Should I Quit?

[ToastyEM80s]

So this is going to be another "Should I leave EM?" post. No eye-rolls please.

Worked community ER for > 10 years. Early 40s, and finally hit my FI number.

Experienced firsthand all the usual reasons for wanting to quit.

• Sued twice, which led to a period of depression and suicidal thoughts. Thankfully, both cases were dismissed after years of litigation, but still fear the next possible lawsuit
• I've worked at a lot of different hospitals in multiple cities and have never found a unicorn practice. All have been plagued by some or all of the following: loss of autonomy, a difficult patient population, unreasonable expectations (high pph, responsible for floor codes/procedures), hostile consultants, difficult admits/transfers, understaffed ancillary staff, etc
• Night shifts getting harder in my 40s
• Most shifts are so brutal now that I have palpitations and a sinking feeling of despair on my drive to work.

But the thing is, I still love practicing emergency medicine but just hate what it's become. Also, feel a bit guilty about retiring early, read some EM statistics that most retire in their 50s.

I know there are a lot of headwinds - physician oversupply, declining reimbursements, midlevel creep, corporatization.

But, are there any reasons for optimism? Anything on the horizon that might reverse the decline?
Maybe unionization or HCA reversing course and closing their residencies? Perhaps real tort reform, I know GA once had gross negligence standard for EM but got overturned.

Seems with anticipated physician oversupply, quitting for > 1 year likely means I won't be able to return. Just looking for reasons not to quit.

Lastly, for the parents, do you feel your children would be embarrassed that you retired early? I feel like I've tied my identity and take pride to being a doctor.

- Just another burned out ER doc.

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[Splenda88]

Since you still like EM, 6 shifts per month at a different hospital might be more palatable. At least that what I would do

 

[ToastyEM80s]

Since you still like EM, 6 shifts per month at a different hospital might be more palatable. At least that what I would do

Yeah, looked into that. I'm so burned out, even 6 shifts seems too much. I'm open to 2-3 shifts per month but Per-Diem gigs seem pretty hard to get.

Recently moved, could still work per-diem at my old hospital but it would mean a flight/hotel.

Also worried about liability risks. I know malpractice awards above policy limits is unheard of, but seems like we're moving to a more litigious environment.

 

[Splenda88]

Yeah, looked into that. I'm so burned out, even 6 shifts seems too much. I'm open to 2-3 shifts per month but Per-Diem gigs seem pretty hard to get.

Recently moved, could still work per-diem at my old hospital but it would mean a flight/hotel.

Also worried about liability risks. I know malpractice awards above policy limits is unheard of, but seems like we're moving to a more litigious environment.

4-6 shifts per month depending on how you feel that particular month.

I like medicine as a hospitalist but once I reach my FI number, I will work part time regardless how old I am.

The less shift you work, the less you are exposed to malpractice in theory.

If you did not like EM, I would tell you to get boarded in obesity medicine and open your weight loss clinic 3 days a week.

 

[RustedFox]

Quit.

 

[cyanide12345678]

What was your FI no. and how confident are you that you are emotionally okay with making significantly less money?

look into some non clinical gigs to see if you like something else or urgent care gigs that are less stressful. Or even look at some online gigs. If you officially don’t need the money, then find something where you dont do nights, weekends, and have less malpractice risk.

Here’s some examples:

1) hospital review committe - pays about 250-300k a year. These guys try to fight insurances regarding denials

2) nursing home medicine - wife just got an offer for 300k to round on 5 nursing homes weekly - 15 patients each.

3) urgent care and/or online urgent care - wife and i are getting a free steak dinner for a recruitment event for an online urgent care gig

4) online medicine - extra points if asynchronous. Usually pays about 80-100 per hour. You need 10 medical license minimum

5) med school teaching faculty

6) concierge medicine side hustle where you are your own boss.

Yeah…. So many different things can be done as long as you are not tied to any particular company.

I would also start responding to recruiter emails and ask them if they want you as prn - you could work 3-4 shifts between several different hospitals if you are prn.

I’m also personally working on my exit plan and have started my journey of getting prn gigs with the goal of just working prn at some point.

 

[thegenius]

• Sued twice, which led to a period of depression and suicidal thoughts. Thankfully, both cases were dismissed after years of litigation, but still fear the next possible lawsuit
• I've worked at a lot of different hospitals in multiple cities and have never found a unicorn practice. All have been plagued by some or all of the following: loss of autonomy, a difficult patient population, unreasonable expectations (high pph, responsible for floor codes/procedures), hostile consultants, difficult admits/transfers, understaffed ancillary staff, etc
• Night shifts getting harder in my 40s
• Most shifts are so brutal now that I have palpitations and a sinking feeling of despair on my drive to work.

