got gobbled up by huge hospital chains

Who knows what all these specialties, and ours, will look like in 20 years.
Click to expand...
Excellent post!
 
I'm just at the start of my career, and doing a fellowship that will have me spending a lot of time outside the ER, but I say on a nearly daily basis that I have the coolest job in the entire world.
 
I love this job, for the most part. This job can crush your soul, but, so can working at Denny's. I cant imagine being as happy doing anything else.
 
I wouldn't have done medicine at all. But that's not because I succumb to the mantra that there are a ton of other better ways to make good reliable money. (I don't think there are many other safe routes to financial and job security. Honestly, the job security in medicine--specifically EM--is unrivaled.)

Rather, I unfortunately don't have a passion for medicine and should have gone the humanities route, even though it has terrible job security. (Maybe I would have regretted that if I had ended up not securing a tenure job at a TT university.)

However, if I had to re-pick a speciality within medicine, then EM it would have been again. For multiple reasons.

By the way, this question is asked every few months... But, I guess I enjoy answering it.
 
Last edited:
I enjoy the medicine part. I hate patient satisfaction and patient complaints. These two things suck the soul out of medicine and obliterate any enjoyment. Practicing in Texas helps as I'm not worried about being sued. Frequent vacations and the very nice salary also make it worthwhile.
 
What sometimes gets to me is the shifts. None of them are good. For example, the one that starts at 6 am sucks because it's hard to get out of bed that early because I can't get to sleep at 9 pm, so I stay up until 11 or 12. The evening shifts cause me to miss out on dinner with the family, bedtime with the kids, volunteer opportunities, and playing on sports teams. The overnight shifts make me feel jet lagged. The 11am-7pm shift sucks up my whole day, with no time before or after to do anything meaningful.

So yes, there is an effect on the family. But it's less of an effect than many specialties that take call or work long hours. I mean, I'm working<30 hours a week now and will soon be under 25. I go on lots of trips with the family (and without them!)

But the actual practice of emergency medicine as opposed to some other specialty, definitely no regrets there.
 
are the strange hours really worth the cost to one's health? What about factoring in the fact that you will likely retire much earlier than doctors in other specialties since your body can no longer put up with the abuse. With marginal boost in income (relative to say FM/psych/etc), is it worth it to the damage to your health? How about the loss of income in terms of not making money for say 15 years less than your peers since you retired at 50 rather than 65?
 
Members don't see this ad :)
asdf123g said:
(1) are the strange hours really worth the cost to one's health? What about factoring in the fact that you will likely retire much earlier than doctors in other specialties since your body can no longer put up with the abuse. With marginal boost in income (relative to say FM/psych/etc), is it worth it to the damage to your health? (2) How about the loss of income in terms of not making money for say 15 years less than your peers since you retired at 50 rather than 65?
Click to expand...


1.) Yes.
2.) You can always have an "encore career" doing something else in your silver years. I don't plan on doing this EM gig forever and ever, amen. I want to get set up, then cut back on hours, and go do something else that's awesome, too.
 
asdf123g said:
are the strange hours really worth the cost to one's health? What about factoring in the fact that you will likely retire much earlier than doctors in other specialties since your body can no longer put up with the abuse. With marginal boost in income (relative to say FM/psych/etc), is it worth it to the damage to your health? How about the loss of income in terms of not making money for say 15 years less than your peers since you retired at 50 rather than 65?
Click to expand...

A few points:

1) The pay difference between EM and those other specialties is not marginal. You might find the rare guy who started a large practice 50 years ago, or the psychiatrist who does "talk therapy" for the wealthy who might have similar income, but those situations are very rare. And you certainly should not count on that if you decide to chose those specialties.

2) The advantage of EM is that you can pretty much set your schedule after you have a couple years in. The other specialties - particularly FM - are based on "continuity of care." If you own a practice - or are employed to do the same - you are expected to be there 50 weeks a year. You might be able to scrounge working at an urgent care center or do some locums here or there, but the opportunities for "part-time" work are not the same. Yes, as a psychiatrist you might be able to do some inpatient shift/coverage work, but keep in mind few of those patients have great health insurance. The reimbursement - and hence the salaries - are terrible.

