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yeah I’d do EM again if I was back in 1999 when I originally chose it. Now not so much.
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If you could go back in time, would you do EM again?
- Thread starter g3tb0mbed
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yeah I’d do EM again if I was back in 1999 when I originally chose it. Now not so much.
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Right. As long as there's a 10-year period in your career where you can make 350-500K per year then it's worth doing. I would tell new grads that this is unlikely to occur for them.
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I squandered many of the golden years but still should end up doing OK.
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getting out early = the best
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Yes, I am. I think the bigger question is if you could go back in time, would you pursue a career in healthcare.
Of all the specialties, I do appreciate the role ER medicine has in healthcare. People say we are glorified triage docs. Couldn't be more true! We get paid well on our gestalt with limited information - and we are pretty good at it. Someone needs to do this job and that person needs to have our unique/specific skill set. I like not having to own a patient base, utilizing skills from multiple specialties, bedside procedures (hate the OR).
I would say the hardest aspects of the job are patients who abuse the medical system which is surprisingly quite frequent, but I would rather have to deal with a 10 minute temper tantrum than having to round on this person for days-weeks on end. I am also discouraged by the medico-legal reality of healthcare and how physicians do not do a great job of representing themselves as a collective (we should be governing hospitals, we should be creating the laws for mid-levels, we should be organized to protect our future financial interests), but these issues are pervasive and not unique to EM.
Lastly, I have no interest in medicine dictating my life. I really enjoy my work life balance, which you cannot fully/truly appreciate until after residency.
Of all the specialties, I do appreciate the role ER medicine has in healthcare. People say we are glorified triage docs. Couldn't be more true! We get paid well on our gestalt with limited information - and we are pretty good at it. Someone needs to do this job and that person needs to have our unique/specific skill set. I like not having to own a patient base, utilizing skills from multiple specialties, bedside procedures (hate the OR).
I would say the hardest aspects of the job are patients who abuse the medical system which is surprisingly quite frequent, but I would rather have to deal with a 10 minute temper tantrum than having to round on this person for days-weeks on end. I am also discouraged by the medico-legal reality of healthcare and how physicians do not do a great job of representing themselves as a collective (we should be governing hospitals, we should be creating the laws for mid-levels, we should be organized to protect our future financial interests), but these issues are pervasive and not unique to EM.
Lastly, I have no interest in medicine dictating my life. I really enjoy my work life balance, which you cannot fully/truly appreciate until after residency.
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EM has given me the background to point my life in the direction I want it to go. And I still find much of the medicine to be cool (except rashes and eyeballs, blech). So overall I'm glad I picked it.
Yet many of the lamest features of EM boil down to the fact that you often have minimal control over your work environment. Probably more than any other specialty. You often have to adapt your practice to how other people want the ED to do things. Sometimes it makes sense and I learn a new trick but usually it's completely arbitrary, irrational, and "because that's the policy." It gets old. If your leadership is weak you'll drown in inefficiencies, scut, midlevel mayhem, metrics, and politics. I would sooner become a goat herder than work at shops like that.
If my life allowed me to move to a tiny ED someplace like rural Montana, far from CMG clutches and without a ton of BS, I think I'd be pretty content with full-time EM for the long run.
If I had to pick a residency again in the past, I'd probably pick EM. If I was picking a field right now and aware that winter is coming for EM thanks to the swirling market forces...I don't think so. I'd pick something outpatient with the option to do a solo practice if I wanted. FM or IM to do direct primary care sounds good. Or psych or PM&R.
Yet many of the lamest features of EM boil down to the fact that you often have minimal control over your work environment. Probably more than any other specialty. You often have to adapt your practice to how other people want the ED to do things. Sometimes it makes sense and I learn a new trick but usually it's completely arbitrary, irrational, and "because that's the policy." It gets old. If your leadership is weak you'll drown in inefficiencies, scut, midlevel mayhem, metrics, and politics. I would sooner become a goat herder than work at shops like that.