But the thing is, I still love practicing emergency medicine but just hate what it's become. Also, feel a bit guilty about retiring early, read some EM statistics that most retire in their 50s.

The two in bold, especially the last one, makes me think it's time for you to leave ER ASAP. You shouldn't dread going to work everyday.

 

[betamale]

I'm worried for you. Sounds like you do need to walk out for your own sanity. My redline would be having SI. You should take care of yourself first. A colleague of mine quit for several years after severe depression from death of a spouse and was able to return to practice without problems. That doctor was more happy with medical practice after coming back. I also volunteered at an indigent primary care clinic with another ED doc who had quit to prevent a break in his medical practice history. Leaving completely may cause credentialing problems unless you have connections and able to obtain work once you are ready. Make sure you keep your medical license(s) active.

 

[Rendar5]

So this is going to be another "Should I leave EM?" post. No eye-rolls please.

Worked community ER for > 10 years. Early 40s, and finally hit my FI number.

Experienced firsthand all the usual reasons for wanting to quit.

• Sued twice, which led to a period of depression and suicidal thoughts. Thankfully, both cases were dismissed after years of litigation, but still fear the next possible lawsuit
• I've worked at a lot of different hospitals in multiple cities and have never found a unicorn practice. All have been plagued by some or all of the following: loss of autonomy, a difficult patient population, unreasonable expectations (high pph, responsible for floor codes/procedures), hostile consultants, difficult admits/transfers, understaffed ancillary staff, etc
• Night shifts getting harder in my 40s
• Most shifts are so brutal now that I have palpitations and a sinking feeling of despair on my drive to work.

But the thing is, I still love practicing emergency medicine but just hate what it's become. Also, feel a bit guilty about retiring early, read some EM statistics that most retire in their 50s.

I know there are a lot of headwinds - physician oversupply, declining reimbursements, midlevel creep, corporatization.

But, are there any reasons for optimism? Anything on the horizon that might reverse the decline?
Maybe unionization or HCA reversing course and closing their residencies? Perhaps real tort reform, I know GA once had gross negligence standard for EM but got overturned.

Seems with anticipated physician oversupply, quitting for > 1 year likely means I won't be able to return. Just looking for reasons not to quit.

Lastly, for the parents, do you feel your children would be embarrassed that you retired early? I feel like I've tied my identity and take pride to being a doctor.

- Just another burned out ER doc.

If getting sued lead to suicidal thoughts I agree you need a way out. Odds are you will be sued again at some point in your career like everyone else.

If it was purely an emotional response, there’s not much you can do about that other than to avoid getting sued by quitting. If it is more an intellectual response and worry about what might happen to you personally should you lose, it’s almost unheard of for you to have Personal losses even if you lose a suit well above your malpractice insurance limits.

 

[MechEDoc]

What about EM in a totally different environment. If you've hit FI and don't want to be sued, how about one of the air access only community ERs in Alaska? I believe that they are IHS / tribal ERs and should be nearly immune from lawsuit.

 

[dchristismi]

So this is going to be another "Should I leave EM?" post. No eye-rolls please.

Worked community ER for > 10 years. Early 40s, and finally hit my FI number.

So you have, as my sister the MBA says, "FU Money"

Experienced firsthand all the usual reasons for wanting to quit.

• Sued twice, which led to a period of depression and suicidal thoughts. Thankfully, both cases were dismissed after years of litigation, but still fear the next possible lawsuit
• I've worked at a lot of different hospitals in multiple cities and have never found a unicorn practice. All have been plagued by some or all of the following: loss of autonomy, a difficult patient population, unreasonable expectations (high pph, responsible for floor codes/procedures), hostile consultants, difficult admits/transfers, understaffed ancillary staff, etc
• Night shifts getting harder in my 40s
• Most shifts are so brutal now that I have palpitations and a sinking feeling of despair on my drive to work.

Hm, lets see. I know that feeling. I think many of us do. The palpitations are the worst. I actually deliberately did night shifts to avoid the Nurse Manager who induced said palpitaitons because I decided that the palpitations were worse than just biting the bullet and becoming a nocturinst for a while. (I was in an awesome group that was eaten by TeamUnhealth which was the beginning of the end.)

But the thing is, I still love practicing emergency medicine but just hate what it's become. Also, feel a bit guilty about retiring early, read some EM statistics that most retire in their 50s.

