(I've posted this before, but I thought it would be more appropriate to place it here on the sticky. So, if you've already read this, I apologize.)
Warning: just one mans opinion.
Pros:
There is no call and no business/practice to run. No staff to hire and fire.
The adrenaline rush can be cool at times.
When you are off, you are off (sort of, see cons).
Its the highest paid specialty for the shortest residency (3yrs).
You are a real doctor. Despite the many consultants who will try to make you think they are superior, you are the only one who can see ANYTHING. The only one with the courage. You are the only one with the courage to walk in that room and take on any patient, any challenge. Youre not a neurosurgeon who says, I only do spines, not brains. Or the plastic surgeon who says, I do eyelids, but not tear ducts. You do brains, spines, car accidents, heart attacks, adults, kids, normal people, crazy people, surgical patients, non-surgical patients, everything. You at least see the patient, do what you can, a do whats right. This is probably the coolest thing about the specialty. I think most of the ER bashing you see and hear from other specialties is that deep down it kills them to know they gave this up. It covers up a huge insecurity that a lot of specialists have. Deep down they know that when the st hits the fan, and the secretary at their office collapses and goes into cardiac arrest and theyre shaking in their boots, theyre going to call 911-thats you. If someone collapses on an airplane at 37,000 feet and they call for a doctor youll know what to do. Youre everyones hero even if they dont say it. You wont have to say, Yes Im a doctor, but I only do rectums. Also, there is nothing cooler than bringing a young person through a life-threatening situation and saving a life.
Its the most secure profession on the planet. Recession, depression, peace, war, people will always get sick. And if not, theyll still go to the ER, trust me. People love the ER. More visits yearly than Disneyworld. Youd think theyre giving away free stuff (oh, wait, they are).
Cons-
When youre off, youre not really off. On a huge number of days off, you may have worked the night before until 2, or 3, or 5 in the morning on the day you are off. The shift work thing is fine, when youre 28 single, or even just married without kids. Who cares, you just sleep all day. You work Friday, Saturday and Sunday
who cares? Youre off Monday, Tuesday and Wednesday. When you have a family, the lifestyle specialty does a complete 180 on you. If you work 2 pm midnight Monday through Friday one week, you dont see your kids, at all (if theyre in school). Or you work a stretch of 4 or 5 or 6 night shifts
.no big deal right, youve got 4 days off? Well, the first 2-3 days, youre a post-nights zombie who wants to sleep all day and be up all night. Your first 2-3 days off youre miserable trying to recover from your nights. Then guess what, back to day shift. Jobs where you dont work any nights are rare. If you have one, never let it go. It still doesnt get you out of the 3pm-11pm shifts, or 6pm 4am shifts, etc. Those arent nights. In my medical school ER rotation, they let us off easy and didnt make us do any overnights. I think if I had been forced to work a tougher schedule that month, I may have chose differently. Probably not, though. The shift work is the biggest reason Im leaving the specialty. I think if I could work in the ED 7-3pm or even 8am-6pm, Monday through Friday, I probably wouldnt be leaving the specialty. Theres just very little way around it at most jobs. Its a necessary evil of the specialty and just kills you as time goes on. It has eaten away at me like a cancer. Shift work sleep disorder is actually a diagnosable disease now, and I think most, if not all ER doctors have some degree of it (yet we pretend its no big deal and soldier on). Rotating shift work has actually been shown to take years off your life, much equivalent to the effect of a pack per day smoking, due to the stresses. I cant wait until I can live a normal life again.
You are either an employee or a de-facto employee of a group or hospital. You may be a partner but really you are highly paid hourly help. You or your group can be thrown out any day, sometimes with no notice. It happens all the time. It hasnt happened at my group, yet, but guys have left my group and gotten thrown out, or been thrown out and come to work at my group. They bring in cheaper help. Yes, its that simple. See, you dont bring any business into the hospital. In fact, the hospital is doing you a favor by giving you patients to see, that you can bill. If you leave, your patients will not follow you and take business (money) from the hospital. Yes, its all about money. All for-profit hospitals care about is profits. All not-for-profit hospitals care about is profits (they just dont call it profit, its called re-investment). The profits are put back into the system (and not necessarily in your pocket). When you dont bring any money into the system, what you say doesnt matter. If your department wants an ultrasound machine, it may not be in the budget. If the hospital wants some new computer system that saves money but makes your job miserable, tough. If there are ten things about the hospital that you could easily fix to make your job easier, they may not care, if the fix is not in the budget.
