Is EM a lifestyle specialty?

[moto_za]

Already read past posts so wanted more recent thoughts on what attendings thought about this. Especially in terms of having a family and being older than most students. And it’s comparison to other specialties like PM&r, psych, etc.

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[theseeker4]

Already read past posts so wanted more recent thoughts on what attendings thought about this. Especially in terms of having a family and being older than most students. And it’s comparison to other specialties like PM&r, psych, etc.

I am a somewhat non-traditional PGY 3 EM resident, with a wife and one child born before med school and another born at the beginning of residency, and i have to say if you want a lifestyle specialty, look harder into PM&R and Psych. EM has its advantages of some flexibility, very generous total amount of time off, and pay per hour worked is high, but the nights, weekends, holidays, all are detriments to having a family. It isn't that it can't be done, and it is definitely a lot better than most other specialties, but it does not compare to the ability to work only 9-5 (at most) M-F work of PM&R, Psych, Derm, etc. If lifestyle is your main concern, you should reconsider EM. Do EM only if the crazy hours and requirement to work nights and weekends and holidays are outweighed by your love of the actual work.

 

[Arcan57]

Yes.

 

[slz1900]

Depends what kind of lifestyle you're after. If you want stretches of days off to travel or to have ample time for hobbies (often solitary, since your free time is when the rest of the working world is busy), then yes. If you want to reliably be off when your partner/kids are, it's tougher and honestly most non surgical specialties have it beat, even though you'll be a lot better rested than them.

 

[Frazier]

No.

 

[Money Moniker]

Depends what kind of lifestyle you're after. If you want stretches of days off to travel or to have ample time for hobbies (often solitary, since your free time is when the rest of the working world is busy), then yes. If you want to reliably be off when your partner/kids are, it's tougher and honestly most non surgical specialties have it beat, even though you'll be a lot better rested than them.

Sounds like the perfect life for a bachelor. No wife happy life!

 

[Birdstrike]

In my opinion, for middle aged or older people, or those with families, EM is absolutely not a lifestyle specialty. For single, young people, the EM "lifestyle" is much better tolerated but it doesn't last. This is one of the biggest myths about EM, that it's a "lifestyle" specialty on par with Derm, Psych, PMR, Pain, Rad Onc and others. It's just not. I've just seen too many fellow EPs (myself included) deal with chronic burnout from the circadian rythm havoc the EM schedule causes, to conclude otherwise.

If you do EM and "lifestyle" is (or will become) any concern at all, make sure you have an iron clad plan in place, usually through one of the fellowships, that will allow you to reduce your general EM shift and replace them with hours that don't destroy your circadian rhythms. The extent to which one has to work a rotating mix of nights, weekends and holidays, is the extent to which shift work kills you, physically and emotionally.

Like many young EM hopefuls, I ignored the warnings of EM burnout related to the lifestyle until I was deeply entrenched in it. Doing a fellowship (Pain) saved me. Also, many people I did residency with or worked with in soon after residency have done similar things to reduce their clinical shifts drastically and it's helped a lot; one did hyperbarics and runs a fellowship, another runs an EM/Cards obs unit, another that does EMS 80%/EM shifts 20%, another that did Hospice/Pall fellowship, and another admin. They all exercised the option to reduce their general EM shifts by 50-90%.

EM can work over a career, but you have to do it right, and with proper planning. To grind out a full schedule in general EM for 30 years, is a tough, tough road.

 

[DocRPP]

I am a med student, so take what I have got to say with a pinch of salt. During one of my EM rotations, a slightly older EM attending I talked to asked me if I am sure about my decision to try for EM. Her exact words were "Don't pick this, pick something Monday to Friday, 9-5". She was probably 40-50 and is absolutely hating having to come in at 7 PM for an overnight shift on a weekend, at her age. On the other hand, the Chairman of the ED was a much younger person. He seemed to be in love with his job. He will see all the patients quickly, go to triage and see the patients there too, and then come and teach the med students for one hour straight. He told me that both he and his wife are ER physicians, and they love their job. If they had to, they both will do this all over again. So my understanding is that things are much easier when you are young or have an additional admin position or anything that can compensate for your hours, as Birdstrike mentioned above. Being an older EM physician following a regular EM attending schedule can be hard for most people and that is when the overrated "lifestyle" tag fades away and burnout sets in.

