Nights as an er doc

[EctopicFetus]

I don't have a problem with a group deciding to pay a weekend differential, a holiday differential, or a night differential. I prefer to think my ACEP dues are going to weightier matters such as lobbying. We can figure out how to run a group on our own.

For example, the guy who gets the paid vacation. There's really no difference between someone who gets paid $20K every month even though he only works 110 hours 3 months a year and someone who gets paid $22K a month for 9 months a year and then $14K 3 months a year except one of them doesn't know how to budget on an annual basis.

Actually I look at as a forced break. Thats the real difference. Leads to happier folks. $$$ wise you are correct. My group implemented this prior to my arrival and folks have loved it. The push now will be more vacation (hoping to get to 4 weeks).

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[EctopicFetus]

Re 24 hour shifts. I did them moonlighting in a low volume place. Got $80/hr or 1920 for 24 hours.

First shift I saw 9 in 24 hours, avg was 15/24 hours. slept no less than 5 consecutive hours every shift but my last. Prob never saw more than 20-22 (but this was like 3 years ago now).

Cush shifts for the most part, low acuity but low resources can make the job interesting since I came from a high resource place.

 

[Birdstrike]

.

 

[deleted65604]

People that don't practice EM just don't get it. It's just a tough specialty. Some people are cut out for it, some aren't.

With all the obsessing on patient satisfaction and Press Gainey surveys, directing some of these resources to EM physician job satisfaction would be money well spent.

I agree with Active Duty, ACEP should focus on lobbying Washington to protect our pay. If you don't like your schedule, you should act like an adult and discuss it with your boss and/or scheduler. If you can't come to a mutually beneficial agreement, you find someplace that will or you quit ER medicine. I want as little third party involvement in my life as is possible.

Running to ACEP to tell on your boss seems very immature. "Mommy, they're bein' mean to meeeee!"

If you go into ER, you need to assume that nights will be part of your life. If you can't accept that, please don't go into ER, for your sake.

 

[RustedFox]

Running to ACEP to tell on your boss seems very immature. "Mommy, they're bein' mean to meeeee!"

If you go into ER, you need to assume that nights will be part of your life. If you can't accept that, please don't go into ER, for your sake.

+1.

This is what separates us from IM zeroes... that... and our ability to willingly perform any reasonable procedure.

 

[The White Coat Investor]

Actually I look at as a forced break. Thats the real difference. Leads to happier folks. $$$ wise you are correct. My group implemented this prior to my arrival and folks have loved it. The push now will be more vacation (hoping to get to 4 weeks).

Why be happy just 3 months a year? Why not work 110 hours every month?

 

[deleted65604]

I agreed wholeheartedly with your first post Birdstrike. Your second post was weird for me. You want Emergency Medicine to change for you, or you won't go back. Emergency Medicine will go on as it is, and can only get worse, not better. We are part of the 1% whose money, freedom and desires will be torn from us by the government on behalf of the 99%.

I'm going to make some conjecture here. You tried one job at one place out of residency and it sucked. You assumed it would uniformly suck everywhere. Your spouse was in a job that required that you stay in the same geographic area, so you couldn't move and were forced, in order to be happy, to do something outside ER.

What you missed and what I hope to convey is that the potential practice variability is virtually endless. You can have a cush job working in the boonies or in a free-standing ER in the burbs. You can have a 2.5 patient per hour job, or you could have a 0.5 patient per hour job. Imagine surfing the internet all morning and getting paid for it. You can fly into a joint and work 6 days straight and fly home and spend 2 weeks with your family if you want. During the summer, you can drag along the whole family.

If you are burned out, there are endless possibilities if you are willing to think outside the "I must live near a metropolitan area with access to the opera." I agree with the above posters, if you are burned out, work less. If you can't stand the pace of your ER or would like to sleep more at night, go to a place where the pace is slow and you can sleep.

If you are doing Emergency Medicine to find fulfillment in life, you will soon find yourself terribly unfulfilled, like Birdstrike. If you are doing Emergency Medicine to feed you and your family, you will take it as it is, a job, that puts food on the table, and is something you tolerate to get a pay-check.

 

[The White Coat Investor]

I agreed wholeheartedly with your first post Birdstrike. Your second post was weird for me. You want Emergency Medicine to change for you, or you won't go back. Emergency Medicine will go on as it is, and can only get worse, not better. We are part of the 1% whose money, freedom and desires will be torn from us by the government on behalf of the 99%.

