Second year medical student asking about the field

Started by Dr. Pineal Gland
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WhatJobDoIPick said:
Why do we allow these threads?

Serious question.

There's about 37 threads on the same topic.

These delusional med students can use the search function.

All these threads do is accentuate burnout by having members put their feelings in writing and white knight for these entitled students who think they are the exception to the rule.
Click to expand...
Med students must "pursue their passion" similarly to incoming college students who get degrees in unemployable fields and then graduate suddenly realizing mistakes were made.

I don't think any of my colleagues in practice for 2+ years actually like this field. The only saving grace is the pay. And now with this rapidly spreading virus known as Vituity with their army of ******* new grads, pay will continue to decline and burnout will hit new levels. They've managed to destroy the locums market with their "champion" program, fooling people into $300/hr to travel for them in places that are absolute dumpster fires and should be paying $400/hr+.
 
always.chillin said:
Med students must "pursue their passion" similarly to incoming college students who get degrees in unemployable fields and then graduate suddenly realizing mistakes were made.

I don't think any of my colleagues in practice for 2+ years actually like this field. The only saving grace is the pay. And now with this rapidly spreading virus known as Vituity with their army of ******* new grads, pay will continue to decline and burnout will hit new levels. They've managed to destroy the locums market with their "champion" program, fooling people into $300/hr to travel for them in places that are absolute dumpster fires and should be paying $400/hr+.
Click to expand...

But but but they're physician owned!!!
 
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WhatJobDoIPick said:
Why do we allow these threads?

Serious question.

There's about 37 threads on the same topic.

These delusional med students can use the search function.

All these threads do is accentuate burnout by having members put their feelings in writing and white knight for these entitled students who think they are the exception to the rule.
Click to expand...

Brohh.

The search function is about as useful as asking a dementia patient when their symptoms began.
I've tried to find my own creative writing on here. Things that I know that I wrote - the precise sentences. It whiffs HARD.

We allow these threads because we should be allowed to speak, and speak the truth - not have it policed by the ****s over at Reddit.
 
The most exciting part about Vituity is its incredibly effective KoolAid.

At least with TH, Envision, USACS etc., you know you're being screwed, and they know they're screwing you. It's almost a stable equilibrium; both sides know what they're dealing with.

With Vituity, however, the physician-owned partnership aspect gives you JUST enough money as a full partner to put up with what are effectively the same working conditions as any given TH, Envision, or USACS site.

Vituity has to operate locally and regionally using the same tactics as the big PE-backed national CMGs we love to slam online. They're almost (if not just as) big as them; thus, they have to stoop to those same tactics to continue growth.

This also means it requires a steady stream of new blood, which is why you see the aggressive hiring of new partners in all these newly acquired Vituity contracts.

This creates a perfect little corporate culture bubble where full-time Vituity partners willingly double down on trash conditions, unsafe staffing, higher use of midlevels, and various other cost-cutting measures simply because "we gotta keep the CEO happy."

That said, if I were given a choice between TH, USACS, Envision, or Vituity to take over my hospital, I would choose Vituity 1000 times out of 100. Once you're a full partner, the pay structure puts you ahead of the other large CMGs.
 
TooMuchResearch said:
I now view procedures as a general inconvenience to my day. I know I'm not the only one.
Click to expand...
I still love procedures as an attending, and I still very often find myself wishing I did something other than EM.

My main gig is a knife and gun club where I tube, line, staple and suture to my hearts content and despite my job having a higher percentage of actual emergencies than most jobs, I still find myself wishing I did something more sustainable like anesthesia or critical care.
 
always.chillin said:
Med students must "pursue their passion" similarly to incoming college students who get degrees in unemployable fields and then graduate suddenly realizing mistakes were made.

I don't think any of my colleagues in practice for 2+ years actually like this field. The only saving grace is the pay. And now with this rapidly spreading virus known as Vituity with their army of ******* new grads, pay will continue to decline and burnout will hit new levels. They've managed to destroy the locums market with their "champion" program, fooling people into $300/hr to travel for them in places that are absolute dumpster fires and should be paying $400/hr+.
Click to expand...
Sound has increased this to $325 + benefits.

You can thank Tony who led APP into bankruptcy/f*cked over tons of docs and is now the new CEO of EM for Sound.
 
Dr. Pineal Gland 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.
Click to expand...

Here’s my honest advice to you. And really listen and pay attention.

It actually sounds a little like you want ortho but don’t have the numbers. So EM is kind of like a second choice. It’s very hard to sustain a EM lifestyle especially if it’s your second pick. Yes, i get it, ortho is very very hard to get in.

You say you don’t like kids - 20 percent of ER visits is kids.

You also say you don’t like women’s health. 10 ish percent of ER visits are gynecology/obstetrics related.

So 30 percent of your job as an ER doctors, you already don’t like.

You say ‘no to psych’ - the reality is a lot of the patients we see are some degree of anxiety disorder, running to the ER at the simplest thing. Then obviously there’s all the depressed suicidal people you’ll see. Psych is probably another 5-10 percent of patients we see.

Now throw in the drunks, the drug seekers, the disrespectful, and the belligerent.