 

[Brigade4Radiant]

EM is a variable specialty. You don't have to work 16 shifts a month. You also get paid well. If you don't like doing holidays you can do locums. Because of the nature of the job though. The fact is EM is a young doctors game. Every ER shift is a punch in the gut sure you work less days than most but you work way harder than most doctors. EM doctors get interrupted at multiple times a day. However you do get to enjoy some weekday shifts and weekends can be fun since you don't have to do chores on the weekends so it's a purely social day.

I would recommend ER but I would recommend financial independence. Doing this at 50+ would hurt. EM is also the dog of the hospital. Since EM docs are apart of contract management groups whether it be SDG or CMG it makes you really replaceable since you don't bring patients to the hospital. In all honesty I would hate a 9-5 as I don't believe in living only for the weekends .

 

[Birdstrike]

I am a med student, so take what I have got to say with a pinch of salt. During one of my EM rotations, a slightly older EM attending I talked to asked me if I am sure about my decision to try for EM. Her exact words were "Don't pick this, pick something Monday to Friday, 9-5". She was probably 40-50 and is absolutely hating having to come in at 7 PM for an overnight shift on a weekend, at her age. On the other hand, the Chairman of the ED was a much younger person. He seemed to be in love with his job. He will see all the patients quickly, go to triage and see the patients there too, and then come and teach the med students for one hour straight. He told me that both he and his wife are ER physicians, and they love their job. If they had to, they both will do this all over again. So my understanding is that things are much easier when you are young or have an additional admin position or anything that can compensate for your hours, as Birdstrike mentioned above. Being an older EM physician following a regular EM attending schedule can be hard for most people and that is when the overrated "lifestyle" tag fades away and burnout sets in.

Those are two different jobs. The "Chairman of the ED" doesn't have the same job as your "slightly older attending." Two different jobs, two different careers and two different lifestyles. You're comparing apples to oranges, in this example. The majority of EM physicians will never work the "Chairman of the ED" job. And as an exception, it's an exception that proves the rule. Most people that become administrators are specifically volunteering for those positions, precisely so they can reduce their ED shifts, although many won't admit it. So their contentment in their "lifestyle," is not evidence that the EM lifestyle is easy, it's actually evidence of the opposite.

 

[Birdstrike]

Another rule of thumb that's pretty reliable: Any specialty that has an ongoing debate such as "Is this specialty, a lifestyle specialty?" is not a lifestyle specialty. No one has to ask, debate, question or ponder whether lifestyle specialties are lifestyle specialties. The moment that conversation starts, is actually the moment it ends, because if you're debating whether or not it is, it certainly is not.

 

[suckstobeme]

EM can work over a career, but you have to do it right, and with proper planning. To grind out a full schedule in general EM for 30 years, is a tough, tough road.

Yeah, but if you're in EM for 30 years because you have to be, you probably did it wrong. The way salaries are, get in at 30, get out at 50, and you should be set. You should at least be able to go to a setup that pays less but is less taxing (less shifts, less nights, etc).

 

[TheComebacKid]

Agree with what everyone else has said here. Not even close to a lifestyle specialty. I'm married to a surgeon in residency who says she cannot tolerate the schedule we have in the ED. Granted as ED residents we work more than ED attendings, it just gives you a sense of the circadian disruptions, holidays/nights, flip flopping schedules that is really challenging.

When you are 26 and single, the challenge of a crazy weekend overnight shift with multiple crashing patients, GSWs, etc is what motivates you. When you are 50 with a family, it's the reason you hate the job.