3) Medical training in general is horrible when it comes to leadership and management. There are a few ex-military who managed to pick up a few skills, but apart from that EM physicians, by nature of the specialty, generally tend to have the best skills in these areas. As a result, it is fairly easy to move into administrative roles within a healthcare system. I have never heard of a psychiatrist doing administrative work (i.e. as medical director of a non-psychiatric hospital), and most of the FM who do have military experience.

Between picking up a few shifts here and there - New Year's for example has no appeal to me at all now - and administrative work, it is possible to earn as much when you are 60 as a FM/ambulatory care physician does full time at that age.
 
asdf123g said:
are the strange hours really worth the cost to one's health? What about factoring in the fact that you will likely retire much earlier than doctors in other specialties since your body can no longer put up with the abuse. With marginal boost in income (relative to say FM/psych/etc), is it worth it to the damage to your health? How about the loss of income in terms of not making money for say 15 years less than your peers since you retired at 50 rather than 65?
Click to expand...

So EM full time is tough at 65 but you can easily cut back to a couple of shifts a month you can work weekend days or urgent care. With FM/IM you have to work at least 75% capacity because you still have to book a good amount of patients in clinic in order for you to make money. You also make about 50% more in EM than pure clinic. Urgent Care one can easily transfer to part time since it's based on single visits. You can work admin since EM deals with a wide variety of specialties.
 
Vandalia said:
Something along the lines of "Democracy is the worst form of government except for all the others." In the same way, emergency medicine is a terrible way to earn a living, except everything else is worse.
Click to expand...

haha
 
asdf123g said:
are the strange hours really worth the cost to one's health? What about factoring in the fact that you will likely retire much earlier than doctors in other specialties since your body can no longer put up with the abuse. With marginal boost in income (relative to say FM/psych/etc), is it worth it to the damage to your health? How about the loss of income in terms of not making money for say 15 years less than your peers since you retired at 50 rather than 65?
Click to expand...

Pay difference is not marginal.
 
GeneralVeers said:
Theoretically I could work 2 days per month and make over 100K per year. If I really wanted to cut back, I think I could handle 2 days per month for the rest of my life.
Click to expand...

would that be, theoretically, if you did all saturday overnights or some such, or even mix?
 
asdf123g said:
according to google the average is 230 k
Click to expand...

Google doesn't know all.

Secondly: you have to look at per hour rate, which is substantially higher for EM compared to the specialties you mentioned.
 
GeneralVeers said:
I'd rather Google and the other sites keep doctor's salaries falsely low. The less the public (and politicians) think we are greedy and overpaid, the better.
Click to expand...

Oh, me too, just saying. Much as I'm interested in the free surveys -- Medscape and the like -- part of me always wonders what the public at large thinks of them. Especially the part of the public that just wants to be pissed at doctors without thinking about it.
 
Can anyone comment on NP's encroaching on EM and its possible ramifications in the future? Below are some posts from a thread in the allopathic forum regarding NP's rapidly encroaching on Derm however its applicable to EM as well.

"Always ask yourself about a nonsurgical specialty, what is the barrier to entry? If it is low and the field is lucrative, that's like inviting the fox into the henhouse. There must be clear and distinct roles between physicians and midlevels. If the midlevel does the exact same job as you, your field is in trouble long term. Look at primary care, anesthesiology, ED, and derm."

"Surgical and fields like radiology, pathology, etc are not big parts of nursing midlevel training. Primary care, ED, and anesthesiology are. Derm is in danger because it can easily be integrated within the scope and training of nursing midlevels.
Can nursing midlevels be trained to read CTs in radiology? Sure, but can you see it be done as part of a nationwide push without the support of national radiology leadership? No.
Can nursing midlevels be trained to do surgery or read path slides? Sure, but can it be done without the blessing of the surgeons or pathologists? Nope.
Anesthesiology screwed the pooch because their leaders embraced and supported the CRNAs. They created their own monster and now they can't control what they have wought."

"If you are interested in a field that is in the cross hairs of midlevel nurses, then you must be the type of person who does not mind working with someone who has lesser training than you but gets the same title and nearly the same/identical pay as you. You must check your ego at the door. For me, that's unacceptable. It makes you look like a fool for going the medicine route."

"Yeah, that's how primary care, anesthesiology, and ED screwed themselves. They thought they could control the monster they created. They thought their monster would not have a mind of its own, that it would never want to be free of the leash around its neck. Don't be a fool. Give a midlevel nurse an inch and they want to take a mile."