Good post, except the part about the 1%. It's a rare ER doc that makes over $500K.

http://whitecoatinvestor.com/youre-not-the-1/

 

[StevieStud]

Can anyone comment on working 24 hr shifts in a rural location?

What is this, residency all over again?

Ok, a little more serious this time.

You need to watch out for lack of backup & support services. That little 3 passenger minor car wreck out by the by the highway just needing some sutures followed by a confused little old lady from the local nursing home can drain you fast if your charge nurse can't start an IV to save her life and the other nurse is notorious for her two hour lunch breaks and the "bad back" flair ups whenever there might be work to do.

And when the stuff hits the fan.... and you know it will eventually happen and it doesn't have to be very bad .... who do you call for backup?

 

[BJJVP]

If you are doing Emergency Medicine to find fulfillment in life, you will soon find yourself terribly unfulfilled, like Birdstrike. If you are doing Emergency Medicine to feed you and your family, you will take it as it is, a job, that puts food on the table, and is something you tolerate to get a pay-check.

I agree with this statement. However, I want to add that this sentiment is not explicitly stated strongly enough to premeds and med students thinking of going into EM. We write our personal statements thinking of how we want to "help others," "save lives," learn the "art and science of medicine." They hear that medicine is a "noble profession." I do not think most premeds or med students choose EM or even medicine simply to get a pay check.

I've had my share of premeds and MS1/MS2s shadow me in the ER. I always tell them that EM, at this point in time, provides for good job security & financial security (as long as you're not foolishly spending). But for me, I don't feel I get any of the benefits of being a doctor I had hoped for. I didn't do this for fulfillment in my life, but I at least hoped for some career fulfillment.

Burnout is multifactorial but I don't think attibuting all of it to working nights is fair. I think that the increasing demand on the EM physician to see more, smile like you're taking orders at McDonalds, be graded like a car salesman with surveys, is also huge. I also hate being used by some community physicians as a their personal house officer. Add to that the general population's unrealistic expectations of medicine in general and you've got one stressed out and burned out group of docs.

I used to wonder why the hell anyone would go into oncology. But I was thinking the other day, if you tell the avg person he has cancer, he thinks he has a <1% chance of survival. If he lives, the doctor saved him and is a hero forever in the pts mind.

But the avg 35 yo that goes to the ER with 2 months of back pain will probably be told that xrays are not indicated and there is no treatment other than motrin, weight loss and exercise. The doc probably gets a bad satisfaction survey, and the pt probably sends in a letter about why he shouldnt pay the bill since the doctor did nothing. A 90 yo septic pt was cool in residency, but now I find no enjoyment in treating these pts that just die in a few days anyways. STEMIs are definitively treated by cardiologists. Really bad traumas usually need surgery. My role in the pts care is critical, but I don't get the sense that all the struggles with MCATs, Boards, residency was necessarily needed for me to do my job.

Basically, it's a very taxing job. Getting paid well and having time to spend with family are HUGH pluses. But we cannot deny to premeds, med students and each other that the ED doc is the hospital and medical staff b*&tch. You do what they tell you because at all costs, the contract cannot be threatened.

I have thought about moving to a different geographic location or changing to a different group that sees less volume. But that doesn't change a lot of the above.

I hope to one day join Birdstrike in leaving the field for something more fulfilling and less taxing on my mental health.

 

[EctopicFetus]

Why be happy just 3 months a year? Why not work 110 hours every month?

$$$$.. My goal is to have the $$ to comfortably retire by 51. I also want to enjoy my life and my pay is decent.

I look at it like this. I can tolerate working 150 hours a month. Those 110 hour months are easy and a welcome rest. My biggest worry is that they will make me soft.

 

[EctopicFetus]

Good post, except the part about the 1%. It's a rare ER doc that makes over $500K.

http://whitecoatinvestor.com/youre-not-the-1/

http://money.cnn.com/2011/10/20/news/economy/occupy_wall_street_income/index.htm

AGI per the IRS of the top 1% was only 343k.

There are a bunch of ER docs who fit in there. That number is down simply because the market is in the tank.

