Second year medical student asking about the field

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Do what you love and follow your passion sounds like you are giving insightful advice but once you have lived experience as an adult you realise that money rules everything about work.

You should be focused on buying your time and making a good amount of money doing something you don't hate
 
In my opinion, it’s okay to chase dreams and passions. But its a big mistake not to fully consider what a career will feel like if and when the “passion” becomes routine and the “dream” begins to feel like a job. It can’t only be about passion. Passion has to be backed up with foresight and a plan.

Will intubation #1000 still feel the same as the first one did, at 4 am?

Will that shoulder reduction still feel “fun” after the gloom of chronic circaidian-rythm dysphoria gets more oppressive, not only during work time, but having to carry it during free, time, too?

Will you still feel like a “hero” working shifts in search of a life saved when you’re missing important moments in the life of the family?

That’s the mistake I made, the questions I didn’t fully explore.

EM worked out for me, just not in the way envisioned. I got to have my 10 years in EM when I was young and use it as a stepping stone to something that fits me better for the second half of my career.

Now, I still get to use my skills in a way that would have seemed “boring” to my younger self, but in a way that allows me to sustainably feel healthy, rested, positive and whole.

Everyone has to find their own path and mine is unlikely to work for most.
 
thegenius said:
That's fantastic. This will sound uneducated and silly, but how is it treating people with a wide variety of inflammatory conditions. Symptoms seem so vague, PE findings are vague, and my impression from the little I know is people with moderate to severe inflammatory conditions are just miserable all the time.
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So - I love treating the actual rheumatologic/inflammatory conditions. For one thing, we can actually get those patients better the overwhelming portion of the time now. I actually enjoy a lot of the sleuthing and looking for patients’ symptoms with a long history as well as PE clues - but usually people with real rheumatologic conditions have findings that are fairly obvious, which is nice. You just have to go looking for them. When the clinic is full of sick complex rheum patients, I’m grooving…even if those visits are often long and complicated.

On the flip side…when the clinic is full of kooks and cranks complaining about a bunch of weird random functional symptoms that don’t make any sense, that can wear on you after a while. For whatever reason, over the last couple of months I’ve had a lot of these whiny folks with random pains and a negative workup come in (I personally think this may be CoVID-related myalgias/arthralgias - it’s going around again, and they seem to magically get better after a couple of months with no tx). It can get exhausting when the 5th person of the day with no clear diagnosis or etiology for their symptoms is looking at you intently for what I call “a magical solution to an unsolvable problem”. Also, another problem is that PCPs don’t seem to bother to do any meaningful workup or triaging of a lot of these patients anymore, so sometimes you get these “undifferentiated mess” situations where you’re doing a lot of the workup and then making referrals that honestly the PCP probably could have done themselves etc. I do my best to filter out as much of this nonsense as possible, but some of it gets through regardless.

Bottom line: actual rheumatology rocks. A lot of the rest of the nonsense that gets shipped to rheumatologists doesn’t. But you can filter out a lot of that nonsense before it ever gets to you, or at least get the patients referred to the proper doctors asap.

Furthermore, when I’m starting to get frustrated I remind myself I’m making $400k plus to work 4.5 days a week with zero call and zero hospital rounding, with more income potential going forward at my current PP job. That part definitely helps.
 
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dozitgetchahi said:
Bottom line: actual rheumatology rocks. A lot of the rest of the nonsense that gets shipped to rheumatologists doesn’t. But you can filter out a lot of that nonsense before it ever gets to you, or at least get the patients referred to the proper doctors asap.

Furthermore, when I’m starting to get frustrated I remind myself I’m making $400k plus to work 4.5 days a week with zero call and zero hospital rounding, with more income potential going forward at my current PP job. That part definitely helps.
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Sounds a lot like EM. Except for the good pay, good schedule, and upward future income potential part.
 
Everyone's Job in medicine is to use your big shovel and give yourselves bunch of options.

You have given up your 20's, you have 20 yrs to get to the point when you are 50 to be FIRE.

You make 300+K/yr. At 50, you should do what you want on your own terms. You have made more in 20 yrs than most make in 60 yrs.
 
Birdstrike said:
EM gave me a lot. But the cost was astronomical.
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Lets be real. IMO, 90% of jobs are worse than being a doc/EM.

