Tell me why I SHOULD still pursue EM

[Kr#36]

This forum in general tends to lean towards dissuading applicants from applying EM. While I've become pretty versed in the shortcomings and (based on the posts here) the rapid downfall of the field into oblivion, I find it impossible to believe that it is ALL doom and gloom as tons of applicants flock to the field every year. What are some good things that still exist and likely will still exist in 10 or 20 years?

For me I am interested in the breadth of the field, the opportunity to care for a population that most people don't want to care for, the fact that its the shortest residency of the fields I'm considering, and the opportunity to work nights/overall fewer hours for the same amount of money other fields make with longer hours (anesthesiology, radiology, surgery).

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[Jabbed]

This forum in general tends to lean towards dissuading applicants from applying EM. While I've become pretty versed in the shortcomings and (based on the posts here) the rapid downfall of the field into oblivion, I find it impossible to believe that it is ALL doom and gloom as tons of applicants flock to the field every year. What are some good things that still exist and likely will still exist in 10 or 20 years?

For me I am interested in the breadth of the field, the opportunity to care for a population that most people don't want to care for, the fact that its the shortest residency of the fields I'm considering, and the opportunity to work nights/overall fewer hours for the same amount of money other fields make with longer hours (anesthesiology, radiology, surgery).

It's pretty fun at times. In the last week I had a harrowing intubation of a severe angioedema, whip stitched an arterial UE bleed, caught a subtle left main STEMI, reduced a nursemaid's elbow, resuscitated a young DKAer that came in with a pH of 6.8 and SBP of 60, dug a small metallic foreign body out of a guy's hand, completely took away someone's hip fracture pain with a good nerve block.

I also did a fecal disimpaction, had to deal with opiate-seekers, was forced to over work-up a guy with probably fake neuro findings, had to make a call to DCF for possible elder abuse that probably did more harm than good, and made a few death notifications.

It's a very unique field.

 

[DO3]

You can make $300k working 12-13 days a month and a touch over 100 hours. Not many fields where you can do that.

 

[cyanide12345678]

You can make $300k working 12-13 days a month and a touch over 100 hours. Not many fields where you can do that.

We don't know if this will continue 5-10 years from now. Compensation is under a lot of pressure.

 

[Fox800]

It's okay - if you find a place where you are well-supported. Money is not nearly as good as it used to be. About 5 years ago it was easy to find shifts for $275-325 per hour throughout the country. TX was a honeypot - now it's a mediocre dumpster fire. Working in DFW or Austin for $200 per hour, assuming you can elbow your way into a job.

Way, WAY too many residencies. Thanks HCA for contributing to the destruction of EM. Don't work at HCA. Don't work for USACS at a low-ball rate.

Too many midlevels that have no clue what they are doing. But admin loves them because ra ra midlevels and they are cheaper.

Try to find a place that has more positives than negatives. Malignant administration, crappy EMR, crappy nursing/nursing mafia, bad medical malpractice climate. These things wear on you.

I'm in student loan repayment mode so I sacrificed some degree of cush for higher pay. I have to travel for work to make money. My feelings would be much different and I'd probably be working in a different place or different country if my loans were gone.

 

[WilcoWorld]

I don't mean to sound rude, this is my genuine advice: If you need to be convinced to pursue a career in EM, then you probably shouldn't pursue a career in EM.

This field isn't for everyone, it's not even a field for most.

 

[Kr#36]

I don't mean to sound rude, this is my genuine advice: If you need to be convinced to pursue a career in EM, then you probably shouldn't pursue a career in EM.

This field isn't for everyone, it's not even a field for most.

I'm not looking to be convinced of anything one way or the other. Experiences from a student's perspective are only a small piece of the puzzle for any field. I just know people tend to focus on the negatives of something (this forum is definitely not an exception) and wanted to hear what some of the positives were from the viewpoint of people already in practice.

 

[Tenk]

It’s a job. It has one of the best $/hr and it’s purely shift based with most jobs having zero call. It also gives you a lot of weekdays off in case you love doing stuff and want to avoid any weekend crowds like me.

In terms of the job itself I think EM gives you the most practical toolbox outside of the hospital as well which is cool.

 

[Rekt]

These threads always come down to "EM is the best specialty because you have to work less". So it has nothing to do with EM itself.

You can make $300k working 12-13 days a month and a touch over 100 hours. Not many fields where you can do that.

Also this isn't true anymore. So don't pick it for compensation.

 

[Kr#36]

These threads always come down to "EM is the best specialty because you have to work less". So it has nothing to do with EM itself.