Executives, managers and supervisors working outside of finance accounted for 31%, the largest share, according to an analysis by Jon Bakija of Williams College, Adam Cole of the Treasury Department and Bradley Heim of Indiana University. Medical professionals came in at 15.7%, while lawyers made up 8.4%.

 

[GeneralVeers]

http://money.cnn.com/2011/10/20/news/economy/occupy_wall_street_income/index.htm

AGI per the IRS of the top 1% was only 343k.

There are a bunch of ER docs who fit in there. That number is down simply because the market is in the tank.

It's nice to be in the top 1% if that data's accurate. I always assumed you neeed $1 million plus yearly to qualify.

 

[EctopicFetus]

Agreed. Just doesnt feel like it does it?

 

[EM_Rebuilder]

I agree with this statement. However, I want to add that this sentiment is not explicitly stated strongly enough to premeds and med students thinking of going into EM. We write our personal statements thinking of how we want to "help others," "save lives," learn the "art and science of medicine." They hear that medicine is a "noble profession." I do not think most premeds or med students choose EM or even medicine simply to get a pay check.

I've had my share of premeds and MS1/MS2s shadow me in the ER. I always tell them that EM, at this point in time, provides for good job security & financial security (as long as you're not foolishly spending). But for me, I don't feel I get any of the benefits of being a doctor I had hoped for. I didn't do this for fulfillment in my life, but I at least hoped for some career fulfillment.

Burnout is multifactorial but I don't think attibuting all of it to working nights is fair. I think that the increasing demand on the EM physician to see more, smile like you're taking orders at McDonalds, be graded like a car salesman with surveys, is also huge. I also hate being used by some community physicians as a their personal house officer. Add to that the general population's unrealistic expectations of medicine in general and you've got one stressed out and burned out group of docs.

I used to wonder why the hell anyone would go into oncology. But I was thinking the other day, if you tell the avg person he has cancer, he thinks he has a <1% chance of survival. If he lives, the doctor saved him and is a hero forever in the pts mind.

But the avg 35 yo that goes to the ER with 2 months of back pain will probably be told that xrays are not indicated and there is no treatment other than motrin, weight loss and exercise. The doc probably gets a bad satisfaction survey, and the pt probably sends in a letter about why he shouldnt pay the bill since the doctor did nothing. A 90 yo septic pt was cool in residency, but now I find no enjoyment in treating these pts that just die in a few days anyways. STEMIs are definitively treated by cardiologists. Really bad traumas usually need surgery. My role in the pts care is critical, but I don't get the sense that all the struggles with MCATs, Boards, residency was necessarily needed for me to do my job.

Basically, it's a very taxing job. Getting paid well and having time to spend with family are HUGH pluses. But we cannot deny to premeds, med students and each other that the ED doc is the hospital and medical staff b*&tch. You do what they tell you because at all costs, the contract cannot be threatened.

I have thought about moving to a different geographic location or changing to a different group that sees less volume. But that doesn't change a lot of the above.

I hope to one day join Birdstrike in leaving the field for something more fulfilling and less taxing on my mental health.

I guess I am still just too new...

Who cares what the patient thinks... the infant that was intubated by me for RD who is now on the floor, the inhalation injury that was intubated by me, the LP I did with the small SAH.... I can go on and on and I think we all can....

Maybe the kids parents think the PICU doctor is awesome or the old man loves the surgeon, or the SAH loves her NSG... at the end of the day, I know that these people did well because they presented to an ED with well trained providers who acted early and made a difference....

Could you imagine the cluster that goes on when a pedi needs intubated in a rural/ill equipped ED? Or the inhalation injury with OP edema that a tube barely slipped in?

Again..maybe I am just too new and am not jaded yet or maybe some of your guys are too jaded... there are not many shifts when I dont go home knowing I 'made a difference' to someone.... and they pay me for this?? and pay me well!

Life is good...

 

[EctopicFetus]

Im barely out 2+ years but the job is a job to me. I feel I make a difference but dare I say I find my happiness at home with my wife and kids and work is but a very small sliver of what makes me happy.

 

[tkim]

Im barely out 2+ years but the job is a job to me. I feel I make a difference but dare I say I find my happiness at home with my wife and kids and work is but a very small sliver of what makes me happy.

I like what I do, but if someone offered me the same money and hours to do something else, I'd seriously consider it.