I know partners in the Big 3 who prob make less than I do who travels 5 dys/week, never sees/have much relationships with their kids.
 
emergentmd said:
Big 3 accounting firms. Its prob the big 4 now.
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Oh...Lol. In Detroit, the "Big 3" stands for GM, Ford and Chrysler. I assumed you meant that.

emergentmd said:
Lets be real. IMO, 90% of jobs are worse than being a doc/EM.

I know partners in the Big 3 who prob make less than I do who travels 5 dys/week, never sees/have much relationships with their kids.
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When I was referring to "costs," keep in mind not all costs are financial.
 
emergentmd said:
Yeah, the big 3 Auto will be bankrupt 3 in 10 yrs unless the Gov does a huge voting push bailout
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I think you're right. They're nudging them towards failure again, by pushing them to go all in on electric vehicles, which the majority of the public doesn't want. And yes, they (we the tax payers) will end up bailing them out again.

Example: Ford is projected to lose $4,500,000,000 on their electric car program this year alone. That's a staggering number: Four and a half BILLION dollars lost in one year alone. And the CEO has doubled down on moving forward with the program. And when they go bankrupt they'll cry, "Nobody saw this coming!"

OP, that means you should go to business school, where you can be a Fortune 500 CEO, lose billions for your company, still get paid $20 million and a raise for next year!
 
Birdstrike said:
Oh...Lol. In Detroit, the "Big 3" stands for GM, Ford and Chrysler. I assumed you meant that.


When I was referring to "costs," keep in mind not all costs are financial.
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No doubt but everyone in the house of medicine gives up a significant cost which is the decade of their lives. As I grow older, one regret was sacrificing my 20's
 
Birdstrike said:
I think you're right. They're nudging them towards failure again, by pushing them to go all in on electric vehicles, which the majority of the public doesn't want. And yes, they (we the tax payers) will end up bailing them out again.

Example: Ford is projected to lose $4,500,000,000 on their electric car program this year alone. That's a staggering number: Four and a half BILLION dollars lost in one year alone. And the CEO has doubled down on moving forward with the program. And when they go bankrupt they'll cry, "Nobody saw this coming!"

OP, that means you should go to business school, where you can be a Fortune 500 CEO, lose billions for your company, still get paid $20 million and a raise for next year!
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The Big 3 esp ford depends on their trucks/Pro division to make money. Everything else are loss leaders. Transitioning to Electric Truck will cannibalize their current main money maker at a loss. Now that Others are coming out with electric trucks, they are surly in for alot of trouble.

They will survive b/c they are too big to fail but they will not be the same in 10 years. The big 3 Auto are just not competitive in the EV space.
 
BoardingDoc said:
Interesting. I searched for your quote as I had remembered it as the version I posted and found this: .

That said, I also found your quote from 87 as you mentioned. It appears that Mike himself has been changing what he said over time.

In any event, all of this is largely a re-quotation of Helmuth von Molkte. "No plan of operations extends with any certainty beyond the first encounter with the main enemy forces." Or more succinctly: "No plan survives first contact with the enemy."
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I’m told von Moltke the Elder’s words have a deeper meaning in their original German, but I’m not sure if that is true. His works on strategy are some of my favorites. He was basically repeating a Napoleonic maxim.

“The tactical result of an engagement forms the base for new strategic decisions because victory or defeat in a battle changes the situation to such a degree that no human acumen is able to see beyond the first battle. In this sense one should understand Napoleon's saying: "I have never had a plan of operations."
Therefore no plan of operations extends with any certainty beyond the first contact with the main hostile force”

Or a different, extended translation:
“The material and moral consequences of every major battle are so far-reaching that they usually bring about a completely altered situation, a new basis for the adoption of new measures. One cannot be at all sure that any operational plan will survive the first encounter with the main body of the enemy. Only a layman could suppose that the development of a campaign represents the strict application of a prior concept that has been worked out in every detail and followed through to the very end.”
“Certainly the commander in chief will keep his great objective continuously in mind, undisturbed by the vicissitudes of events. But the path on which he hopes to reach it can never be firmly established in advance. Throughout the campaign he must make a series of decisions on the basis of situations that cannot be foreseen. The successive acts of war are thus not premeditated designs, but on the contrary are spontaneous acts guided by military measures. Everything depends on penetrating the uncertainty of veiled situations to evaluate the facts, to clarify the unknown, to make decisions rapidly, and then to carry them out with strength and constancy.”

Clausewitz and Napoleon touched on similar themes in their writing, but didn’t quite say what Moltke said, and Tyson’s paraphrasing is, IMO, the most poetic version.
 
