M3 interested in EM: Do you plan on practicing into your late 50s or 60s?

[Doctor_Strange]

I recently learned that a popular EM Twitter doc runs a headache clinic on the side. In conjunction with the constant threads and talks about the very real and understandable burnout in EM, I've begun thinking long-term about the implications of pursuing the specialty if I choose to do so. One area that is hard for me to get good insight and data on is on what being an EP would look like once past 50 or even 60 years of age. I am hoping for some insight from this community on this topic! Intuitively, I imagine EPs either go part-time (I've read this is hard to do in general just based off the unwillingness of hospitals/CMGs/whatever to sign someone to such a contract), go admin, leave the specialty entirely, or retire. Is it silly for me to think this long-term? As a third-year student, I've only done 14 shifts at relatively quiet ED, but with my one year of being an ED scribe as well, I feel I have a relatively good understanding of the scope and challenges of the specialty, but this is one area that I struggle to anticipate for myself. My father being an academic pediatrician, he always earnestly says that he wants to continue practicing medicine even in his 60s -- he genuinely enjoys his work. Frankly, I want to believe I will hold the same level of satisfaction that I too will want to work even into my golden years no matter what specialty I pursue, likely at part-time. Finally, for reference, outside of EM, I also enjoy anesthesiology (I know other than airway management there is little overlap between these two fields, so they appeal to me in different ways!). I'm sure the data would say go with anesthesiology in terms of longevity and having a more stable attending life (albeit w/ more hours worked compared to EM), but there may be other factors I haven't considered.

I know this topic has been discussed in the past (and I've read many threads on the topic), but was hoping for newer insight!

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[TheSingularity]

Short answer: I certainly hope not.

I don't think EM is the type of job you can do into your 60s, safely anyway (safely, for YOU).

 

[EMikate]

With my mountain of debt, I plan on practicing after my death.

 

[scoopdaboop]

I recently learned that a popular EM Twitter doc runs a headache clinic on the side. In conjunction with the constant threads and talks about the very real and understandable burnout in EM, I've begun thinking long-term about the implications of pursuing the specialty if I choose to do so. One area that is hard for me to get good insight and data on is on what being an EP would look like once past 50 or even 60 years of age. I am hoping for some insight from this community on this topic! Intuitively, I imagine EPs either go part-time (I've read this is hard to do in general just based off the unwillingness of hospitals/CMGs/whatever to sign someone to such a contract), go admin, leave the specialty entirely, or retire. Is it silly for me to think this long-term? As a third-year student, I've only done 14 shifts at relatively quiet ED, but with my one year of being an ED scribe as well, I feel I have a relatively good understanding of the scope and challenges of the specialty, but this is one area that I struggle to anticipate for myself. My father being an academic pediatrician, he always earnestly says that he wants to continue practicing medicine even in his 60s -- he genuinely enjoys his work. Frankly, I want to believe I will hold the same level of satisfaction that I too will want to work even into my golden years no matter what specialty I pursue, likely at part-time. Finally, for reference, outside of EM, I also enjoy anesthesiology (I know other than airway management there is little overlap between these two fields, so they appeal to me in different ways!). I'm sure the data would say go with anesthesiology in terms of longevity and having a more stable attending life (albeit w/ more hours worked compared to EM), but there may be other factors I haven't considered.

knew a doc in his late 50's practicing. Some people I scribed at also said they knew a doc in his 70s practicing. The late 50s doc I scribed with was super slow and the other physicians would of course snicker behind his back. Kind of funny. Yet, there was another 50s doc that was really fast. There's a night guy whose in his mid 40s where I was that would let me (the scribe) and the other attending working 4-2am leave at like 11 pm and just do the rest of the night (7a-7p) shift. How sustainable is that? Idk, but every time I saw him he didn't seem stressed (probably because he's a crazy nocturnist anyways). In addition, some docs see 1, and then do orders for 1, whereas other docs saw 3-5 in a row, and then dictated exams to me and then did all the orders for those sets then repeat.

