Question about Academic EM life -- how much clinical time can you buy down?

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Let's say you have qualifications in another somewhat (un)related field, say in palliative care or medical ethics, bench research, epidemiology, etc.
How much clinical time can you buy down, especially if you have buy-in from the other department in which your qualification lies?
On that note, how many shifts/hrs do academic EM guys work?
 
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Basically, you're saying:

"I'm already special, so how much does me being special excuse me from doing my job."
 
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Basically, you're saying:

"I'm already special, so how much does me being special excuse me from doing my job."
Ha. Nah, it is more like, should I continue to work part-time in a community ER and do academic stuff at a different institution, or should I seek to combine these two under the same roof.

(I think you and I got into it a while ago, so maybe that's why you gave me that response? You might find it interesting that I have started shifting politically and moved a little less left and more right on some issues. Or you might not find it interesting at all, whatever! Hello again!)
 

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Ha. Nah, it is more like, should I continue to work part-time in a community ER and do academic stuff at a different institution, or should I seek to combine these two under the same roof.

(I think you and I got into it a while ago, so maybe that's why you gave me that response? You might find it interesting that I have started shifting politically and moved a little less left and more right on some issues. Or you might not find it interesting at all, whatever! Hello again!)
We "get into it" a lot. Primarily because I feel that your attitude is myopic, and (in kind) you feel that I'm a codgery old man.

We have crossed swords on the political spectrum, because your arguments against the present office amount to: "Orange Man is Bad Because Brown People Are Mad" and my arguments are easily distilled to "you can do whatever you want; just don't ask me to pay for it" (admission of reuctio ad adsurdum)

If you're ekeing out a hybrid model, then good on you. I'm doing the same.

Paz.
 
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We "get into it" a lot. Primarily because I feel that your attitude is myopic, and (in kind) you feel that I'm a codgery old man.

We have crossed swords on the political spectrum, because your arguments against the present office amount to: "Orange Man is Bad Because Brown People Are Mad" and my arguments are easily distilled to "you can do whatever you want; just don't ask me to pay for it" (admission of reuctio ad adsurdum)

If you're ekeing out a hybrid model, then good on you. I'm doing the same.

Paz.
Well, I don't really take such debates to heart nor dislike you or anyone because of them, even if in the heat of the debate I might have said something unnecessarily judgmental or ad hominem. So, if I did do those things, I apologize. I have, in any case, decided to move away from making summary judgments like that, due to the current political climate, in which free speech is being targeted.

I don't think my disagreements with Trump can be reduced to that, although I do find certain things he did in that regard to be morally atrocious, such as family separations at the border.

On the other hand, I no longer identify with the left anymore and find myself turned off by racial and gender identity/woke politics.

But, in any case, back to the subject matter at hand; yes, I am looking for such a hybrid model but will need to determine if it makes sense. Do you mind sharing the hybrid model that has worked for you? You can, of course, be vague if you don't want to reveal too much.

Thanks! Cheers!
 

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Well, I don't really take such debates to heart nor dislike you or anyone because of them, even if in the heat of the debate I might have said something unnecessarily judgmental or ad hominem. So, if I did do those things, I apologize. I have, in any case, decided to move away from making summary judgments like that, due to the current political climate, in which free speech is being targeted.

I don't think my disagreements with Trump can be reduced to that, although I do find certain things he did in that regard to be morally atrocious, such as family separations at the border.

On the other hand, I no longer identify with the left anymore and find myself turned off by racial and gender identity/woke politics.

But, in any case, back to the subject matter at hand; yes, I am looking for such a hybrid model but will need to determine if it makes sense. Do you mind sharing the hybrid model that has worked for you? You can, of course, be vague if you don't want to reveal too much.

Thanks! Cheers!
Apologies accepted.
Similar apologies issued.

I'm not in a spot right now where I have actuated my hybrid model just yet.

I don't mind sharing it via PM.
 

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Apologies accepted.
Similar apologies issued.
Thanks!
Now, I gotta make up with that old geezer General Veers!

I'm not in a spot right now where I have actuated my hybrid model just yet.