I mean you’re basically saying you already dont like 50 percent of what we do.

So i have no idea where your desire to pursue EM is coming from? Let’s be real…. Are you sure you don’t like the idea of making 400k working 36-40 hours a week? I fell for that trap since I’m very financially minded.

You say you like procedures - the reality is when you have a very busy ER, a procedure is the last thing you want to do. Central lines take so long! Sutures take so long!!! When it’s busy, you really really don’t want to do procedures.

I work 10 days a month. I still don’t have perfect work life balance. My wife works 12 days a month, she has better work life balance. She’s off on weekends, i still work quite a few of those. I work nights and don’t sleep in my bed plenty of nights, my body struggles to recover. If your circadian rhythm is flip flopping between days and nights - I’m sorry that’s not work life balance. If you miss a bunch of family events on the weekends, that’s just not work life balance.

Ill tell you what’s work life balance - my wife who goes into work for 4-5 hours a day for 3 days a week - Tuesday through Thursday. Is back from work at 2 pm everyday and still makes 250k as FM -_- that’s work life balance. Even on her work days she has time for life -_-

So….. you think EM is work life balance. It’s better than some, but it’s not derm, psych, allergy/immunology, rheum, pm&r and others. I mean yeah our work life balance is better than surgeons - but thats about all i can say for EM.

Think long and hard. You’re probably better off doing IM and getting a fellowship in something else.
 
Last edited:
cyanide12345678 said:
Here’s my honest advice to you. And really listen and pay attention.

It actually sounds a little like you want ortho but don’t have the numbers. So EM is kind of like a second choice. It’s very hard to sustain a EM lifestyle especially if it’s your second pick. Yes, i get it, ortho is very very hard to get in.

You say you don’t like kids - 20 percent of ER visits is kids.

You also say you don’t like women’s health. 10 ish percent of ER visits are gynecology/obstetrics related.

So 30 percent of your job as an ER doctors, you already don’t like.

You say ‘no to psych’ - the reality is a lot of the patients we see are some degree of anxiety disorder, running to the ER at the simplest thing. Then obviously there’s all the depressed suicidal people you’ll see. Psych is probably another 5-10 percent of patients we see.

Now throw in the drunks, the drug seekers, the disrespectful, and the belligerent.

I mean you’re basically saying you already dont like 50 percent of what we do.

So i have no idea where your desire to pursue EM is coming from? Let’s be real…. Are you sure you don’t like the idea of making 400k working 36-40 hours a week? I fell for that trap since I’m very financially minded.

You say you like procedures - the reality is when you have a very busy ER, a procedure is the last thing you want to do. Central lines take so long! Sutures take so long!!! When it’s busy, you really really don’t want to do procedures.

I work 10 days a month. I still don’t have perfect work life balance. My wife works 12 days a month, she has better work life balance. She’s off on weekends, i still work quite a few of those. I work nights and don’t sleep in my bed plenty of nights, my body struggles to recover. If your circadian rhythm is flip flopping between days and nights - I’m sorry that’s not work life balance. If you miss a bunch of family events on the weekends, that’s just not work life balance.

Ill tell you what’s work life balance - my wife who goes into work for 4-5 hours a day for 3 days a week. Is back from work at 2 pm everyday and still makes 250k as FM -_- that’s work life balance.

So….. you think EM is work life balance. It’s better than some, but it’s not derm, psych, allergy/immunology, rheum, pm&r and others. I mean yeah our work life balance is better than surgeons - but thats about all i can say for EM.

Think long and hard. You’re probably better off doing IM and getting a fellowship in something else.
Click to expand...

Dear God Man.
Yes.
 
RustedFox said:
Right ON.
Third year med students, heed these words.
Click to expand...
Don't get me wrong. I took my time on two complex wounds on two teens last week. And I'm happy with the work.

But I was also working rural and had lots of time to think and expertly reassemble the wounds.

I'm quite happy with the "peripheral pressors or hey can we just get a PICC placed?" standard most days.
 
WhatJobDoIPick said:
Why do we allow these threads?

Serious question.

There's about 37 threads on the same topic.

These delusional med students can use the search function.

All these threads do is accentuate burnout by having members put their feelings in writing and white knight for these entitled students who think they are the exception to the rule.
Click to expand...
Because we need to continue to have new threads before reddit pushes us out completely.

I see some of you over there (pretty sure).
 
cyanide12345678 said:
Here’s my honest advice to you. And really listen and pay attention.

It actually sounds a little like you want ortho but don’t have the numbers. So EM is kind of like a second choice. It’s very hard to sustain a EM lifestyle especially if it’s your second pick. Yes, i get it, ortho is very very hard to get in.

You say you don’t like kids - 20 percent of ER visits is kids.

You also say you don’t like women’s health. 10 ish percent of ER visits are gynecology/obstetrics related.

So 30 percent of your job as an ER doctors, you already don’t like.

You say ‘no to psych’ - the reality is a lot of the patients we see are some degree of anxiety disorder, running to the ER at the simplest thing. Then obviously there’s all the depressed suicidal people you’ll see. Psych is probably another 5-10 percent of patients we see.

