atelectasis

10+ Year Member
Oct 2, 2006
25
1
Status
This is a different spin on the usual burnout question. I'm not interested in the "getting crispy" type of burnout but more along the line of how old is too old to be practicing EM? Obviously, it's very individual and can depend on the group versus corporate, private versus academic, Level I/II versus small ED in the middle of nowhere, etc, and how happy one was with their practice model but I'm curious as to what y'all (residents and attendings) think.

I guess the question is not necessary about age but more about being physically able to handle the decathlon of a busy ED and remaining mentally alert to hand all medical crises, running around the rooms, handling all those consultant phone calls, etc. Forget the burnout of dealing with frequent flyers or some BS narc seeker, when is it too old to juggle that COPDer, the DKA pt, that stab coming in, and that MI who's still in the ED because the cath lab already have one they're dealing with upstairs, all at once?

I just think that EM is not conducive for being like a Debakey or any other old surgeons who can scrub in at 70 or even 80 (even if all they do is make one stitch while the fellow does all the work). But I also suspect that EM doesn't attract folks that think of medicine as a calling; most realize that it's just a job.

But what if you do want to keep going? Regardless of the money issues. An internist or FP can keep going if s/he wants to, but what about EM? What are the factors that will push you to say, "I'm done" or "the spirit is willing but the flesh is weak"? I guess anybody can say once the kids get jobs and you have some money saved up for retirement but I would love to hear what vague or hazy plans you have for those twilight years. Do you want to fade out at an UC? Do you plan on continuing to contribute to the field? Open up a tattoo removal clinic? What do y'all think?

Some personal info: I'll graduate medical school (assuming I don't screw up now that I'm in) in my mid-30s after trying other careers. I've also worked fulltime as a Scribe at a tertiary center with great Docs who have taught me a lot about the non-medical aspects of the practice of medicine. So I may be an idiot, but not a complete one about the field EM nor about being an adult. I'm also not expecting "the answer to how my life will go" in a forum - nothing in my 20s worked out exactly as I planned when I was in high school so I sure as heck ain't expecting a blue print for the next 30 years of my life from any of y'all. Just curious about the diverse views out there. Thanks!
 

vtucci

Attending in Emergency Medicine
Moderator Emeritus
15+ Year Member
Aug 6, 2003
1,671
13
Houston
Status
Attending Physician
Allow me to preface this with saying that I am just a medical student (albeit one with a good deal of life experience prior to entering medical school like the OP)... Age is largely irrelevant so long as certain manual dexterity and mental facilities are intact. It is personality and interest that matter the most.

I disagree with the OP and believe that medicine is a calling. That is why I left the legal profession in order to follow what I believe I am meant to do. I recognize that not everyone in the field will take this view but like most of us, I also believe in balance and think that the best physicians are those who can enjoy family life, hobbies outside of work while at the same time, enjoy the intellectual and humanistic demands of their job.

We have one physician in our ED who is legendary and in his 70s I believe. Ditto on a trauma surgeon in his 70s who does not allow the fellows to do the lion's share of the work. Both have amazing (sometimes exhausting to their peers) enthusiasm and commitment to medicine and outshine many of their younger counterparts. They love to teach and are two of the best ones I have seen. In spirit, I would place them in their 30s not 70s. They are kindred.

I also believe that EM can be a calling in and of itself. There are plenty of incredibly bright young (and old) physicians who are not capable of functioning in an ED. It takes a certain kind of person to multitask the way that emergency medicine demands. That ability does not just go poof as we age- some of us may even get better at it as we learn how to anticipate the landmines being lobbed our way. Likewise, it requires at least some tolerance of dealing with portions of the public that other physicians loathe and dread (i.e., drug-seekers, addicts/drunks, indigent, illegal immigrants- noting that some of these categories may overlap) and avoid at all costs.

Do not get me wrong-- I think it takes a certain kind of person to take overnight call on a regular basis and round with the ward teams or to work in the OR for hours on end with no food or pee-break. It is fortunate that most of us can choose a specialty that is the best fit for our talents and personalities.

I love that EM also enables us to nuture our outside interests. Like my mentors, I plan on staying in this field as long as my mental powers remain sharp and my physical abilities do not betray me. In short, for as long as I am able to serve the public and make a difference in this world.
 

awdc

Senior Member
7+ Year Member
15+ Year Member
Jul 13, 2002
436
2
Los Angeles
Status
Attending Physician
Quite frankly, I think I would burn out a whole lot sooner if I were in a different specialty. The physical part of it will depend on the individual and like you said, the type of ED and practice arrangement. It's hard to say what I'll be doing in my twilight years but I have a feeling that I'll remain in EM until the day I retire (if you take the traditional age 65 as retirement age). I don't know if I'll still be running around the county ED like one of the residents but who knows... At the least, I wouldn't mind tapering off into a low volume, lower acuity ED or the fast-track area. Beyond whatever physical burnout there may be, I'd like to think that I'll remain in EM in some capacity, probably teaching/mentoring med students or EMS personnel. Like VTUCCI said, I believe EM itself can be a calling. As cheesy as it sounds, I went the medical profession because I felt it was a calling and EM happened to be the best fit for me.
 