Unless you're a woman, then the average is 43. Which is when I left. And I'm a woman. YMMV.

I know there are a lot of headwinds - physician oversupply, declining reimbursements, midlevel creep, corporatization.

But, are there any reasons for optimism? Anything on the horizon that might reverse the decline?
Maybe unionization or HCA reversing course and closing their residencies? Perhaps real tort reform, I know GA once had gross negligence standard for EM but got overturned.

Seems with anticipated physician oversupply, quitting for > 1 year likely means I won't be able to return. Just looking for reasons not to quit.

Sounds like you have plenty of reasons. Like, oh, survival. You're preaching to the choir, my friend.

Lastly, for the parents, do you feel your children would be embarrassed that you retired early? I feel like I've tied my identity and take pride to being a doctor.

The identity crisis is real. Took me about 5 years, which is why I took several years to slowly dip my toes into my new life (HPM) and allow myself time to grieve the loss of who I was. Because this is a very real thing. I don't have human children, but my dog doesn't seem to mind.

 

[oldtown]

You don’t owe it to society, patients, family, or anyone else to practice up to a certain age. The first two won’t miss you one bit and will just move on to the next host.

When you do this job for everybody but yourself, the emotional burden can become unbearable.

You do owe it to yourself to preserve your sanity, mental health, and emotional well being. Whatever that takes.

And, this is easier said than done- work on crafting a new primary identity for yourself. Whether it’s parent, spouse, fitness guru, whatever. Start with making it a joint identity alongside EP, and let it gradually take over. This will help no matter what you end up deciding to do. When EM is just a job and not your identity, you don’t get so worked up over all the BS- because jobs are always full of BS. When that BS is no longer an assault on your identity but rather just job BS, you don’t as offended by it all.

 

[Birdstrike]

“I still love practicing emergency medicine but just hate what it's become“

These are two contradictory emotions that can’t both logically be true. Explore this sentence deeply, until you determine which one of the two, is true. Then you’ll have you’re answer.

 

[dozitgetchahi]

“I still love practicing emergency medicine but just hate what it's become“

These are two contradictory emotions that can’t both logically be true. Explore this sentence deeply, until you determine which one of the two, is true. Then you’ll have you’re answer.

My first thought also.

My suspicion is that this is more like “I loved practicing emergency medicine in the past, but the practice of emergency medicine is no longer like the way it was before, and I haven’t yet come to terms with that fact”.

 

[Birdstrike]

My first thought also.

My suspicion is that this is more like “I loved practicing emergency medicine in the past, but the practice of emergency medicine is no longer like the way it was before, and I haven’t yet come to terms with that fact”.

For me it was, “I love what Emergency Medicine should be and could be, but despise what it has become.”

 

[endo]

So this is going to be another "Should I leave EM?" post. No eye-rolls please.

Worked community ER for > 10 years. Early 40s, and finally hit my FI number.

Experienced firsthand all the usual reasons for wanting to quit.

• Sued twice, which led to a period of depression and suicidal thoughts. Thankfully, both cases were dismissed after years of litigation, but still fear the next possible lawsuit
• I've worked at a lot of different hospitals in multiple cities and have never found a unicorn practice. All have been plagued by some or all of the following: loss of autonomy, a difficult patient population, unreasonable expectations (high pph, responsible for floor codes/procedures), hostile consultants, difficult admits/transfers, understaffed ancillary staff, etc
• Night shifts getting harder in my 40s
• Most shifts are so brutal now that I have palpitations and a sinking feeling of despair on my drive to work.

But the thing is, I still love practicing emergency medicine but just hate what it's become. Also, feel a bit guilty about retiring early, read some EM statistics that most retire in their 50s.

I know there are a lot of headwinds - physician oversupply, declining reimbursements, midlevel creep, corporatization.

But, are there any reasons for optimism? Anything on the horizon that might reverse the decline?
Maybe unionization or HCA reversing course and closing their residencies? Perhaps real tort reform, I know GA once had gross negligence standard for EM but got overturned.

Seems with anticipated physician oversupply, quitting for > 1 year likely means I won't be able to return. Just looking for reasons not to quit.

Lastly, for the parents, do you feel your children would be embarrassed that you retired early? I feel like I've tied my identity and take pride to being a doctor.

- Just another burned out ER doc.

I was in a similar situation. I tried to push through and ignore the fact that I hated going to work. At 17 years I left my private group job and went to the VA. Even doing that was difficult- a pay and ego hit. But I was done with the grind. Now I see ~1pph and have immunity from lawsuits. The patients are nicer, the anxiety level is way less.

