Is Emergency Medicine genuinely that saturated, and should that still be my long-term goal?

[xaelia]

Sure, if you want your house to be overrun with rats!

Well, just get yourself some cats!

... and when your house is overrun with cats ....

---

Members don't see this ad.

 

[EctopicFetus]

Thanks guys but I’ve already matched and I know I’ll be fine. I was referring to awesome hours AND the whole part about not going into more debt than 6 months of salary. Nothing makes $800k and has no call and bankers hours.

A business owner can. Own a nice derm practice. Some other fields too. Don’t restrict your beliefs. Some people have it way more figured out. Good ophtho practices make insane money, work banker hours and take 0 call.

 

[miacomet]

EM is such a total scam.

 

[Splenda88]

Re-assess when you are in years 3 and 4 of med school. If market conditions remain the same or worse (and they probably will be worse...), then consider an alternate career path that provides similar mental stimulation and skill set...i.e. critical care.

The truth is that human beings are incredibly flexible and medicine is so varied and interesting to most physicians that you could probably reach equal degrees of career satisfaction in multiple specialties. I've said it before but I could have probably been equally happy doing CC and/or hospitalist medicine. I enjoy procedures but after 12 years of doing them...they aren't nearly as exciting anymore. Some days I even envy our hospitalist colleagues with their flexibility, "slower" pace, deeper understanding of pathology and 7on - 7off schedules (many of which don't require nights).

The grass is always greener... I envy my psych colleagues who work 4 days/wk(Mon-Thurs) and make 250k-275k/yr.

I assume some hospitalists (not me) envy you guys because of your 10-12 days/month schedule while making 300-350k/yr

 

[RoyBasch]

Reminds me of these responses:

What contributes to burnout in Radiology?

Genuinely curious - what are the big factors that contribute to Radiology burnout? Is it mostly because of high volume or are there other factors I don't understand as a non-radiologist? Thanks in advance.

forums.studentdoctor.net

"What I think non-radiologists don't understand about radiology is intensity-level that we perform at consistently (on-call). It's not uncommon to have a call shift where, other than getting up to pee and maybe answering phones calls, we're reading a huge stack of acute cases. 80-100 acute cross sectional cases where the radiologist's input directly drives patient care. Baseline that's like a 7-8 out of 10 on the stress scale.

I remember clinical medicine calls; in my opinion, people wildly underestimate just how much time they spend doing low-intensity activities: calling consults, walking to see a patient, putting in orders, writing notes, waiting for a trauma patient to arrive, doing the closure on a surgery, etc.... I would liken radiology to doing the most intensive part of a surgery, some sort of delicate anastamosis, for 8-10 straight hours. Or running 8 codes in 8 hours. That's gonna be mentally fatiguing."

"I am at a high-end academic medical center, and our IR residents and fellows compare their IR call to their general radiology call. IR call is busy without too much time downtime since there are few fellows covering a large health system; despite this, they almost always consider IR call a bit of a break when compared to general diagnostic radiology call. Some of the IR residents/fellows partake in ICU/SICU rotations, and DR work to them is relatively more intense, especially on a per unit of time metric.

My co-residents all felt more mentally tired working 50-60 hours a week in radiology compared to internal medicine or surgery intern year where many of us routinely worked 70-80+ hours/week. The closest analogy is focused non-stop driving for 10-12 hours, but this not an apt comparison since diagnostic radiology requires even more mental focus/intensity, or else miss rates go up."

I agree, radiology has very high "critical decision density" per hour worked/call. I think this is under appreciated. That being said, that is job security right there. As far as I can tell the specialty is nearly impervious to MLP encroachment, and the number and role of cross sectional axial imaging seems to be growing rapidly in medicine currently and thus demand for radiologists to interpret them.

 

[Taurus]

I agree, radiology has very high "critical decision density" per hour worked/call. I think this is under appreciated. That being said, that is job security right there. As far as I can tell the specialty is nearly impervious to MLP encroachment, and the number and role of cross sectional axial imaging seems to be growing rapidly in medicine currently and thus demand for radiologists to interpret them.

I agree and I’ve been saying this for a while. The biggest threat to radiology is corporate radiology and Wall $treet.