The adrenaline rush gets old. 4 critical traumas at 5 in the morning when a minivan full of kids rolls over may not always be fun when its just you and a few nurses. Putting a chest tube in when youre a resident: cool. Telling a 10 year olds parents that their son is dead, when they didnt even know he was in the ER: brutal. This never gets any easier. Not for me anyways. Not if youre even partly human. Dermatologists dont have to do this. Radiologists dont have to do this.
Working a small set-number of shifts per month is getting harder and harder to do. In the future, it may be impossible. Let me explain: there is a huge shortage of ER doctors. In fact, roughly 40% of ER hours are covered by non-board certified (non-ER) doctors. Could you imagine if 40% of neurosurgeon jobs were covered by non-neurosurgeons? Hospitals and the government are getting more and more intolerant of 12hr, 6hr, or even 1 hr waits in hospital EDs. In fact, at my hospital, if the ER wait is more than 45 min the hospital CEOs bosss, bosss, boss, who is in another state watching a computer screen following all of his ED wait times, calls immediately in a panic and raises h--l due to the increased wait times. Of course this is always when youre most stressed and working way over red-line. They never send in an extra nurse, tech or unit secretary. The assumption is that youre all a bunch of inefficient screwballs. Its infuriating. The point is this: they may want you to work 14, 15, 18 or 24 shifts a month because there arent enough ER doctors, PAs or nurse practitioners to achieve these numbers. The old policy of see the sick ones and the not-so-sick can wait, is becoming extinct. Patients are money, and they want you to see them fast, and 24 hours a day, at night, on weekends and holidays, too. They want you to see everybody within 5 minutes, even if there are critical patients to attend to. Its impossible, but they dont care. Not all hospitals are as aggressive about this as the one Im at, but they will be. When they see the $ signs, theyll all be doing it. Theyve got live ER wait times posted on a billboard now on the highway, directing people in!
Despite the hero factor, you wont get paid like one, or be appreciated like one. Yes, youll do very well, but like a soldier, police officer, school teacher, youll always get way less than you deserve. 2/3 of the bills your group sends to patients wont get paid. Thats your money down the drain. People who cant afford their own house payment will save up for years for breast implants, or drop cash on beer, drugs or cigarettes, but when it comes down to paying you a couple hundred bucks for literally saving their life, they wont hesitate to rip that bill up and throw it in the garbage, because youre a rich greedy doctor and you make too much. Yes, a 2nd string football player on the worst football team in the NFL, makes thousands for making a catch in a losing football game. You save a life and 2/3 of the time you make nothing. Yes, nothing. You can, however, get sued for millions of dollars by patients who youre required by law to see, yet who are required to pay you nothing.
Youre treated with unfathomable contempt and disrespect at times. One day, I had the most hair-raising, sphincter-clenching airway case Ive ever had. I had a 500lb asthmatic who came in on Bipap who needed to be intubated (put on life support). I go in to intubate her and shes got a tongue the size of a football, her sat drops to 50% (dying) and I cant get the tube. My two partners and I take turns struggling to get this lady intubated using multiple techniques before she dies, which is going to be very soon, minutes, seconds. Shes young and shes going to die, right now. No one can get any airway in and shes not breathing, at all. I call ENT and anesthesia (which Id never done before, in years of practice) and plan on cric-ing this ladies neck (cutting a hole in her neck and putting a tube in), which is going to be an abominable nightmare since shes 500lbs with no neck at all. Luckily, thank god, my partner tries again and blindly, luckily, gets the airway before we need to cric her and before any consultant arrives. Its the worst case of almost any kind Ive had in years, but thank god, we saved this ladies life. None of this so far is what bothers me. Heres the kicker: I walk out of the room and this old man in the room next door starts swearing at me, pointing his finger in my face nearly spitting centimeters from my nose saying hes been on the phone with his lawyer and hes going to sue me because his (adult) daughter whos totally stable and barely sick enough to be in the hospital had been in the ER 4 hours and wasnt upstairs to a room yet. I said to the guy, I was next door, working to save that ladies life. We saved her life. He had watched the whole thing, he said I dont care, were going to sue you!! Were going to sue you! You hear me, sue the pants off you! This is not the first time this has happened. Ive coded children whove died after working to save them for what seems like forever and immediately after returning to my other patients whove now been waiting for hours, Ive been sworn at and verbally berated because someone who came in for a stubbed toe had to wait while I worked on a dying child. Its truly unbelievable. You can let this roll of your back the first 50 times, but at some point enough is enough.
I'm not saying the specialty is all bad. There's lots of great things about it, but make no mistake about it, it's not for p-----s. It takes a special person to do this. It takes an even more special person to do it for 25 years.