Emergency medicine as a specialty is plagued with ridiculous hospital metrics, door to X times, litigation, and the duty to take care of some of society's worst individuals. That being said, it's not all doom and gloom. If I had to do it all over again, I would ten times over. I won't go into all the reasons that I love my job (there are too many to count), but lifestyle is not one of them.

EM is what you make of it in terms of longevity and happiness. One of my mentors in medical school told me: You are only going to be able to work a set number of shifts over the course of your lifetime. How you choose to spread out those shifts is up to you. You can work a lot as a new attending, make tons of money, but you'll burn out early, or you can spread it over a lifetime.

I personally am choosing an academic career and fellowship because I believe working 8-10 clinical shifts a month and the rest of the time doing research, education etc is the perfect balance for me (at the expense of significantly less pay). This is not the only option, and people who work in the community can find other ways to offset the stress of the job. That being said, none of these things really ever get you into the "lifestyle" arena. EM physicians are, year after year, per every single survey study in physicians, the most burned out specialty. There's a reason. I am still always so shocked to hear medical students discuss how they like the lifestyle aspects of our job. They are completely clueless.

It's a satisfying job on some days. Other days its hell. But all in all, the work is hard. Do it because you love it, not because you want a lifestyle. If you want a lifestyle, there are other better options.

 

[GonnaBeADoc2222]

Meh. I'm a pretty salty person, but I think it's a pretty good lifestyle.

It's work. They call it that for a reason. They have to pay you to make someone want to do it.

Yeah, yeah...circadian rhythm stuff, difficult personalities, crashing patients...at the end of the shift I walk away and forget.

I travel so I have almost complete control over my schedule. I go on 3 big vacations a year, I go out to nice meals whenever I want, I live in a nice place, I drive a safe (not expensive) car, I save a ton for retirement and for our future house. My wife and I have a good time. Will get more complicated once we have children for sure though. But there's much worse jobs in medicine out there.

 

[namethatsmell]

In terms of lifestyle EM is probably in the middle of the pack. We're the fodder for the front lines of medicine and are often abused. We put up with much more crap than most other fields. But our ability to work as much or as little as we want and never have a pager--that's pretty cool.

IMHO the best lifestyle field now and for the foreseeable future is psychiatry.

 

[Brigade4Radiant]

EM can be variable to for some other specialties you can't live in certain areas like Radiation Oncology. Also EM is reasonable for an average medical student to get in. PM&R has a decent life if you go into pain (which EM can do but it's harder) also the salary is like 230K starting then mostly RVU driven and you can't just practice anywhere the fact that most medstudents and doctors don't know about the specialty means you don't get many referrals and you compete with Ortho.

Psychiatry is a nice life and you can make a good amount of money but you have to like psychiatry.

 

[Birdstrike]

get in at 30, get out at 50, and you should be set.

This isn't real.

 

[bravotwozero]

This isn't real.

You don't think 20 years as an EM doc will allow you enough savings to become financially independent, or at the very least, semi financially independent?

 

[Brigade4Radiant]

This isn't real.

Uhh yeah it is. If you can't do this then I doubt that someone can work ER for 20 years then find a full time job doing a fellowship.

 

[Moose A Moose]

Yes

 

[Birdstrike]

You don't think 20 years as an EM doc will allow you enough savings to become financially independent, or at the very least, semi financially independent?

It's certainly possible, but only a very, very small minority achieve that. Of the people I've known, the success rate in achieving that is very low.

 

[Birdstrike]

Uhh yeah it is.

On the continuum from "sure thing" to "bulls**t" it's a lot closer to the b******t end of the bell curve than the other. It certainly is "real," like becoming a pro-athlete is real. But not as "real" as having a failsafe back up plan, in my opinion.

... I doubt that someone can work ER for 20 years then find a full time job doing a fellowship.

I recommend people do their fellowships as soon as possible, preferably immediately after residency or soon after. Waiting 20 years is far from ideal.


Regardless, people can do whatever they want. My opinion is just one of many. It has as much worth as you assign to it. We're all grown ups here. People will live as they choose.

 

[bravotwozero]

It's certainly possible, but only a very, very small minority achieve that. Of the people I've known, the success rate in achieving that is very low.

