dhcofc

10+ Year Member
Jan 30, 2008
70
26
261
Status
Medical Student
This is definitely something I am thinking about while trying to decide what residency to go into. I'm mostly interested in anesthesia vs EM, and from talking to people that have done EM for a long time (one that switched to rads...) I hear from them that the nights and circadian rhythm switching wears on you as you get older. In fact, that is probably the #1 reason I'm shying away from EM at the moment. I would love to hear what people with experience have to say about this topic!
 

lgher

7+ Year Member
Aug 10, 2009
21
2
141
Status
Resident [Any Field]
as someone who was in a similar situation a year ago (EM vs. anesthesia) i can give my biased perspective (as i chose and just matched into anesthesia)

1. my personal feeling is most ER docs in their 50's in 60's just seem "tired". I've spent about 12 weeks of clinical time in both ER and Gas, and have meet several anesthetists in their 60's and even early 70's, but have seen few ER docs in their 60's (maybe one?)

2. I've meet many people within anesthesia who were either deciding between the two as a medical student and choose anesthesia ultimitely, or switched from ER to Anesthesia during residency, or retrained in Anesthesia after working in ER fore a few years.

I think i might know only 1 medical student who choose ER when deciding between the two, and maybe 1 ER doc who considered anesthesia as a medical student but decided on ER eventually because he thought anesthesia would be too boring for him.

I don't know ANYONE who has transitioned from anesthesia residency or practice to ER (although if you look hard enough i'm sure you could find someone). I think this says alot about the lifestyle and long term tolerability of the two.

3. I chose Gas because i feel there are alot more procedures, less social issues to deal with than ER, generally higher acuity overall (i don't like the GP side of ER- prescription refills, cough's and colds etc.), really into phys and pharm, and can see myself doing it when i'm 50 or 60 (not so sure i would be wanting to do ER in 50's and 60's), and hours seem better for when i have a family in the future.

I used to think the hours in ER were pretty sweet, but i think once i have a family in the future, i won't be so cool being away from home in the evenings and overnight.
 

It'sElectric

10+ Year Member
Dec 5, 2005
1,502
6
251
Status
Attending Physician
as someone who was in a similar situation a year ago (EM vs. anesthesia) i can give my biased perspective (as i chose and just matched into anesthesia)

1. my personal feeling is most ER docs in their 50's in 60's just seem "tired". I've spent about 12 weeks of clinical time in both ER and Gas, and have meet several anesthetists in their 60's and even early 70's, but have seen few ER docs in their 60's (maybe one?)

2. I've meet many people within anesthesia who were either deciding between the two as a medical student and choose anesthesia ultimitely, or switched from ER to Anesthesia during residency, or retrained in Anesthesia after working in ER fore a few years.

I think i might know only 1 medical student who choose ER when deciding between the two, and maybe 1 ER doc who considered anesthesia as a medical student but decided on ER eventually because he thought anesthesia would be too boring for him.

I don't know ANYONE who has transitioned from anesthesia residency or practice to ER (although if you look hard enough i'm sure you could find someone). I think this says alot about the lifestyle and long term tolerability of the two.

3. I chose Gas because i feel there are alot more procedures, less social issues to deal with than ER, generally higher acuity overall (i don't like the GP side of ER- prescription refills, cough's and colds etc.), really into phys and pharm, and can see myself doing it when i'm 50 or 60 (not so sure i would be wanting to do ER in 50's and 60's), and hours seem better for when i have a family in the future.

I used to think the hours in ER were pretty sweet, but i think once i have a family in the future, i won't be so cool being away from home in the evenings and overnight.
I get what you're trying to say in bold, but if I'm still working well into my 60s or God forbid my 70's, someone please take me out back and shoot me.

Personally, I considered anesthesia, but the biggest downside to me is the CRNA debacle (not trying to dismantle this thread by even mentioning it). If anything, we all should have gotten a nursing degree, then cheaply/fairly quickly gotten our CRNA and started raking in the big bucks before we were even 27...that would've been the wise decision.

Plus, I just felt that EM personifies what I always imagined being a physician would entail (too much of a med student answer, I know). I think there's something incredibly rewarding about the field - you can end nearly every shift feeling as though you had a rather significant impact on someone else's life. I just never got that feeling with anesthesia, personally.

Plus, the idea of "burnout" in EM is a fallacy. That docs that became "burnt out" in the past were the ones that trained as FM/IM/whatever docs then tried to transition to the EDs in order to fill a void. Traditional EM training is still very young.
 

AbbyNormal

Yes. No. Maybe.
7+ Year Member
Mar 11, 2010
1,796
335
181
... but if I'm still working well into my 60s or God forbid my 70's, someone please take me out back and shoot me.
Really??