"The whole notion of "team based" and "collobaration" is a concept invented by administration and nursing serpents. Nurses have their roles as nurses. An ED doc doesn't need a nurse practicing medicine for him or her"
 
asdf123g said:
according to google the average is 230 k
Click to expand...

Double that and that is closer to what a full time doc should make working 140hrs.

I never understood such a low average. I am sure its a mix of full timers, part timers, academics, Urgent care, ect. That number is worthless unless you just quote full time docs. Everything else just waters down the real numbers.
 
asdf123g said:
Can anyone comment on NP's encroaching on EM and its possible ramifications in the future? Below are some posts from a thread in the allopathic forum regarding NP's rapidly encroaching on Derm however its applicable to EM as well.

"Always ask yourself about a nonsurgical specialty, what is the barrier to entry? If it is low and the field is lucrative, that's like inviting the fox into the henhouse. There must be clear and distinct roles between physicians and midlevels. If the midlevel does the exact same job as you, your field is in trouble long term. Look at primary care, anesthesiology, ED, and derm."

"Surgical and fields like radiology, pathology, etc are not big parts of nursing midlevel training. Primary care, ED, and anesthesiology are. Derm is in danger because it can easily be integrated within the scope and training of nursing midlevels.
Can nursing midlevels be trained to read CTs in radiology? Sure, but can you see it be done as part of a nationwide push without the support of national radiology leadership? No.
Can nursing midlevels be trained to do surgery or read path slides? Sure, but can it be done without the blessing of the surgeons or pathologists? Nope.
Anesthesiology screwed the pooch because their leaders embraced and supported the CRNAs. They created their own monster and now they can't control what they have wought."

"If you are interested in a field that is in the cross hairs of midlevel nurses, then you must be the type of person who does not mind working with someone who has lesser training than you but gets the same title and nearly the same/identical pay as you. You must check your ego at the door. For me, that's unacceptable. It makes you look like a fool for going the medicine route."

"Yeah, that's how primary care, anesthesiology, and ED screwed themselves. They thought they could control the monster they created. They thought their monster would not have a mind of its own, that it would never want to be free of the leash around its neck. Don't be a fool. Give a midlevel nurse an inch and they want to take a mile."

"The whole notion of "team based" and "collobaration" is a concept invented by administration and nursing serpents. Nurses have their roles as nurses. An ED doc doesn't need a nurse practicing medicine for him or her"
Click to expand...

One thing that will not change is the litigious nature of America. You have to deal with so many aspects of care and you have to call in other doctors. It's not like FM where you can be really awful and no one cares. In EM everyone sees your mistakes hence why you need to have tough skin. You deal with some sick people in EM even after 3 years you have newly minted attending crapping their pants as they work alone. Derm is mostly a cash business and unlike FM patient's are very educated so they are not going to pay top dollar for a non-dermatolgist it's the same reason why FM who tries to get into Derm don't really do that well.
 
Brigade4Radiant said:
Derm is mostly a cash business and unlike FM patient's are very educated so they are not going to pay top dollar for a non-dermatolgist it's the same reason why FM who tries to get into Derm don't really do that well.
Click to expand...

Derm is more a cash business than other fields, but its still 90% medical. The things that most midlevels aren't doing in derm are what generate the most revenue - excisions of cancers on the face, flaps/grafts, filler, co2 ablative laser. Also most aren't managing immunomodulators regularly and know zero about pathology. They certainly aren't reading their own slides.

I'm not stupid enough to think they wont try to encroach on these areas (seeing what happened in anesthesia we should not make the mistake of training them to replace us) but the barriers to entry are present beyond just patient perception. If other physicians get minimal exposure to dermatology in 4 years of med school and 3-7 years of residency how much do you think pas/nps get?
 
Vandalia said:
A few points:

1) The pay difference between EM and those other specialties is not marginal. You might find the rare guy who started a large practice 50 years ago, or the psychiatrist who does "talk therapy" for the wealthy who might have similar income, but those situations are very rare. And you certainly should not count on that if you decide to chose those specialties.

2) The advantage of EM is that you can pretty much set your schedule after you have a couple years in. The other specialties - particularly FM - are based on "continuity of care." If you own a practice - or are employed to do the same - you are expected to be there 50 weeks a year. You might be able to scrounge working at an urgent care center or do some locums here or there, but the opportunities for "part-time" work are not the same. Yes, as a psychiatrist you might be able to do some inpatient shift/coverage work, but keep in mind few of those patients have great health insurance. The reimbursement - and hence the salaries - are terrible.