Ok, but why do you think that is? Could it be that most of those docs, like the rest of the country, fail to live within their means? I know plenty of doctors across all specialties who live like that. And if you do live like that, no amount of income will allow you to become financially independent - this is exactly how multimillionaire professional athletes end up going broke.

 

[Brigade4Radiant]

On the continuum from "sure thing" to "bulls**t" it's a lot closer to the b******t end of the bell curve than the other. It certainly is "real," like becoming a pro-athlete is real. But not as "real" as having a failsafe back up plan, in my opinion.

I recommend people do their fellowships as soon as possible, preferably immediately after residency or soon after. Waiting 20 years is far from ideal.


Regardless, people can do whatever they want. My opinion is just one of many. It has as much worth as you assign to it. We're all grown ups here. People will live as they choose.

I suppose it is if you have no financial discipline. Most doctors don't do this because they are poor accumulators of wealth and buy whole life insurance. But if you budget and have control of your m

Having a fellowship means that you need to start practicing that fellowship. So you would have to do some of your fellowship with some of your ER shifts you can't finish a fellowship and not practice it unless its like an admin fellowship like EMS

 

[dchristismi]

Wait a sec... I read that totally differently.
I was in at 30. But there's no way I could last until 50.

The financial independence thing is totally doable IF YOU PLAN and make that a goal. I just know I can't do 20 years in the pit. (Maybe I'm a minority, and yes, I am subspecializing, although I'm not doing a fellowship) but I read his comment differently.

 

[Birdstrike]

WHAT TIME IS IT?

I suppose it is if you have no financial discipline. Most doctors don't do this because they are poor accumulators of wealth and buy whole life insurance. But if you budget and have control of your m

I'm not saying it's financially impossible for an Emergency Physician to retire as they approach 50. It is possible. I've just never seen it done. It's very uncommon. It's the exception to the rule, in my experience. But what I have seen, is a crap-ton of EPs wanting to leave EM as they approach 50, not out of a positive place of financial security, but out of an uncomfortable place of quiet desperation and lack of realistic planning. But by all means, if you can retire young, do it. If that's within reach for you, that's what you should be doing; that is ideal. But at 50, after 2 decades in the pit?

Pffffffttt

I was burnt to a crisp by my mid 30's.

As a single, 27-yr-old childless EM intern, I figured I'd live frugally and retire by 50 and I didn't foresee any trouble making it to 50. By the end of residency, now 30 and married without children, I figured I'd probably need to work until 55, but only could imagine making it to about 45. By age 35, married with 2 kids, my likely feasible retirement date moved to 60, and that age to which I felt I could feasibly practice EM moved up to about 40.

That's when the clock struck f**k this s**t o'clock.

 

[Birdstrike]

Having a fellowship means that you need to start practicing that fellowship. So you would have to do some of your fellowship with some of your ER shifts you can't finish a fellowship and not practice it unless its like an admin fellowship like EMS

Yes, the whole point of a fellowship, is to practice it. There’s no point in learning a new, less common, more specialized and refined skill and refusing to use it, for fear of "losing" a more common skill. This is where many Emergency Physicians somehow can’t see what so many other physicians see. They see their “EM skills” as an end point, a zero sum game, a skill that can never be added to, a blade that can never be sharpened, lengthened or used in novel ways.

A little bit of opening of the mind goes a long way, here. Fellow EPs have often asked me, “Are you afraid you’ll ‘lose your skills?’ Aren’t you worried you won’t be able to work in the ED anymore?”

But just stop a moment to ponder that. Consider the absurdity of that.

Do people ask interventional cardiologists, "Are you going to still do 5 general IM shifts per month? Don't you want to 'keep up your skills'"?

Why the heck would a Cardiologist want to keep up his general IM skills, when he has something more specialized, refined and in his eyes, better?

Apply that to any IM or surgical sub-specialty where people do a fellowship. No one asks them, "Are you going to keep up your non-specialist skills, now that you're a specialist?”

