Is it just me, or is EM getting Fricken HUGE

[Ryan]

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It seems about half my class talks about going into EM. If things keep going this way it will be one of the most competitive specialties to get into. Although, I need to remind myself that we are only second years and many have not had any (or very little) clinical exposure. 😀 😀

 

[Radiohead]

EM is the shiznit. I think even now you need at least a 250 on step I to get an interview. Better hit the books.

 

[EctopicFetus]

EM is the shiznit. I think even now you need at least a 250 on step I to get an interview. Better hit the books.

250 wont even get you an interview at the almighty Inn n' Out.. where Dr. McFattypanys is..

250 only gets you into the bottom of the barrel places.

 

[DrQuinn]

It seems about half my class talks about going into EM. If things keep going this way it will be one of the most competitive specialties to get into. Although, I need to remind myself that we are only second years and many have not had any (or very little) clinical exposure. 😀 😀

Fear not. When i was an M2... everyone in my class wanted to be either a :

Pediatric Endocrinologist
a Pediatric CT surgeon
a neuropsychiatrist

Now everyone is FP or IM, with a few sprinkles of EM.

Q

 

[EctopicFetus]

I sort of agree that it is continuing to grow. I think there are 10 more US grad EM applicants overall this yr over last but I get the feeling it is gonna explode. Over 20 people from my school are gonna do it this yr.

 

[roja]

I think it varies. EM is definately one of those fields that you really have to love. The shift work (while sounding appealing) is kind of a downer and the pace/mentality appeals to only a small section of the population.

It seems very glam when you are 'young' in your medical career. But I think most phase out after doing a rotation. I have yet to meet someone who 'liked it alot but notn enough...' It seems like most people either love it or would rather have needles in their eyes....

 

[Gregg]

Well then it's a good thing that new programs are opening. Georgetown (hi Quinn), that one in Florida, maybe Vegas (should know soon about this year), West Virginia (has an ad in this month's JAOA for a DO to run a new program). More applicants plus more positions may just work out in the end for everyone involved.

 

[PTOSIS]

roja,
can u expand on shiftwork beeing a downer? p

 

[Soup]

roja,
can u expand on shiftwork beeing a downer? p

I also wonder about this.

 

[spyderdoc]

I also wonder about this.

I took it to mean that some people don't like working nights, holidays, birthdays, anniversaries, Etc. Shift work destoys the good old circadian rhythm. So, if you want to go into EM, you must know that you will be affected by the shift work...

 

[EctopicFetus]

I took it to mean that some people don't like working nights, holidays, birthdays, anniversaries, Etc. Shift work destoys the good old circadian rhythm. So, if you want to go into EM, you must know that you will be affected by the shift work...

Exactly... Some programs dont require you to work overnights when you hit 50. It can be a real hard life.

 

[ERMudPhud]

Exactly... Some programs dont require you to work overnights when you hit 50. It can be a real hard life.

One long standing community group I know recently had to revoke this policy because all of a sudden they realized that damn near everyone was over 50 and the few under 50 weren't getting any younger and weren't going to do many more nights. So don't count on something like this. Its not just the circardian rhythyms. Realize that many of your shifts are going to be at weird or inconvienent times. The ED has to be covered 24/7/365 so you will do plenty of nights, weekends, and holidays. Take this weekend for example. I'm off but my wife is working the AM on christmas eve and the overnight on christmas day. I'm also starting to realize as my kids get old enough for school that many of my days off will fall on days when they are in school and many of their weekends off either my wife or I will be in the ED. The same applies to friends who work 9-5 m-f. They can't go skiing with us during the week and we are often working when they are off.

I still like the shift work when compared to many other options but its not necessarily perfect.

 

[turtle md]

They can't go skiing with us during the week and we are often working when they are off.

The slopes are usually better during the week - less people.

 

[roja]

I personally like shift work (most of the time) but some people like knowing they are working m-f 9-5 or something like that. Shift work means that you work nights, swing, am, weekends, holidays, etc. Its not like you are working all of these all the time but you have to work overnights, weekends, and some holidays. I like having time off during the week and I like the diversity of shift work (a crazy monday afternoon is very different froma crazy friday overnight).

But it can be rough on sleep cycles. I am a world champion sleeper and it sometimes trips mine up and I have to take something.

However, I was off thanksgiving and christmas and am only working new years so....

 

[mikecwru]

However, I was off thanksgiving and christmas and am only working new years so....

New Year's Eve overnight is the absolute worst shift I've ever worked in emergency medicine.

mike

 

[The White Coat Investor]

December 26th has been my worst day ever.