I think it just depends on how you think you can handle the pace. I can't for the life of me imagine the slow late 50's doc ever being fast in the past just based on his personality and how he likes to do things (mind you he saw < 2 PPH) with me as a scribe several times (he showed me statistics of him and the other docs, the other docs easily clearing 2). And on the same token, I cannot imagine the mid 40s doc ever being slow... All the docs I scribed with had their certain rhythm and pace, and I was comfortable with all of them after a while. Maybe this changes in the future as a doctor, but as someone also interested in EM as a med student right now, that's sort of been my experience.

 

[Porfirio]

No.

 

[RustedFox]

I work with a guy who is 80, and still works 8 nightshifts a month.
And he's a good doc.
Sure, he struggles with CERNER sometimes, but so do we all.

Personally, I never want to fully "retire" from medicine.
But I want to do something else on the side. Preferably in medicine.

I work with another guy who is 69.
He just recertified.
The day that he got his passing score back, he said to me:
"Buddy; this brings new meaning to the term... FINAL exam."

I want to be like them.
They're happy.

 

[southerndoc]

I also don't see myself retiring. Maybe try to cut down to 4 shifts/month when I'm 70.

 

[EM2019Midwest]

So much of this depends on the specific environment you practice in. One amazing site I rotated at, we had both junior attendings and 4+ that were 70+, one 75+ (!) and they were full time academicians still. Incredible instructors, super happy, as youthful as the attendings who just graduated from residency, which I think speaks a lot to an academic practice warding off burnout. Just my n=1 experience, but still worth considering I think.

 

[Tenk]

I plan to work full time until around 45-50 (14 shifts). I’ll then switch to part time (probably 7 or so) and work until I fizzle out around like 3-4 a month. Probably won’t work past 60s assuming I’m still alive.

 

[Frazier]

Regular EM: no, likely stop grinding occasional shifts in the early 40's when the large "mid-life" expenses are covered (kids tuition, mortgage, etc.)

My subspecialty: yes, plan to continue until I die

 

[Groove]

Option A: FT until 59. 6-10 shifts/mo until 65. Then Cash out.
Option B: FT until 62. 6-10 shifts/mo until 67. Then Cash out.

I enjoy medicine and it’s not like I couldn’t work longer but then you have to start asking yourself...what have you been working your entire life for if you can’t take advantage of retirement? I’d like to enjoy a good 10-15 years of actual retirement while I have my health. I don’t want to be one of these guys that works until he’s 75 and retires to a bunch of health problems and moves into a nursing home a few years later. Being retired doesn’t have to mean “not working”. Hell, I’d like to buy a ranch and/or do any number of things that would still have me getting up and working outside for several more years.

Keep in mind, these things look great on paper but life has a funny way of dealing you new cards every few years. Let’s say you were 63, nearing retirement and the kids are out of the house and wifey suddenly can’t stand the thought of living with you for 20 more years and you get the big D papers served. Well, there goes half your retirement savings and a huge chunk of assets and probably lifetime alimony if you were married 10 years depending on your state. It’s hard to plan for these things. You just gotta roll with them.

 

[Backpack234]

I’m just starting out. No kids. So I have no idea what the future holds. But I do plan to keep my high savings rate and hit FI within 7-10 years. After that continuing to practice becomes a choice.

if I can find a gig without nights, weekends, or holidays, I’ll work forever.

but that probably doesn’t exist. So at some point I’ll write a blog or start YouTube or something, try to build something outside of medicine.

or work in wound care? I hear that’s good too

 

[TooMuchResearch]

Our oldest doc is mid-late 50s and is retiring.

I don't think I'll make it that long.

 

[CajunMedic]

42 year old intern here. Definitely will have to practice into my late 50's-early 60's. After that, will probably start cutting back, or find the ED director position at Podunk General Hospital, Haircare, Tire Center, and Crawfish Hut. Would also consider doing some teaching at my med school alma mater.

Ultimate goal is to come home one day, drop my keys at the door, and go "I'm done, Let's move to the Keys"

I need to do more research, but FI may be possible for us, just difficult.

 

[Doctor_Strange]

Thanks everyone so far for your thoughts. Being a 26 year old, some of you have offered something I don't have much of yet: perspective. I suppose right now my life revolves around medicine so it's tough to imagine a point in time when I won't be working in medicine anymore. And I hope I never reach the point where I resent the profession or feel dissatisfied with it. That's certainly a fear I have no matter what speciality I end up pursuing.

