Are ED jobs in hospitals located in upper-middle-class suburbia as crazy as the ones in big city trauma centers? Why can't ED docs work 50 hrs/wk on these jobs and make a boatload of cash? Where I attended med school, the hospital ED is a small one (probably 22 adults bed and 8 peds), and things weren't as bad as the big trauma center I am working now.
In EM too it makes a difference what you want to be busy with.
On my community rotation we were busy with emergent URI and constipation. In the inner city there was a lot more trauma.
People that belong in a PCP office in your ED, vs victims of trauma one after another, can represent different kinds of busy and different drain on the EM soul. At the same time, how well each type of practice was shouldered also seemed to depend on the individual EM provider's temperament.
Universally it seems that providers don't relish being busy with non-emergencies in their ER, so a "slow" community setting can still leave a lot to be desired and feel more onerous than a "busier" one with a lot of trauma. That truism aside, even the most enthusiastic EM docs that get their "wish" to be busy with real medical emergencies, get drained.
What I find true is that most EM providers are in a catch 22. They tend to like a fast pace and high acuity that burns most people out right away. They in turn are burnt out by things that are too slow and boring, or essentially low acuity ambulatory medicine, which is not what the practice setting is designed for nor are they really trained for. They are then burnt out over time by the high acuity medicine they find stimulating, because they're human.
I've known some that did their training and then went to the community for the slower pace. You have to survive the faster pace of training no matter what. That's a special breed of human. Because most people that are content to do what is essentially overglorified PCP'ing under way worse conditions, are usually better suited to some sort of outpt training and practice over going into EM. Not that it doesn't happen.
I've seen EM docs in your described setting. It seems a little fish out of water for them. They don't seem overworked but it seems like they lack a sense of fulfillment, feeling like what they do matters. Or they do feel overworked because there's a sense that a lot of what they are doing isn't really supposed to be their job if they're busy.
Did you ever want to take a 30 patient 8 hour clinic day of an FM provider, but instead do it during a community gastroenteritis epidemic, and instead see 50 who are not your patients, you have little history on, over a 12 hour graveyard shift, all of whom likely have limited income and no insurance and no PCP? With higher liability and some high acuity stuff mixed in? Sounds like a dream.
More patients = more notes even if they're short. The setting being in the ER even if you get a lot of low acuity, the setting alone makes the malpractice liability even for stubbed toes just ridiculous so your medicolegal responsibility is still high, out of proportion with the care actually being rendered at that point. ED notewriting presents a special challenge when it comes to efficiency, saying enough/not too much for proper and necessary CYA.
Even in well to do surburbia the EM practice demographic skews to those with challenging socioeconomic determinants of health you can't do shyte about, namely the non or underinsured.
TLDR
EM is NOT a good way to try to wring money out of a 50 hr work work, even in surburbia, because it will be little of what there is to love about EM and a lot of what there is to hate about outpt medicine.