 

[WilcoWorld]

I agree with the general tenor that EM is a job. However, when I start to consider what alternatives could offer me similar pay, control over my schedule and job security then I start to realize that there are very few alternatives. Add on the criteria of having a job I can be proud of at my son's career day and that already small number gets pretty close to zero.

 

[deleted65604]

I agree with the general tenor that EM is a job. However, when I start to consider what alternatives could offer me similar pay, control over my schedule and job security then I start to realize that there are very few alternatives. Add on the criteria of having a job I can be proud of at my son's career day and that already small number gets pretty close to zero.

agree

 

[The White Coat Investor]

http://money.cnn.com/2011/10/20/news/economy/occupy_wall_street_income/index.htm

AGI per the IRS of the top 1% was only 343k.

There are a bunch of ER docs who fit in there. That number is down simply because the market is in the tank.

I've had my AGI be nearly half my real income before. You really want to use that number?

 

[EctopicFetus]

I've had my AGI be nearly half my real income before. You really want to use that number?

AGI Income (including wages, interest, capital gains, income from retirement accounts, alimony paid to you) adjusted downward by specific deductions (including contributions to deductible retirement accounts, alimony paid by you); but not including standard and itemized deductions.

All these numbers can be fooled around with. Ill take it. Remember it is pre-deductions though there is no way to account for IC's and other ways people write off their money pre-AGI.

Trust me I get that..

 

[Birdstrike]

.

 

[Jack is Back]

As a medical student currently interested in EM, I always find these threads interesting.

Those of us that are deciding between emergency and surgery though, I think it would be tough to think that the EM schedule is so rough on the family. Compared to general surgery, EM is much more compatible.

Obviously it's not radiology or derm, but it surely isn't the worst work schedule for physicians (see neurosurg).

And while we can all complain about how much we get paid, lets look at it like this:

You are either in the 99th percentile OR if you don't qualify for that you are in the 98th or 97th percentile for income earners in the richest country/civilization ever known to man. I.e. your quality of life (by ability to buy goods/take vacations/etc) is among the best ever in history. If you earn 150k you are likely in the 99.99th percentile for quality of life throughout time.

 

[DeadCactus]

A lot of negativity lately. Or maybe I'm just noticing it more. Anyone actually love their job?

Edit:

And on that note, anyone who considers EM more than just a job? Don't get me wrong. I don't buy into the walks-on-water saint in a white coat image of physicians nor the idea that you're not allowed to make family and leisure important parts of your life. But I never wanted to have a job. Clocking in, grinding out some hours, and cashing out? F--k that. Even 36 hours a week with great pay is too much of life to waste on a job. Maybe it's just an issue of semantics and we're all on the same page, but how can you stand to spend 11 years in school just to get a job?

Certainly some of you have carved something more than a job out of your investment?

And I agree that physicians don't have a monopoly on helping people. Everyone has moments when they're presented an opportunity to reach out and help someone. But there isn't an ambulance personally delivering opportunities to "do good" to the barrista at Starbucks.

 

[deleted65604]

You are either in the 99th percentile OR if you don't qualify for that you are in the 98th or 97th percentile for income earners in the richest country/civilization ever known to man. I.e. your quality of life (by ability to buy goods/take vacations/etc) is among the best ever in history. If you earn 150k you are likely in the 99.99th percentile for quality of life throughout time.

Well said.

I'd add that if you are in the bottom 1% of our society, your quality of life is still better than 99% of those who have ever lived on the Earth. Regardless, you are right, we really shouldn't be complaining much.

 

[deleted65604]

A lot of negativity lately. Or maybe I'm just noticing it more. Anyone actually love their job?

People generally get paid for the amount of mental anguish, stress, and discomfort that they endure at work, and as a result of work, in addition to the amount of time, money and mental anguish it takes to train for said job. We get paid really well. So if you are a cotton-headed ninny muggin, I want to warn you that you are going to have a tough time of it in ER.

 

[Apollyon]

I am very fulfilled in my life. 99.9% of that comes from my family, not my "job", whatever that has happened to be, at whatever point in my life.

Yeah, but, dude - you're not with your family 99.9% of the time, and they're not fulfilling you 99.9% of the time (if you say your kids completely fulfill you, they never bother you, and you can't get enough of them, and never need time away from them, it's one of two things: perfect (no), or you're lying).