If my life allowed me to move to a tiny ED someplace like rural Montana, far from CMG clutches and without a ton of BS, I think I'd be pretty content with full-time EM for the long run.
If I had to pick a residency again in the past, I'd probably pick EM. If I was picking a field right now and aware that winter is coming for EM thanks to the swirling market forces...I don't think so. I'd pick something outpatient with the option to do a solo practice if I wanted. FM or IM to do direct primary care sounds good. Or psych or PM&R.
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Out of curiosity though, have you thought about an academic gig? It might be a way of practicing EM and solving some of your problems.
EM faculty are somewhat more insulated from the circus suite and metrics chasers, and not as easy to dislodge. I remember an attending of mine in residency that had ZERO tolerance for stupid BS. He actually chased an alcoholic out of the ED, yelling 'don't you come back here again, you hear me?' I'm pretty sure he got away with that because of his academic position. I'd get fired in a hot second if I did that. The VA will also give you that advantage, but that's not everyone's kettle o'fish.
At a lot of academic places, you'll trade MLPs for residents, something I'm pretty sure you'll be more than ok with. Not everywhere but these places are out there. My residency had zero.
If you're willing to do research/didactic stuff, you might even be spared night shifts, so less circadian disruption. You seem like the cerebral type so this might be right up your alley. Again, that's not everywhere, but those gigs exist.
Sure, you'll take a significant pay cut for this, but you've already made abundantly clear that you're willing to do that if it means a better work environment.
Just a thought.
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I'm a PGY 12 who has been a split of community/academics for the past decade and I would absolutely do it again. The bottom line I've found to avoiding burnout has been to keep my # of ED shifts reasonable. I've worked ~20/month and wanted to quit medicine, I work ~12/month now and love what I do. Academics certainly isn't for everyone as the non-clinical hours can add up but having some exposure to learners has really helped me stay intellectually excited. The hourly rates at community shops have gone down but compared to everyone I know outside of medicine the pay is still tremendous.
Side gigs are a huge help as well. I do a day each week in wound care clinic which is a nice counterpart to what I do in the ED. I have a pretty involved side gig with medical education but this took years of free work to get to the point where it started to bring in some income and I think it may have been more of a stars aligning or right place right time rather than a path I'd recommend to someone just starting out.
I don't know that I'd be as happy in another specialty. In EM the lows are tremendously low (pedi codes, abusive patients), most of our time is spent doing repetitive and mundane tasks (low risk chest pain, rear end MVC) but the actual high points and saves have made for a really great career.
My dream job and current side hustle is to get a big check from Spotify for podcasting, but even if I get some of Joe Rogan's $100,000,000/year I'd still pick up a few ED shifts each month.
Side gigs are a huge help as well. I do a day each week in wound care clinic which is a nice counterpart to what I do in the ED. I have a pretty involved side gig with medical education but this took years of free work to get to the point where it started to bring in some income and I think it may have been more of a stars aligning or right place right time rather than a path I'd recommend to someone just starting out.
I don't know that I'd be as happy in another specialty. In EM the lows are tremendously low (pedi codes, abusive patients), most of our time is spent doing repetitive and mundane tasks (low risk chest pain, rear end MVC) but the actual high points and saves have made for a really great career.
My dream job and current side hustle is to get a big check from Spotify for podcasting, but even if I get some of Joe Rogan's $100,000,000/year I'd still pick up a few ED shifts each month.
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Well...
I did get out. Did I enjoy the ED? Most of the time. Especially at the beginning.
Things came to an unsustainable crisis for me almost 5 years ago... I was crispy as hell, overworked and nearly quit medicine altogether. I've waxed poetic over the years about it, but the bottom line was that I'd hit my expiration date and needed to get out. Some of it was the patients, some of it was the stupid crap that admin pulls, some of it was the nights and weekends, and some of it was (and this might sound weird) what I've realized was moral injury. Yes, intubating and resuscitating grandpa can be hella fun. But it's often the wrong thing to do, and I never felt like I had the time to do that part "right." (And I made a point to carve out time.)