I also had two lawsuits in my 21 years in EM - 1 as a resident and 1 as an attending. Both dismissed, but both dragged on for 2-3 years and added tons of stress - I think these experiences burned me out as much as the grind / metrics / irritating patients. I knew if I was sued again I would not be able to continue working as I would be cooked to a crisp.

 

[Porfirio]

The old days are dead. Judge what you have at hand. You are lucky to have this freedom. You could find a place that has less of this however you will have to travel.

It might be time to just pivot to something else, and that is ok. Remember, you pivoted when you went to medical school, pivoted again for residency, and pivoted when you became an attending. Pivot your career again - who knows what wonderful things might happen.

 

[WhatJobDoIPick]

I hear you bro.

Spent two years at my first job and four at my second. Hoping that the switch to SDG is the magic pill. We'll see, who knows.

I don't have any great wisdom for you. It seems like EM has become detrimental to both your physical and mental health.

The environment has gotten worse every year I've been in EM. It's not going back.

 

[RustedFox]

. If it is more an intellectual response and worry about what might happen to you personally should you lose, it’s almost unheard of for you to have Personal losses even if you lose a suit well above your malpractice insurance limits.

Yeah. Been thru jackpot lawsuit.
Didn't coat me a dime, but pissed me off interminably.

 

[namethatsmell]

Given your financial independence, you have won the game. You get to decide if you wanna stop on YOUR terms, which is a blessing you’ve worked hard to earn. You don’t owe anybody anything with regards to choosing to continue to slug it out in the trenches.

Based on what you’ve written, it seems like you’d value working in a place where it’s almost impossible to be personally sued. If so you should definitely check out prn work at your local military hospital, VA, IHS, Kaiser, academic or municipal place—ie anyplace that offers the equivalent of sovereign immunity. I did this and it was remarkable how much my stress level decreased.

That said, if you want to do something outside of the ED there are so many options both clinical and non-clinical.

Whatever you do, just recognize you are solely in the drivers seat of the decision to be made. Nobody can forecast what the “right” move will be. You just have to be willing to trust yourself a little bit, take a leap, and see how things go. These type of career decisions are not irreversible, and you can always make further changes as needed.

 

[ToastyEM80s]

Appreciate all the advice from everyone. Thank You.

Everyone's posts have given me a lot of valuable insight. Agree with the post that said,

“I loved practicing emergency medicine in the past, but the practice of emergency medicine is no longer like the way it was before, and I haven’t yet come to terms with that fact”

Seems I'm still in the denial/bargaining phases of grief. We're all workaholics, otherwise we wouldn't have made it through training. I've always assumed that this would be a life-long career, but as many pointed out, it's ultimately just a job. Working shouldn't come at the cost of both my mental and physical health.

It seems I'm unknowingly hoping that emergency medicine will return to the old days. What strikes me most is that there haven't been any posts

about any potentially upcoming catalysts that might materially reform working conditions. I do know there is a senate committee investigating the impact of private equity in emergency medicine, but I doubt this will lead to any meaningful change.

For those suggesting sovereign-immunity sites. Definitely open to working at such sites. However, in my recent job search, I'm surprised how tight the market has become compared to a decade ago. I'm not really willing to travel either, I travelled quite a bit to pursue high paying gigs and the thought of staying in another motel nauseates me lol.

For now, I've decided to work at a slow free-standing and mull over my next steps.

 

[Mount Asclepius]

Back when I started, I went into EM expecting a 10 year career. 10 years with decent compensation and saving results in FIRE. I think that was a more realistic approach than thinking EM is a life long career. You don’t do EM because you live and die to practice medicine. We aren’t old school general surgeons, or lifer neurosurgeons. We live just as much for the life outside of medicine. EM has a lot to offer. It just doesn’t offer more than 10-20 years for most.

 

[ToastyEM80s]

I would like to explore the idea of teaching.

Is there such a thing as volunteer faculty? If so, could anyone point me to some resources on how to obtain such a position?

 

[Robotic Wis-Hipple]

Dude, quit. Take a couple months off and turn your brain off for awhile. Go visit friends/family you haven’t seen as much as you’d like, go on a trip you’ve had your eye on. Then, with a clear head, consider the teaching or few locums shifts/month future and work on that.

You’ve put in your time, you’ve saved your money, and you don’t owe anyone else a thing. Palpitations and depression about going to work or dealing with a F’n nurse stupidvisor? Nope. Go live.