Even if you are working 30hrs/week, that's almost 20% of the week. If you have a complete void, completely null, for fulfillment/satisfaction for 20% of your time, then that is a sad situation. If you get no fulfillment from your job, you are not invested, so you're not optimized, doing the best either for your family or your patients (one or the other). Likewise, if you are unfulfilled by your job, what do you think your kids will get from that? "Dad loves us, but hates his job and gets nothing about going to work every day." Like the line from "The Last Saskatchewan Pirate", "I've got too much pride/to end up just another bum".

I'm not teeing off on you, guy, but part of life is being productive and doing something, and if you're not doing something that makes you feel good or fulfilled, then that's a problem.

 

[EctopicFetus]

As a medical student currently interested in EM, I always find these threads interesting.

Those of us that are deciding between emergency and surgery though, I think it would be tough to think that the EM schedule is so rough on the family. Compared to general surgery, EM is much more compatible.

Obviously it's not radiology or derm, but it surely isn't the worst work schedule for physicians (see neurosurg).

And while we can all complain about how much we get paid, lets look at it like this:

You are either in the 99th percentile OR if you don't qualify for that you are in the 98th or 97th percentile for income earners in the richest country/civilization ever known to man. I.e. your quality of life (by ability to buy goods/take vacations/etc) is among the best ever in history. If you earn 150k you are likely in the 99.99th percentile for quality of life throughout time.

Just a point.. You are 30+ by the time you can save for retirement meaning you should save a decent amount of money. Throw that in with the reality of student loans that 150k you mention really isnt much. It is more like 100k which is a lot of money but not buy a BMW every 3 year money.

 

[GeneralVeers]

Just a point.. You are 30+ by the time you can save for retirement meaning you should save a decent amount of money. Throw that in with the reality of student loans that 150k you mention really isnt much. It is more like 100k which is a lot of money but not buy a BMW every 3 year money.

I prefer Porsche.

 

[EctopicFetus]

i should add most er docs make way more than 150. Ill just say I make more now than I thought I could doing this. That being said im married with kids so the porsche is out of the question til the kids are older, though Im more of an aston martin or maserati guy.

 

[Mighty Mouse]

i agree...there is a fair amount of negativity in this post. the opinions here are posted by a lot of different people with different lengths of clinical experience, and frankly, dramatically different practice environments. their opinions are real and shouldn't be dismissed, but there are definitely a lot of people out there who really like their jobs. and i am one of them.

a lot of community shops have the potential to be difficult work environments. the hospital makes its money off the low acuity patients who can choose where to go, and that we can treat and street quickly. which is why the Press Ganeys (especially the "likely to return" and the "likely to reccomend") are so important to the suits higher up -- which filters down to your medical director, and then on to you and the entire culture in the ED. we never think about that stuff when we go into medical school. we think car accidents, tubes, lines, and cardiac arrest.

there is no perfect specialty. you need to find one where the pluses are the things you love, and the minuses are things you can tolerate..

but, to the above poster who asked if there is anyone who loves their job....yes, i emphatically do.

i've been out of residency for 1.5 yrs. i work in a major trauma center as core academic faculty for a residency. i get to teach on every patient and every shift, which i find to be very rewarding. supervising a busy emergency department is an entirely different kind of challenge. i realized about halfway through residency that the run of the mill procedure didn't give me the rush it used it. but, i taught a resident how to put in his first chest tube this week, and the smile and sense of accomplishment on his face when we were done made it awesome for me all over again,

we have a shift in the ED where I work alone and see my own patients. and i moonlight in 3 of our community satellites, where I am single or double coverage. I make a base salary, have sweet benefits, and lots of easily attainable bonuses based on academic performance and contribution rather than RVUs. I make an hourly rate when i moonlight. i like that i know what i'm getting paid, and any extra cash i make is because i wanted to work for it....not because of RVUs or press ganeys or because the rest of the guys finally voted me in as a partner. i will make 300,000+ this year.

we have dedicated night people that makes it so i average 1-2 overnight shift per month, which is easy to gut through. we have paid vacation and an easy and accomodating scheduling system.