Now throw in the drunks, the drug seekers, the disrespectful, and the belligerent.

I mean you’re basically saying you already dont like 50 percent of what we do.

So i have no idea where your desire to pursue EM is coming from? Let’s be real…. Are you sure you don’t like the idea of making 400k working 36-40 hours a week? I fell for that trap since I’m very financially minded.

You say you like procedures - the reality is when you have a very busy ER, a procedure is the last thing you want to do. Central lines take so long! Sutures take so long!!! When it’s busy, you really really don’t want to do procedures.

I work 10 days a month. I still don’t have perfect work life balance. My wife works 12 days a month, she has better work life balance. She’s off on weekends, i still work quite a few of those. I work nights and don’t sleep in my bed plenty of nights, my body struggles to recover. If your circadian rhythm is flip flopping between days and nights - I’m sorry that’s not work life balance. If you miss a bunch of family events on the weekends, that’s just not work life balance.

Ill tell you what’s work life balance - my wife who goes into work for 4-5 hours a day for 3 days a week - Tuesday through Thursday. Is back from work at 2 pm everyday and still makes 250k as FM -_- that’s work life balance. Even on her work days she has time for life -_-

So….. you think EM is work life balance. It’s better than some, but it’s not derm, psych, allergy/immunology, rheum, pm&r and others. I mean yeah our work life balance is better than surgeons - but thats about all i can say for EM.

Think long and hard. You’re probably better off doing IM and getting a fellowship in something else.
Click to expand...
My med school buddy didn't have the numbers for ortho but they let him become a vascular surgeon. I bet he's good at it too.
 
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cyanide12345678 said:
My friend who is finishing his rheumatology fellowship is seeing anywhere between 250-400k. He’s having me review his contracts so i know the exact specifics.

350-400k for 4.5 days usually. Community practice.

250-300 for university academic settings. One of his university offers is literally 250k, 3 days a week, 5 wks paid vacation. 10 days cme. 200% 401k match and rvu bonus after 2600 rvus. The match itself is worth 40k essentially. I forget what each rvu was worth, but i think it was around $50. Literally with all benefits he was getting 300k for working 24 hours a week clinically. The rest was protected research time because he’s into research and has like 15 publications….
Click to expand...
FM is at 350k for 4.5 clinical days now seeing 80 patients a week for 44 weeks working for some corp. If your entrepreneurial or want to bust your ass, do procedures you will see 450.
 
Dr. Pineal Gland 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.
Click to expand...

Cyanide said it well, ill try to make it a little more direct.

You like Ortho, cards, cc. You don’t think you’ll make the cut or don’t want to do the training. That’s rational, but extremely short sighted.

You like:
-procedures
-not working all the time

You don’t like:
-peds
-women’s heath
-outpt medicine
-psych
-anesthesia personalities (I assume)

I’ve got really bad news. Real em as an attending in community or academic is 10% peds, 10% women’s health, 20% (bad) outpt medicine. It’s nominally 10% psych, but it’s more like 50% of your encounters. You will not like any of this.

Also, if you think 7 on/off is bad, having worked both I can tell you it’s way better than em scheduling. Want to know if you can do something in 3 months? You know on 7 on/off, you don’t know when the wheel of fate /scheduler you hate (I hated every one of em) is in charge.

As a brief aside into the hidden curriculum, I was a decent Ed doc when I did it. You know what makes you a better Ed doc? Being a f’in bully. You gotta do it at the right time and be “professional”, but it’s a huge part of the job. Based on your handle, I’m guessing this won’t go well.

You are pretty much the poster child for someone who should not do em.
 
throway134 said:
Cyanide said it well, ill try to make it a little more direct.

You like Ortho, cards, cc. You don’t think you’ll make the cut or don’t want to do the training. That’s rational, but extremely short sighted.

You like:
-procedures
-not working all the time

You don’t like:
-peds
-women’s heath
-outpt medicine
-psych
-anesthesia personalities (I assume)

I’ve got really bad news. Real em as an attending in community or academic is 10% peds, 10% women’s health, 20% (bad) outpt medicine. It’s nominally 10% psych, but it’s more like 50% of your encounters. You will not like any of this.

Also, if you think 7 on/off is bad, having worked both I can tell you it’s way better than em scheduling. Want to know if you can do something in 3 months? You know on 7 on/off, you don’t know when the wheel of fate /scheduler you hate (I hated every one of em) is in charge.

As a brief aside into the hidden curriculum, I was a decent Ed doc when I did it. You know what makes you a better Ed doc? Being a f’in bully. You gotta do it at the right time and be “professional”, but it’s a huge part of the job. Based on your handle, I’m guessing this won’t go well.

You are pretty much the poster child for someone who should not do em.
Click to expand...

I also want to add there’s an emotional toll to EM.

I can’t stop thinking about a case from yesterday. Going over the what ifs. Doubting myself essentially. Normal outpatient specialties do not experience the ‘what if feeling’ as much as us as we deal with true emergencies and bad outcomes happen even when you do everything right.

I know i did everything right. Absolutely perfectly yesterday. Still got a bad outcome and a kid lost a testicle. I had him diagnosed, transferred, and on a OR table within 3 hours of onset of symptoms. But the outcome was bad. Literature says 97% outcomes is good within 6 hours. He is the 3 percent.