I am 17 years out of residency and burned out. I recently left private practice (non-CMG group) for the VAMC, which has made me much happier. EM was good for me but if I had to chose a specialty today I wouldn't choose it. Not just because of the lack of future good jobs. The job itself isn't as fun anymore - when I started no one even knew what press ganey was. The job ground me down after 17 years but I think nowadays it would have been more like 5-10. For me it was:

1. constant grinding at 2+ pph, every shift
2. weird shift times, even after I got off nights
3. lawsuits (I've been involved and dropped from 2, but they each lasted 3 years). I couldn't imagine going through another.
4. rude, entitled, drunk, psychotic patients account for a large fraction of what you see. It eventually gets old.
5. BS: actual medicine ratio is much worse.
6. I worked at a high acuity center and always coming to work hyper-ready, like it's the superbowl wears you down.
7. Looking around at my partners and seeing how old & burned out they look

I think the best jobs are now rural ones, or where I work (VA). Funny, because those were always the ones looked down upon. 🙂
 
endo said:
I am 17 years out of residency and burned out. I recently left private practice (non-CMG group) for the VAMC, which has made me much happier. EM was good for me but if I had to chose a specialty today I wouldn't choose it. Not just because of the lack of future good jobs. The job itself isn't as fun anymore - when I started no one even knew what press ganey was. The job ground me down after 17 years but I think nowadays it would have been more like 5-10. For me it was:

1. constant grinding at 2+ pph, every shift
2. weird shift times, even after I got off nights
3. lawsuits (I've been involved and dropped from 2, but they each lasted 3 years). I couldn't imagine going through another.
4. rude, entitled, drunk, psychotic patients account for a large fraction of what you see. It eventually gets old.
5. BS: actual medicine ratio is much worse.
6. I worked at a high acuity center and always coming to work hyper-ready, like it's the superbowl wears you down.
7. Looking around at my partners and seeing how old & burned out they look

I think the best jobs are now rural ones, or where I work (VA). Funny, because those were always the ones looked down upon. 🙂
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Best patient populations are where there is high personal responsibility and accountability. Volumes will typically be low at night as the levels of co-morbid psych and substance abuse which lead to somatization are low. In addition, would be patients will self select to UC or primary care settings or...gasp...settle with "Hey maybe I'll just wait this little ache out for a few hours and see what happens..."
 
emergentmd said:
Lets be real. IMO, 90% of jobs are worse than being a doc/EM.

I know partners in the Big 3 who prob make less than I do who travels 5 dys/week, never sees/have much relationships with their kids.
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I am pretty sure 95%+ of people out there would like to have a job in which they can work 10 days/month to make 270-300k/yr.

My job as a hospitalist is not perfect but I am damn sure it's better than 90% jobs out there.

I am going to reiterate that. Most of us in medicine do not realize how fortunate we are when it comes to salary and job security.
 
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Splenda88 said:
I am pretty sure 95%+ of people out there would like to have a job in which they can work 10 days/month to make 270-300k/yr.

My job as a hospitalist is not perfect but I am damn sure it's better than 90% jobs out there.

I am going to reiterate that. Most of us in medicine do not realize how fortunate we are when it comes to salary and job security.
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IM nocturnist, 12 shifts a month, closed ICU, PA does crosscover pages, typically 6-8 admissions a night. So 0.58 pph?
340K a year. No stupid meetings, conferences or admin breathing down the neck.

If I had to do EM…you need to pay me like at least 500/hr (so >1M a year?) for 2 pph shifts. I’m not gonna take on the risk of seeing totally undifferentiated patients all the dang time, critically ill patients, risk of discharging patients, having to know peds and obgyn knowledge, seeing the worried well but not knowing which is a ticking time bomb….not worth it for 200/hr. That’s burnout city.

I don’t know how you ER guys do it.
 
wamcp said:
IM nocturnist, 12 shifts a month, closed ICU, PA does crosscover pages, typically 6-8 admissions a night. So 0.58 pph?
340K a year. No stupid meetings, conferences or admin breathing down the neck.

If I had to do EM…you need to pay me like at least 500/hr (so >1M a year?) for 2 pph shifts. I’m not gonna take on the risk of seeing totally undifferentiated patients all the dang time, critically ill patients, risk of discharging patients, having to know peds and obgyn knowledge, seeing the worried well but not knowing which is a ticking time bomb….not worth it for 200/hr. That’s burnout city.