Also this isn't true anymore. So don't pick it for compensation.

Are EM docs working more hours than in the past? The most recent compensation data I can find shows EM well over 300k

 

[Porfirio]

Compensation is going down. Do not pick EM just for the money. Do what you love.

 

[Birdstrike]

This forum in general tends to lean towards dissuading applicants from applying EM. While I've become pretty versed in the shortcomings and (based on the posts here) the rapid downfall of the field into oblivion, I find it impossible to believe that it is ALL doom and gloom as tons of applicants flock to the field every year. What are some good things that still exist and likely will still exist in 10 or 20 years?

For me I am interested in the breadth of the field, the opportunity to care for a population that most people don't want to care for, the fact that its the shortest residency of the fields I'm considering, and the opportunity to work nights/overall fewer hours for the same amount of money other fields make with longer hours (anesthesiology, radiology, surgery).

Us telling you why should should pursue EM defeats the purpose You tell us why you should “still pursue EM.”

 

[thegenius]

For me I am interested in the breadth of the field, the opportunity to care for a population that most people don't want to care for, the fact that its the shortest residency of the fields I'm considering, and the opportunity to work nights/overall fewer hours for the same amount of money other fields make with longer hours (anesthesiology, radiology, surgery).

There you go, you answered it yourself! Well done

 

[The Knife & Gun Club]

I’m a resident, but I personally really enjoy the circus aspect of EM. Like last night my manic patient shackled to hall bed 3 started having a rap battle with my drunk guy in hall 4.

 

[cyanide12345678]

For me I am interested in the breadth of the field, the opportunity to care for a population that most people don't want to care for, the fact that its the shortest residency of the fields I'm considering, and the opportunity to work nights/overall fewer hours for the same amount of money other fields make with longer hours (anesthesiology, radiology, surgery).

This was my rationality when i went in. 3 year residency. 120-140 hrs per month, which is significantly less than most specialties. No call days. Lots of days off of work.

But i would probably pick anesthesia over EM now. The greater number of hours they do, are nearly not the same intensity of the work an EM doctor does. You know how they say that 1 EM hour is equal to 1.5 hours of most other specialties. That is absolutely true. You truly feel the time pressure and volume pressure as an attending.

Pay is falling, but still decent. It probably will be worse in 5-10 years.

Working nights is easier when young. This is coming from a nocturnist, once you have a family and kids, it's truly hard to stay a nocturnist, and even harder to switch between days and nights. I work nights only, it's not as easy as i thought it would be.

The opportunity to care for those that no one else cares for. Used to be something i wanted to do. But there are two kinds of in need people. One type that truly needs help, they don't game the system, are nice genuine people, those are very few, but a true pleasure to take care of. These are the people that rejuvenate your soul. Then there are the people who abuse the ER. They have no copay to the emergency department or do not pay their bill, so they utilize the emergency department as a convenience care. One guy was seen 178 times in a year in my training shop. That is abusing the system. A lot of these patients have been kicked out from their pain clinic, their pcps, and then we deal with them. They will happily call your admin and complain too when you appropriately don't prescribe a bunch of narcotics. Literally my medical director called me to change the diagnosis on a patient a week ago because she complained about the "opoid over dose" diagnosis.

The reality is... The biggest positive of emergency medicine is that you don't work as much. Which says a lot about the field and how people feel about it.

The money is going away, the patients are amongst the hardest population, the job is stressful, procedures get really old and annoying when 5 people just dropped in and you're thinking about how long that Central line will take and how many patients will be in the waiting room when you come out. The nights get old, the shift work hurts your health.

Pick anesthesia, pm&r, radiology, derm, optho, psych. 10 years down the line, you'll be thankful when you won't be as burned out.

 

[Shufflin]

....the opportunity to care for a population that most people don't want to care for, the fact that its the shortest residency of the fields I'm considering, and the opportunity to work nights/overall fewer hours for the same amount of money other fields make with longer hours (anesthesiology, radiology, surgery).

In psych we care for people most don't want to care for, and our pay to hours work ratio is only going up in many parts with a lot less stress/burnout.

 

[cyanide12345678]

Over time interacting with the standard ED population, you probably won’t completely retain your desire of wanting to care for the population that most don’t want to care for. There is a reason most don’t want to take care of them. EPs often go into the field partially due to a sense of wanting to help others, yet many altruistic people lose that desire over time.

Completing the shortest residency will no longer matter to you 10-20 years down the road.