 

[Paws]

I like EM and to be honest, the only forums I read on sdn are allo and EM. You guys are the best for humor and I am so impatient when the "Things I learned from my patients" thread doesn't have anything new for while. 😛

But for lifestyle, hmmmm .... I wonder if I would not like the shifts and not knowing my patients. Would I ever miss important things because I don't have a history on the person? What about all the social issues that come with em. Would that stuff drive me nuts and make me depressed when it's like, the tenth homeless person in two days and they're screaming at us, etc.

On the other hand, a local em doc said that he likes the shift work because when you walk away, you really do walk away. In a smaller city or even rural, your shift ends at the set time and so it's more like a regular job. IM or FP would be more time consuming in other ways.

I am 1.5 years into the degree, so we'll see what happens.

 

[roja]

Mikecwru- I have worked new years the last couple of years (always off on xmas and t-day) and last years was crazy but I wouldn't say worst every. We have extra coverage so its not to bad.


Paws- I don't mind shift work. And trust me, you end up getting to know many of your patients. Even primary's miss significant diagnosis. Its not just about knowing your patients.

Homelessness is a frustrating issue. Probably dependent on where you practice. In NYC, we see tons of it. Sometime we are their firstline to healthcare.

 

[EctopicFetus]

December 26th has been my worst day ever.

Care to elaborate?

 

[threepeas]

I like EM and to be honest, the only forums I read on sdn are allo and EM. You guys are the best for humor and I am so impatient when the "Things I learned from my patients" thread doesn't have anything new for while. 😛

But for lifestyle, hmmmm .... I wonder if I would not like the shifts and not knowing my patients. Would I ever miss important things because I don't have a history on the person? What about all the social issues that come with em. Would that stuff drive me nuts and make me depressed when it's like, the tenth homeless person in two days and they're screaming at us, etc.

On the other hand, a local em doc said that he likes the shift work because when you walk away, you really do walk away. In a smaller city or even rural, your shift ends at the set time and so it's more like a regular job. IM or FP would be more time consuming in other ways.

I am 1.5 years into the degree, so we'll see what happens.

As mentioned there are pros/cons to shiftwork. In a well structured practice your should be working no more than 3-4 overnights/month which i dont think is too bad. i probally stay up for one reason or another that much anyway (watching a latenight movie, restlessness, late night sex) It is true that evening shifts take away from dinner and bed time stuff and can put some strain on the primary caretaker of the kids. However, i use those days to spend some quality time with the wife. we exercise, shop, or hang out and watch movies with no kid interruptions. if your spouse doesnt work you can really spend some unique quality time together which is good for the marriage. i also enjoy getting around town, and going to events when the rest of the world is working. lines are short, traffic is minimal, etc. i cant stand routine so shiftwork takes care of that. you have to be made somewhat to handle the odd hours. my body and mind do quite well but for some it's a GD greek tragedy if they tried to keep our hours. but the absolute sweetest trade off in the positive about shiftwork, that has already been mentioned, is when you walk out and the fresh air hits you, you are done, done, done. it is a great feeling. you accomplished something and you move on to the rest of your life until the next shift.

lastly, if your body and mind does suffer during the twilight years of your career, work express care hours which will cut out the nights. sometimes in your later years you will have more administrative responsibilities because of seniority and you will have to do day hours to accomomadate meetings and hospital politics.

anyway. shiftwork can be tough but no tougher than most of medicines work schedule. the nice thing is a 40 hour week or less if you want, and virtually zero call.

 

[Paws]

Hmmmm .... no call?

I think maybe I would like a more rural EM position. Or a small city. I know the NYC ERs and whoo-eee yes, you certainly do see just about everything. I sort of liked it, actually.

On the other hand, sometimes the idea of an overweight, chronically uncontrolled diabetic patient who has a good income and good health insurance, but no brains or will power - that sort of patient load might also drive me nuts. I have a big mouth and might want to tell this primary care patient to flippin' take care of themself and stop wasting everone's (ok, my) time.

Decions, decisions ...

 

[jaunita]

I agree with a lot of the people who posted here. Working shifts can be extremely tiresome and draining on the body. Even worse is switching from days to nights, which can totally f you up for a while. And you end up using your days off to sleep and eat etc. the basics.

I still like EM but my impression has changed since med school. Its not as glorious as it may seem. You are in the trenches of the US health care system. It can be very frustrating. Being an EM doc is physically demanding. You keep moving, you keep seeing patients and a lot of the time you end up doing full workups to find a diagnosis. These workups can require multiple procedures, labs, radiology etc. I expected this but add this to seeing multiple patients at once in a limited time span with limited help can be stressful.