 

[Rekt]

Thanks everyone so far for your thoughts. Being a 26 year old, some of you have offered something I don't have much of yet: perspective. I suppose right now my life revolves around medicine so it's tough to imagine a point in time when I won't be working in medicine anymore. And I hope I never reach the point where I resent the profession or feel dissatisfied with it. That's certainly a fear I have no matter what speciality I end up pursuing.

Once you actually start working you'll quickly be able to imagine yourself outside of medicine. Sadly, imagine is an appropriate term here with the direction medicine and EM is heading.

 

[TheSingularity]

High IQ advice incoming:

Go Ortho and do hips and knees all day.

Or Cards and Cath healthy people with "abnormal stress."

The hospital is ****ing love you

Sent from my Pixel 3 using SDN mobile

 

[Janders]

(1) I know plenty of docs in their 50s working FT community gigs who can run circles around the average ED Doc.
(2) I've worked with people well into their 60s (again, community busy medicine) who were excellent, but almost all of them voiced a need/desire to slow down at they got into their mid-60s... be it 0 nights, cutting back to 75% FTE, etc.
(3) In academics, with team of residents, I think it is relatively easy to add 5-10 years onto the timelines above.

Personally? I'm thrifty, save a lot, and bust my arse currently. If I keep the pedal down, I should be able to ride off into the sunset at 49-50. Frankly, I have so many interests outside of medicine I could quit now and (intellectually) be OK. But I do LOVE working in the pit. What am I good at? Taking care a ton of undifferentiated patients simultaneously.

So I'm not sure. My intermediate-term plan (next 4-5 years) is to keep pushing. But at some point, I think it'll be good for me (and my wife, and marriage, and family, and hobbies, and health) to cut back a bit. Thats the nice thing about EM, I'm pretty sure I'll be able to get a 2/3 or 1/2 FTE position if needed. Glide towards retirement a bit, and just have more quality time outside the ED.

What to do in my 60s? Part of me would like a position doing 4 shifts a month somewhere academic, with a role in Healthcare Quality (I'm actually rather fond of quality work). The other side of me is opening a trashy bar on the gulf coast of Florida somewhere.

 

[The Knife & Gun Club]

42 year old intern here. Definitely will have to practice into my late 50's-early 60's. After that, will probably start cutting back, or find the ED director position at Podunk General Hospital, Haircare, Tire Center, and Crawfish Hut. Would also consider doing some teaching at my med school alma mater.

Ultimate goal is to come home one day, drop my keys at the door, and go "I'm done, Let's move to the Keys"

I need to do more research, but FI may be possible for us, just difficult.

Move to Islamorada and work at Mariners hospital on key largo. When I was down there they were willing to hire any BC/BE EM doc with a pulse, and paying not terribly.

The one of the guys I rotated with down there with was making close to $600k/year doing a mix of ED shifts (5 24s/month I think?) and wound care hyperbarics.

Of course he could’ve been blowing smoke talking to a ******* M4, but it seemed feasible given the number of sick snowbirds and few healthcare professionals willing to live 2.5 hours from Miami on an island.

 

[TooMuchResearch]

I'd work there if it wasn't Florida.

Move to Islamorada and work at Mariners hospital on key largo. When I was down there they were willing to hire any BC/BE EM doc with a pulse, and paying not terribly.

The one of the guys I rotated with down there with was making close to $600k/year doing a mix of ED shifts (5 24s/month I think?) and wound care hyperbarics.

Of course he could’ve been blowing smoke talking to a ******* M4, but it seemed feasible given the number of sick snowbirds and few healthcare professionals willing to live 2.5 hours from Miami on an island.

 

[CajunMedic]

Move to Islamorada and work at Mariners hospital on key largo. When I was down there they were willing to hire any BC/BE EM doc with a pulse, and paying not terribly.

Funny you mentioned that. I'm taking the wife to Key West in January for her birthday and was planning to talk to them and Lower Keys Medical Center while we were there.

 

[TooMuchResearch]

Don't get me wrong, I'm going to the Keys this winter, but wouldn't work there.

I'd work there if it wasn't Florida.

 

[dchristismi]

Eh, Florida is basically just an amalgamation of the rest of the country. Maybe a little weirder, but there are benefits.