You probably won’t want to work nights 10-20 years down the road.
This is more true your first year out. As the years pass by you get quicker in your independent decision making. Surges no longer stress you near as much. Most people aren’t actively dying. You get better at managing multiple sick patients at once. You can only see so many people at a time anyways.

Not sure anyone should go into it thinking nights are easy. They take a toll. You choose them for the trade off of more money, a better schedule or other perks. You don’t do them because they are easy. At a very low volume shop nights may be easier, but at any place with volume the staffing and amount of resources are often decreased making the job harder.

You need a better medical director. They should shield you from this and never ask you to change a diagnosis like that.

You become more facile and perform procedures with greater speed over time. You are competent after you graduate residency, but you become even better over further time. Slow is smooth and smooth is fast. If you feel busy and feel the pressure of the waiting room while doing a procedure it will take you longer. I think over time you also realize you don’t really have to do a lot of procedures you thought you had to and so you stop doing them if you are busy. Some LPs can wait. You can run peripheral vasopressors if you are slammed and then the intensivist can consider putting in a CVC in a less chaotic environment if the patient has an escalating pressor requirement.

@cyanide12345678 your post has a lot of good points, but you discussed many of the negatives and not the positive attributes of EM that the OP was looking to hear about.

The surges still stress me out. But i work at a single coverage shop and often see 5 an hour the first few hours of my shift. I've gotten really good at managing multiple sick people and had the joys of running two cardiac arrests simultaneously recently a few days ago.

I know i didn't highlight that many positives. But OP is stating some positives that Drew me to emergency medicine as well. But they aren't really positives over the long term and i wanted to point that out.

When i said, nights were not easier, i didn't mean volume. I see as much as the day guys, with sometimes less staff. I meant the ability to have a normal life when working nights. Before i had a baby, i stayed on a nocturnist schedule. Now with my wife working and a baby that's awake in the mornings, the switching between days and nights sucks between days on and off. So someone may think they prefer nights, but in reality, a consistent morning schedule is probably better.

 

[SeekerOfTheTree]

The surges still stress me out. But i work at a single coverage shop and often see 5 an hour the few hours of my shift. I've gotten really good at managing multiple sick people and had the joys of running two cardiac arrests simultaneously recently a few days ago.

I know i didn't highlight that many positives. But OP is stating some positives that Drew me to emergency medicine as well. But they aren't really positives over the long term and i wanted to point that out.

When i said, nights were not easier, i didn't mean volume. I see as much as the day guys, with sometimes less staff. I meant the ability to have a normal life when working nights. Before i had a baby, i stayed on a nocturnist schedule. Now with my wife working and a baby that's awake in the mornings, the switching between days and nights sucks between days on and off. So someone may think they prefer nights, but in reality, a consistent morning schedule is probably better.

The night thing I agree with. Half the people that go into ED think nights are great and I was one of them. You couldn't convince me otherwise. I have worked night straight for 5 years outside of residency. Gradually I have seen it take a toll on me. The health does suffer. Your 4 mile daily runs aren't as easy and the weight gain creeps up. Your switch days suck the life out of you. The sleep back sucks the life out of you. I had that same mentality that nights are amazing and I can do them forever but I think eventually I will have to give them up.

I can't think of many positives other than it is shift work and that makes it nice.

 

[cyanide12345678]

My point was that I don’t know why you’d go into it thinking nights would be easier than they are. There is a lot of information out there about the deleterious health effects of working nights and the circadian rhythm disruption in switching back to days. I say this as someone that works nights. I knew it would be hard, and it is.

A lot of people do think nights will work well with their life. I certainly did.

Through college i would sleep around 4-5 am. Then during the preclinical years of med school when classes were streamed online, i slept at 8-9 am and woke up at 4-5 pm.

For someone like me who always used to be awake late at night, i always thought working nights is easier than waking up for a 7 am shift.

I'm just pointing out that even a guy like me who literally sleeps at 9 am most days, im starting to feel the health decline from nights, the weight gain, the disruption to the circadian cycle. And my preference for nights is starting to wane.

It just doesn't work long term. I went into it thinking the same thing as OP that i would prefer nights. I was single then, but now i have a family. Wait till you have a family.

 

[TheSingularity]

I spent the first few years of my career working at **** holes with team health special ops. Paid off my ~200K loans 1.5 yrs after residency graduation and still lived however I wanted while maintaining a high savings rate.

I was hella stressed out though. The travel sucked and the work was taxing AF.