I don’t know how you ER guys do it.
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Yeah, EM is a tough job. I am pretty sure there are EM gig where these docs are seeing 1 pph.

6-8 admits for a 12 hr shift is extremely good. Wish I had the stamina to work night. I worked two night shifts the other day to cover for someone and I was like a zombie after night 2.

Hospitalist market has been good lately. Give the bean counter 5-7 years to turn it into hell.
 
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wamcp said:
If I had to do EM…you need to pay me like at least 500/hr (so >1M a year?) for 2 pph shifts. I’m not gonna take on the risk of seeing totally undifferentiated patients all the dang time, critically ill patients, risk of discharging patients, having to know peds and obgyn knowledge, seeing the worried well but not knowing which is a ticking time bomb….not worth it for 200/hr. That’s burnout city.

I don’t know how you ER guys do it.
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We don't. We burn out 😉

There are some decent EM jobs out there. I think that's what keeps some of us still doing it instead of jumping ship.

Our personalities are perhaps better suited for the quick pace, but don't mesh well with a longer medical career.
 
Mount Asclepius said:
We don't. We burn out 😉

There are some decent EM jobs out there. I think that's what keeps some of us still doing it instead of jumping ship.

Our personalities are perhaps better suited for the quick pace, but don't mesh well with a longer medical career.
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Yeah plus some of us are probably too old for a career change (almost 50 in my case), just hoping to be able to get to half time by 55 or so. Then coast from there. Spent the first half of my career being underpaid in academics (first job was 150k/year) so can’t punch out just yet.
 
Okay its been about a year and EM is the only specialty I can see myself doing. I have spoken to some EM docs and they all reverberate what I read online except the job market. maybe in CA there is an exception but they said the job market thing has been over blown. All 3rd year residents from ****ty programs even are getting job offers in the 3-400k range, locum work is available for extra shifts too.

I think i have a good work/life balance and can tolerate burn out. I do not like being on call and I am not a fan of inpatient medicine. I have an exit strategy in mind if I am so burnout in the future (fellowship or urgent care). I am in the middle of my third year, so maybe some things will change.

Thank you everyone for sharing your perspectives and I will keep this in mind and be selective with where I end up for residency and afterwards. I wish there was something else out there, I will update this thread if anyone cares later on
 
Be careful banking on fellowshipping out. Most ED fellowships don’t get you out. The handful that do (e.g. critical care, pain, sports, hyperbaric) are not perfect solutions. No guarantee you’ll get a spot for starters. Then on top of that there’s the opportunity cost of at least one year of fellowship. Plus who knows if you’ll like any of those options. Just keep that in mind.
 
Bulliedinschool2doc said:
Okay its been about a year and EM is the only specialty I can see myself doing. I have spoken to some EM docs and they all reverberate what I read online except the job market. maybe in CA there is an exception but they said the job market thing has been over blown. All 3rd year residents from ****ty programs even are getting job offers in the 3-400k range, locum work is available for extra shifts too.

I think i have a good work/life balance and can tolerate burn out. I do not like being on call and I am not a fan of inpatient medicine. I have an exit strategy in mind if I am so burnout in the future (fellowship or urgent care). I am in the middle of my third year, so maybe some things will change.

Thank you everyone for sharing your perspectives and I will keep this in mind and be selective with where I end up for residency and afterwards. I wish there was something else out there, I will update this thread if anyone cares later on
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You’re 5 years away from having a ER job.

The job market is fine today, not as great as 5 years ago, significantly better than post covid days as a lot of older docs retired.

In these 5 years you will have 17.5k new ER doctors. Are you going to have that many people retire in 5 years? I don’t know. We probably were at equilibrium at 2500-3000 residents per year, but 3300-3500 annual residents over time will start making the job market worse.

Job market fundamentals dont necessarily change in 1 year. Give it 5-10 years, the weak job market fundamentals will show. Give it time. Math is math. Supply and demand really matters
 
cyanide12345678 said:
You’re 5 years away from having a ER job.

The job market is fine today, not as great as 5 years ago, significantly better than post covid days as a lot of older docs retired.

In these 5 years you will have 17.5k new ER doctors. Are you going to have that many people retire in 5 years? I don’t know. We probably were at equilibrium at 2500-3000 residents per year, but 3300-3500 annual residents over time will start making the job market worse.