I don't mind sharing it via PM.
Got it. That makes sense. I'll PM you.
 

southerndoc

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Generally, core faculty work 110-120 hours per month. APD's around 90-100 hours/month and PD's around 80 hours/month. Associate medical directors around 120 hours/month and medical directors around 100 hours/month. These are averages and not requirements (although PD's and APD's may be limited by RRC; core faculty were previously limited by RRC).

At a minimum, you probably have to work at least 40-60 hours/month to make it worthwhile to cover your malpractice insurance, recruitment costs, etc. If you are working at a university where you are also doing whatever primary gig you have (epidemiology, palliative care, etc.), then you can work less.

I remember during residency we had an attending who was studying for his MBA and only worked 20 hours/month.
 

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Generally, core faculty work 110-120 hours per month. APD's around 90-100 hours/month and PD's around 80 hours/month. Associate medical directors around 120 hours/month and medical directors around 100 hours/month. These are averages and not requirements (although PD's and APD's may be limited by RRC; core faculty were previously limited by RRC).

At a minimum, you probably have to work at least 40-60 hours/month to make it worthwhile to cover your malpractice insurance, recruitment costs, etc. If you are working at a university where you are also doing whatever primary gig you have (epidemiology, palliative care, etc.), then you can work less.

I remember during residency we had an attending who was studying for his MBA and only worked 20 hours/month.
This is gold. Thank you.
 
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On the other hand, I no longer identify with the left anymore and find myself turned off by racial and gender identity/woke politics.
No! No! Stop this! Stay woke!

#WHITESILENCEISVIOLENCE

:laugh:

(No it's not)
 
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You got a problem with codgery ol' men, bro?
Inasmuch (sic) as I was once called (by an administrator) ... "The Oldest Young Man to Ever Live".

I am at level 38 in this bizarre MMORPG called "life".

I am debt-free. I have no children. I am just looking for some degree of enlightenment.
 
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Birdstrike

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...I am looking for such a hybrid model but will need to determine if it makes sense...
In all seriousness (disregard all my other posts today, I'm in too good of a mood for you to take me at all seriously today) anything that reduces your general EM shift exposure is a good, healthy, smart long term move. I'm not telling you to "leave EM." I'm not saying "EM is terrible and will be soul crushing if you continue as is." But I am saying, that if you can reduce your exposure to the toxic parts (excess circadian rhythm life destruction; acuity x volume x stress = burnout) then you're doing a great thing for yourself.
 

Birdstrike

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Inasmuch (sic) as I was once called (by an administrator) ... "The Oldest Young Man to Ever Live".
You're closer to Enlightenment than you think. I feel like I got a half a yard closer today myself. Or maybe I'm just delirious with runner's high from running to the point of absofrickenlute exhaustion while listening to feel-good hippy-music.
 
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alpinism

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From my experience it varies between academic hospitals.

In many ways its like a community job where the more desirable the job the less flexible administration is willing to be with scheduling requests.

Generally speaking though most places want 120+ hours for full time with the option to go down to maybe 80+ hours if you're fellowship trained with the understanding that you'll be practicing your subspecialty when you're not working any shifts in the emergency department.
 

RustedFox

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You're closer to Enlightenment than you think. I feel like I got a half a yard closer today myself. Or maybe I'm just delirious with runner's high from running to the point of absofrickenlute exhaustion while listening to feel-good hippy-music.
I hear you. I raise you sitting in my car, looking at nature, and breathing out, saying: "This is the joy of a normal person."

I have not felt this in 8 years.
 

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Going to vary heavily among residency programs. We work 9s. Our clinical faculty work 16 with no academic/teaching/admin responsibility. Our core faculty work 12. So there’s a four shift difference for us.
 

CliveStaples

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Clinical buy down was like a well guarded secret at my training program. The impression I got was that you were a lemming by not pursuing it with reckless abandon. Wanted to work at the ivory tower and do nothing else? Great. You work 120/hrs per month base and any extra was overload.

The key was to fight claw, tooth, and nail to get every little hour you could. Direct the 3rd year clerkship? Sure, give me some hours. Director of Hyperbarics? Clinical buy down please. Assistant medical director? I'll need 5 hours a month for that plus a side of fries. Yeah, I'll spearhead the next big multi-center clinical trial if you pay up the hours, Mr. Chair.

