New attendings.. how do you like it so far?

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Do you all remember those first few months? Free from the slavery of residency. Had a few attending paychecks in the back (more money than you've ever had). Managed a few dicey cases on your own, going home proud of your training and abilities.

Now? It takes me at least 2 days off from a run of shifts to feel any feelings again, good or bad. Now? I get frustrated if I have to wait behind any ***** not paying with a one-tap credit card. Now? I wonder what my kid will answer when his friends ask him "what does your dad do for work?" and I'm two years post-quitting, wife supporting the family financially. Now? Awesome, I get to build model trains and jack off three times a day.

Emergency Medicine
 
HemorrhagicShock said:
Do you all remember those first few months? Free from the slavery of residency. Had a few attending paychecks in the back (more money than you've ever had). Managed a few dicey cases on your own, going home proud of your training and abilities.

Now? It takes me at least 2 days off from a run of shifts to feel any feelings again, good or bad. Now? I get frustrated if I have to wait behind any ***** not paying with a one-tap credit card. Now? I wonder what my kid will answer when his friends ask him "what does your dad do for work?" and I'm two years post-quitting, wife supporting the family financially. Now? Awesome, I get to build model trains and jack off three times a day.

Emergency Medicine
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You're two years post quitting?
 
HemorrhagicShock said:
Do you all remember those first few months? Free from the slavery of residency. Had a few attending paychecks in the back (more money than you've ever had). Managed a few dicey cases on your own, going home proud of your training and abilities.

Now? It takes me at least 2 days off from a run of shifts to feel any feelings again, good or bad. Now? I get frustrated if I have to wait behind any ***** not paying with a one-tap credit card. Now? I wonder what my kid will answer when his friends ask him "what does your dad do for work?" and I'm two years post-quitting, wife supporting the family financially. Now? Awesome, I get to build model trains and jack off three times a day.

Emergency Medicine
Click to expand...

I was gonna reply, but….holy **** that’s dark.
 
The only thing I remember from a month in was the paycheck. It was more money than I'd ever been paid in a single check, including moonlighting from residency. I took a snapshot of it with my phone and held it up thinking I had "made it". I think the check was for 20K and some change or something like that. It was a partial month.

Now, I get frustrated when my paychecks are only 20K because that means I worked fewer shifts and/or I have to wait for my quarterly bonus each quarter for the remaining ~25% of my pay. I call those "bad months". I fret if I'm going to be able to pay off my American Express card along with expenses, put aside my income tax portion and have any left over for my SEP. Funny how things change....
 
It's been an interesting transition from a Level 1 academic center to a community hospital. The residents are good to work with. The ancillary staff like me. There's only 1 hospitalist I want to drag outside by their tailored white coat, the rest of the consultants have been OK so far. The realization hit after running a critical trauma, that the buck truly did stop with me. Living in a hotel for 4 days at a time is getting old, but we can handle it for a few more months. Looking forward to my first attending paycheck
 
midwesterdoc said:
I'm almost a month in, and I love it. The group is supportive, consultants are nice, and ancillary staff is excellent. Huge step over residency, which frankly sucked. Love the new city I'm in as well.
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I wonder often how much of my dissatisfaction is inherent to the work , patients, environment, patients , patients , admin, patients …. And how much is because it used to be better. And I’ve been out 10 years only .. not even a BOOMER 🤣
 
CoolDoc1729 said:
I wonder often how much of my dissatisfaction is inherent to the work , patients, environment, patients , patients , admin, patients …. And how much is because it used to be better. And I’ve been out 10 years only .. not even a BOOMER 🤣
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The number one cause of burnout is...
 
Eh…. Enjoy your first month. Being 3 years out, i personally have buyers remorse lol. I swear even family medicine is a better gig than EM. I literally did a night shift yesterday, will do a day shift tomorrow and a night shift the day after tomorrow -_- in my 30s and with pre diabetes now and ridiculously poor sleep hygiene because of shift work. I swear I’m going to die several years earlier because of EM and shift work disorder. I have to wake up at 5 am tomorrow but can’t sleep because i came home at 9 am from work today -_- sure i saw only 8 patients in 12 hours and slept about 2-3 hours, but EM is a young persons game and i don’t know if i can keep doing it for many years.