Anyway, I retired from EM this year, and am doing 90% hospice now, which I can easily see myself doing for a VERY long time. Physically and and stress-wise, it's light years from EM. Do I make as much? Nope. Is it still plenty? Still wrapping my brain around it, but yeah. It is.

 

[katmandu]

For those with the thought of working 4 shifts a month for the long term, how many shifts a month do you think you need to maintain proficiency? How much does the type of shop matter in determining the number for proficiency?

 

[TooMuchResearch]

I think if I worked 4/month at our big house, I'd be fine. 4/month of rural only and it would take a few training wheels shifts at minimum to be able to function in a busy place.

For those with the thought of working 4 shifts a month for the long term, how many shifts a month do you think you need to maintain proficiency? How much does the type of shop matter in determining the number for proficiency?

 

[cyanide12345678]

I personally don't plan on going past 40. I just need 4 million in savings before i call it a day.

 

[TooMuchResearch]

What's your projected withdrawal rate (assuming your plan is traditional equities/bonds)?

I personally don't plan on going past 40. I just need 4 million in savings before i call it a day.

 

[cyanide12345678]

What's your projected withdrawal rate (assuming your plan is traditional equities/bonds)?

Probably 2.5 - 3 percent if i stay in the US

 

[TheComebacKid]

To the OP, academics is not a bad option. We have plenty of docs in their 70s and 80s who pass the time with research, teaching, med school admin responsibilities, etc. They pick up maybe 4-8 shifts a month. The residents love working with the "grandfathers and grandmothers" of EM whenever they get to work a rare shift with them. Sometimes they don't work in the high acuity resus bays, but staff the other areas of the department, which is okay I think.

While metrics exist in academic centers like they do in other places, they don't seem anywhere as bad as it does working for a CMG in your 70s. Job satisfaction in academics, at least on the surface IMO, seems somewhat higher despite the lower salaries. However, I'm sure there are some malignant academic gigs as well, so who knows.

The key to longevity in EM IMO is to avoid working 100% clinically. Sit on committees, go to meetings, work with EMS agencies, travel to conferences, get involved with things that will allow you to take down clinical time.

 

[TooMuchResearch]

The problem with meetings and committees is that they seem to happen at 7 am. I don't like voluntarily waking up before 6 am and missing before school time with the family. Why can't we do that **** at 10 am?

To the OP, academics is not a bad option. We have plenty of docs in their 70s and 80s who pass the time with research, teaching, med school admin responsibilities, etc. They pick up maybe 4-8 shifts a month. The residents love working with the "grandfathers and grandmothers" of EM whenever they get to work a rare shift with them. Sometimes they don't work in the high acuity resus bays, but staff the other areas of the department, which is okay I think.

While metrics exist in academic centers like they do in other places, they don't seem anywhere as bad as it does working for a CMG in your 70s. Job satisfaction in academics, at least on the surface IMO, seems somewhat higher despite the lower salaries. However, I'm sure there are some malignant academic gigs as well, so who knows.

The key to longevity in EM IMO is to avoid working 100% clinically. Sit on committees, go to meetings, work with EMS agencies, travel to conferences, get involved with things that will allow you to take down clinical time.

 

[VA Hopeful Dr]

The problem with meetings and committees is that they seem to happen at 7 am. I don't like voluntarily waking up before 6 am and missing before school time with the family. Why can't we do that **** at 10 am?

So the surgeons aren't late for their OR slots

 

[RuralEDDoc]

I think if I worked 4/month at our big house, I'd be fine. 4/month of rural only and it would take a few training wheels shifts at minimum to be able to function in a busy place.

A lot of rural shops are much more challenging to practice at then the big house, and you do procedures solo that you would never do in a tertiary center. Plenty of rural shops with Single coverage or single MD/single PA together managing a combined 5 patients per hour. Imagine doing that with no in house backup, only gen surg, OB, and anesthesia “on call” but 45 mins away. Try and manage a “surge” of 15 patients in one hour and then you’ll see what you’re really made of

 

[TooMuchResearch]

That one I get. Happy to knock out our trauma meetings before their OR times start. What about ED peer review? Or other meetings that don't involve people that have to be at work at 7 am. Of course, I'm not sure why the surgeons need to start so early anyway. I don't like to do things before sunrise if possible.