Does anyone ask the plastic surgeon, “Aren’t you getting tired of doing all those cash-pay nose & boob jobs during waking hours, when you could be doing appy's and dead-bowel resections at 3am on while taking general call?"

It's absurd on the face of it. Yet in EM, everyone asks similar questions of those EPs who have sub-specialized. And fellowship trained EM people ask themselves that question. It's all about your mindset. When considering whether or not to sub-specialize or do a fellowship, you should ask yourself:

Are you in or are you out?

Are you going to be a specialists or not?

In your sub-specialty practice will you add to your skillset, and gain a new, valuable skill (Hospice/palliative, Pain, Sports medicine, Informatics, Hyperbarics, Critical Care, etc)?

Or will you view yourself as having lost a skillset (general EM)?

The way I look at it, the glass is half full, not half empty. I've gained acumen (in a subspecialty) and not "lost" acumen.

Just think about that again. Does any other fellowship trained sub-specialist that you know, feel that by becoming a specialist they've lost acumen or become dumber? Do you and I view them as having "lower acumen" or as being dumber, by being specialists?

No.

In my opinion, we as Emergency Medicine "sub-specialists" should view ourselves in the same way, as having gained something by sub-specializing. We've not become less whole by doing so. We've become more so. We need to step out of the mindset that EM is an end point, a zero sum game where one cannot gain something with giving something up. In contrast, we should think of our Emergency Medicine training as a beginning point and a skill set with no pre-set limit.

That being said, I do understand the hesitation. I understand that when stepping out of the box we've put ourselves in, there's often a mourning of the loss of the "ER doc" identity. It is a very, very special thing. The people that do it are very special. It's something no one can truly understand as fully as those that have done it. I am blessed and honored I was able to do it for a period of time. But I've come to believe that I wasn't meant to do it forever. That those skills were on loan to me for a finite period of time, and I believe it truly was meant to be, but only for a finite period of time.

 

[Brigade4Radiant]

As a brand new attending, this is the most sobering thread ever. I should have never picked this specialty.

What field would you have done instead?

 

[RustedFox]

I'm six years in and 90+% out of debt. I started with 300K+ in loans.
Saving for retirement.
Wife. No kids.
Ample time off, and we take it.
I generally work 130-145 hours/month, with plans to cut back to 120-130 here soon.
I can see myself doing this until I'm sixty.

 

[takeurmeds02]

I'm six years in and 90+% out of debt. I started with 300K+ in loans.
Saving for retirement.
Wife. No kids.
Ample time off, and we take it.
I generally work 130-145 hours/month, with plans to cut back to 120-130 here soon.
I can see myself doing this until I'm sixty.

Thank God for this post - the almost overwhelming doom and gloom of this thread was getting out of hand lol

 

[RustedFox]

Thank God for this post - the almost overwhelming doom and gloom of this thread was getting out of hand lol

Let me breathe some fresh air into this.