If i had to do it again id probably just pick finance and go down that investment banking route for 5-10 years, make a few million and then go into something very lifestyle friendly.
 
RustedFox said:
You're two years post quitting?
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Oh no, I wish. I was simply imagining a future where I did in fact move on from EM because it's hard to even know what I would do. I think the hardest part for a lot of us in regards to leaving (besides the pay) is that we all put in a lot of work to get trained up to the point where we can expertly save a life... and also expertly write for a refill of Norcos.

turkeyjerky said:
I was gonna reply, but….holy **** that’s dark.
Click to expand...

Ha!! Rest assured I'm doing fine. I use this place to vent because we all know you can't say what's on your mind in real life!
 
I had a year hiatus doing a Pain fellowship without a single EM shift. I felt energized, rejuvenated, and thought I could go back to EM for another 20 years. I just did a handful of shifts this month and am already re-burnt out. The couple day shifts I did with reasonable volumes felt great. As soon as I did one evening shift seeing 3-4 pph I was toast and felt those PTSD type feelings. EM is still cool if the setup is good, but that is unfortunately rare. Thankfully I finally found a good Pain job that I’ll be starting in a couple months.
 
GatorCHOMPions said:
I had a year hiatus doing a Pain fellowship without a single EM shift. I felt energized, rejuvenated, and thought I could go back to EM for another 20 years. I just did a handful of shifts this month and am already re-burnt out. The couple day shifts I did with reasonable volumes felt great. As soon as I did one evening shift seeing 3-4 pph I was toast and felt those PTSD type feelings. EM is still cool if the setup is good, but that is unfortunately rare. Thankfully I finally found a good Pain job that I’ll be starting in a couple months.
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3-4 pph? Damn, man. Is that a common attending rate? I'm in a non-ED fellowship right now and am on the fence about doing some EM on the side. If that's what a lot of shops are making us do nowadays, it'll probably be a hard pass for me.
 
EthylMethylMan said:
3-4 pph? Damn, man. Is that a common attending rate? I'm in a non-ED fellowship right now and am on the fence about doing some EM on the side. If that's what a lot of shops are making us do nowadays, it'll probably be a hard pass for me.
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Industry average is around 1.8 pph, but obviously going to vary a lot based on clinical setting.
 
EthylMethylMan said:
3-4 pph? Damn, man. Is that a common attending rate? I'm in a non-ED fellowship right now and am on the fence about doing some EM on the side. If that's what a lot of shops are making us do nowadays, it'll probably be a hard pass for me.
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It is what I have to do for the time being to make some money in my area. That volume is with midlevels btw, and probably about a third of the visits are Level 4’s. The pay is decent but not $300/hr+ like it should be. I know my boss is making a killing off me but it is what it is for now.
 
I've kind of reached a stage where I'm pleasantly numb. I think I've gone through all the stages of grief for EM. I'm not depressed or disillusioned anymore. I'm not burned out anymore. I don't hate work either. I just....recognize it as work and approach each shift as a puzzle in the never ending game of how to move the pt from point A to point B in as few steps as possible utilizing the least amount of resources. Defensive documentation is a game. Admission is a game. Buffing metrics is a game. Minimizing orders to safely d/c the pt with as few tests as possible is a game. AIDET/PG/Pt satisfaction is a game. Everything has become a game, albeit a nicely paying game...., on the merry road to retirement. I don't have any ambitions or aspirations for management/administration anymore. I don't have any secret entrepreneurial plans to open up a ketamine clinic, build a FSED or grow a real estate empire and strike it rich. I'm not trying to secretly escape the field. I just want to work my shifts, be left alone in between and let someone else worry about the department and put out fires while I work another shift and pull a paycheck.

I would have definitely picked something else other than EM if I had it to do all over again and I most definitely think EM as we know it (or rather remember it...) will cease to exist and will become something else entirely in the near future. I don't think I'll look back on my career and have the same satisfaction or gratification compared to a surgeon or even a family practice physician with all the years of pt/family continuity. I've accepted that and I'm actually ok with it.