i work with the inner city poor and the suburban rich. i get hugged by old ladys i'm taking care of all the time. absolutely, there are days that are hard and days that are awesome. but i love going to work. i love my job. i love that i am a doctor and given the opportunity to help people who literally have nowhere else to turn to. i love seeing a kid's smile when he realizes the stitches i had to put in were not painful. i even love the crazy drunk psychotic psych patients that we have to restrain and get security. its a circus and its fun!

i'm getting married in the summer. i played 40 rounds of golf this year. i had a traveling nightmare last week due to weather, and i just changed my plans and spent a lot of money on it and didn't think twice because i had the cash. i wondered if my friends who have tenous jobs and much less income could have done the same. i've saved a ton, maxed out my retirement funds, and aggressively paid down my loans.

i don't live and breathe my job every second. but this is a job we spent over 10 years persuing. its only natural that its part of our identity. this is not a normal job that anybody can do. its ok to have it be a significant portion of who you are.

sorry for the rant. i just think what we all do is very special.

 

[Jack is Back]

Just a point.. You are 30+ by the time you can save for retirement meaning you should save a decent amount of money. Throw that in with the reality of student loans that 150k you mention really isnt much. It is more like 100k which is a lot of money but not buy a BMW every 3 year money.

I have always had a slightly different view on retirement. If one is capable to work, they should be able to do something through 70+ yrs old. Maybe not overnight shifts or 150 hr months, but part time or teaching or something wouldn't be bad. Even if I had 5 million in the bank, I still would be pursuing this career. It's good to work and produce, we were made to be productive. I'm not advocating a workaholic mentality, I think it's great for a 60-70 y/o to work ~30 hrs a week if they are capable and enjoy what they do.

 

[Jack is Back]

i agree...there is a fair amount of negativity in this post. the opinions here are posted by a lot of different people with different lengths of clinical experience, and frankly, dramatically different practice environments. their opinions are real and shouldn't be dismissed, but there are definitely a lot of people out there who really like their jobs. and i am one of them.

a lot of community shops have the potential to be difficult work environments. the hospital makes its money off the low acuity patients who can choose where to go, and that we can treat and street quickly. which is why the Press Ganeys (especially the "likely to return" and the "likely to reccomend") are so important to the suits higher up -- which filters down to your medical director, and then on to you and the entire culture in the ED. we never think about that stuff when we go into medical school. we think car accidents, tubes, lines, and cardiac arrest.

there is no perfect specialty. you need to find one where the pluses are the things you love, and the minuses are things you can tolerate..

but, to the above poster who asked if there is anyone who loves their job....yes, i emphatically do.

i've been out of residency for 1.5 yrs. i work in a major trauma center as core academic faculty for a residency. i get to teach on every patient and every shift, which i find to be very rewarding. supervising a busy emergency department is an entirely different kind of challenge. i realized about halfway through residency that the run of the mill procedure didn't give me the rush it used it. but, i taught a resident how to put in his first chest tube this week, and the smile and sense of accomplishment on his face when we were done made it awesome for me all over again,

we have a shift in the ED where I work alone and see my own patients. and i moonlight in 3 of our community satellites, where I am single or double coverage. I make a base salary, have sweet benefits, and lots of easily attainable bonuses based on academic performance and contribution rather than RVUs. I make an hourly rate when i moonlight. i like that i know what i'm getting paid, and any extra cash i make is because i wanted to work for it....not because of RVUs or press ganeys or because the rest of the guys finally voted me in as a partner. i will make 300,000+ this year.

we have dedicated night people that makes it so i average 1-2 overnight shift per month, which is easy to gut through. we have paid vacation and an easy and accomodating scheduling system.

i work with the inner city poor and the suburban rich. i get hugged by old ladys i'm taking care of all the time. absolutely, there are days that are hard and days that are awesome. but i love going to work. i love my job. i love that i am a doctor and given the opportunity to help people who literally have nowhere else to turn to. i love seeing a kid's smile when he realizes the stitches i had to put in were not painful. i even love the crazy drunk psychotic psych patients that we have to restrain and get security. its a circus and its fun!

i'm getting married in the summer. i played 40 rounds of golf this year. i had a traveling nightmare last week due to weather, and i just changed my plans and spent a lot of money on it and didn't think twice because i had the cash. i wondered if my friends who have tenous jobs and much less income could have done the same. i've saved a ton, maxed out my retirement funds, and aggressively paid down my loans.

i don't live and breathe my job every second. but this is a job we spent over 10 years persuing. its only natural that its part of our identity. this is not a normal job that anybody can do. its ok to have it be a significant portion of who you are.

sorry for the rant. i just think what we all do is very special.