I have 3-4 months of "cash-only" emergency funds at the ready.
I have 3-4 job sites: one "primary" and three "auxiliary", because variety is the spice of life and if one job site begins to "suck", then it gets "benched".
I have a nice home in Florida. Its not overly opulent. We have a cool pool and an "office" each (me and wife, no kids - we don't want kids). I might soon buy a pinball machine.
My retirement is lagging behind (age 36), but I'm not worried. I spent a little more early-on, as there's no guarantee of tomorrow even happening. I'm ready to double-down on this soon.
I had two 5-day stretches off this month, and still have 136 hours on the books. Take-home pay (after taxes) should be in the neighborhood of 18K.
On one of those stretches of off-time, I simply took four days and watched baseball/grilled by the pool. Its hot as hell right now.
I got bored, so I picked up a shift on the last day.
On the second one, the wife and I went to Orlando for four days. It was even hotter.
Universal Studios was cool, but we both got sick as hell because children are filthy creatures and should be caged.
Although school was in-session here in Florida; it was the last two weeks of "summer holiday" for the UK tourist crowd.
The Wizarding World of Harry Potter was crawling with BritBrats. Jesus, those children were ugly. I'm not a great looker myself; but maan. Poor kids.
I work a lot this week. But on the third of September, we're headed to the Badlands and Black Hills for 10 days. First-class flight.
We got a rather well-appointed cabin for a great rate. Can't wait to see Mount Rushmore and all the National Parks.
We're also headed to Monday Night Football next month. Go STEELERS!
My first-ever malpractice lawsuit just settled.
It was agitating, yes. It was frustrating, yes. But at the end; nobody ever threatened to come for my house, my paycheck, my whatever.
For all of the posts on here about the horrors of med-mal; I didn't lose all that much sleep over it.
I can still look myself in the mirror and say; "I did the right thing." When the final letters are signed and such, I'll post all about it. Feel free to critique my thought process and care.
I get frustrated with work, and I complain about it on here (seemingly a lot, to some), but I have my reasons.
I don't ever really plan in "retiring" - I just want to cut down to a two-day work-week in my sixties.
Even an 80-hour month @ 200/hour is 16K. That's a good amount of money.
I don't ever plan on owning a luxury vehicle (I'm really not a "car guy"), or a luxury watch, or high-end fashion. That's not my thing.
I'll probably leave Florida at some point, as its just becoming "New Jersey South", even here on the gulf coast.
Stay tuned.

 

[emergentmd]

Lifestyle depends on what kind of lifestyle you want.

If you want to work 9-5 and off weekends/holidays then no its not.

If you want to work 14 days a month, make 300K and have 16 days totally Off. If you want to take 7-10 dys off anytime you want to travel. If you want to do slow urgent care/FSER. If you want to move almost anywhere/anytime. If you want to work part time, then full time, then PRN, then back to full time. Then YES it is.

I like the flexibility of EM. I rather do this than have a 9-5 Derm Job where I could not take off when I want without shutting down the practice, or have to stay in one city because starting in another would require me to start the practice over again.

Give me EM anyday.

 

[Birdstrike]

Lifestyle depends on what kind of lifestyle you want.

If you want to work 9-5 and off weekends/holidays then no its not.

If you want to work 14 days a month, make 300K and have 16 days totally Off. If you want to take 7-10 dys off anytime you want to travel. If you want to do slow urgent care/FSER. If you want to move almost anywhere/anytime. If you want to work part time, then full time, then PRN, then back to full time. Then YES it is.

I like the flexibility of EM. I rather do this than have a 9-5 Derm Job where I could not take off when I want without shutting down the practice, or have to stay in one city because starting in another would require me to start the practice over again.

Give me EM anyday.

What you say here is certainly true on the face of it and I think your point is valuable. But I think it's worth pointing out, that you seem to be using a definition of "lifestyle specialty" which goes as follows: "A lifestyle specialty is any specialty which has a lifestyle that is a good fit for any given person." By that definition of 'lifestyle specialty' neurosurgery is a lifestyle specialty because, "Dr. C likes to work long hours, long nights and be on call 15 days a month." Essentially any specialty fits that definition, but it would vary from person to person and is based on their personality as opposed to the personalities of the specialties. So, I'm not sure how useful that definition is to people who don't yet know what they want and haven't lived any of these lifestyles.

The definition I tend to use and I think most people share, is, "A lifestyle specialty is one which has a lifestyle enjoyed by the majority of people." Derm fits this; neurosurgery doesn't. I think this type of definition is more useful in to those who haven't chosen one of these specialities yet, as it is more generalizable and more predictive for the undecided. Sure, what matters to each of us, is that we have a good fit for ourselves, not what matters to the masses. But when the uninitiated are asking the question, "What is a lifestyle specialty?" they're not asking what is a perfect fit for you and I, but what will be the most likely fit for them before having experienced the specialties personally. Ultimately, they'll have to decide for themselves.

 

[mymembernames]

Probably PMR. I walked away from applying to PMR as a med student as my home PMR program was about as bad as it can get. It's interesting to think what my life would be like had I chosen to go to another medical school.