Job market fundamentals dont necessarily change in 1 year. Give it 5-10 years, the weak job market fundamentals will show. Give it time. Math is math. Supply and demand really matters
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well I apply for residency next year. I will see if I love anything else by then...
 
TooMuchResearch said:
Today I love that I've only managed one patient so far.
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Me too, i only love the days where minimum patients show up and i get paid to just sit around 😂

Unfortunately the average ER job involves seeing between 2-2.5 pph. On a busy day that may be close to 3 pph over a shift and sometimes 5 pph in the beginning of a shift for a few hours when it’s very busy
 
cyanide12345678 said:
So what do you like about emergency medicine?

Educate me.
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Okay, going to use this as a reference comment for future discussions and I am also saying all this for my own sake just to put my thoughts on paper.

My class rank is probably average to above average. I passed step 1 and do not have step 2 scores yet because I have not taken the exam. Pretty solid ECs and leadership.
I want a career that I can do procedures, interact with patients, have somewhat of a work/life balance, and varying acuity.

My other interests include Ortho and Cardiology or ICU from IM.

I do not have enough research to be an impactful candidate for orthopedic surgery, all the attendings I was going to work with have stalled our projects and I do not want to waste a year and end up SOAPing.

I do not love IM based on my rotations. I think the acuity and pace is not my jam, I feel like 7 on and 7 off is also not for me. I may consider this should I not like my EM sub-is but right now its my backup. I would probably end up doing a fellowship from IM but easier said than done.

I do not like outpatient medicine, I do not like kids, I wouldn't say I like woman's health enough to make a career out of it, I like radiology but not enough to do that exclusively for a living, no to path, I thought anesthesia was interesting but I was not a fan of some things that I won't mention unless asked. No to psych.

I know this is a sub of people who more or less have strong opinions of emergency medicine, but I feel like I enjoy that environment the most. I will come back and say to everyone 'okay you told me so, I should have listened' if I end up hating the field, but as of now I just feel the strongest desire to pursue EM.
 
Bulliedinschool2doc said:
Okay, going to use this as a reference comment for future discussions and I am also saying all this for my own sake just to put my thoughts on paper.

My class rank is probably average to above average. I passed step 1 and do not have step 2 scores yet because I have not taken the exam. Pretty solid ECs and leadership.
I want a career that I can do procedures, interact with patients, have somewhat of a work/life balance, and varying acuity.

My other interests include Ortho and Cardiology or ICU from IM.

I do not have enough research to be an impactful candidate for orthopedic surgery, all the attendings I was going to work with have stalled our projects and I do not want to waste a year and end up SOAPing.

I do not love IM based on my rotations. I think the acuity and pace is not my jam, I feel like 7 on and 7 off is also not for me. I may consider this should I not like my EM sub-is but right now its my backup. I would probably end up doing a fellowship from IM but easier said than done.

I do not like outpatient medicine, I do not like kids, I wouldn't say I like woman's health enough to make a career out of it, I like radiology but not enough to do that exclusively for a living, no to path, I thought anesthesia was interesting but I was not a fan of some things that I won't mention unless asked. No to psych.

I know this is a sub of people who more or less have strong opinions of emergency medicine, but I feel like I enjoy that environment the most. I will come back and say to everyone 'okay you told me so, I should have listened' if I end up hating the field, but as of now I just feel the strongest desire to pursue EM.
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What you like now is unlikely to be what you will still like in 10, 15 and 20 years. You may still, but unlikely. Unfortunately, EM is very appealing to those early in their careers, but very difficult to make a career out of. The problem with medicine is that it takes years of training, but makes it very hard to pivot. Physicians are bright and mature, but asking them to pick their lifelong field at an early age is problematic. People as a whole want a little variety. When you devote everything to something so limiting it can be incredibly discouraging. EM offers minimal outs for the inevitable burnout. Some of us find quasi-peace with easier jobs, fellowships, or financial independence and early retirement. Few make a career out of EM though.

I entered EM with the goal of 10 years and financial independence. I hit that, but it doesn’t always feel that way. I’m not sure what I would do if I could do it over, but I just know that you need to be as pessimistic as possible on the speciality of EM in order to still pick it. I was told don’t ever pick surgery unless there is nothing else you could see yourself doing other than surgery. The same is true of EM. It’s a great field… for 10 years. Best of luck with the decision. Enjoy those years of exploring options They were some of my favorite years even if others were better.