 

[CCM-MD]

The grass is always greener... I envy my psych colleagues who work 4 days/wk(Mon-Thurs) and make 250k-275k/yr.

I assume some hospitalists (not me) envy you guys because of your 10-12 days/month schedule while making 300-350k/yr

You can always become a PCP and make 250-300k a year for 4 days a week.

 

[darklabel]

Ah; I see.

I didn't mean to imply that "FM is slow, lulz, we R fastR".

That's not true across the board, and you and I both know that.

However, I'll point out that the ER expats around here that now do other things frequently remark that their background as an EP has made them faster at their new gig than their non-EM trained counterparts.

I recently started a side gig as "the EP in the room of FM", and that notion seems to be holding true for me as well.

To be clear, I'm not hating on FM as a field. I think FM can be awesome. I wish I had a lot of the FM skills in my set. What I'm saying is that EM-trained folks have the *move your ass* skill maxed-out, and it's a very useful and translatable skill.

Honestly, I think the biggest barrier is EM docs despise clinic. Though it is anecdotal, all the EM residents I worked with said no clinic was a huge plus for EM as a field. Even if they can pick up stuff with a fellowship, I feel few would want to transition to clinic or they would've gone into FM or IM.

As someone going into primary care, I don't mind if EM offers a 1 year fellowship to work as one. I just feel few would really want to.

 

[RustedFox]

Honestly, I think the biggest barrier is EM docs despise clinic. Though it is anecdotal, all the EM residents I worked with said no clinic was a huge plus for EM as a field. Even if they can pick up stuff with a fellowship, I feel few would want to transition to clinic or they would've gone into FM or IM.

As someone going into primary care, I don't mind if EM offers a 1 year fellowship to work as one. I just feel few would really want to.

I often wish I would have chosen FM, despite my dislike for clinic.

Good on you, amigo.
I hope you have a great career.
Sincerely.

 

[Dr Mantis Toboggan]

Honestly, I think the biggest barrier is EM docs despise clinic. Though it is anecdotal, all the EM residents I worked with said no clinic was a huge plus for EM as a field. Even if they can pick up stuff with a fellowship, I feel few would want to transition to clinic or they would've gone into FM or IM.

As someone going into primary care, I don't mind if EM offers a 1 year fellowship to work as one. I just feel few would really want to.

I did hate clinic as a med student. Can’t really remember why.

 

[turkeyjerky]

I did hate clinic as a med student. Can’t really remember why.

On my clinic days, most of the time I was told to see a patient w/o having any idea why the patient was there or what the goals of the visit were, which made for a pretty awkward, useless visit. This was for primary care, specialty rotations were better (although ended up being more shadowing). Also, dressing up sucked balls.

Med students get to see the best of EM and the worst of everything else.

 

[GeneralVeers]

On my clinic days, most of the time I was told to see a patient w/o having any idea why the patient was there or what the goals of the visit were, which made for a pretty awkward, useless visit. This was for primary care, specialty rotations were better (although ended up being more shadowing). Also, dressing up sucked balls.

Med students get to see the best of EM and the worst of everything else.

I had exactly the same problem. Especially with the well-baby exams in peds. I couldn't wrap my head around why the patients were there and found I had nothing to talk to them about. I don't really care how many oz your baby is taking at feeds or how many poops a day......

 

[namethatsmell]

Med students are primed to "hate clinic" by old-school academic physicians who feel that "real medicine" only occurs during the inpatient setting, by the residents they train under because it is "boring," and by certain proceduralists who devalue it since it forces them to talk with patients when they could otherwise be in an OR.

Clinic is as good or as bad as the intersection of the attitude you bring to it, your staff/EMR +/- admin, and your patients. Same factors that determine how good/bad most other work environments are in medicine.

 

[GeneralVeers]

Med students are primed to "hate clinic" by old-school academic physicians who feel that "real medicine" only occurs during the inpatient setting, by the residents they train under because it is "boring," and by certain proceduralists who devalue it since it forces them to talk with patients when they could otherwise be in an OR.

Clinic is as good or as bad as the intersection of the attitude you bring to it, your staff/EMR +/- admin, and your patients. Same factors that determine how good/bad most other work environments are in medicine.