 

[WorkNoteEmergency]

I got all the way out. I tried working 1-2 shifts per month for 3-4 months but found that was still too much. It is hard knowing that you’re making less money than your potential (and your peers) and also hard to start dipping into the nest egg, even when you know you have enough. I have a part time WFH (mostly) job that covers 85% of expenses. Don’t forget that you have an MD or DO and people will pay you for that outside of the ER. Don’t be that guy or gal who has a massive stroke or MI the day after retiring 10 years too late.

 

[southerndoc]

I'm glad I'm not there. I'm almost 50 and still don't regret going to work. Yes, there are some days that I don't feel well that I wish I had the day off just like with any career, but 99% of the time I still love what I do. I have fun at work. I've been offered a full-time position outside the ER, and although I really want it, my desire to continue practicing clinically may keep me from applying. I plan to continue working until I'm 70 (my magical number).

 

[namethatsmell]

For those suggesting sovereign-immunity sites. Definitely open to working at such sites. However, in my recent job search, I'm surprised how tight the market has become compared to a decade ago. I'm not really willing to travel either, I travelled quite a bit to pursue high paying gigs and the thought of staying in another motel nauseates me lol.

Competition for these type of jobs has definitely increased. With one exception, the opportunities I found over the years to work at sovereign immunity type gigs were at places that weren't advertising. With the exception of the worst year of covid, even the better staffed EDs all have months of short-staffing and most are happy to have a solid/normal prn doc on the roster to help fill the gaps. If you have any shops like this within a tolerable driving distance for you, cold-call/email them.

I'm glad I'm not there. I'm almost 50 and still don't regret going to work. Yes, there are some days that I don't feel well that I wish I had the day off just like with any career, but 99% of the time I still love what I do. I have fun at work. I've been offered a full-time position outside the ER, and although I really want it, my desire to continue practicing clinically may keep me from applying. I plan to continue working until I'm 70 (my magical number).

If this is what you want, more power to you. The country needs as many good physicians practicing as it can get.

 

[southerndoc]

If this is what you want, more power to you. The country needs as many good physicians practicing as it can get.

Whoa, whoa, whoa! Let's not take it too far here. Nobody said I was a good physician. Set the bar low and you will always exceed!

 

[Splenda88]

Whoa, whoa, whoa! Let's not take it too far here. Nobody said I was a good physician. Set the bar low and you will always exceed!

If you are the person that I worked with, I can attest you are a good physician.

 

[miacomet]

Appreciate all the advice from everyone. Thank You.

Everyone's posts have given me a lot of valuable insight. Agree with the post that said,

“I loved practicing emergency medicine in the past, but the practice of emergency medicine is no longer like the way it was before, and I haven’t yet come to terms with that fact”

Seems I'm still in the denial/bargaining phases of grief. We're all workaholics, otherwise we wouldn't have made it through training. I've always assumed that this would be a life-long career, but as many pointed out, it's ultimately just a job. Working shouldn't come at the cost of both my mental and physical health.

It seems I'm unknowingly hoping that emergency medicine will return to the old days. What strikes me most is that there haven't been any posts

about any potentially upcoming catalysts that might materially reform working conditions. I do know there is a senate committee investigating the impact of private equity in emergency medicine, but I doubt this will lead to any meaningful change.

For those suggesting sovereign-immunity sites. Definitely open to working at such sites. However, in my recent job search, I'm surprised how tight the market has become compared to a decade ago. I'm not really willing to travel either, I travelled quite a bit to pursue high paying gigs and the thought of staying in another motel nauseates me lol.

For now, I've decided to work at a slow free-standing and mull over my next steps.

The workaholism is what really made it hard for me to quit. In many ways I wish I'd done plastics or general surgery where I could continue being a workaholic. EM is weirdly not a great field for workaholics because it just burns you out and then you don't know what to do with yourself, which is something I never saw coming- I never realized how much EM and medicine were a part of my identity, nor how much I loved them (if not what they've become) nor how to deal with quitting nor how to fill my day.

I quit and took over a year off at a job I'd worked at for 13 years (and made my FI number) and that was in many ways a unicorn, but had become toxic to me (huge amounts of nurse bullying, huge gender imbalance, lots of nights and weekends). I credentialed in that time at one hospital that was not a good fit. I then credentialed at another hospital and started a year to the day after I quit. It's a temporary job; I wish it were perm but they don't have openings and it's true PRN gigs are hard to find. So it will be over in July and I have no idea what I will do with myself after that. I love this job though, and it's been a revelation. In that year off I realized medicine truly is the greatest career, and I realized I was absolutely heartbroken that I picked EM, which just isn't a long career.