I think....I might end my ACEP membership this year. (I just cancelled it actually) It occurs to me that paying all those fees every year has brought me nothing since residency other than observing a steady decline in the specialty and I have completely lost faith in our organizations to do anything to improve our specialty. I'm still a member of AAEM and am a fan of their policies but I don't really think they have the ability to change anything either. They are like the tiny yappy dogs at the dog park...all bark and no bite.

The strange thing is that I'm really not burned out. I'm very grateful for my job and the opportunity to do something that I've become good at over the years, even if it's not what I originally envisioned for my life. I'm grateful for the job security and the ability to earn a decent income in the house of medicine doing work that although can be tiresome and taxing...is rarely boring.

Maybe this is what the second decade of EM feels like....?
 
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Groove said:
I've kind of reached a stage where I'm pleasantly numb. I think I've gone through all the stages of grief for EM. I'm not depressed or disillusioned anymore. I'm not burned out anymore. I don't hate work either. I just....recognize it as work and approach each shift as a puzzle in the never ending game of how to move the pt from point A to point B in as few steps as possible utilizing the least amount of resources. Defensive documentation is a game. Admission is a game. Buffing metrics is a game. Minimizing orders to safely d/c the pt with as few tests as possible is a game. AIDET/PG/Pt satisfaction is a game. Everything has become a game, albeit a nicely paying game...., on the merry road to retirement. I don't have any ambitions or aspirations for management/administration anymore. I don't have any secret entrepreneurial plans to open up a ketamine clinic, build a FSED or grow a real estate empire and strike it rich. I'm not trying to secretly escape the field. I just want to work my shifts, be left alone in between and let someone else worry about the department and put out fires while I work another shift and pull a paycheck.

I would have definitely picked something else other than EM if I had it to do all over again and I most definitely think EM as we know it (or rather remember it...) will cease to exist and will become something else entirely in the near future. I don't think I'll look back on my career and have the same satisfaction or gratification compared to a surgeon or even a family practice physician with all the years of pt/family continuity. I've accepted that and I'm actually ok with it.

I think....I might end my ACEP membership this year. (I just cancelled it actually) It occurs to me that paying all those fees every year has brought me nothing since residency other than observing a steady decline in the specialty and I have completely lost faith in our organizations to do anything to improve our specialty. I'm still a member of AAEM and am a fan of their policies but I don't really think they have the ability to change anything either. They are like the tiny yappy dogs at the dog park...all bark and no bite.

The strange thing is that I'm really not burned out. I'm very grateful for my job and the opportunity to do something that I've become good at over the years, even if it's not what I originally envisioned for my life. I'm grateful for the job security and the ability to earn a decent income in the house of medicine doing work that although can be tiresome and taxing...is rarely boring.

Maybe this is what the second decade of EM feels like....?
Click to expand...

I don't think I have your level of Zen yet, but I think I am getting there. Certainly closer today than I was 1,2,3 years ago.

I think you make an interesting point. This job isn't what I originally envisioned, but I think I have come to appreciate it for what it actually is. I think there is a period of grieving you go through when something you are really committed to that took a lot of effort to achieve isn't actually what you expect. A kind of buyer's remorse if you will. That grief manifest itself as a frustration and anger that a lot of people feel.

But like the actual stages of grief, you hope to eventually reach a place of acceptance. Sure, the future of the specialty seems fairly grim, and I wouldn't recommend the specialty to a student who still has choices and will have to spend more time practicing in the future than I will.

But all that being said, right now, at this moment: the job still offers good pay, good security, and interesting work.
 
You now:
2A92F3A1-EFDF-4B0D-BCDA-D54811794384.jpeg


You in 12 months:
84737987-2CD3-4673-AA2C-DF383DB58687.gif
 
RoyBasch said:
I don't think I have your level of Zen yet, but I think I am getting there. Certainly closer today than I was 1,2,3 years ago.

I think you make an interesting point. This job isn't what I originally envisioned, but I think I have come to appreciate it for what it actually is. I think there is a period of grieving you go through when something you are really committed to that took a lot of effort to achieve isn't actually what you expect. A kind of buyer's remorse if you will. That grief manifest itself as a frustration and anger that a lot of people feel.