The end result was a lot of attending physicians who continued to work 120 clinical hours per month but who all had varying degrees of overload pay from their negotiated buy-down. I've heard that COVID has since really put a damper on some of this buy reducing the number of available shifts per month while increasing hiring.
 
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Going to vary heavily among residency programs. We work 9s. Our clinical faculty work 16 with no academic/teaching/admin responsibility. Our core faculty work 12. So there’s a four shift difference for us.
Yeah, I'm looking for 8 shifts/month, although willing to do 12-hour shifts. But, I'm thinking it is going to be tough to get.
 

Angry Birds

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No! No! Stop this! Stay woke!

#WHITESILENCEISVIOLENCE

:laugh:

(No it's not)
Well, it is this sort of language that really drove me away from the left. I was never actually leftist but I was forgiving of their excesses due to what I saw on the right. Now, I think both left and right are crazy. And yeah, it became hard to deny the antipathy towards white people or the race & gender identity politics going on.
 

Birdstrike

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Now, I think both left and right are crazy.
I’ve always said elections are a choice between the lesser of two evils. Just think about it. Do you know any sane, ethical, decent people that would ever subject themselves to a life in politics? I don’t.

Both sides want you to drink the exactly the same Kool Aid, which always is, “My side is 100% good and the other side is 100% evil.” And it’s always bu*****t. It actually makes it easier for me to make the decision that’s best for me and my family, to assume both sides are full of terrible, self-serving people who all are all lying, all the time to benefit themselves.

Once you find yourself (or anyone else) buying into the belief that one aide or candidate is a savior, and the other is the embodiment of evil, you’ve effectively been hypnotized and drank the Kool Aid.
 

Angry Birds

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I’ve always said elections are a choice between the lesser of two evils. Just think about it. Do you know any sane, ethical, decent people that would ever subject themselves to a life in politics? I don’t.

Both sides want you to drink the exactly the same Kool Aid, which always is, “My side is 100% good and the other side is 100% evil.” And it’s always bu*****t. It actually makes it easier for me to make the decision that’s best for me and my family, to assume both sides are full of terrible, self-serving people who all are all lying, all the time to benefit themselves.

Once you find yourself (or anyone else) buying into the belief that one aide or candidate is a savior, and the other is the embodiment of evil, you’ve effectively been hypnotized and drank the Kool Aid.
I'm at the point where I think one side is evil and the other is crazy. haha
 

EctopicFetus

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Generally, core faculty work 110-120 hours per month. APD's around 90-100 hours/month and PD's around 80 hours/month. Associate medical directors around 120 hours/month and medical directors around 100 hours/month. These are averages and not requirements (although PD's and APD's may be limited by RRC; core faculty were previously limited by RRC).

At a minimum, you probably have to work at least 40-60 hours/month to make it worthwhile to cover your malpractice insurance, recruitment costs, etc. If you are working at a university where you are also doing whatever primary gig you have (epidemiology, palliative care, etc.), then you can work less.

I remember during residency we had an attending who was studying for his MBA and only worked 20 hours/month.
UNrelated to this but I do believe there are limits of APDs and PDs though I don't remember / know what they are. At my residency the faculty could buy down their hours. I think it was something like $300 to buy down 1 hour (which is insane). My friend who I am thinking about essentially bought down all his EM clinical hours.

If it is not in the same insti
 

namethatsmell

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In my small n of academic shops, % buy down comes from a combination of timing+connections.

Also consider your goals. Is it to absolutely have a hybrid role at the same place? Or is it to be able to work in both spaces? If it's the latter and you want to do academic EM and you have some really unique non-EM skills then you could consider contacting the chair or PD at local academic shops and chat. Sell them on your unique area of expertise that you can bring to their dept and see if they'll let you come on PT or prn.
 

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I'm at the point where I think one side is evil and the other is crazy. haha
Funny. I'm at the same spot. One side is evil. The other is Crazy.