I am 50 y/o now and want to go to grad school (as soon as my son is self sufficient). Two of my grandmothers and one great grandmother lived til they were 93-94. My grandmother was still working part time in her 80s and my dad still works fulltime at 74. I just don't see myself sitting at home eating turtles and watching TV all day.
 

coldweatherblue

10+ Year Member
Nov 24, 2007
1,085
8
251
Status
Medical Student
Can someone with more experience comment on the feasibility of easing into a more sleep-rhythm friendly practice as a senior attending? (ie, after 15 or so years of practicing..).

At the moment I'm all over the place sleep-wise and never have problems staying up all night and being functional the next day, etc so it doesn't seem like a big deal but I can see how in the long-run working a night-shift a week could get very tiring.

Is it reasonable to expect to have enough connections/seniority so that once you're 50-60 years old you can work like 3 daytime 8s a week with 1 night shift a month or something similar? at the expense of some compensation of course..
 

EMDoc0411

10+ Year Member
7+ Year Member
Jan 2, 2009
124
4
141
Status
Attending Physician
Really??

I am 50 y/o now and want to go to grad school (as soon as my son is self sufficient). Two of my grandmothers and one great grandmother lived til they were 93-94. My grandmother was still working part time in her 80s and my dad still works fulltime at 74. I just don't see myself sitting at home eating turtles and watching TV all day.
One of my current partners in the ED is 80 yrs. old and works 18 12's per month. And he takes a week off each month to visit his 20 year old girlfriend in the Philippines.
Another partner is a 65 yr old guy who does 21 (overnight) 12's per month.
I hope to be a cruise ship physician in my 60's.
 

drchekhov

Member
10+ Year Member
Dec 6, 2005
117
0
241
36
San Francisco, CA
Status
Medical Student
as someone who was in a similar situation a year ago (EM vs. anesthesia) i can give my biased perspective (as i chose and just matched into anesthesia)

1. my personal feeling is most ER docs in their 50's in 60's just seem "tired". I've spent about 12 weeks of clinical time in both ER and Gas, and have meet several anesthetists in their 60's and even early 70's, but have seen few ER docs in their 60's (maybe one?)
I think you're overlooking the youth of EM as a field here, as the first residency only started in 1970 and practitioners only became eligible for board-certifiecation starting in 1979. Combined with the fact that there were a very, very small number of residencies in the early days, it's not surprising that there are few EM physicians in their 60's or 70's trotting around today. I'd wager that most of them that you do see of that age are actually the founders of the field/early pioneers (Rosen, Wagner, Goldfrank, etc.), who trained in something else initially and then came into EM through the practice pathway. (And are happily close to retirement now.) In fact, it wouldn't surprise me if there were more total EM-certified physicians in their 70's than in their 60's.

But don't you worry: I'm sure there are plenty of EM-docs who trained in the 1980's (and are thus in their 50's) who will soon swell the sexagenarian ranks. ;)
 

Jeff698

EM/EMS nerd
15+ Year Member
Aug 11, 2000
1,998
15
351
Salado, Texas
Status
Attending Physician
One of my current partners in the ED is 80 yrs. old and works 18 12's per month. And he takes a week off each month to visit his 20 year old girlfriend in the Philippines.
Wow. Now that's a man I'd salute. Oh, and working all those shifts is pretty impressive, too.

As for the OP, I think work period gets old. I've only been out of residency two years and it is already seriously getting in the way of my hobbies.

Take care,
Jeff
 

It'sElectric

10+ Year Member
Dec 5, 2005
1,502
6
251
Status
Attending Physician
Really??

I am 50 y/o now and want to go to grad school (as soon as my son is self sufficient). Two of my grandmothers and one great grandmother lived til they were 93-94. My grandmother was still working part time in her 80s and my dad still works fulltime at 74. I just don't see myself sitting at home eating turtles and watching TV all day.
I have more than enough hobbies/plans/dreams to fill my time for the 2nd half of my life. There's much more to do than work, eat, sleep, and watch tv. Call me lazy, but I can just find a million more things to do with my time than work.

Not to mention, if I live to be 90, I'll be absolutely shocked...my predecessors haven't exactly set the curve.

Cruise ship doc does sound right up my alley, however.
 

It'sElectric

10+ Year Member
Dec 5, 2005
1,502
6
251
Status
Attending Physician
One of my current partners in the ED is 80 yrs. old and works 18 12's per month. And he takes a week off each month to visit his 20 year old girlfriend in the Philippines.
Another partner is a 65 yr old guy who does 21 (overnight) 12's per month.
I hope to be a cruise ship physician in my 60's.
Any idea why? Do they truly just love working that much? Expensive habits? Never learned how to set aside for the future early on?