About the Ads

ABBY109

PGY-28
10+ Year Member
7+ Year Member
Nov 24, 2006
92
13
Status
Attending Physician
Its been over 20 years since I graduated med school and I am still having fun in the ED. I recently transitioned from community practice to a busy academic center. I see myself easily going another 10-15 years.

Burnout means #1 that you have picked the wrong profession or #2 Right profession but wrong place
 

Sweeper

Waiting for a late drop
10+ Year Member
5+ Year Member
Jul 24, 2005
13
0
in the green room
Status
Resident [Any Field]
I'll chime into this one, I finished med school in my early 30's, after having a successful 1st career. Now mid-30's and a resident, I totally think that EM is a calling. We practice medicine because for various reasons, we were all drawn to EM because we realized it was the medicine we wanted to practice, and we just wouldn't be happy/satisfied doing any other specialty. I remember being an intern, and literally dreading going to work. Of course everyone has days when you are tired, etc. But I actually get energized doing what I do, and I think that is how you know that you're in the right field. I don't think that age applies. (and I'll be pushing 40 when I finish residency). You've heard the addage: If you love what you do, you'll never work a day in your life.
 

DrQuinn

My name is Neo
Moderator Emeritus
10+ Year Member
15+ Year Member
Dec 6, 2000
4,227
16
Wisconsin
Visit site
Status
To the OP:

Depends on the group you are at. We have several attendings in our ED that basically don't work nights. They are in their 50s, and none of us have a problem with that. I actually don't mind working nights. "They" (being the older docs) don't have so much trouble with the pace of the ED, but hte transition from days to evenings to nights is what they say takes their toll on them.

Some of them are also transitioning into more "fast track" shifts, which at our place is run by docs only (no PAs or ARNPs).

Q
 

AmoryBlaine

the last tycoon
10+ Year Member
7+ Year Member
May 1, 2006
2,179
24
Status
Attending Physician
As with any field you are going to meet docs in their 70s who couldn't imagine slowing down and docs in their 40s who want to jump off the parking garage.

As others have said and has been discussed many times on this forum the issue of burnout is one that is a) not unique to EM despite what your IM attending tells you, b) not all that well supported by data, and c) highly individual.

I do have a pet theory (which I have hinted at recently) that there are alot of medical students going into EM for all the wrong reasons. There is a great thread going on the misconceptions about the field. Coming of "the trail" I really don't think that these misconceptions are gone in all M4s.

Others have said that "burnout" is really just a symptom of picking the wrong field (medicine) or the wrong specialty (EM). It will be interesting with the surging interest in EM to see how things look in the future. My personal prediction is that 15-20 years from now we're going to have a not-insignificant component of the workforce that are frustrated, "burnt-out" docs trying their hardest to work part-time. I suspect that many of these will be people who "talked themselves into" EM because of misconceptions about ease of work, salary, and relative glamour of the field in the lay sphere.
 

gman33

Moderator Emeritus
10+ Year Member
Aug 18, 2007
2,188
496
Status
Attending Physician
I found this thread when thinking about a similar question.

Are there any older attendings (55+) out there who can comment on the physical toll of EM?

If I pick EM, I'll be in my early 40's when I start practicing. Obviously, everyone's body reacts differently to the changing swing shifts. Just wondering how the older docs are handling it.

A common response seems to be that some of the docs switch into more fast-track type work. I could be way off base, but in my experience it seems like a lot of fast track is similar to is seen by FP/GP.

Part of my concern is that I don't want to pick a field based on the EM part which I like and then transition into a part I don't like just based on physical weardown.

Another separate issue.
I have a few GI conditions that are fairly well controlled, but still have some flareups. Sometimes they can cause an "emergency" trip to the bathroom for like 10-15 minutes. Kind of hard to predict if/when this may happen. Anybody out there dealing with this kind of issue?
I know EM isn't the best field for someone in this situation.
Just wondering if anyone is dealing with something similar.
 

gman33

Moderator Emeritus
10+ Year Member
Aug 18, 2007
2,188
496
Status
Attending Physician
They probably can't comment on this forum, as those over 40 don't know how to use the interweb. :D
Very true.
I know it's going to be a stretch to find many in that age range. :eek:

I guess I'll settle for stories anyone can offer.
 