Unfortunately, "crazy" might be what the nation needs. If only to get back to simplicity.

Icarus is flying high. Really, really high.
 
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Angry Birds

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In my small n of academic shops, % buy down comes from a combination of timing+connections.

Also consider your goals. Is it to absolutely have a hybrid role at the same place? Or is it to be able to work in both spaces? If it's the latter and you want to do academic EM and you have some really unique non-EM skills then you could consider contacting the chair or PD at local academic shops and chat. Sell them on your unique area of expertise that you can bring to their dept and see if they'll let you come on PT or prn.
So, this is the question I face. I guess I won't find out until I actually shop around. But, I am waiting for COVID to die down first.
 
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xaelia

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FWIW, I had this sort of magical buy down at Kaiser – start at a base of ~135 hours per month as 0.8 FTE full-time ... then use vacation/education leave hours as quickly as they accrued to get down to ~120 hours per month ... chair of the IRB ... 30 hours per month ... clinical practice lead for the department ... 20 hours per month ... resource stewardship review ... ~10 hours per month ... boom! 65 clinical hours per month.

I'd put in for six or seven 9-hour shifts per month, and if I was short hours in any pay period, they'd just deduct the hours short from my paycheck. If I wanted more money, I put in for more (never did). Oh, and I also sold a night a month. It was pretty glorious, other than hating pretty much all aspects of the job – but I was doing a different thing I disliked every day, so it sort of worked for awhile. And a lot of the people I worked with were pretty great.

In NZ, by union largesse, senior staff have 35% of FTE as non-clinical time. For me, this works out to two ~8s a week plus 10 hours a week of non-clinical, plus working a full weekend as a base ... but then I have to somehow take something like 300 hours of leave each year from that, so it'll probably end up closer to that aforementioned 8 shifts a month on average.

It's definitely an academic salary, though ... and paid in pacific pesos ....

When I was in true academics for four years before that, we were all doing 14 8s as core academic faculty and I was given two shifts of credit for buydown for departmental service and to support my professional development (blogging and tweeting, actually), because it reflected favorably on the department.
 

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The herculean efforts some of you guys put into escaping clinical time in the ED is nothing short of awe inspiring, lol.

I don't work academics, but the thought of chairing committees and responding to a gazillion emails or zoom conferences regarding my particular committee +/- having to spend hours per week sitting in a departmental office to keep appearances sounds nauseating. I'd rather chemically restrain a hundred angry, drunk homicidal schizophrenics. Maybe I'm a broken horse but I LOVE clocking out/checking out and not feeling guilty if I decide to turn my phone off for 6 hours at a time. If I have 3 days off in a row, I absolutely treasure having zero work related responsibilities and feeling absolutely no obligation or pressure to respond to anyone from work.

What I've found, at least at this stage... is that the monthly shift requirements from EM is only half the problem. It's the daily, cumulative stress coefficient that slowly gets to you. The more I've focused on "finding my zen" during a shift. I.E. Not picking up too many patients, not picking up too many shifts, not staying over after a shift, not hooking into departmental deficiencies, not hooking into patients, not hooking into overlord metric horse whipping, the more easily I can just calmly navigate through my shifts without ever breaking a heart rate of 60, even during a code. Now, that doesn't solve the circadian craziness and poor sleep hygiene but it has remarkably improved my quality of life.
 
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Thanks!
Now, I gotta make up with that old geezer General Veers!



Got it. That makes sense. I'll PM you.
Always glad to welcome people to sanity! I think certain "nameless" movements have opened up people's eyes to the tactics of the extreme left. I think most sane Americans are not with that movement, and don't want it infecting their communities.

Sorry I've been absent from the thread. I have been vacationing in New England. It's been surprisingly pleasant, except for a few bizarre, and non-sensical regional COVID restrictions.
 

RoyBasch

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The more I've focused on "finding my zen" during a shift. I.E. Not picking up too many patients, not picking up too many shifts, not staying over after a shift, not hooking into departmental deficiencies, not hooking into patients, not hooking into overlord metric horse whipping, the more easily I can just calmly navigate through my shifts without ever breaking a heart rate of 60, even during a code.
I'm working on this to. It's hard.
 