The big problem with clinic for me was that the attendings let well-patients ramble on and on. A 15-minute visit would take 45 minutes. It was intensely boring and the day dragged on. I'm in favor of timed clinic visits, so when the 15-minute buzzer is up, you get to leave the room. Need more time to ramble about your life? Schedule another day.

 

[RustedFox]

The big problem with clinic for me was that the attendings let well-patients ramble on and on. A 15-minute visit would take 45 minutes. It was intensely boring and the day dragged on. I'm in favor of timed clinic visits, so when the 15-minute buzzer is up, you get to leave the room. Need more time to ramble about your life? Schedule another day.

Schedule a therapist.

 

[namethatsmell]

The big problem with clinic for me was that the attendings let well-patients ramble on and on. A 15-minute visit would take 45 minutes. It was intensely boring and the day dragged on. I'm in favor of timed clinic visits, so when the 15-minute buzzer is up, you get to leave the room. Need more time to ramble about your life? Schedule another day.

Sounds like academics where these docs would not want to go faster even if they could. It’s kind of like working in the ED when another doc on is ordering MRIs on every single patient...nails on a chalkboard. In private practice what you’re describing would not be compatible with viability.

Depending on the nature of the complaint I can see a new clinic patient in as little as 15 minutes and a stable follow up in 5 or less. The thing is, I often want to take longer if the patient has something complicated going on, has interesting things to say, or is simply nice. I also don’t want to set the expectation that I’ll go that fast all the time…not looking to keep up warp ED speed and in clinic I have much more control and I still relish it.

If perceived clinic “boredom” comes at the price of not being interrupted every three seconds by a nurse/alarm/phone call/belligerent pt in the ED then I can happily say that clinic is boring. Wonderfully, spectacularly boring.

 

[darklabel]

The big problem with clinic for me was that the attendings let well-patients ramble on and on. A 15-minute visit would take 45 minutes. It was intensely boring and the day dragged on. I'm in favor of timed clinic visits, so when the 15-minute buzzer is up, you get to leave the room. Need more time to ramble about your life? Schedule another day.

Resident clinic also primes people to hate clinic. You don't great follow up and the patient population isn't always the best. Nvm a lot of times you don't follow up with your patients as closely and see a lot of other residents' patients instead of your own. Checking patients out can really bog you down sometimes too.

Its a shame, I think more people can like clinic if we can change the culture around it. Increasing pay would also be great.

 

[Splenda88]

Resident clinic also primes people to hate clinic. You don't great follow up and the patient population isn't always the best. Nvm a lot of times you don't follow up with your patients as closely and see a lot of other residents' patients instead of your own. Checking patients out can really bog you down sometimes too.

Its a shame, I think more people can like clinic if we can change the culture around it. Increasing pay would also be great.

Will you be doing hospital medicine darklabel?

 

[darklabel]

Will you be doing hospital medicine darklabel?

Nope, all outpatient. I'll be starting July so excited & nervous about it.

 

[Splenda88]

Nope, all outpatient. I'll be starting July so excited & nervous about it.

That is great. Is it a good deal? Do you think your residency prepare to do outpatient on day 1?

 

[VA Hopeful Dr]

I had exactly the same problem. Especially with the well-baby exams in peds. I couldn't wrap my head around why the patients were there and found I had nothing to talk to them about. I don't really care how many oz your baby is taking at feeds or how many poops a day......

Yeah in the real world we don't care about that stuff (or if you do, have the MA ask about it). Is the baby gaining weight? Good, that means it's getting fed enough.

One of the best things my school did was to have 2 weeks of the FM rotation be with a PP group. That's pretty much when I decided to do FM. Regular patients, good mix of mostly healthy and complicated.

Oh, and they were paid well. Got to hear about boats, vacations, lake houses. Offered a nice contrast to the "FPs don't make money" mantra that you hear in medical school.

 

[bravotwozero]

The big problem with clinic for me was that the attendings let well-patients ramble on and on. A 15-minute visit would take 45 minutes. It was intensely boring and the day dragged on. I'm in favor of timed clinic visits, so when the 15-minute buzzer is up, you get to leave the room. Need more time to ramble about your life? Schedule another day.

Nailed it right there. This is precisely what made clinic medicine, and even IM hospital rounds, a soul sucking experience. The attendings would ramble on about nothing at all, because they liked hearing the sound of their own voices.