I will say that in retrospect, I'm surprised I lasted as long as I did (11 years, the last 2-3 of which were a gradual phaseout). I'm waaay too touchy-feely to have lasted in the ED long. I am, however, deliriously happy managing the sickest of the dying. I do 100% hospice now, but have created a niche position where I basically run an ICU-with-different-goals-of-care. Less beeping and alarms, but the pharmacology gets complicated. I get to use all of my clinical skills honed in the ED to focus on the amelioration of suffering. I can take the time needed to do it right. (And in a final nod to EM, while I do get bouncebacks when I've bought sometime some time, they pretty much always eventually die. So a little continuity of care, but not too much.)
Would I do it that way again? Tough call. I was in for some good times, the money was good, the camaraderie was always a big part: the biggest redeeming factor was always the colleagues. I was lucky to work and learn from some awesome folks. Now I basically work alone, although I have a team of nurses I've groomed to work how I want. I could have jumped ship a lot sooner - maybe I should have. But it all worked out in the end. It took me a looong time to psychologically make the leap, but I'm much happier now.
(And since everyone always asks about the $$$, I signed a contract for a little under 200K for M-F 32 hours a week, an occasional meeting, one weekend of call a month and full benefits. And thanks to my bruising EM days, I totally feel like it's a sweet deal. The work is physically so much easier. And I have a nice nest egg saved thanks to EM - technically FI, but needed something to do with my time.)
I did get out. Did I enjoy the ED? Most of the time. Especially at the beginning.
Things came to an unsustainable crisis for me almost 5 years ago... I was crispy as hell, overworked and nearly quit medicine altogether. I've waxed poetic over the years about it, but the bottom line was that I'd hit my expiration date and needed to get out. Some of it was the patients, some of it was the stupid crap that admin pulls, some of it was the nights and weekends, and some of it was (and this might sound weird) what I've realized was moral injury. Yes, intubating and resuscitating grandpa can be hella fun. But it's often the wrong thing to do, and I never felt like I had the time to do that part "right." (And I made a point to carve out time.)
I will say that in retrospect, I'm surprised I lasted as long as I did (11 years, the last 2-3 of which were a gradual phaseout). I'm waaay too touchy-feely to have lasted in the ED long. I am, however, deliriously happy managing the sickest of the dying. I do 100% hospice now, but have created a niche position where I basically run an ICU-with-different-goals-of-care. Less beeping and alarms, but the pharmacology gets complicated. I get to use all of my clinical skills honed in the ED to focus on the amelioration of suffering. I can take the time needed to do it right. (And in a final nod to EM, while I do get bouncebacks when I've bought sometime some time, they pretty much always eventually die. So a little continuity of care, but not too much.)
Would I do it that way again? Tough call. I was in for some good times, the money was good, the camaraderie was always a big part: the biggest redeeming factor was always the colleagues. I was lucky to work and learn from some awesome folks. Now I basically work alone, although I have a team of nurses I've groomed to work how I want. I could have jumped ship a lot sooner - maybe I should have. But it all worked out in the end. It took me a looong time to psychologically make the leap, but I'm much happier now.
(And since everyone always asks about the $$$, I signed a contract for a little under 200K for M-F 32 hours a week, an occasional meeting, one weekend of call a month and full benefits. And thanks to my bruising EM days, I totally feel like it's a sweet deal. The work is physically so much easier. And I have a nice nest egg saved thanks to EM - technically FI, but needed something to do with my time.)
D
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I have said it many times on this forum: if I could go do it all over again, I would definitely not have gone to medical school. I would have gotten a JD and then a PhD, and then become a law school professor.
However, if you mean I can only go back in time to M3, then yeah, I think I would have still picked EM, only because it allowed me the flexibility to do other things.
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Hindsight 20/20. I think most people would still do medicine even knowing all the ups and downs and change the way they practice or their specialty.. giving medicine up all together? I think maybe 10 percent would do that IMO.