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xaelia

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The herculean efforts some of you guys put into escaping clinical time in the ED is nothing short of awe inspiring, lol.
Two kids under the age of 5 and a spouse working 40+ hours a week – yeah, I need more flexible time where I can be answering e-mails and working during business/daycare hours.

Yeah, we could throw money at the problem, but why do so if it can be avoided.
 

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Wow guys, I'm really impressed. It used to take me scrolling through three or four threads before the awful attitudes and thoroughly irrelevant political bickering made me switch off, but here you all came together and did it by just the second post of the first thread. Strong work, guys.
 

Groove

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I'm working on this to. It's hard.
It's an elusive state of mind and one that I didn't actually learn to attain until a few years out. We had this FT traveler come through who was probably 20 years into his career or more. He was doing FT old @GeneralVeers style locums. Hell, it may have been Veers for all I know. He always wore business attire, meticulously groomed, expensive cologne, very dapper dude. Worked 12 hour shifts, 7 in a row and I never saw a bead of sweat on him nor a single hair out of place. Smelled just as good at the end of his shift as he did at the beginning. Always calm, always pleasant, never ruffled, never frustrated. Well, it frustrated the hell out of me because I felt like I had SVT all the time with beads of sweat that would start at my hairline and end up in my gluteal cleft by the end of my shift. I started trying to emulate this guy and low and behold worked a shift where I found this calm and relaxed center state that I like to call my zen state. Well, I had it for about 15 mins, probably less, and then lost it and went back to SVT state for the rest of the shift. I did this over and over until I finally was able to capture it again and maintain it throughout an entire shift. It was a true epiphany for me. I suppose it was kind of similar to biofeedback in a way. Anyway, through trial and error I have finally figured out how to reach and maintain a semi relaxed state throughout the shift and I can't help but think this will have many health benefits further down the line. I'm not 100% by any means, more like 70% or so. It's a work in progress. If I drink a pot of coffee before my shift, I screw myself. Low dose beta blockers help. I take a low dose propranolol on the days that I work. It cuts out some of the the physiological feedback loop that tachycardia has on the rest of your body and helps me maintain a more relaxed state. It also obliterates hand tremor for complicated procedures. My avg heart rate during my shift yesterday according to my Apple Watch was 57 with a range 51-79.
 
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sloh

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FWIW, I had this sort of magical buy down at Kaiser – start at a base of ~135 hours per month as 0.8 FTE full-time ... then use vacation/education leave hours as quickly as they accrued to get down to ~120 hours per month ... chair of the IRB ... 30 hours per month ... clinical practice lead for the department ... 20 hours per month ... resource stewardship review ... ~10 hours per month ... boom! 65 clinical hours per month.

I'd put in for six or seven 9-hour shifts per month, and if I was short hours in any pay period, they'd just deduct the hours short from my paycheck. If I wanted more money, I put in for more (never did). Oh, and I also sold a night a month. It was pretty glorious, other than hating pretty much all aspects of the job – but I was doing a different thing I disliked every day, so it sort of worked for awhile. And a lot of the people I worked with were pretty great.

In NZ, by union largesse, senior staff have 35% of FTE as non-clinical time. For me, this works out to two ~8s a week plus 10 hours a week of non-clinical, plus working a full weekend as a base ... but then I have to somehow take something like 300 hours of leave each year from that, so it'll probably end up closer to that aforementioned 8 shifts a month on average.

It's definitely an academic salary, though ... and paid in pacific pesos ....

When I was in true academics for four years before that, we were all doing 14 8s as core academic faculty and I was given two shifts of credit for buydown for departmental service and to support my professional development (blogging and tweeting, actually), because it reflected favorably on the department.
Can you elaborate on “hating all aspects of the job”?
 