Honestly.
 

emedpa

GlobalDoc
10+ Year Member
15+ Year Member
Aug 25, 2001
6,014
301
381
Taking an Away team....
Status
Post Doc
I work mostly nights now and really enjoy it. sicker pts, fewer pts overall/shift, and we get a night differential so more meaningful work and less primary care scut for more money.
also it really is good for the family life. when the kids are home I am there with them. we can have dinner together and I can put the little ones to bed. I sleep when they are at school.
also I can go to the bank, go shopping, etc during nl business hrs when places aren't crowded.
being able to get by with very little sleep is key. I do fine with 6 hrs/night and still have enough energy to train for and do multiple distance running events/yr of marathon length plus(50k, 50 mile, 100k).
 

It'sElectric

10+ Year Member
Dec 5, 2005
1,502
6
251
Status
Attending Physician
I work mostly nights now and really enjoy it. sicker pts, fewer pts overall/shift, and we get a night differential so more meaningful work and less primary care scut for more money.
also it really is good for the family life. when the kids are home I am there with them. we can have dinner together and I can put the little ones to bed. I sleep when they are at school.
also I can go to the bank, go shopping, etc during nl business hrs when places aren't crowded.
being able to get by with very little sleep is key. I do fine with 6 hrs/night and still have enough energy to train for and do multiple distance running events/yr of marathon length plus(50k, 50 mile, 100k).
:eek:
 

J ROD

Watch my TAN walk!!
Lifetime Donor
10+ Year Member
Aug 1, 2005
58,227
1,968
281
working on my tan......
Status
Resident [Any Field]
I work mostly nights now and really enjoy it. sicker pts, fewer pts overall/shift, and we get a night differential so more meaningful work and less primary care scut for more money.
also it really is good for the family life. when the kids are home I am there with them. we can have dinner together and I can put the little ones to bed. I sleep when they are at school.
also I can go to the bank, go shopping, etc during nl business hrs when places aren't crowded.
being able to get by with very little sleep is key. I do fine with 6 hrs/night and still have enough energy to train for and do multiple distance running events/yr of marathon length plus(50k, 50 mile, 100k).
Good, I get along fine with 5-6hrs/night.....

I like EM more than Anes...but I like aspects of both....but I like the ER pace....
 

Greenbbs

10+ Year Member
Sep 21, 2007
305
39
261
Glorious upstate NY
Status
Attending Physician
The job I'm starting in July after I'm done with training doesn't require me to do nights. I'll be in a high acuity, high volume place, but they have a dedicated night staff, so I'm quite OK with working 16 9's during the days or evenings, and sleeping in my own bed at night.
 

docB

Chronically painful
Moderator Emeritus
Lifetime Donor
10+ Year Member
15+ Year Member
Nov 27, 2002
7,742
213
281
Las Vegas, NV
Status
Attending Physician
Yeah, shifts does get annoying sometimes. Whenever I want to go out and do something on a weekend or an evening and I have to work instead it sucks. Especially when you are making plans with other people who do have normal schedules.

That said sometimes it is great too. I took my daughter to a movie today at 10 am and it's a weekday so it wasn't too crowded. Now I'm on a 3p to 1a.

Any idea why? Do they truly just love working that much? Expensive habits? Never learned how to set aside for the future early on?

Honestly.
Most of the guys I know who work into their 60s have divorces, tax problems or both.
 

Apollyon

Screw the GST
Lifetime Donor
15+ Year Member
Nov 24, 2002
19,886
4,590
381
SCREW IT!
The first person we had switch into our residency from another was a guy that was a PGY-2/CA-1 at a very high powered California program.

As for cruise ship doc - as always, it's not exactly as cushy as it sounds (when you are working, your ass is getting kicked - absolutely).
 

kungfufishing

Senior Member
7+ Year Member
15+ Year Member
Mar 7, 2003
1,053
5
0
Visit site
Status
Attending Physician
Yes the shift work hurts. For me, doing something I didn't enjoy as much or paid less for the same amount of time at work would hurt worse.
 

EMDoc0411

10+ Year Member
7+ Year Member
Jan 2, 2009
124
4
141
Status
Attending Physician
Any idea why? Do they truly just love working that much? Expensive habits? Never learned how to set aside for the future early on?

Honestly.
The 80 yr. old guy has 10 children of which he provides total financial support for some of them.

The 65 yr. old guy just likes money. He's building a home that is costing him over a million.
 

Lucylu123

ASA Member
10+ Year Member
Aug 2, 2007
86
0
241
Status
Medical Student
I used to work at an urgent care center that was staffed mostly with FM docs, but there were a few older retired EM guys who would work a few 7 hour shifts a week. I asked one of them why he stopped working in an ER to do this, and he said that at that point he was financially secure, and just wanted to do this so that he could keep working as a doc but with less stress and to put a little extra cash in his pockets to pay for his horses.

Probably a good option for later in life when you might feel burnt out by the ER, but don't want to do nothing.