I've met quite a few burned out docs. When I was a student I was told "training in an EM residency has reduced burn out etc" compared to the days when IM doctors ran ERs. But I have seen A LOT of burned out older physicians who trained at respectable EM programs. I know a lot of this depends on personality issues and balancing life with work, but I feel like I see way more burned out docs than really happy attendings. Working nights and weird hours will reduce your life span.

I still would go into EM, but my view was totally idealized as a student and I never got a true realistic opinion...except for one doc at Cook County during the interview who told me how much it sucks to work weekends and have monday off. etc etc.

 

[Hoya11]

hey everyone i am interested in EM and have been lurking for a while on here and I have a couple questions...

I have heard you can work under 40 hours per week, how common is this?

How common is it to be "full time" at one location ( say for less than 40 hours per week) and work another day at another location?

When Jobs says "Full pension" what does this mean, your full salary after you retire? And can you meet pension after X number of years and then bail, collect pension, and get another job to make basically twice as much?

WHen you are an older ED physician looking to just work that <40 hours per week, how much are you making? Are older, more experienced physicians making more in hospitals? as partners? How much do partners in private practice usually make?

When you are at the hospital and have downtime, how free are you? Can you surf the internet and make personal phone calls? or are you monitored and annoyed by superiors?

I know I have a lot of questions, I really like EM but I dont want to be physicallyor financially unable to do it. Im not looking ot make 500K, but is it possible to get a stable job making 300 after a few years?

Any insight appreciated, thanks..

 

[southerndoc]

hey everyone i am interested in EM and have been lurking for a while on here and I have a couple questions...

Welcome to the boards.

I have heard you can work under 40 hours per week, how common is this?

Most EM docs work 30-40 hours/week.

How common is it to be "full time" at one location ( say for less than 40 hours per week) and work another day at another location?

Some EM docs work two full-time jobs, but usually only for a very short period of time. When you're in the ED, you're working your tail off. So working extra only risks you getting burned out and jaded at the profession.

When Jobs says "Full pension" what does this mean, your full salary after you retire? And can you meet pension after X number of years and then bail, collect pension, and get another job to make basically twice as much?

Jobs? Steve Jobs? Or are you referring to jobs? 🙂 Full pensions vary by institution and corporation. Most contribute to a 403(b)/401(k) (currently limited at $15,000 per year of contribution), while some actually have pensions. These pensions are usually contributions of $40,000 per year. If you're good at investing, you can do much better with an investment account working one job and investing wisely than you can make with two pensions.

When you are at the hospital and have downtime, how free are you? Can you surf the internet and make personal phone calls? or are you monitored and annoyed by superiors?

Depends on the institution.

 

[EctopicFetus]

Southerndoc, are you telling me that if you are a "good investor" you can have more money in the long run investing your 15K over a 40K per yr pension? I dont think that is true. Perhaps I misunderstood you there.

Because correct me if I am wrong but you can still put in 15K of your own money into a 401(k) or an equivalent.

 

[EctopicFetus]

Sorry.. So you can have 30K per yr in a 401(k)/403(b) type account or 40K pension plus 15K in a 401(k)/403(b) type account for a total of 55K. Now I know the pension will grow slower than my own investing but I dont think you will ever catch up unless one rate of return is like 2% and the other 15%.

 

[southerndoc]

Southerndoc, are you telling me that if you are a "good investor" you can have more money in the long run investing your 15K over a 40K per yr pension? I dont think that is true. Perhaps I misunderstood you there.

Because correct me if I am wrong but you can still put in 15K of your own money into a 401(k) or an equivalent.

I'm talking about rather than working yourself to death, take $40,000 of your own money, invest it wisely, and the rewards will be far better than another $40,000 pension. Yes, it will cost you your own money, but it will also let you enjoy life instead of working all the time.

 

[southerndoc]

Sorry.. So you can have 30K per yr in a 401(k)/403(b) type account or 40K pension plus 15K in a 401(k)/403(b) type account for a total of 55K. Now I know the pension will grow slower than my own investing but I dont think you will ever catch up unless one rate of return is like 2% and the other 15%.

I seem to be averaging a 18% return over the past few years.

My 403(b) return is only 14% last year -- 11% over the past 2 years.

The difference might seem small, but in the long run, that extra 3% translates into a lot of money.

 

[EctopicFetus]

Gotcha southern doc.

You can def do good for yourself if you know how to invest money. My dad is a stock broker so I know who to ask, beyond all the stuff he taught me. 🙂