But like the actual stages of grief, you hope to eventually reach a place of acceptance. Sure, the future of the specialty seems fairly grim, and I wouldn't recommend the specialty to a student who still has choices and will have to spend more time practicing in the future than I will.

But all that being said, right now, at this moment: the job still offers good pay, good security, and interesting work.
Click to expand...
Great insight. I think "finding that zen" is key in this field to staying content and at peace throughout our careers and even during our shifts. Each shift, I try to reach that state of mind where nothing can touch my emotions or affect me. I literally detach from everything. In the beginning I could only hold it about 30 mins or an hour before my gasket would blow. With more practice, I could make it about 4-5 hours or even halfway through my shift. Eventually, I managed to reach it faster and stay there for longer periods of time until now...I can almost go at will. It's a fantastic feeling. I truly almost never get upset during a shift, no matter what is going on around me. I think much of the psychology underneath it all has to do with what you touched on....learning to perceive the specialty in an entirely new way, restructure my own expectations and approach work and the hospital in an entirely new light and making it an almost daily habit to remind myself what I can be grateful for instead of the other way around. Maximizing the smaller things that bring me enjoyment while minimizing everything else. Combined with a profound degree of abject acceptance that the system is broken and recognizing that I cannot fix it and must learn to function within that broken system. I'm not perfect at it yet, but am def making progress and feel so much better about the job than I did a few years ago. Maybe not so positive after a long string of night shifts but that has more to do with the circadian disruption than the actual work.
 
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Groove said:
Great insight. I think "finding that zen" is key in this field to staying content and at peace throughout our careers and even during our shifts. Each shift, I try to reach that state of mind where nothing can touch my emotions or affect me. I literally detach from everything. In the beginning I could only hold it about 30 mins or an hour before my gasket would blow. With more practice, I could make it about 4-5 hours or even halfway through my shift. Eventually, I managed to reach it faster and stay there for longer periods of time until now...I can almost go at will. It's a fantastic feeling. I truly almost never get upset during a shift, no matter what is going on around me. I think much of the psychology underneath it all has to do with what you touched on....learning to perceive the specialty in an entirely new way, restructure my own expectations and approach work and the hospital in an entirely new light and making it an almost daily habit to remind myself what I can be grateful for instead of the other way around. Maximizing the smaller things that bring me enjoyment while minimizing everything else. Combined with a profound degree of abject acceptance that the system is broken and recognizing that I cannot fix it and must learn to function within that broken system. I'm not perfect at it yet, but am def making progress and feel so much better about the job than I did a few years ago. Maybe not so positive after a long string of night shifts but that has more to do with the circadian disruption than the actual work.
Click to expand...
Sounds like you have your new side-gig of mindfulness coaching.
 
I'm getting better at this too.

It's called learned helplessness.

It's the mouse in the Skinner box.

I jest (kind of), but it's in the same ballpark. It's sad that the solution to our work environment is emotional detachment.
 
vector2 said:
Lol, there I was complaining about some of the moderately annoying problems in anesthesia and meanwhile over in the EM forum there was an existential Kafka-esque nightmare occurring.
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Been this way for years.

We ER docs can never do anything right, but all the powers that be keep saying "just send it to the ER".

The cognitive dissonance is amazing.
 
I'm still seeing jobs of like $ 220+ at remote locations. Is going into EM with the goal of working in the middle of nowhere making big bucks still a bad idea?
 
scoopdaboop said:
low ball, im seeing higher in practicelink etc
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Raw $/hr is only part of the equation. Some of those rural places offering 220/hr might be a great gig where you work 24s and only see 16 patients the whole shift. Some of them are utterly insane and offering 220 to work in BFE seeing 30 patients per 9hr shift with an NP. Hard to judge what a good deal is strictly by hourly rate.

Back in the heyday of 500/hr locums you just assumed everywhere was a dumpsterfire and dealt with it for the cash. Now, you actually have to evaluate all the intangibles of the job.
 
Lots of those "high rates" nowadays are at sweatshop type places with 30k single coverage and new grad NP you're supervising.
 
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