Good to hear.

 

[The White Coat Investor]

I might work 8 or 10 day shifts a month out of love for my job. Anything above and beyond that is for the money.

I enjoy what I do far more than any other work I could do (except perhaps writing) but EM is a fantastic way to trade time for money (far better than writing).

Don't get me wrong, I love being there to help people on the worst day of their life, but there's enough bad things at work that I don't expect to ever work 150 hours a month at it again nor do it in my 60s. But who knows, that's a long ways away. Perhaps if I stepped away at 55 I'd really miss it and come back.

 

[Birdstrike]

.

 

[Birdstrike]

.

 

[Jack is Back]

As the Vice-President of my local chapter of ACCHNM (Amercian College of Cotton Headed Ninny Muggins) and proud, card-carrying cotton-headed ninny muggin, I have to agree 100%.

I lol'ed.

 

[EctopicFetus]

I have always had a slightly different view on retirement. If one is capable to work, they should be able to do something through 70+ yrs old. Maybe not overnight shifts or 150 hr months, but part time or teaching or something wouldn't be bad. Even if I had 5 million in the bank, I still would be pursuing this career. It's good to work and produce, we were made to be productive. I'm not advocating a workaholic mentality, I think it's great for a 60-70 y/o to work ~30 hrs a week if they are capable and enjoy what they do.

Jack.. I perhaps didnt state my position quite right. I had lunch with 2 of my partners today. One is almost 60 and the other in his early 40s. The older one is gonna cut back his hours some more and outside of some stressful cases enjoys his job. We had a long talk about savings, retirement and our future.

My point is simply that in 18 years I will be able to retire comfortably. I have no plans to retire at that time. Both my kids will probably be in college and while I have some hobbies I still really enjoy my job.

That number is more like a point where if I felt abused by my job or the system I could quit and pursue something else I enjoyed without concern for money.

In the end I plan to work for a while. Maybe 60, maybe 70 like you said. I am a realist though. I dont know your experience but I dont see a ton of 60 or 70 year olds working at a Level one trauma center. In fact my group has one guy over 60 and a few nearing 60 who will likely retire before then.

I love my job.. I really do. It keeps my brain working, allows me to meet interesting people and help a few folks along the way. That being said I enjoy my family as well and I think if you are expecting to be some hero by working in EM you likely will be unsatisfied. Once you have kids and your time becomes more valuable I think this point becomes clearer. I work a lot by EM standards. I worked over 160 per month the last 3 months. I didnt feel burnt but I also think I see those around me and dont think Im better or different than them. I hope to love my job in 20 years, my plan is that if I dont I will have my out.

 

[EctopicFetus]

I might work 8 or 10 day shifts a month out of love for my job. Anything above and beyond that is for the money.

I enjoy what I do far more than any other work I could do (except perhaps writing) but EM is a fantastic way to trade time for money (far better than writing).

Don't get me wrong, I love being there to help people on the worst day of their life, but there's enough bad things at work that I don't expect to ever work 150 hours a month at it again nor do it in my 60s. But who knows, that's a long ways away. Perhaps if I stepped away at 55 I'd really miss it and come back.

Well said. I almost feel the exact same way. Substitute writing for football.

 

[Jack is Back]

Jack.. I perhaps didnt state my position quite right. I had lunch with 2 of my partners today. One is almost 60 and the other in his early 40s. The older one is gonna cut back his hours some more and outside of some stressful cases enjoys his job. We had a long talk about savings, retirement and our future.

My point is simply that in 18 years I will be able to retire comfortably. I have no plans to retire at that time. Both my kids will probably be in college and while I have some hobbies I still really enjoy my job.

That number is more like a point where if I felt abused by my job or the system I could quit and pursue something else I enjoyed without concern for money.

In the end I plan to work for a while. Maybe 60, maybe 70 like you said. I am a realist though. I dont know your experience but I dont see a ton of 60 or 70 year olds working at a Level one trauma center. In fact my group has one guy over 60 and a few nearing 60 who will likely retire before then.