What about Psych?

 

[Birdstrike]

What about Psych?

Both psych and PM&R are specialties that when I was a medical student, I never would have considered. But looking back, I realize they're both so, SO much better than I thought. So many of the sleeper specialties I got little if any exposure to, I can see now, are so much better than I knew back then. One thing I try to drive home to pre-meds and medical students is to work as hard as possible, to shadow as many oddball specialties that you'll never get exposure to, and might not have any (current) interest in, as you can, as soon as you can. Because once clinicals start, you're applying for residency in no time, and it comes before you have any exposure to that majority of specialties that exist. It's a major flaw in medical training, in my opinion; lack of exposure to a wide range of specialties, early in training and pre-training.

 

[GonnaBeADoc2222]

Gonna second @RustedFox

I'm pretty sure if I had chosen 90% of most non-EM specialties I would have quit residency.

I work 12 days a month, design my schedule, live comfortably in a medium cost of living city, saving aggressively for retirement and paying off loans.

I've already gone on two "bougie" vacations this year and have another coming up that will be even better than the last two, oh and then I'm going away again 2 months after that and then again 3 months after that.

I also do not do fancy cars, watches, or fashion type stuff. Just doesn't appeal to me.

However, when I see an experience or a great meal or a fantastic beer that I want, I buy it without hesitation.

The work is HARD. They call it work for a reason - they have to pay you to get you to do it. Everyday, I make a small contribution, some days I get to really connect with a patient or family and that tends to make up for the other BS I have to deal with.

I shudder when I see the work requirements of other specialties. My spouse is a critical care doc. She's a baller. But, she deals with some of the worst circumstances and families. After getting abused by some family who thinks they know more about the intricacies of their family member's incredibly complex disease process and optimal treatment (stuff that would make me s*** my pants), she has to deal with them again the next day, and the next, and the next, and the next into perpetuity. In contrast, after a difficult day, I walk away and forget.

I love complaining, but EM is pretty great for me. Now, if you'll excuse me, I'm going to play video games.

 

[JAFERD]

Yes and no.

On the plus side, EM is paid well for the hours worked, probably more than most. $300k is not a stretch and you can easily make more. Full time is usually 12-15 shifts, and when your shift is over, you walk out the door with no concerns. It’s very nice to be able to leave work at work. Also, the majority of the time, when I have a particularly awful or difficult patient, I only have to see them once. My advice in EM (and the advice I’m trying to follow) is to just see work as a means to do the things you enjoy.

That said, I probably wouldn’t do EM again. While we don’t work many shifts, having to work all times of day and night, weekends, holidays, and switching frequently between them takes its toll. We’re dumped on by pretty much everyone and when other doctors don’t feel like doing anything, the default answer is always “go to the ER.” Patient satisfaction is a huge deal, but we deal with mostly the worst of society. I sometimes am concerned about my job, because some of the lowest contributing (being generous here) members of society don’t think I was empathetic enough about their chronic pain or 4 hours of sore throat. Arguing about admits, or having to call consults for other people is annoying and not infrequent.

I often times have to remind myself that I drive a tesla, have a nice house, go flying when I want, go on nice vacations, and don’t have to work too much. Then, I go see the next 20 year old with a cold...

 

[Shufflin]

Already read past posts so wanted more recent thoughts on what attendings thought about this. Especially in terms of having a family and being older than most students. And it’s comparison to other specialties like PM&r, psych, etc.

I can't comment on EM since I'm in Psych, but since you asked about other specialties including Psych I can chime in. In Psych you can do whatever you want. Work as much or as little as you want, for a hospital, group practice, or your own practice. Jobs are everywhere. Can work into your 80s. You'll have time for family, hobbies, leadership positions. Pay is good to great depending. Lawsuits are hardly seen. Stress is lower compared to procedural-based specialties. No overnights.

If you need an example, I work about 5 hrs a day at a hospital and a few days a month in my private practice ($400 / hour cash). I had over $360K in loans when I left fellowship last July, and will have it 100% paid off by this Jan. So we're not starving.