WilcoWorld

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It's an elusive state of mind and one that I didn't actually learn to attain until a few years out. We had this FT traveler come through who was probably 20 years into his career or more. He was doing FT old @GeneralVeers style locums. Hell, it may have been Veers for all I know. He always wore business attire, meticulously groomed, expensive cologne, very dapper dude. Worked 12 hour shifts, 7 in a row and I never saw a bead of sweat on him nor a single hair out of place. Smelled just as good at the end of his shift as he did at the beginning. Always calm, always pleasant, never ruffled, never frustrated. Well, it frustrated the hell out of me because I felt like I had SVT all the time with beads of sweat that would start at my hairline and end up in my gluteal cleft by the end of my shift. I started trying to emulate this guy and low and behold worked a shift where I found this calm and relaxed center state that I like to call my zen state. Well, I had it for about 15 mins, probably less, and then lost it and went back to SVT state for the rest of the shift. I did this over and over until I finally was able to capture it again and maintain it throughout an entire shift. It was a true epiphany for me. I suppose it was kind of similar to biofeedback in a way. Anyway, through trial and error I have finally figured out how to reach and maintain a semi relaxed state throughout the shift and I can't help but think this will have many health benefits further down the line. I'm not 100% by any means, more like 70% or so. It's a work in progress. If I drink a pot of coffee before my shift, I screw myself. Low dose beta blockers help. I take a low dose propranolol on the days that I work. It cuts out some of the the physiological feedback loop that tachycardia has on the rest of your body and helps me maintain a more relaxed state. It also obliterates hand tremor for complicated procedures. My avg heart rate during my shift yesterday according to my Apple Watch was 57 with a range 51-79.
I'm working on this to. It's hard.
I find that if I'm trying to be in a state of calm it works best for me to not try too hard to be in a state of calm - that just stresses me out! What works well is to simply try to notice when I'm NOT calm, then say to myself - "I'm getting stressed out" and then pay attention to the effect it's having (clenched jaw, or hollow feeling in my epigastrium, or being short with the ECG tech, etc). Just by noticing, soon the stress fades.

So, for me anyway, it's less about trying to stay calm and more about noticing when I'm getting stressed. Simply noticing it is usually a potent antidote.
 
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ThreadStalker

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Who are you?
Just a doc who knows how to use the search function to find most of the answers s/he is looking for and, therefore, doesn't post often. Hence the screen name. Also a doc who knows the internet isn't as anonymous as we think, so a couple SDN and Google searches could narrow me down to a small group or even by name, if you're so inclined.

Turn ons: nature, medicine, well-crafted IPAs, @gamerEMdoc, hammocks

Turn offs: Traffic, slow internet connections, people with bad attitudes that abuse whatever power they have in the world, soggy pineapple pizza
 
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Angry Birds

Angry Troll
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Dec 4, 2011
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The herculean efforts some of you guys put into escaping clinical time in the ED is nothing short of awe inspiring, lol.
Haha. Well, in my case, I had a genuine interest that I developed and would do even if I cannot reduce my clinical hours. But, yeah, I would not go into medicine at all if I could do this all over again. So, there's that.
 
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Apollyon

Screw the GST
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Nov 24, 2002
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SCREW IT!
Just a doc who knows how to use the search function to find most of the answers s/he is looking for and, therefore, doesn't post often. Hence the screen name. Also a doc who knows the internet isn't as anonymous as we think, so a couple SDN and Google searches could narrow me down to a small group or even by name, if you're so inclined.

Turn ons: nature, medicine, well-crafted IPAs, @gamerEMdoc, hammocks

Turn offs: Traffic, slow internet connections, people with bad attitudes that abuse whatever power they have in the world, soggy pineapple pizza
But, if one doesn't post, using the search function yields little to nothing. On a message board, I don't see it as a badge of honor when someone states that they rarely or never post. This board (as others) is made of content.

And, in many cases, "well crafted IPA" is oxymoronic. A well held saw of brewing is "heavy hopping hides bad brewing". Not to say that they don't exist, but are rather rarefied.
 
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ThreadStalker

Runnin' up on ya, I ain't gonna warn ya
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Mar 31, 2011
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You're not hating on Hawaiian style pizza, are you?!? Just saying you don't like it when it's soggy, I hope.
I hate on no food (except, maybe, microwaved blueberry corndogs dipped in baconaise), but a good pizza with pineapple is a rare find in my experience. I have had it, but I couldn't tell you when or where.
 
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