Read this thread as it matters more than the question you are asking.
 
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Bulliedinschool2doc said:
Okay, going to use this as a reference comment for future discussions and I am also saying all this for my own sake just to put my thoughts on paper.

My class rank is probably average to above average. I passed step 1 and do not have step 2 scores yet because I have not taken the exam. Pretty solid ECs and leadership.
I want a career that I can do procedures, interact with patients, have somewhat of a work/life balance, and varying acuity.

My other interests include Ortho and Cardiology or ICU from IM.

I do not have enough research to be an impactful candidate for orthopedic surgery, all the attendings I was going to work with have stalled our projects and I do not want to waste a year and end up SOAPing.

I do not love IM based on my rotations. I think the acuity and pace is not my jam, I feel like 7 on and 7 off is also not for me. I may consider this should I not like my EM sub-is but right now its my backup. I would probably end up doing a fellowship from IM but easier said than done.

I do not like outpatient medicine, I do not like kids, I wouldn't say I like woman's health enough to make a career out of it, I like radiology but not enough to do that exclusively for a living, no to path, I thought anesthesia was interesting but I was not a fan of some things that I won't mention unless asked. No to psych.

I know this is a sub of people who more or less have strong opinions of emergency medicine, but I feel like I enjoy that environment the most. I will come back and say to everyone 'okay you told me so, I should have listened' if I end up hating the field, but as of now I just feel the strongest desire to pursue EM.
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If you really want to do EM I would consider becoming an intensivist instead. Multiple paths to get there, but IM or anesthesia would be best. When you burn out you’ll have other options, especially from IM. What you want now and what you want 10 years from now aren’t likely going to be the same. You will not want “excitement” every day you show up to work after 10 years… you will wish for boring. And the types of patients you routinely see in the ER will permanently damage your soul, it’s inevitable.
 
OP,
I’m over 10 years out of training. I could rehash the above-mentioned reasons why EM is unsustainable long term, but I sense that you may realize that. I just want to poke a couple holes in your plan and views on the workforce issue.

1. You like procedures and are resilient to burn out: the reality is that the shops that get a lot of procedures are the very jobs that will burn you out the fastest. Most of these are low-paying hospital employee or county hospitals, or CMG shops that will burn you to the ground. The jobs that are sustainable are low volume, low acuity places in rural areas, or VA-type jobs. These places don’t get many procedures. The only exception may be a few unicorn private groups, but you won’t find one of those in a few years. Many in this group thought that they were resilient to burnout; see prior posts. Most docs that I know that are 10 years out are looking for an escape plan.

2. You will do a fellowship or urgent care: Do you really think you will want to go back and do a fellowship 10 years out? Most of these don’t even get you out of the ED. Urgent care will involve close to a 50% paycut, along with seeing 3-4 pts/ hr. Probably even competing with midlevels for jobs. It honestly sounds like a nightmare to me.

3. Workforce issues: this is really the greatest consideration. Anyone telling you otherwise is either clueless, or ignorant of basic supply/demand economics. The original ACEP report predicted a 20% oversupply by year 2030. That has since been revised because the ATTRITION rate from the field has been much higher than expected. There is a reason for that, and this shouldn’t be reassuring. We are still expected to have an oversupply within the next few years. Even a 2-3% oversupply will wreak havoc on the job market. At this time 4 years ago after the market had been decimated by covid, there were attendings 10 years out posting on the EM facebook group begging for a job. You don’t want to be in that position. Good luck OP.
 
Mtbk said:
OP,
I’m over 10 years out of training. I could rehash the above-mentioned reasons why EM is unsustainable long term, but I sense that you may realize that. I just want to poke a couple holes in your plan and views on the workforce issue.

1. You like procedures and are resilient to burn out: the reality is that the shops that get a lot of procedures are the very jobs that will burn you out the fastest. Most of these are low-paying hospital employee or county hospitals, or CMG shops that will burn you to the ground. The jobs that are sustainable are low volume, low acuity places in rural areas, or VA-type jobs. These places don’t get many procedures. The only exception may be a few unicorn private groups, but you won’t find one of those in a few years. Many in this group thought that they were resilient to burnout; see prior posts. Most docs that I know that are 10 years out are looking for an escape plan.

2. You will do a fellowship or urgent care: Do you really think you will want to go back and do a fellowship 10 years out? Most of these don’t even get you out of the ED. Urgent care will involve close to a 50% paycut, along with seeing 3-4 pts/ hr. Probably even competing with midlevels for jobs. It honestly sounds like a nightmare to me.