 

[Cinclus]

I can't comment on EM since I'm in Psych, but since you asked about other specialties including Psych I can chime in. In Psych you can do whatever you want. Work as much or as little as you want, for a hospital, group practice, or your own practice. Jobs are everywhere. Can work into your 80s. You'll have time for family, hobbies, leadership positions. Pay is good to great depending. Lawsuits are hardly seen. Stress is lower compared to procedural-based specialties. No overnights.

If you need an example, I work about 5 hrs a day at a hospital and a few days a month in my private practice ($400 / hour cash). I had over $360K in loans when I left fellowship last July, and will have it 100% paid off by this Jan. So we're not starving.

And I considered Psych pretty seriously, too...

 

[miacomet]

It's certainly possible, but only a very, very small minority achieve that. Of the people I've known, the success rate in achieving that is very low.

That doesn't mean it's difficult, it just means people can't handle money!

Pay off loans in 5 years, or find a job that will pay them for you. Buy a 500-700k house, sock away 125k k a year pre kids, then cut down a bit to say 75k a year to save for college and also to pay for activities and childcare. At fifty, do palliative care/pain (hard to get)/urgent care etc. 75k a year compounded at 7% is 3.5mm after twenty years. That and a paid off house should put a doc in a nice position to take a cush job at fifty and continue working for 10-15 years either very part time or in another field. Retire at 65 with 10mm (5 mm or so in today's dollars). This is not rocket science.

EM is great if you want to crank hard and save early, front loading your retirement, paying off your loans and mortgage. It's not great to do if you want to work into your eighties like some folks do.

We have saved hard and early and are debt-free at 45 with a reasonable net worth and two pensions coming. Will continue doing this until I'm fifty and then do occmed, UC, pain, or something else more diurnal. Being debt-free has allowed me to work 80-100 hours a month at a cush gig while still socking away 100k a year.

That having been said, I wouldn't do it again due to the stress, shift work issues, and general lack of career satisfaction. I would have done psych, PM&R, a peds subspecialty, ID, or onc.

 

[NYYk9005]

Even though I’ve been an EM attending for less than a year, I can confidently say that this lifestyle is great for me. Every person has a different personality and different values, so what’s traditionally good for some people may not be good for others. I am married and have no kids right now, but thankfully this lifestyle is great. I work the minimum amount which is about 120 to 130 hours a month. The acuity level at my place is not ridiculous, nor is the volume. There are full-time nocturnists, which means I only have to do night shift two or three times max every month. I will likely get out of all of my student loans within this year, go on multiple vacations, and I currently live in a nice apartment, am saving for a down payment for a house… And drive a luxury car. We spend well within our means.

Emergency medicine has too many good things about it . If I had to do it all over again, I would definitely choose emergency medicine. If you want to work five days a week, carry pagers, constantly talk to your patients even when you’re home, as long as you get weekends off, then sure go for it. If you want possible uncertainties with business, paying overheads, hoping to build a patient base, so that you can be extremely busy so that you can make the money, all the power to you.

If you take away all of the gratification of diagnosing and resuscitating patients and doing what “a doctor” does, this is still a great profession to be in. You barely work in the month, you have so much free time to travel, spend time with family, learn more about yourself. You make a great amount of money, and if you want to make more money you can pick up more shifts, and if you don’t want to make more money you don’t have to. This can be as big a part of your life as you want it to be.

I find that people naturally find problems no matter what they do. If you are upset about flipping from day shift to night a couple times, and having to work on certain weekends or holidays with the trade off being making a great amount of money and having 2/3 of the month off...I mean I’ll take it.

Again, this could be since I’m young, and relatively easy going. I do think the place you work matters a lot. If I worked where I did residency and dealt with 2-3 ICU patients every shift while seeing a crap ton per hour and doing all the physical work- I’d burn out fast. If you work at a place with good nurses, modest acuity, manageable volumes most days, and not so many shifts a month, it can be a huge blessing.