Fast forward to now. I took a pay cut and now make ~200/hr in a "low paying" area of the country. However, I work in a place where the leadership is phenomenal, the EMR is great, the pph is < 2, the attending staffing is high. I am waaaaay less stressed out. I also get to teach residents which is cool. Yes, the place has its problems here and there, but overall, it's a unicorn job.

If I were advising a medical student now, I would probably say to try to pick a specialty that allow you the lowest reliance on hospitals and insurance companies as possible. Derm (although increasingly being bought up by private equity) and cash only outpatient psych some to mind. Would never in a million years choose anesthesia at this time as their situation is far worse than EM's right now.

 

[Spikebd]

I spent the first few years of my career working at **** holes with team health special ops. Paid off my ~200K loans 1.5 yrs after residency graduation and still lived however I wanted while maintaining a high savings rate.

I was hella stressed out though. The travel sucked and the work was taxing AF.

Fast forward to now. I took a pay cut and now make ~200/hr in a "low paying" area of the country. However, I work in a place where the leadership is phenomenal, the EMR is great, the pph is < 2, the attending staffing is high. I am waaaaay less stressed out. I also get to teach residents which is cool. Yes, the place has its problems here and there, but overall, it's a unicorn job.

If I were advising a medical student now, I would probably say to try to pick a specialty that allow you the lowest reliance on hospitals and insurance companies as possible. Derm (although increasingly being bought up by private equity) and cash only outpatient psych some to mind. Would never in a million years choose anesthesia at this time as their situation is far worse than EM's right now.

Would you recommend path or rads, despite being reliant on hospitals, purely for the lifestyle aspects of those fields?

 

[namethatsmell]

Buckle up hombre, let's go on a ride.

Much of dissatisfaction in life boils down to a mismatch of expectations vs reality.

You're seeing a lot of doom and gloom here because most of us came into EM with expectations that roughly matched the workplace landscape that existed whenever we entered the field. Most of these expectations are now wildly obsolete as the reality of working many EM jobs has changed drastically in a short amount of time.

So ~10 years ago when I decided to go into EM patient satisfaction scores were a major doom and gloom issue, and they do remain a crappy aspect of the field. CMGs (primarily PE-owned or publicly traded EM companies that function by taking money from the doc's pocket and giving it to the investors) were there, but could often be avoided. But pay was still good, demand for your services was high, and you could still find a decent private group to join in many parts of the country.

Fast-forward ~5 years and many of these private groups have been swallowed up by CMGs and what small or moderate amount of control EM docs had over their workplace diminished significantly. CMGs always seek to cut physician staffing and increase midlevel staffing regardless of patient safety issue (or physician satisfaction which is conspicuously never discussed). Dealing with patient satisfactions issues still sucked. However, pay remained pretty good and you could still find a job almost anywhere you wanted to live...which did not go unnoticed by for-profit hospital chains and CMGs so they began to plant tons of saplings in the form of newly-created EM residencies (created purley out of profit motive and of highly questionable quality).

Fast forward another few years...the CMGs are massive and have effectively cornered the market in many areas so they can pay EM docs 50% less of what salaries were in these exact EDs earlier in the decade (Denver is a great example of this). At the same time they're paying way less, the CMGs are continuing to extract more work from the docs as they slash physician staffing. Oh, and now the plantings of the for-profit hospital chains (ie HCA) and CMGs have started to bear fruit in the form of tons of new EM grads being pumped out each summer from their pop-up EM residencies. So now there's way less employer competition, less demand for EM docs as CMGs have replaced physician jobs with midlevel jobs, and now the market is starting to be flooded with physician supply thanks to our overlords.

To recap these massive changes in recent years: workload/stress/liability has gone up, pay has significantly lowered, and finding a job in many areas is difficult or not possible.

But now let's finish this montage (cue your inner Cartman voice) down EM's recent memory lane...we fast forward to these last few months which nicely highlights the realities of being an EM physician in the present-day. EM docs are frequently put in high-risk covid exposure situations while often lacking appropriate PPE. Perhaps you'd think there would be some temporary hazard pay to compensate for this increased personal risk of just showing up for work. Well, for the most part, the opposite happened: in the face of temporarily depressed volumes (along with skyrocketing acuity) most EM docs have had their hours or pay (or both) cut. And many EM docs have lost their jobs. Why? Because our for-profit employers take every chance to cut costs. Now places that have laid off EM docs are starting to hire EM docs back but only in exchange for a pay cut. And do not be deluded that this happening to EM docs is just "fair" or "market forces"...when HCA made over a billion in profit in Q2 of this year: Hospital chain HCA posts massive Q2 profit despite pandemic slowdown

Notice that nobody talks much about the medicine as being a downside to EM. It's not. The medicine and the stories are great. But you have to put up with a tremendous amount of bul****t to practice EM (as many recent posts on the forum illustrate). And after working for a bit after residency--and proving to yourself that you can indeed practice EM well--then you'll probably join the other 98% of EM docs who realize what they do has value and they're worthy of being treated decently. But the current trajectory sees the value of EM docs being more and more short-changed while at the same time we're being treated worse and worse by our employers...with no clear end in sight.