3) Medical training in general is horrible when it comes to leadership and management. There are a few ex-military who managed to pick up a few skills, but apart from that EM physicians, by nature of the specialty, generally tend to have the best skills in these areas. As a result, it is fairly easy to move into administrative roles within a healthcare system. I have never heard of a psychiatrist doing administrative work (i.e. as medical director of a non-psychiatric hospital), and most of the FM who do have military experience.

Between picking up a few shifts here and there - New Year's for example has no appeal to me at all now - and administrative work, it is possible to earn as much when you are 60 as a FM/ambulatory care physician does full time at that age.
Click to expand...


It is not rare at all to find a psychiatrist who makes an EM level salary. Most psychiatrists work < 40 hours per week, but they have some of the best $/hr in all of medicine.

Also, some psychiatrists do psych ER where you basically practice psychiatry in scrubs and work an ER shift work lifestyle
 
asdf123g said:
Can anyone comment on NP's encroaching on EM and its possible ramifications in the future? Below are some posts from a thread in the allopathic forum regarding NP's rapidly encroaching on Derm however its applicable to EM as well.
Click to expand...

Search this forum as this has been addressed many times. Short version is that there is excellent job security for a boarded EM doc.

Don't believe med students.
 
GeneralVeers said:
Two 12 hour night shifts per month. If I worked days it would only be about 95K.
Click to expand...

so in theory, work like four 12 hr night shifts a month and make 200k? Which is more than most full time family med docs make... is this possible? or is this pretty rare?
 
4 is about right for a standard contract in difficult to staff places for 200k/yr.

If I was super flexible, i could make 350k+ doing 48 shifts a year but would require alot of flexibility, holidays. But you get my drift. Last Christmas, I was offered 150k in December to cover 20 shifts.
 
weasel23 said:
so in theory, work like four 12 hr night shifts a month and make 200k? Which is more than most full time family med docs make... is this possible? or is this pretty rare?
Click to expand...

It may be possible (anything is possible) but rare. Is it fairly common to pick up a shift for double pay? Yes. However, few EPs have the opportunity to reliably make $400k/yr working 8 shifts a month without exclusively doing locums in high-paying/high-demand locations. So yes this is possible if you have a certain job in a certain location, but for the majority of EPs it will not be the norm.

Average $/hr in the best reimbursing regions in the US is just above $200/hr. 200 x 4-shifts x 12-hrs x 12-months = $115k/yr.

You are much more likely to end up making $180-$200/hr working 140/hrs/mo making ~$320k/yr. I would also recommend working in a place that does not exclusively work 12-hr shifts (as it is more sustainable) and is part of a well-run, comprehensive health-care system with good access to care and a reliable patient population. You may make more per hr doing locums at some disaster of an ER with understaffed nurses, poor specialty backup, high-turnover, etc, but the extra $20/hr is not worth the reduced sustainability.

that said, yes I would absolutely do EM again, it's an outstanding career with excellent reimbursement, enviable lifestyle, and imo great stability over the next 20 yrs or so..

We are blessed.
 
asdf123g said:
are the strange hours really worth the cost to one's health? What about factoring in the fact that you will likely retire much earlier than doctors in other specialties since your body can no longer put up with the abuse. With marginal boost in income (relative to say FM/psych/etc), is it worth it to the damage to your health? How about the loss of income in terms of not making money for say 15 years less than your peers since you retired at 50 rather than 65?
Click to expand...

Is the boost really marginal?

And couldnt an EM doc just "retire" to an urgent care clinic?
 
You must log in or register to reply here.

Similar threads

O
If you could go back in time knowing what you know now, what specialty would you choose?
2 3
Replies
136
Views
14K
miacomet
M
D
Would you recommend EM?
2 3
Replies
133
Views
15K
BoardingDoc
BoardingDoc
B
EM Alliance
Replies
1
Views
533
RustedFox
RustedFox
C
Would you refer to a cash pay podiatrist?
Replies
13
Views
1K
RustedFox
RustedFox
C
Transitioning from residency at a large academic center to a suburban community ED: what do you wish you would have learned?
Replies
24
Views
3K
Rendar5
R
Top