EM is a lot of emotional toll when you think back and doubt yourself, doubt your capabilities. Worse are cases when you miss things - and in emergency medicine that happens, patients dont read textbooks.

Do you want to guess what percentage of cases that go to peer review involve the ER? 70-80 percent. It’s a lot.
 
throway134 said:
You are pretty much the poster child for someone who should not do em.
Click to expand...

Agreed. This is a specialty for people who love EVERYTHING and truly can’t see themselves doing something else. You can’t hate kids, Gyn, psych. That’s so many of our patients. So so so so much psych - half the 30 yr olds with chest pain in reality are psych disorders.

10 years later when OP will flip flop the 5th time between days and nights then OP will deal with the regret of ‘what if i had tried for ortho or cardiology’.

I know because i live with that regret.
 
cyanide12345678 said:
I also want to add there’s an emotional toll to EM.

I can’t stop thinking about a case from yesterday. Going over the what ifs. Doubting myself essentially. Normal outpatient specialties do not experience the ‘what if feeling’ as much as us as we deal with true emergencies and bad outcomes happen even when you do everything right.

I know i did everything right. Absolutely perfectly yesterday. Still got a bad outcome and a kid lost a testicle. I had him diagnosed, transferred, and on a OR table within 3 hours of onset of symptoms. But the outcome was bad. Literature says 97% outcomes is good within 6 hours. He is the 3 percent.

EM is a lot of emotional toll when you think back and doubt yourself, doubt your capabilities. Worse are cases when you miss things - and in emergency medicine that happens, patients dont read textbooks.

Do you want to guess what percentage of cases that go to peer review involve the ER? 70-80 percent. It’s a lot.
Click to expand...

I think this is the real thing that you can’t figure out as a med student or even as a resident. Being a “ruminator” and in em is an insanely toxic combination.

Every medical specialty has it, but I think em has the worst case because you usually only get one shot at it.

if you can leave your attending shifts and turn off the Ed like a light switch, can probably have way more longevity. I’d put the number of people I’ve met like that in the specialty at 10-20% max, and most of those still have bad days/cases.

I’m hoping this guy/gal figures it out before the mistake is made, but I really do mean what I said above. Some people can do the specialty without regret.

I don’t think they’re one of them. I think they’re another fool being trapped by shiny lights and delusions of a good schedule.

I cannot emphasize this enough for med students, the Ed schedule is *not* a positive for the specialty for 99% of humans.
 
throway134 said:
I think this is the real thing that you can’t figure out as a med student or even as a resident. Being a “ruminator” and in em is an insanely toxic combination.

Every medical specialty has it, but I think em has the worst case because you usually only get one shot at it.

if you can leave your attending shifts and turn off the Ed like a light switch, can probably have way more longevity. I’d put the number of people I’ve met like that in the specialty at 10-20% max, and most of those still have bad days/cases.

I’m hoping this guy/gal figures it out before the mistake is made, but I really do mean what I said above. Some people can do the specialty without regret.

I don’t think they’re one of them. I think they’re another fool being trapped by shiny lights and delusions of a good schedule.

I cannot emphasize this enough for med students, the Ed schedule is *not* a positive for the specialty for 99% of humans.
Click to expand...

I will openly admit i was one of those med students.

I fell for the trap. I regret it. My thoughts used to be:

‘Wow i can make 400k working 12 days a month? That’s incredible’ - but didn’t realize that i would struggle to even work 10 years in the specialty. Just finished 5 yrs as attending and burned out

‘Working nights doesn’t bother me. I love nights’ - then i had kids and a family.

‘All the burned out docs are those trained in FM - they weren’t trained in EM’ - actually those older FM docs survived much much longer than the new EM trained cohort.

‘Just 3 years of training!’ - except an extra 1-2 years could have prolonged my career by a couple decades.

‘I love procedures’ - wait till you run a busy ER.
 
throway134 said:
Cyanide said it well, ill try to make it a little more direct.

You like Ortho, cards, cc. You don’t think you’ll make the cut or don’t want to do the training. That’s rational, but extremely short sighted.

You like:
-procedures
-not working all the time

You don’t like:
-peds
-women’s heath
-outpt medicine
-psych
-anesthesia personalities (I assume)

I’ve got really bad news. Real em as an attending in community or academic is 10% peds, 10% women’s health, 20% (bad) outpt medicine. It’s nominally 10% psych, but it’s more like 50% of your encounters. You will not like any of this.

Also, if you think 7 on/off is bad, having worked both I can tell you it’s way better than em scheduling. Want to know if you can do something in 3 months? You know on 7 on/off, you don’t know when the wheel of fate /scheduler you hate (I hated every one of em) is in charge.

As a brief aside into the hidden curriculum, I was a decent Ed doc when I did it. You know what makes you a better Ed doc? Being a f’in bully. You gotta do it at the right time and be “professional”, but it’s a huge part of the job. Based on your handle, I’m guessing this won’t go well.