I love my job.. I really do. It keeps my brain working, allows me to meet interesting people and help a few folks along the way. That being said I enjoy my family as well and I think if you are expecting to be some hero by working in EM you likely will be unsatisfied. Once you have kids and your time becomes more valuable I think this point becomes clearer. I work a lot by EM standards. I worked over 160 per month the last 3 months. I didnt feel burnt but I also think I see those around me and dont think Im better or different than them. I hope to love my job in 20 years, my plan is that if I dont I will have my out.

I think our perspectives are actually pretty similar after reading this.

 

[EctopicFetus]

Yeah. Im not 2 years in and hate it. Honestly, I think im lucky. Job is great, no one leaves, fair pay, fair scheduling, true democratic group. In time this might change. I dont want to HAVE to work. if pay stays good ill hit my goal. If it doesnt then Ill HAVE to work longer. There is something to be said about showing up at work because you like your job and not because you need the money.

Im lucky cause while I need the money i still enjoy showing up to work.

 

[Jack is Back]

As the Vice-President of my local chapter of ACCHNM (Amercian College of Cotton Headed Ninny Muggins) and proud, card-carrying cotton-headed ninny muggin, I have to agree 100%.

Btw, Birdstrike, are you bearish on diagnostic radiology? Just curious as it is an outlier for me. What are your thoughts on that specialty?

 

[EctopicFetus]

All of medicine is bearish. Anyone who doesnt believe this is gonna have a ruyde awakening. I still think we will do well but incomes have over time diminished as a relative number.The higher the pay the more bearish one should be.

 

[Birdstrike]

.

 

[EctopicFetus]

I know a bunch of rads guys and their incomes have dipped drastically over the past 5 years.

 

[docB]

Basically, it's a very taxing job. Getting paid well and having time to spend with family are HUGH pluses. But we cannot deny to premeds, med students and each other that the ED doc is the hospital and medical staff b*&tch. You do what they tell you because at all costs, the contract cannot be threatened.

I have thought about moving to a different geographic location or changing to a different group that sees less volume. But that doesn't change a lot of the above.

I hope to one day join Birdstrike in leaving the field for something more fulfilling and less taxing on my mental health.

This.

I have discovered that contracts come first. NOTHING is as important as the contract and people, policies and principles will all get the shaft before the contract gets put on the line.

Who cares what the patient thinks…

The administrators care. They will investigate every complaint no matter how harebrained. They will slavishly buy into Gallup and PG numbers. They will create and believe in ludicrous metrics and punish those who are found lacking in the flavor of the week competition. And we are subservient to them. Because they sign the contracts.

 

[Jack is Back]

If you really want the answer to this question, take it to the radiology forum for the inside scoop. I swore I was done with this thread, but since you asked...

I do know that the radiologists face some trouble due to the fact that with tele-radiology, it's getting much easier to outsource their services to cheaper radiologists overseas. My guess is that if you're good at what you do, or have a fellowship, you'll be okay, but ask some radiologists.

Ectopic Fetus is right that there will continue to be downward pressure on all physicians salaries. The more you make, the more they can cut. We do have the ultimate trump card on that, though. The more docs that leave certain specialties, leave Medicine in general, retire early, cut their hours, or just plain don't go into Medicine, the more incentive there is to pay docs more, give better benefits, better hours, better working conditions and less ridiculous administrative interference. The government could counter this, however, by letting more foreign medical grads in the country, who generally come from countries where doctors make much less, and therefore are willing to work for less (yes, even you and I can be outsourced). If the American people are okay with that, that makes things harder for us.

In my opinion, since the large top-end financial rewards likely won't be there, the premium will more and more be on the jobs/specialties where you can have the least stress, the most normal hours (8-4 Mon-Fri), best lifestyle and least night shifts and night-call for emergencies.

That being said, if you pick something you enjoy (and will always enjoy), the rest will likely work itself out. Also, the more unique your niche (specialty + fellowship, instead of 3 year primary care residency) the more insulated you'll be from all of this uncertainty.

I'm going to pick something I enjoy. I like EM and a few others. The only thing that I don't like about EM is I want to work until 70s and still be productive and get fulfillment out of my career.

I don't care much about $ as long as I can earn 180k plus. I know rads earns more than that, so even if they cut by 50% I would still be ok with that. As you said, the schedule and the work are more important than the $. Who knows, I'm just trying to learn about everything right now.