So the surgeons aren't late for their OR slots

 

[VA Hopeful Dr]

That one I get. Happy to knock out our trauma meetings before their OR times start. What about ED peer review? Or other meetings that don't involve people that have to be at work at 7 am. Of course, I'm not sure why the surgeons need to start so early anyway. I don't like to do things before sunrise if possible.

Ah, I thought you meant general meetings that had people from multiple other specialties.

If its just within the ED, I'd assume its just habit to have all meetings at the same time.

Also possible that the admin types want you out of "their" conference rooms when they show up to work at 8:30-9am.

 

[TooMuchResearch]

A lot of rural shops are much more challenging to practice at then the big house, and you do procedures solo that you would never do in a tertiary center. Plenty of rural shops with Single coverage or single MD/single PA together managing a combined 5 patients per hour. Imagine doing that with no in house backup, only gen surg, OB, and anesthesia “on call” but 45 mins away. Try and manage a “surge” of 15 patients in one hour and then you’ll see what you’re really made of

We don't contract at those types of rural EDs (but we'd take it if one of our major health system partners "offered" one). Sure, I get my butt kicked on occasion but not daily. I don't think these hospitals have equipment for me to do rare procedures I wouldn't do at our referral center. Venous Pacer? Probably don't have a kit. Disposable Ambu scopes? I know we don't have them. Thoracotomy tray? Patient wouldn't make it to the city anyway. I probably have a cardiocentesis kit with drain. I don't really want to do any breech deliveries if I can avoid it anyway. What else am I missing? The biggest issue with those big patient surges is my rural nurses, some of which haven't worked in the city/suburban grinders or aren't really ED trained, get easily overwhelmed.

A lot of rural shops are much more challenging to practice at then the big house, and you do procedures solo that you would never do in a tertiary center. Plenty of rural shops with Single coverage or single MD/single PA together managing a combined 5 patients per hour. Imagine doing that with no in house backup, only gen surg, OB, and anesthesia “on call” but 45 mins away. Try and manage a “surge” of 15 patients in one hour and then you’ll see what you’re really made of

 

[BoardingDoc]

Single coverage or single MD/single PA together managing a combined 5 patients per hour.

This is not a "see what you're made of" work environment. This is a "we are grossly understaffed to save someone some money and I'm going to miss something and get sued as a result" work environment.

5pph unless it is 100% urgent care BS complaints is in no way safe or reasonable.

I hope for your sake that this is either hyperbole, or that you're getting paid entirely in a keep what you kill model. Otherwise, some admin is making a crapton of money off of an unjustifiable amount of liability and ****ty work environment being dumped in your lap.

 

[RuralEDDoc]

I hope for your sake that this is either hyperbole, or that you're getting paid entirely in a keep what you kill model. Otherwise, some admin is making a crapton of money off of an unjustifiable amount of liability and ****ty work environment being dumped in your lap.

I fully agree with your point that 5 PPH split between doc and PA is unsafe and exploitative. Thankfully I haven’t worked in this environment for a while now. My real point here was that rural medicine does not mean quiet or easy. People on SDN often talk about rural medicine meaning sleepy 1 PPH gigs with overnight naps, which does exist but is rare. Many rural docs do difficult work and routinely do procedures never done by EPs in the big city, as the specialists and their fellows or residents are around to do them.

 

[RuralEDDoc]

This is not a "see what you're made of" work environment. This is a "we are grossly understaffed to save someone some money and I'm going to miss something and get sued as a result" work environment.

Sorry to split your post just another quick thought. Lawsuits in rural medicine are much less common than in the big city. Plenty of lawyers in big cities. Not many lawyers in the sticks. This matters quite a bit.

 

[miacomet]

No.

 

[psychapp121]

42 year old intern here. Definitely will have to practice into my late 50's-early 60's. After that, will probably start cutting back, or find the ED director position at Podunk General Hospital, Haircare, Tire Center, and Crawfish Hut. Would also consider doing some teaching at my med school alma mater.

Ultimate goal is to come home one day, drop my keys at the door, and go "I'm done, Let's move to the Keys"

I need to do more research, but FI may be possible for us, just difficult.

42 year old intern? ****..