The other thing that drove me nuts in clinic medicine was seeing the sheer amount of medications each patient was on. Of course, every visit, the patient would bring every singe pill bottle that they owned, and had enough to stock a small pharmacy, and I was expected to go through every single damn one. If clinic medicine just meant shoving more and more pills down peoples throats, count me out, is what I had told myself at the time.

 

[Splenda88]

Yeah in the real world we don't care about that stuff (or if you do, have the MA ask about it). Is the baby gaining weight? Good, that means it's getting fed enough.

One of the best things my school did was to have 2 weeks of the FM rotation be with a PP group. That's pretty much when I decided to do FM. Regular patients, good mix of mostly healthy and complicated.

Oh, and they were paid well. Got to hear about boats, vacations, lake houses. Offered a nice contrast to the "FPs don't make money" mantra that you hear in medical school.

You know 300k/yr is no money for med students. Everyone was gunning for ortho and derm until step1 result.

 

[DoctorMD1]

Last group I was with was around 800-850K w/most partners in the 17-18K RVU range. Weekday shifts were 8 hours, but only 8 weeks vacation. Weekend call could be soul-crushing but you do get acclimated/desensitized. About 20 miles outside of largest metro area in the country. Moved on for family reasons. Very solid democratic group where the leaders actually produced the most RVUs and would not ask anyone to do anything that they were already doing. Probably shouldn't have left!

8 weeks vacation for partners?!! How come you haven't left earlier?

 

[dl2dp2]

The big problem with clinic for me was that the attendings let well-patients ramble on and on. A 15-minute visit would take 45 minutes. It was intensely boring and the day dragged on. I'm in favor of timed clinic visits, so when the 15-minute buzzer is up, you get to leave the room. Need more time to ramble about your life? Schedule another day.

This is called psychiatry...

 

[Birdstrike]

Going into Emergency Medicine right now, would be a terrible idea. That's not because of potential salary decreases, although that's a drawback. It's because Emergency Medicine leadership has doubled down on their refusal to take Emergency Physician burnout seriously, by agreeing to massively increase training programs.

They're not worried about paying you too much. Hospital profits are massive. They want more bodies to replace those of you they're going to immolate. It's not cheaper salaries they're breading. It's soldiers to replace the fallen.

 

[Rekt]

Even with this year being transiently "better", it's still very apparent that this field is oversaturating quickly. I'm done with my job search, but talking to all the other residents that are graduating it's very obvious.

Them: "Oh I'm going to clinic at A and B road" "I'm going to clinic at D and C road". "I''ll be at X hospital across the way". "I'll be signing on here" "I'll be splitting time here and at Y". etc etc etc.

Me: "Oh, uh, there was no openings in the entire city or surrounding areas"

 

[turkeyjerky]

Going into Emergency Medicine right now, would be a terrible idea. That's not because of potential salary decreases, although that's a drawback. It's because Emergency Medicine leadership has doubled down on their refusal to take Emergency Physician burnout seriously, by agreeing to massively increase training programs.

They're not worried about paying you too much. Hospital profits are massive. They want more bodies to replace those of you they're going to immolate. It's not cheaper salaries they're breading. It's soldiers to replace the fallen.

Por que no los dos?

 

[vm26]

8 weeks vacation for partners?!! How come you haven't left earlier?

That was the norm for the geographic area. Def rough. But at the same time, these high volume groups with 12-13 weeks off, make work days that much harder given the decrease in # shifts/year one has to hit the high RVU

 

[Birdstrike]

Por que no los dos?

Por ambos

 

[qwerty89]

Even with this year being transiently "better", it's still very apparent that this field is oversaturating quickly. I'm done with my job search, but talking to all the other residents that are graduating it's very obvious.

Them: "Oh I'm going to clinic at A and B road" "I'm going to clinic at D and C road". "I''ll be at X hospital across the way". "I'll be signing on here" "I'll be splitting time here and at Y". etc etc etc.

Me: "Oh, uh, there was no openings in the entire city or surrounding areas"

username checks out.

 

[Febreeze]

I'd say about 50% of EM residents that I know (including myself) across different programs are applying to various fellowships over this year and the next. People are realizing the reality.