Like you, I don't know what to do next. I'm 51 which is waaaay too young to retire. No idea what to do.

 

[Splenda88]

Like you, I don't know what to do next. I'm 51 which is waaaay too young to retire. No idea what to do.

You don't have to retire if it's not the goal. You can work on your own term, which might make EM more enjoyable.

I like my job but I am already foreseeing that working on my own term will change my job from a 6.5 to an 8 in term of desirability.

 

[miacomet]

You don't have to retire if it's not the goal. You can work on your own term, which might make EM more enjoyable.

I like my job but I am already foreseeing that working on my own term will change my job from a 6.5 to an 8 in term of desirability.

Sure, except there just aren't that many jobs out there, even fewer per diem and while I needed to quit my job two years ago, I really miss it.

I'm trying hard to find a 6 shift a month gig and it's just not happening. I hope it does. It won't in my state.

 

[emergentmd]

OP, only you can answer this question. I think you need to look deeper because being sued twice leading two depression/anxiety and suicidal thoughts are not normal. Getting out of EM may not fix these issues.

We practice medicine, lawsuits typically have little to do with how good of a doc you are.

 

[laserbeam]

Seems with anticipated physician oversupply, quitting for > 1 year likely means I won't be able to return. Just looking for reasons not to quit.

Is there physician oversupply in general or just EM physician? I am in hospital medicine, it appears at least there is no shortage of us :-(

 

[emergentmd]

There are a shortage of we docs right now or atleast those wanting to work. The locums market is hot and there are jobs everywhere.

 

[alpinism]

Sure, except there just aren't that many jobs out there, even fewer per diem and while I needed to quit my job two years ago, I really miss it.

I'm trying hard to find a 6 shift a month gig and it's just not happening. I hope it does. It won't in my state.

I just laugh whenever anyone suggests to cut down to 4-8 shifts a month if you start hating the shifts at your hospital.

Pretty sure most of these people have never actually done it and just assume its a quick and easy fix for most docs.

These part time jobs are few and far in between in most cities and its normally only at severely understaffed hospitals.

 

[Splenda88]

I just laugh whenever anyone suggests to cut down to 4-8 shifts a month if you start hating the shifts at your hospital.

Pretty sure most of these people have never actually done it and just assume its a quick and easy fix for most docs.

These part time jobs are few and far in between in most cities and its normally only at severely understaffed hospitals.

I suggested that because I thought it was not something difficult to find. We have a few ED docs at my shop, and one that I am acquainted with that does 3-4 night shifts every month. He just come to town for 4-5 days and then leave.

In fact, the ED group here own by 2 of the ED docs have a townhome for these docs who don't live here to stay in when they come.

 

[comp1]

So did your SI resolve just because the lawsuits were dismissed or did you do some formal work on yourself in the interim? If the former...you need to get out, at the very least, of your current job because statistically you absolutely will be sued again. While you definitely don't owe it to your kids to practice until 70, you do kind of owe it to them not to kill yourself. Physicians are unfortunately quite good at suicide if you let yourself get in that situation again without preparing for it. The good news is that it can be a lot easier to make a change in yourself than in the economic system of a very large country. Also second the person talking about the VA above. Yes, there can be a lawsuit in the VA, but it's much rarer because the plaintiff's attorneys have to overcome the FTCA to even start the process which unless it's just absolutely horribly gross negligence (and often even if it is), it's just not worth it financially to try. Also, it wouldn't technically be against you. It's also just a less stressful kind of life in general and the VA could definitely use more people who take pride in being a doctor. Can't promise super nice patients, however....

 

[emergentmd]

I just laugh whenever anyone suggests to cut down to 4-8 shifts a month if you start hating the shifts at your hospital.

Pretty sure most of these people have never actually done it and just assume its a quick and easy fix for most docs.

These part time jobs are few and far in between in most cities and its normally only at severely understaffed hospitals.

When I quit my job and did locums, I could do 4 shifts very easily. I can do it now in a big Tx city. I get offers for part time, prn, full time, locums. You name it.

If you are stuck in one city that doesn’t have it then that is life. It’s not everywhere but it’s not hard.