Jeff698

EM/EMS nerd
15+ Year Member
Aug 11, 2000
1,998
15
Salado, Texas
Status
Attending Physician
They probably can't comment on this forum, as those over 40 don't know how to use the interweb. :D
Hey now!

I'm 40 and know how to use the web.

I'm just too tired after my shift to reply. :)

I work 12 hours shifts and doing the nights isn't a big deal if scheduled correctly. What kills me is doing a string of nights and then having a short turn around to days.

I think the most likely reason I would have for leaving clinical EM is that I may loose interest. I have a tendency to need to do something new after awhile. It's why I went to medical school after my EMS career. Fortunately, with EM, there are many different things you can do within the specialty.

Take care,
Jeff
 
About the Ads

DPT2MD

10+ Year Member
Mar 24, 2008
58
1
Status
Pre-Medical
Jeff (or anyone else)...could you elaborate on some of the other different things you can do within the EM speciality?
 

Aloha Kid

Senior Member
10+ Year Member
15+ Year Member
Mar 9, 2001
419
0
Visit site
Status
I've watched some of our older attendings in an academic setting and seen how they function. I think the biggest issues that keep them in the ball game are these.

1. They do very little documentation and rely on the resident to do most if not all of it. They usually write a few comments and sign their names to the chart.

2. They know the staff personally and usually give the RNs lots of verbal orders so they don't have to enter orders themselves.

3. They are masters at turfing patients and getting them admitted. Their systems based knowledge is excellent.

4. Overall, I think they are able to free themselves from the mundane, repetitive, and non-essential things in order to focus on patient care. Old dog experience and knowledge helps them deal with cases smoother and quicker.
 

8744

Guest
15+ Year Member
Dec 7, 2001
9,322
171
Status
Non-Student
they Probably Can't Comment On This Forum, As Those Over 40 Don't Know How To Use The Interweb. :hungover:
C:/ Hey, You Try Surfing The Internets On A Vintage
C:/ 1981 Commodore 64 And See How You Like It.
C:/ Oh, And You Damn Kids Get Off Of
C:/ My Lawn.
 

docB

Chronically painful
Moderator Emeritus
Lifetime Donor
10+ Year Member
15+ Year Member
Nov 27, 2002
7,742
220
Las Vegas, NV
Status
Attending Physician
C:/ Hey, You Try Surfing The Internets On A Vintage
C:/ 1981 Commodore 64 And See How You Like It.
C:/ Oh, And You Damn Kids Get Off Of
C:/ My Lawn.
Wow! Dot matrix!
 

gman33

Moderator Emeritus
10+ Year Member
Aug 18, 2007
2,188
496
Status
Attending Physician
Another separate issue.
I have a few GI conditions that are fairly well controlled, but still have some flareups. Sometimes they can cause an "emergency" trip to the bathroom for like 10-15 minutes. Kind of hard to predict if/when this may happen. Anybody out there dealing with this kind of issue?
I know EM isn't the best field for someone in this situation.
Just wondering if anyone is dealing with something similar.
Thanks for all the feedback.

Can anyone comment on my second question?
 

8744

Guest
15+ Year Member
Dec 7, 2001
9,322
171
Status
Non-Student
Seriously though, Emergency Medicine doesn't seem to be too stressful. It's true that we see a lot of really sick patients but we also have almost instantaneous access a lot of big gun studies, tests, and medications. Plus we get to declare victory when the patients go home or are admitted and ultimate victory at the end of our shifts.
 

EMpb

10+ Year Member
Jul 29, 2007
14
0
Status
Resident [Any Field]
I started thinkin about this the other day... I'll be late 20s when I finish residency... That means 40 years in emergency medicine until traditional retirement. I guess that means I have time for plenty of different niches. maybe I'll do cruise ship med the last 5 years or so.

Oh well, just hope I like it as much then as i do now.
 

bartleby

Senior Member
10+ Year Member
Jan 18, 2005
447
4
Status
I am certainly not one to trivialize the amount of energy it takes to last through an ED shift, but it's not like IM/FP people have some sweet four hour day with two patients scheduled. Many of my IM friends have brutal days of 9-10 hours when you include charting. Most of the people I've encountered who are leaving medicine are more generally sick of the BS involved in the practice of modern medicine rather than encountering a discrete physical limitation.


. An internist or FP can keep going if s/he wants to, but what about EM? What are the factors that will push you to say, "I'm done" or "the spirit is willing but the flesh is weak"?!
 