 

[GonnaBeADoc2222]

The field is dead.
Admin gaslighting.
"We value you."
"Heroes work here."
Yet, paycuts.

I'm the top producer in the group yet I hear about it when the three nurses who don't like me have too much box white wine the night before and complain about me.

Working on my 5 year "sell out" plan.

 

[kenjixshadow]

I'm signing with a group in the middle out of nowhere because that's the only job I could find. Saw my friends just matched to cardiology and other IM sub-specialties yesterday questioned why did I not go to IM in the first place (second choice after EM). Hindsight 20/20.

 

[EctopicFetus]

I'm signing with a group in the middle out of nowhere because that's the only job I could find. Saw my friends just matched to cardiology and other IM sub-specialties yesterday questioned why did I not go to IM in the first place (second choice after EM). Hindsight 20/20.

Let me play devils advocate and point out much of cardiology was decimated 5 years or more ago. Most are employed and being told by their hospital bosses what to do. It’s not a lot of docs with real power. Surgical sub specialists and non surgical specialists who dont depend on hospitals. But private equity and hospitals are. Owing for them and insurers are haply to help that happen.

 

[sylvanthus]

Lets be real dudes, medicine is dying. Instead of dealing with the real issues out national organizations are focusing on horsepuckey. See the AMAs most recent focus. A freaking 54 page guide on acceptable terms in medicine. Better not call that guy you see next in the ED homeless. Hes a person experiencing homelessness. Get your terms right!

https://www.ama-assn.org/system/files/ama-aamc-equity-guide.pdf

Yaaaa were hosed.

 

[sylvanthus]

Lets be real dudes, medicine is dying. Instead of dealing with the real issues out national organizations are focusing on horsepuckey. See the AMAs most recent focus. A freaking 54 page guide on acceptable terms in medicine. Better not call that guy you see next in the ED homeless. Hes a person experiencing homelessness. Get your terms right!

https://www.ama-assn.org/system/files/ama-aamc-equity-guide.pdf

Yaaaa were hosed.

Oh and I got this email today from WAACEP

WA-ACEP Journal Club
Join us for a discussion on,
"Anti-Racism in Emergency Medicine"

Yaaaaa lets ignore the real issues here guys and focus on whatever social justice warrior thing is popular at the time.

 

[thegenius]

Lets be real dudes, medicine is dying. Instead of dealing with the real issues out national organizations are focusing on horsepuckey. See the AMAs most recent focus. A freaking 54 page guide on acceptable terms in medicine. Better not call that guy you see next in the ED homeless. Hes a person experiencing homelessness. Get your terms right!

https://www.ama-assn.org/system/files/ama-aamc-equity-guide.pdf

Yaaaa were hosed.

Yup we are hosed.

Also another reason why I’m not going to give the AMA any money. I wonder how much it cost the AMA to put forth that document? 54 pages of nonsense

 

[BoardingDoc]

From the document @sylvanthus linked. If you told me this came from the onion, I would believe you.

 

[deleted941485]

The field is dead.
Admin gaslighting.
"We value you."
"Heroes work here."
Yet, paycuts.

I'm the top producer in the group yet I hear about it when the three nurses who don't like me have too much box white wine the night before and complain about me.

Working on my 5 year "sell out" plan.

The healthcare hero thing was the biggest farce. “A flyover from the Blue Angels as a thank you?” screw you.

The last thing I’d ever want to be in US healthcare is a “hero”.

 

[Siggy]

Lets be real dudes, medicine is dying. Instead of dealing with the real issues out national organizations are focusing on horsepuckey. See the AMAs most recent focus. A freaking 54 page guide on acceptable terms in medicine. Better not call that guy you see next in the ED homeless. Hes a person experiencing homelessness. Get your terms right!

https://www.ama-assn.org/system/files/ama-aamc-equity-guide.pdf

Yaaaa were hosed.

So... use terms in left column... not the middle column.

When a significant part of the recommendation is "don't use X, use "person experiencing X," then you know it's people trying to justify their pay.

 

[Siggy]

From the document @sylvanthus linked. If you told me this came from the onion, I would believe you.

View attachment 346382

I mean... there is a valid discussion to be had on structural racism with historical roots from things like redlining that destroyed generational wealth.