 

[miacomet]

So did your SI resolve just because the lawsuits were dismissed or did you do some formal work on yourself in the interim? If the former...you need to get out, at the very least, of your current job because statistically you absolutely will be sued again. While you definitely don't owe it to your kids to practice until 70, you do kind of owe it to them not to kill yourself. Physicians are unfortunately quite good at suicide if you let yourself get in that situation again without preparing for it. The good news is that it can be a lot easier to make a change in yourself than in the economic system of a very large country. Also second the person talking about the VA above. Yes, there can be a lawsuit in the VA, but it's much rarer because the plaintiff's attorneys have to overcome the FTCA to even start the process which unless it's just absolutely horribly gross negligence (and often even if it is), it's just not worth it financially to try. Also, it wouldn't technically be against you. It's also just a less stressful kind of life in general and could definitely use more people who take pride in being a doctor. Can't promise super nice patients, however....

I love this because it means those of us without kids are free to kill ourselves. Liberating.

 

[comp1]

I love this because it means those of us without kids are free to kill ourselves. Liberating.

Eh, had the OP specifically mentioned their spouse or parents or anybody else, I would have cited them. Other people are hopefully one of many reasons not to kill yourself.

 

[xaelia]

I just laugh whenever anyone suggests to cut down to 4-8 shifts a month if you start hating the shifts at your hospital.

Interestingly, I can change my FTE at my hospital any time I like (within reason). Went from 0.8 FTE down to 0.5 FTE in order to work 0.3 FTE admin, no problem. Folks coming back from maternity sometimes come back at 0.5 FTE. Retirement glide path is 0.5 FTE. Etc. Mostly the young folks trying to build up their savings eager to pick up additional FTE.

Paradoxically, working less means I frequently end up making just as much – because I'm available to come in on short notice and cover part of a sick call at 2-3x my base hourly rate.

If the OP is flexible and open to travel, there's lots of fixed-term opportunity here in New Zealand ....

 

[DeadCactus]

It sounds like you don't really love emergency medicine, you love the idea of what you wish it was. It sounds like your options are retire, continue and be unhappy, move somewhere that practices emergency medicine the way you want, or switch to another career.

 

[ToastyEM80s]

So did your SI resolve just because the lawsuits were dismissed or did you do some formal work on yourself in the interim? If the former...you need to get out, at the very least, of your current job because statistically you absolutely will be sued again. While you definitely don't owe it to your kids to practice until 70, you do kind of owe it to them not to kill yourself. Physicians are unfortunately quite good at suicide if you let yourself get in that situation again without preparing for it. The good news is that it can be a lot easier to make a change in yourself than in the economic system of a very large country. Also second the person talking about the VA above. Yes, there can be a lawsuit in the VA, but it's much rarer because the plaintiff's attorneys have to overcome the FTCA to even start the process which unless it's just absolutely horribly gross negligence (and often even if it is), it's just not worth it financially to try. Also, it wouldn't technically be against you. It's also just a less stressful kind of life in general and the VA could definitely use more people who take pride in being a doctor. Can't promise super nice patients, however....

The depression and SI resolved after the dismissals.

It was the factor of two things:

1. It was early in my career and I wasn't sure of the impact. I was far from FI, in quite a bit of student loan debt, and impact on my career/future credentialing.
2. The opposing side is quite good at tearing down the ego of a defendant physician. They will trot out "experts" with testimonies to paint you as an uncaring and incompetent. If it's your first lawsuit, it can be a psychological roller coaster. I also had very few support systems - I was single at the time and working too much - to the point that I had few friends or social relationships. Not to mention, these were travel gigs - high paying but socially very isolating.

I think if I were to get sued again, it wouldn't have the mental health impact as before. I know what to expect now, I am FI and at this point not concerned about impacts to future credentialing/hiring. Having said that, it would be nice to work in a protected setting.

After my experience though, I think we really do need significant malpractice reform to protect physicians who are early in their career.

 

[ToastyEM80s]

I just laugh whenever anyone suggests to cut down to 4-8 shifts a month if you start hating the shifts at your hospital.

Pretty sure most of these people have never actually done it and just assume its a quick and easy fix for most docs.

These part time jobs are few and far in between in most cities and its normally only at severely understaffed hospitals.

This has been my experience as well.

Jobs are plentiful if you are agnostic to location or willing to travel.

However, PRN jobs within a desirable metro is fairly nonexistent unless you are willing to start out full-time and downgrade to PRN/part time. I haven't found a hospital-based ER in my area that's willing to credential for PRN status

 

[ToastyEM80s]

I'm glad I'm not there. I'm almost 50 and still don't regret going to work. Yes, there are some days that I don't feel well that I wish I had the day off just like with any career, but 99% of the time I still love what I do. I have fun at work. I've been offered a full-time position outside the ER, and although I really want it, my desire to

continue practicing clinically may keep me from applying. I plan to continue working until I'm 70 (my magical number).