3. Workforce issues: this is really the greatest consideration. Anyone telling you otherwise is either clueless, or ignorant of basic supply/demand economics. The original ACEP report predicted a 20% oversupply by year 2030. That has since been revised because the ATTRITION rate from the field has been much higher than expected. There is a reason for that, and this shouldn’t be reassuring. We are still expected to have an oversupply within the next few years. Even a 2-3% oversupply will wreak havoc on the job market. At this time 4 years ago after the market had been decimated by covid, there were attendings 10 years out posting on the EM facebook group begging for a job. You don’t want to be in that position. Good luck OP.
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Thank you for your reply, I appreciate the insight you provided. I will keep an open mind moving forward this next year and a half.
 
Mtbk said:
OP,
I’m over 10 years out of training. I could rehash the above-mentioned reasons why EM is unsustainable long term, but I sense that you may realize that. I just want to poke a couple holes in your plan and views on the workforce issue.

1. You like procedures and are resilient to burn out: the reality is that the shops that get a lot of procedures are the very jobs that will burn you out the fastest. Most of these are low-paying hospital employee or county hospitals, or CMG shops that will burn you to the ground. The jobs that are sustainable are low volume, low acuity places in rural areas, or VA-type jobs. These places don’t get many procedures. The only exception may be a few unicorn private groups, but you won’t find one of those in a few years. Many in this group thought that they were resilient to burnout; see prior posts. Most docs that I know that are 10 years out are looking for an escape plan.

2. You will do a fellowship or urgent care: Do you really think you will want to go back and do a fellowship 10 years out? Most of these don’t even get you out of the ED. Urgent care will involve close to a 50% paycut, along with seeing 3-4 pts/ hr. Probably even competing with midlevels for jobs. It honestly sounds like a nightmare to me.

3. Workforce issues: this is really the greatest consideration. Anyone telling you otherwise is either clueless, or ignorant of basic supply/demand economics. The original ACEP report predicted a 20% oversupply by year 2030. That has since been revised because the ATTRITION rate from the field has been much higher than expected. There is a reason for that, and this shouldn’t be reassuring. We are still expected to have an oversupply within the next few years. Even a 2-3% oversupply will wreak havoc on the job market. At this time 4 years ago after the market had been decimated by covid, there were attendings 10 years out posting on the EM facebook group begging for a job. You don’t want to be in that position. Good luck OP.
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I now view procedures as a general inconvenience to my day. I know I'm not the only one.
 
As EM to HPM (after a solid 10 years in the pit), going the IM to CC/cards/pulm/insert-any-other-subspecialty-where-you-have-some-control probably would fit your bill better. Procedures just aren't the thing in community medicine you long for. In the ICU, yes, you will have them, and they're not as much of a pain (I assume. I honestly don't know, and I leave that to our CC buds here.) When you've got 15 in the rack and there are only 2 of you and your midlevels aren't churning and burning? Ugggg.

FWIW, rounds as an attending are soooo much different than as a learner. Now that I round daily on my own patients, I actually love it. And I utterly despised rounding as a med student and a resident. It's so much different when you're the one in charge. I really didn't understand that because when you decide what order you go in, when to start, and you chop out all the stand around "what about urine lytes..." teaching stuff, it's much different.
 
Bulliedinschool2doc said:
Thank you for your reply, I appreciate the insight you provided. I will keep an open mind moving forward this next year and a half.
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OP, we can’t change your mind. Truth is, most of our younger selves wouldn’t have changed our minds either.

Go into EM if you can’t find anything else you like, but have several (realistic) exit plans in mind. Plan your residency electives, do your networking, review your contracts, and just generally live your life with “what if EM is untenable in the near future” in the back of your mind.

Maybe you’ll love EM forever, maybe you’ll tolerate it, or maybe you’ll hate it. We don’t know. You don’t know. The best you can do is have some knowledge of what you can do in case the worst happens.

One word of advice: The usually unstated qualifier for “EM has no good exit strategies” is “EM has no good exit strategies [with zero tradeoffs]”. Maybe you need to take a significant pay cut, maybe you need to do a fellowship, maybe you need to move, maybe you need to do a job you are not excited about, or maybe it’s all of the above, but there usually is a way out. What you can tolerate usually depends on how burned out you actually are.
 
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