You are pretty much the poster child for someone who should not do em.
Click to expand...
I am not sure why 7 on/off gets a bad rap. I have been doing for 3 years now as a hospitalist and I really like it. I will take it over M-F (9a-5p) schedule especially in my situation in which I can leave the hospital officially at 4 pm (but I often leave @ 2pm) 3 out of these 7 days and 6 pm the other 4 days.
 
throway134 said:
Cyanide said it well, ill try to make it a little more direct.

You like Ortho, cards, cc. You don’t think you’ll make the cut or don’t want to do the training. That’s rational, but extremely short sighted.

You like:
-procedures
-not working all the time

You don’t like:
-peds
-women’s heath
-outpt medicine
-psych
-anesthesia personalities (I assume)

I’ve got really bad news. Real em as an attending in community or academic is 10% peds, 10% women’s health, 20% (bad) outpt medicine. It’s nominally 10% psych, but it’s more like 50% of your encounters. You will not like any of this.

Also, if you think 7 on/off is bad, having worked both I can tell you it’s way better than em scheduling. Want to know if you can do something in 3 months? You know on 7 on/off, you don’t know when the wheel of fate /scheduler you hate (I hated every one of em) is in charge.

As a brief aside into the hidden curriculum, I was a decent Ed doc when I did it. You know what makes you a better Ed doc? Being a f’in bully. You gotta do it at the right time and be “professional”, but it’s a huge part of the job. Based on your handle, I’m guessing this won’t go well.

You are pretty much the poster child for someone who should not do em.
Click to expand...
Some days I'm a real bully. I had a 9 day stretch and by that 9th day, I was so done and found myself jumping on every psych patient to boost my numbers (double coverage ER).
 
always.chillin said:
Some days I'm a real bully. I had a 9 day stretch and by that 9th day, I was so done and found myself jumping on every psych patient to boost my numbers (double coverage ER).
Click to expand...

I'll take the bullying thing one step further.

I started to take weight training/strength training seriously back in 2022.
I wanted to feel better about myself. Be healthier. Hit some goals and big numbers.
I got unexpectedly huge.
I didn't mean to, but I've definitely intimidated a squirrely patient or three into compliance with a stern flex.
I sound like a total jackass typing this, but it's true. There's a certain type of patient around these parts that doesn't want to tangle with a guy that looks like he has death stars for shoulders and a scar thru the eyebrow.

You gotta be a bully sometimes in this field.
 
RustedFox said:
I'll take the bullying thing one step further.

I started to take weight training/strength training seriously back in 2022.
I wanted to feel better about myself. Be healthier. Hit some goals and big numbers.
I got unexpectedly huge.
I didn't mean to, but I've definitely intimidated a squirrely patient or three into compliance with a stern flex.
I sound like a total jackass typing this, but it's true. There's a certain type of patient around these parts that doesn't want to tangle with a guy that looks like he has death stars for shoulders and a scar thru the eyebrow.

You gotta be a bully sometimes in this field.
Click to expand...
I am not in any kind of good shape, but being 6'6 often accomplishes the same thing in my experience. Plus I can eat junk food.
 
cyanide12345678 said:
I will openly admit i was one of those med students.

I fell for the trap. I regret it. My thoughts used to be:

‘Wow i can make 400k working 12 days a month? That’s incredible’ - but didn’t realize that i would struggle to even work 10 years in the specialty. Just finished 5 yrs as attending and burned out

‘Working nights doesn’t bother me. I love nights’ - then i had kids and a family.

‘All the burned out docs are those trained in FM - they weren’t trained in EM’ - actually those older FM docs survived much much longer than the new EM trained cohort.

‘Just 3 years of training!’ - except an extra 1-2 years could have prolonged my career by a couple decades.

‘I love procedures’ - wait till you run a busy ER.
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These are my thoughts exactly

Especially the "I feel for the trap" part as a medical student

Too late though
 
Honestly I think the only fields that are truly immunized from admin pressures, crappy patients, etc are Ortho and Int Cards.

Rads is WFH maybe and low patient interaction but the list never ends and the patients have so much imaging complexity to them now.

Anesthesia is going through a little post covid Renaissance, it'll change back don't worry.

Derm is cool is you can be a good businessman otherwise it's PE target now

I think there's maybe 3 ways to min/max yourself into a tolerable EM career:

1) Be a true academic with legit NIH funding to persue research that you love, with shift buy down

2) Join a fair and strong SDG with a reasonable partnership track

3) get your nest egg, set it to coast FIRE, then credential at 10 places and do local PRN / local locums. A true gun for hire. No weekends / nights / holidays unless the price meets your threshold. No meetings. No metrics or performance reviews.

That's it I think, and unfortunately it's the minority of situations. CMG and Hospital employment is trash and is a frog in a boiling pot path to destruction.
 
WhatJobDoIPick said:
Honestly I think the only fields that are truly immunized from admin pressures, crappy patients, etc are Ortho and Int Cards.

Rads is WFH maybe and low patient interaction but the list never ends and the patients have so much imaging complexity to them now.

Anesthesia is going through a little post covid Renaissance, it'll change back don't worry.