That's fantastic. Skilled EM physicians older than 60 seems to be a rare treasure now-a-days.

Just curious, but what do you think was key to maintaining your longevity in EM?

Are you working for a CMG? Academic? SDG?

I mostly worked with CMG's - which I think partly led to my early burn out. I heard from former colleagues that certain practices (ie Kaiser) will do things like round-robin patient assignments and cap PPH. Is there something about your practice that is unique compared to a typical CMG?

Some of my younger colleagues ask me what type of practice I felt was ideal. Unfortunately, I usually have no answer as I've really only worked with CMGs.

 

[emergentmd]

2. The opposing side is quite good at tearing down the ego of a defendant physician. They will trot out "experts" with testimonies to paint you as an uncaring and incompetent. If it's your first lawsuit, it can be a psychological roller coaster. I also had very few support systems - I was single at the time and working too much - to the point that I had few friends or social relationships. Not to mention, these were travel gigs - high paying but socially very isolating.

You are looking at lawsuits all wrong. It has nothing to do with you but everything to do with getting top dollars. No one cares is you were right, wrong, negligent. Experts don't care either.

Also, most lawsuits do not go to trial because both sides understand the cost and risk. It is just not worth it from both sides. Its a game for the Lawyers to get alot of $$$, the plaintiff to get alittle $$, and you settle.

In my only lawsuit in over 20 years, both sides were happy to settle. I did nothing wrong and was given the option to fight or settle. Fight, even if I win gets me hours in the courts with constant schedule changes and loss of $$$. Settle, and the insurance pays for it.

There is a reason I pay for insurance.

 

[miacomet]

The depression and SI resolved after the dismissals.

It was the factor of two things:

1. It was early in my career and I wasn't sure of the impact. I was far from FI, in quite a bit of student loan debt, and impact on my career/future credentialing.
2. The opposing side is quite good at tearing down the ego of a defendant physician. They will trot out "experts" with testimonies to paint you as an uncaring and incompetent. If it's your first lawsuit, it can be a psychological roller coaster. I also had very few support systems - I was single at the time and working too much - to the point that I had few friends or social relationships. Not to mention, these were travel gigs - high paying but socially very isolating.

I think if I were to get sued again, it wouldn't have the mental health impact as before. I know what to expect now, I am FI and at this point not concerned about impacts to future credentialing/hiring. Having said that, it would be nice to work in a protected setting.

After my experience though, I think we really do need significant malpractice reform to protect physicians who are early in their career.

Are you in a crappy state for medmal? IL or PA etc?

 

[ToastyEM80s]

You are looking at lawsuits all wrong. It has nothing to do with you but everything to do with getting top dollars. No one cares is you were right, wrong, negligent. Experts don't care either.

Also, most lawsuits do not go to trial because both sides understand the cost and risk. It is just not worth it from both sides. Its a game for the Lawyers to get alot of $$$, the plaintiff to get alittle $$, and you settle.

In my only lawsuit in over 20 years, both sides were happy to settle. I did nothing wrong and was given the option to fight or settle. Fight, even if I win gets me hours in the courts with constant schedule changes and loss of $$$. Settle, and the insurance pays for it.

There is a reason I pay for insurance.

1. I understand that now, having gone through two lawsuits and more mature in my career. However, it's not how someone newly practicing, in their first lawsuit views it.

2. One dismissed early, one did go to trial but verdict was in my favor and dismissed with prejudice. These cases came back to back, which further added to my stress. The one that went to trial, the other side wanted unreasonable sum, so my insurance agency refused to settle. Trust me when I say that the cases that go to trial are mentally very difficult to overcome.

The plantiff's side is incentivized to convince laypeople that you were incompetent and frame you in the worst of lights. You have to sit there and quietly listen to it for days. I'm sure many have the mental fortitude to withstand those kind of mental assaults. I know logically this was all about money (I knew this because my lawyers were amazing and able to subpoena the clinical notes from the defendant's psychiatrist). However, for someone like me who has tied their identity to being a good doctor, it was difficult not to succumb to depression. When you are in deep depression, you are not rational regarding things like a lawsuit's impact on one's career, likelihood of over-the-limit awards.

Lastly, we do need serious mental health reform for physicians. Every credentialing form, we have to check off the box that says that you have no psychiatric illness that may your physician duties. For me, that prevented me from seeking mental health assistance.

 

[ToastyEM80s]

Are you in a crappy state for medmal? IL or PA etc?

Not IL or PA, but a state with ZERO tort reform.