GeneralVeers

Stable Genius
10+ Year Member
Mar 19, 2005
5,531
3,269
Las Vegas
Status
Attending Physician
I am certainly not one to trivialize the amount of energy it takes to last through an ED shift, but it's not like IM/FP people have some sweet four hour day with two patients scheduled. Many of my IM friends have brutal days of 9-10 hours when you include charting. Most of the people I've encountered who are leaving medicine are more generally sick of the BS involved in the practice of modern medicine rather than encountering a discrete physical limitation.
Very true. Just the sheer paperwork slows me down. If I didn't have to sign 3 sheets of paper, time/date everything, and document everything myself I could easily see twice the number of patients.
 

arctic187

Junior Member
7+ Year Member
15+ Year Member
Mar 3, 2003
31
0
42
PA
Visit site
Status
Attending Physician
There are other options

  • Go down to half time or 3/4 time (have even seen even 1/4 time)
  • Become the fast track doc 9a-5pm
  • Work at a place with no or few overnights
  • Move from the crazy city ED to a quiet rural one
  • Invest your money well so you can retire early ;)
  • Move more into academics/research/administration as you get older, thus reducing your ED workhours
  • One older attending I know works all overnights for the regular schedule and the quieter shift
Tons of options as you get older
 

alpha62

Membership Revoked
Removed
10+ Year Member
Apr 29, 2006
563
0
Status
Non-Student
There are other options

  • Go down to half time or 3/4 time (have even seen even 1/4 time)
  • Become the fast track doc 9a-5pm
  • Work at a place with no or few overnights
  • Move from the crazy city ED to a quiet rural one
  • Invest your money well so you can retire early ;)
  • Move more into academics/research/administration as you get older, thus reducing your ED workhours
  • One older attending I know works all overnights for the regular schedule and the quieter shift
Tons of options as you get older
Don't do rural. You'll wind up putting in more hours than the city. those rural patients have been spoiled by decades of kindly old doctors and the townfolk think they own the doc.

Be prepared to suture farmers on your kitchen table, the tailgate of a pickup during corn picking season. Housecalls are sometimes expected and you'll get heat from just about every yokel who's daddy's daddy's, daddy was born here, blah, blah, blah.

I'm from one of those little hick farm towns. I'm related to about 1/2 the town and I practiced in one for several years. Every body thinks it's going to be full of interesting colorfull charactures like Northern exposure...well's it's not.

What it usually winds up being is one big welfare pocket because anybody with any gumpton has already bugged out to make an honest living.
 

DogFaceMedic

Member
10+ Year Member
5+ Year Member
Jul 18, 2006
552
2
Status
Resident [Any Field]
Don't do rural. You'll wind up putting in more hours than the city. those rural patients have been spoiled by decades of kindly old doctors and the townfolk think they own the doc.

Be prepared to suture farmers on your kitchen table, the tailgate of a pickup during corn picking season. Housecalls are sometimes expected and you'll get heat from just about every yokel who's daddy's daddy's, daddy was born here, blah, blah, blah.

I'm from one of those little hick farm towns. I'm related to about 1/2 the town and I practiced in one for several years. Every body thinks it's going to be full of interesting colorfull charactures like Northern exposure...well's it's not.

What it usually winds up being is one big welfare pocket because anybody with any gumpton has already bugged out to make an honest living.
You have a commie avatar and complaining about entitlement attitudes -- ironic. Perhaps change towns to one with better individual responsibility.
 

ER-ER-Oh

Member
10+ Year Member
5+ Year Member
Jun 2, 2005
100
1
Status
Attending Physician
I'm 50 years old and just finished residency. I'm working 18-20 shifts/mo right now trying to shove some money into the bank so I can retire in 15 years. I love this ****, so I don't feel burnt at all. I work out, bought a boat and took up wake boarding, try to date 25 year olds, study Chuck Norris, buy clothes at Abercrombie and Fitch, etc.

I used to repair ships, often working 90-120 days in a row for 18 hours/day. So this is a breeze in my world. Our group took over the contract at a small rural ED and I work overnights there. It's fun, see some crazy stuff, but can most often nap for 2-3 hours. And compared to the Level-1 Trauma center where I work the rest of the time, this is easy money.

Even with 20 shifts/mo I feel I have a lot of free time to work out, be on the water, and chase coeds.
 

8744

Guest
15+ Year Member
Dec 7, 2001
9,322
171
Status
Non-Student
I betcha' some poor schmuck doing family medicine will burn out a lot quicker. I can't think of anything more demoralizing than seeing thirty bull**** patients in one day. If you take out all of the trauma, all of the critical patients, and all of the truly sick patients from Emergency Medicine leaving nothing but the colds, ear infections, todos me dolore, drug seekers, and old people who smell like fish sticks and need something for their lumbago...well...that's family medicine.
 

pinipig523

I like my job!
10+ Year Member
15+ Year Member
Jan 7, 2004
1,320
23
Missing Chicago
Status
Attending Physician
A lot of it is how YOU approach the ED and the patients and how much stress or pressure you put upon yourself during the shift and your career.

You burn yourself out.
 
About the Ads