The solution to that is difficult because it often revolves around throwing money at the problem... which begets the question, "who should the money be thrown at."

None of this has anything to do with medicine or what gets put into a patient's chart.



Also, things like the bit on poverty does ignore the fact that some people are just lazy or mentally ill. Not everything is a conspiracy to hold down the proletariat.

 

[emergentmd]

Although I have been out of the game, I am getting alot of calls/emails about openings including Hawaii. I have no clue about rate, but looks like there are job openings.

 

[GonnaBeADoc2222]

Although I have been out of the game, I am getting alot of calls/emails about openings including Hawaii. I have no clue about rate, but looks like there are job openings.

I think I've reached the point of wisdom where I know the job just sucks, and it's not specific to any one ED in particular. CMS, private insurance, and healthcare admin have joined forced to bone people who had every good intention of caring for patients to the best of their ability when they started down this path. I've reached my sell out event horizon. I'll be getting an MBA and either joining the darkside to limit my future exposure that is the toxicity of clinical medicine, or best case scenario, getting involved with start up projects.

 

[emergentmd]

I think I've reached the point of wisdom where I know the job just sucks, and it's not specific to any one ED in particular. CMS, private insurance, and healthcare admin have joined forced to bone people who had every good intention of caring for patients to the best of their ability when they started down this path. I've reached my sell out event horizon. I'll be getting an MBA and either joining the darkside to limit my future exposure that is the toxicity of clinical medicine, or best case scenario, getting involved with start up projects.

I hear you man. I am at Fire right now and would have considerably cut back or went went into a nonclinical path.

 

[Birdstrike]

...I've reached the point of wisdom where I know the job just sucks...CMS, private insurance, and healthcare admin have joined forced to bone people who had every good intention of caring for patients... I've reached my sell out event horizon.

A new Jedi has been knighted. Congratulations on seeing the Light.

Like I've always said, they turned us into overpaid hot dog vendors, long ago. All pre-meds and pre-EM folk, read this now:

Respect for physicians

Odd you should mention: "Coffee breaks, and a dinner break." Had the experience the other day where the MLP decided that, well... she was 'closed' to go on dinner break. Picked up the three charts yet to be seen in her rack, dumped them in mine, said - "I gotta go eat. Back soon."...

forums.studentdoctor.net

 

[Apollyon]

Respect for physicians

Odd you should mention: "Coffee breaks, and a dinner break." Had the experience the other day where the MLP decided that, well... she was 'closed' to go on dinner break. Picked up the three charts yet to be seen in her rack, dumped them in mine, said - "I gotta go eat. Back soon."...

forums.studentdoctor.net

What I find more amazing is that the post you cite isn't "."

 

[dchristismi]

FWIW, I've started getting locums emails again. (Which is hilarious because I've been out of the EM game for a couple of years now, and sometimes they're using my very-old hyphenated name... my divorce was final back in 2010.)

I really love passive aggressively writing back "That sounds absolutely terrible, and you couldn't pay me enough to even consider that job."
If I'm not in a snippy mood I'll just say to take me off their list as I've retired because clearly, they're going off of data over 10 years old.

 

[Birdstrike]

What I find more amazing is that the post you cite isn't "."

Those were the best ones, you know. The "." posts. Remember?

I used to be 🔥

 

[Birdstrike]

FWIW, I've started getting locums emails again. (Which is hilarious because I've been out of the EM game for a couple of years now, and sometimes they're using my very-old hyphenated name... my divorce was final back in 2010.)

I really love passive aggressively writing back "That sounds absolutely terrible, and you couldn't pay me enough to even consider that job."
If I'm not in a snippy mood I'll just say to take me off their list as I've retired because clearly, they're going off of data over 10 years old.

I've been out of EM 10 years and STILL get EM recruitment emails and calls. My wife goes berserk on them, when they call. Lol. I don't react at all, anymore. I just never answer my phone and instead, block, delete, or whatever.

But since I do Interventional Pain now, I also get tons of Pain recruitment emails, anesthesia ones, PM&R ones. It's a frickin' disaster. Lol

It doesn't matter how many times you tell them, "I don't do that specialty anymore" "I moved to MARS" "That guy is dead, I just have his phone" they'll still call. It's frickin' hilarious Lol.