Derm is cool is you can be a good businessman otherwise it's PE target now

I think there's maybe 3 ways to min/max yourself into a tolerable EM career:

1) Be a true academic with legit NIH funding to persue research that you love, with shift buy down

2) Join a fair and strong SDG with a reasonable partnership track

3) get your nest egg, set it to coast FIRE, then credential at 10 places and do local PRN / local locums. A true gun for hire. No weekends / nights / holidays unless the price meets your threshold. No meetings. No metrics or performance reviews.

That's it I think, and unfortunately it's the minority of situations. CMG and Hospital employment is trash and is a frog in a boiling pot path to destruction.
Click to expand...
Thank you for the response. Just gonna explore my options and see what specialties I can see myself doing.
 
RustedFox said:
I'll take the bullying thing one step further.

I started to take weight training/strength training seriously back in 2022.
I wanted to feel better about myself. Be healthier. Hit some goals and big numbers.
I got unexpectedly huge.
I didn't mean to, but I've definitely intimidated a squirrely patient or three into compliance with a stern flex.
I sound like a total jackass typing this, but it's true. There's a certain type of patient around these parts that doesn't want to tangle with a guy that looks like he has death stars for shoulders and a scar thru the eyebrow.

You gotta be a bully sometimes in this field.
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Heck yeah dude, good for you. I will never be physically intimidating, so I'm mildly jealous. I recently got cornered by a weirdo family because I couldn't tell them exactly what time grandma's surgery would be in the morning. I imagine if I were more physically impressive, this probably wouldn't have happened. I didn't feel threatened by them, but I was annoyed. It was disrespectful. I had to use my rather biting words, which was ultimately effective, but still...
 
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Ill give my two cents. Been out of residency for ~10 years. I no longer practice EM. Took a leadership opportunity in urgent care which turned into getting my MBA and ultimately taking an executive job at a medical company for a few years. Now I do some utilization management (mostly from home 9-5ish hours), some side gigs including provider oversight and consulting, and even looking to start my own company at some point in the future.

I think EM allowed me to have a good balance of many fields of medicine, but the nights were ultimately what caused me to look elsewhere. I still work some UC shifts to keep my skills up though.

I felt trapped in EM and unhappy so took some steps to branch out. Im much happier now, but miss the ED a bit….. do not miss nights at all. Pay is great, but if you are willing to take a 10-20% pay cut for no nights/weekends then there are tons of opportunities out there with EM training both in and out of ED. All that to say its a good field thats well balanced and gives you opportunities to do alot of things in medicine that many other fields do not. Many CMOs are EM, pain medicine, UC, UM, mid-level oversight, entrepreneurial ventures, etc…. Not sure many other fields have that flexibility. My 8 years in the ED was tough but good, and now im happy doing other things. Feel free to DM me if you have specific questions.
 
HemorrhagicShock said:
The most exciting part about Vituity is its incredibly effective KoolAid.

At least with TH, Envision, USACS etc., you know you're being screwed, and they know they're screwing you. It's almost a stable equilibrium; both sides know what they're dealing with.

With Vituity, however, the physician-owned partnership aspect gives you JUST enough money as a full partner to put up with what are effectively the same working conditions as any given TH, Envision, or USACS site.

Vituity has to operate locally and regionally using the same tactics as the big PE-backed national CMGs we love to slam online. They're almost (if not just as) big as them; thus, they have to stoop to those same tactics to continue growth.

This also means it requires a steady stream of new blood, which is why you see the aggressive hiring of new partners in all these newly acquired Vituity contracts.

This creates a perfect little corporate culture bubble where full-time Vituity partners willingly double down on trash conditions, unsafe staffing, higher use of midlevels, and various other cost-cutting measures simply because "we gotta keep the CEO happy."

That said, if I were given a choice between TH, USACS, Envision, or Vituity to take over my hospital, I would choose Vituity 1000 times out of 100. Once you're a full partner, the pay structure puts you ahead of the other large CMGs.
Click to expand...
This is one of those examples where it's perfectly fine to both hate the player and the game. Ultimately everyone dances to the hospital system's tune, and that tune is relentless expansion or be bought up by someone else who growing. Plenty of stable groups lose that stability because now they're expected to staff multiple no volume shops or pick up dumpster fire critical access hospitals that combine long commutes with crushing volume and no backup. The secret sauce for CMGs is their war chest which allows them to bring in 5-20 new docs into a system reasonably quickly and float their salaries until their billing starts being reimbursed. Any group that hopes to compete is going to need to do the same thing, which means either ferociously screwing over those new docs while the founders mortgage their houses to come up with the cash or making a deal with the devil to obtain the financing.

Eventually it feels like the health care system is going to reach some steady state where everyone's employed by 1 of 4 or so private hospital chains (or possibly 2-3 insurance companies) or by the government. Private groups or CMGs, the expansionist model leads to taking enormous risks for what in the end is a relatively steady but unspectacular income stream. COVID killed off some already, mergers will kill others, and eventually it will all get swallowed by the bigger fish. Companies for whom TH's annual revenue is a rounding error.
 
WhatJobDoIPick said:
Why do we allow these threads?

Serious question.

There's about 37 threads on the same topic.

These delusional med students can use the search function.

All these threads do is accentuate burnout by having members put their feelings in writing and white knight for these entitled students who think they are the exception to the rule.
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We have these threads because it's called "studentdoctor.net" not "oldcrankydoc.net" so we should expect some student doctors.

I agree the search function is not great for this sort of thing

Its too long to repost but here is what I said about it a few years ago

Why EM has been good to me and still is
 
Old_Mil said:
Good. Don't waste that on this field. Emergency Medicine is like a Heisman winning quarterback getting drafted by the Cleveland Browns. It's been 4 years since I worked my last shift. Life has been fantastic since then.
Click to expand...

Well, that situation happened once in recent history, and it was a ****show (Johnny Manziel)
 
Cinclus said:
Heck yeah dude, good for you. I will never be physically intimidating, so I'm mildly jealous. I recently got cornered by a weirdo family because I couldn't tell them exactly what time grandma's surgery would be in the morning. I imagine if I were more physically impressive, this probably wouldn't have happened. I didn't feel threatened by them, but I was annoyed. It was disrespectful. I had to use my rather biting words, which was ultimately effective, but still...
Click to expand...
I’m a taller/solidly built woman but about every other shift the security guards or nurses sense danger to my person and put up a threatening appearance to de escalate. It makes me giggle a bit inside because no one ever messes with me AT ALL, I think I just don’t look very approachable or like a pushover at all. I wonder if they are nervous because I am always single coverage and they don’t want to be doctor-less?

OP, unfortunately community EM where most of us are, is nothing like student rotations where you are being steered towards interesting cases and procedures, and away from your local kooks and drunks (night weekends here in a poor urban area … literally 75% of my patients are kooks or drunks/on drugs). I really like my job but even so, I feel extremely fortunate because it is nothing like what I thought I was signing up for…
 
Splenda88 said:
Where I work, none of these guys/gals would do a therapeutic para, thoracentesis. A few are reluctant to even do central lines.
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I think that's somewhat universal in fields where volume is a big thing. I farm out procedures way more than I used to because in the time it takes me to do lots of procedures I can see 2 follow ups.
 
I would like to thank everyone for taking the time to provide such valuable advice and for some funny insults. I am conflicted with the information I have been given and my passions in medicine. I felt that I did a poor job explaining things which put me at a disadvantage, however I do not feel like I had much of a shot of being told to go into the field to begin with. I will continue to be open minded and explore all options moving forward while being aware of the downsides of EM. I do not know what else to add to this thread, but I will update it as I go along in my clinical years.
 
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Dr. Pineal Gland said:
I would like to thank everyone for taking the time to provide such valuable advice and for some funny insults. I am conflicted with the information I have been given and my passions in medicine. I felt that I did a poor job explaining things which put me at a disadvantage, however I do not feel like I had much of a shot of being told to go into the field to begin with. I will continue to be open minded and explore all options moving forward while being aware of the downsides of EM. I do not know what else to add to this thread, but I will update it as I go along in my clinical years.
Click to expand...
If the only thing in medicine you like is EM, do EM. If not, do something else. That also works pretty well for deciding to go to med school, but it's a little bit late for that.
 
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cyanide12345678 said:
Here’s my honest advice to you. And really listen and pay attention.

It actually sounds a little like you want ortho but don’t have the numbers. So EM is kind of like a second choice. It’s very hard to sustain a EM lifestyle especially if it’s your second pick. Yes, i get it, ortho is very very hard to get in.

You say you don’t like kids - 20 percent of ER visits is kids.

You also say you don’t like women’s health. 10 ish percent of ER visits are gynecology/obstetrics related.

So 30 percent of your job as an ER doctors, you already don’t like.

You say ‘no to psych’ - the reality is a lot of the patients we see are some degree of anxiety disorder, running to the ER at the simplest thing. Then obviously there’s all the depressed suicidal people you’ll see. Psych is probably another 5-10 percent of patients we see.

Now throw in the drunks, the drug seekers, the disrespectful, and the belligerent.

I mean you’re basically saying you already dont like 50 percent of what we do.

So i have no idea where your desire to pursue EM is coming from? Let’s be real…. Are you sure you don’t like the idea of making 400k working 36-40 hours a week? I fell for that trap since I’m very financially minded.

You say you like procedures - the reality is when you have a very busy ER, a procedure is the last thing you want to do. Central lines take so long! Sutures take so long!!! When it’s busy, you really really don’t want to do procedures.

I work 10 days a month. I still don’t have perfect work life balance. My wife works 12 days a month, she has better work life balance. She’s off on weekends, i still work quite a few of those. I work nights and don’t sleep in my bed plenty of nights, my body struggles to recover. If your circadian rhythm is flip flopping between days and nights - I’m sorry that’s not work life balance. If you miss a bunch of family events on the weekends, that’s just not work life balance.

Ill tell you what’s work life balance - my wife who goes into work for 4-5 hours a day for 3 days a week - Tuesday through Thursday. Is back from work at 2 pm everyday and still makes 250k as FM -_- that’s work life balance. Even on her work days she has time for life -_-

So….. you think EM is work life balance. It’s better than some, but it’s not derm, psych, allergy/immunology, rheum, pm&r and others. I mean yeah our work life balance is better than surgeons - but thats about all i can say for EM.

Think long and hard. You’re probably better off doing IM and getting a fellowship in something else.
Click to expand...

A F'ING MEN
 
Arcan57 said:
If the only thing in medicine you like is EM, do EM. If not, do something else. That also works pretty well for deciding to go to med school, but it's a little bit late for that.
Click to expand...

I'd generally agree but the big problem is that med student EM shifts are much different than normal EM shifts.

Probably the best description of modern EM I've heard is working in adult babysitting.

-Elderly pts that can't take care of themselves ---> Call EMS ---> ED
-Young pts that can't take care of themselves ---> Call EMS ---> ED
-Psych pts that can't take care of themselves ---> Call EMS ---> ED

That's 80%+ of typical patients in your typical emergency department.

Now if that actually sounds fulfilling then sure do EM but if not you'll likely be very disappointed in life.
 
cyanide12345678 said:
Here’s my honest advice to you. And really listen and pay attention.

It actually sounds a little like you want ortho but don’t have the numbers. So EM is kind of like a second choice. It’s very hard to sustain a EM lifestyle especially if it’s your second pick. Yes, i get it, ortho is very very hard to get in.

You say you don’t like kids - 20 percent of ER visits is kids.

You also say you don’t like women’s health. 10 ish percent of ER visits are gynecology/obstetrics related.

So 30 percent of your job as an ER doctors, you already don’t like.

You say ‘no to psych’ - the reality is a lot of the patients we see are some degree of anxiety disorder, running to the ER at the simplest thing. Then obviously there’s all the depressed suicidal people you’ll see. Psych is probably another 5-10 percent of patients we see.

Now throw in the drunks, the drug seekers, the disrespectful, and the belligerent.

I mean you’re basically saying you already dont like 50 percent of what we do.

So i have no idea where your desire to pursue EM is coming from? Let’s be real…. Are you sure you don’t like the idea of making 400k working 36-40 hours a week? I fell for that trap since I’m very financially minded.

You say you like procedures - the reality is when you have a very busy ER, a procedure is the last thing you want to do. Central lines take so long! Sutures take so long!!! When it’s busy, you really really don’t want to do procedures.

I work 10 days a month. I still don’t have perfect work life balance. My wife works 12 days a month, she has better work life balance. She’s off on weekends, i still work quite a few of those. I work nights and don’t sleep in my bed plenty of nights, my body struggles to recover. If your circadian rhythm is flip flopping between days and nights - I’m sorry that’s not work life balance. If you miss a bunch of family events on the weekends, that’s just not work life balance.

Ill tell you what’s work life balance - my wife who goes into work for 4-5 hours a day for 3 days a week - Tuesday through Thursday. Is back from work at 2 pm everyday and still makes 250k as FM -_- that’s work life balance. Even on her work days she has time for life -_-

So….. you think EM is work life balance. It’s better than some, but it’s not derm, psych, allergy/immunology, rheum, pm&r and others. I mean yeah our work life balance is better than surgeons - but thats about all i can say for EM.

Think long and hard. You’re probably better off doing IM and getting a fellowship in something else.
Click to expand...

I'd also add that outside of high acuity tertiary hospitals most EM docs rarely do invasive procedures on shifts.

Besides maybe suturing there really isn't a procedure that's usually done on average more than once when on shifts.

Critical Care procedures for example tubes and lines are extremely rare nowadays and the last study that was performed 10 years ago showed that most docs will do 10 a year on average based on a chart review from USACS sites across the United States. I wouldn't be shocked if it was lower now with more widespread usage of CPAP and BIPAP machines and probably closer to 5 a year for the average EM physician.
 
alpinism said:
I'd also add that outside of high acuity tertiary hospitals most EM docs rarely do invasive procedures on shifts.

Besides maybe suturing there really isn't a procedure that's usually done on average more than once when on shifts.

Critical Care procedures for example tubes and lines are extremely rare nowadays and the last study that was performed 10 years ago showed that most docs will do 10 a year on average based on a chart review from USACS sites across the United States. I wouldn't be shocked if it was lower now with more widespread usage of CPAP and BIPAP machines and probably closer to 5 a year for the average EM physician.
Click to expand...
Probably 3/4 of the tubes and 80% of the lines I put in as a resident wouldn't be performed on the same patient with the same pathology today. BiPap, high flow, and the ability to do CT scans in seconds rather than minutes killed a lot of the indications for emergent intubation. U/S guided PIVs, dedicated PICC teams, the EZ-IO, and relaxed rules around peripheral pressors did the same for CVLs.
 
Arcan57 said:
Probably 3/4 of the tubes and 80% of the lines I put in as a resident wouldn't be performed on the same patient with the same pathology today. BiPap, high flow, and the ability to do CT scans in seconds rather than minutes killed a lot of the indications for emergent intubation. U/S guided PIVs, dedicated PICC teams, the EZ-IO, and relaxed rules around peripheral pressors did the same for CVLs.
Click to expand...
Plus goals of care discussions and POLST forms.
I'd guess most of my "most likely non-survivable" ICH patients go directly to comfort cares.
 
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