So close your eyes and imagine yourself in these shoes. Now consider if you're really OK being along for this ride, which will likely keep getting worse for many years before getting better again. If you are really, truly, cool with this...well then maybe EM is for you.

 

[Birdstrike]

This forum in general tends to lean towards dissuading applicants from applying EM. While I've become pretty versed in the shortcomings and (based on the posts here) the rapid downfall of the field into oblivion, I find it impossible to believe that it is ALL doom and gloom as tons of applicants flock to the field every year. What are some good things that still exist and likely will still exist in 10 or 20 years?

For me I am interested in the breadth of the field, the opportunity to care for a population that most people don't want to care for, the fact that its the shortest residency of the fields I'm considering, and the opportunity to work nights/overall fewer hours for the same amount of money other fields make with longer hours (anesthesiology, radiology, surgery).

If someone has to "talk you into" EM, then EM is not for you. Turn around, right now and never look back. Do something you can work 9-5 Mon through Friday, work no nights, weekends, holidays or call, where your stress is at a normal human level, not 9 times that, as it will be in EM. Work a specialty where your biggest problem is you're bored. Because EM is tough. It is the hardest specialty there is. It's not a lifestyle specialty. It wears you down physically, psychologically, emotionally. 1 hours doing EM is 1.5-2 or more hours doing anything else. Money isn't enough to allow the destruction that working rotating nights/days/nights/mid/nights back to days will do to you. Money isn't enough too subject yourself to being jet lagged all the time and chronically dysthymic, emotionally exhausted with a loss of compassion and empathy, while everyone tells you it's not real and if it is, you're flawed, not the specialty. If you need to be an ER doctor to live, or God has called you to do so, that might be enough.

If you can absorb all that, and you still need to do EM to live, and no one can possibly talk you out of it, then EM might be right for you. But if anyone has to talk you into it, it's not. If you do decided EM is right for you, force yourself to do a fellowship that will allow you options to reduce your clinical, circadian-rhythm destroying hours, no matter what anyone tells you. That will be your pressure release valve to deal with mid-career burnout that you'll be told (falsely) one thousand times, is avoidable.

 

[TheSingularity]

neither.

 

[The Knife & Gun Club]

Pick anesthesia, pm&r, radiology, derm, optho, psych. 10 years down the line, you'll be thankful when you won't be as burned out.

To be fair, I’d be bored to tears doing any of the fields you listed Except gas. Maybe Ortho or gen Surg If I could find a way to work at an academic place with tame hours and call burden.

I’m guessing I’m not the only one who rotated through those “lifestyle” fields as a student and was miserable.

Im an intern. I’m sure I’ll burn out and subject y’all to a few whiny posts over the next few years. But I’m sure that burnout would come way faster if I was waking up every day to go to a job that I had 0 interest in or active loathing of (derm).

If you enjoy the practice of EM, go for it. If youre in search of the lifestyle, there’s better options available.

 

[Birdstrike]

To be fair, I’d be bored to tears doing any of the fields you listed ...

This is exactly how I felt as a PGY-1. Fast foreword 7 or 8 years, after being buried under a non-stop Niagara Falls of high-speed, non-stop, pressure-cooked, variety circus of chaos while chronically jet-lagged, I remember saying to myself, “I’d give anything right now to be bored.” I got to the point I remember telling friends, “I’d lay brick 40 hours per week if I could do it and keep my salary.” EM got to the point where the thought of predictable and routine manual labor started to feel comforting.

Fast forward another 7 or 8 years, and I’m much happier doing something that I absolutely 100% would have rejected as “too boring,” 20 years before.

 

[Hot_Sauce]

I spent the first few years of my career working at **** holes with team health special ops. Paid off my ~200K loans 1.5 yrs after residency graduation and still lived however I wanted while maintaining a high savings rate.

I was hella stressed out though. The travel sucked and the work was taxing AF.

Fast forward to now. I took a pay cut and now make ~200/hr in a "low paying" area of the country. However, I work in a place where the leadership is phenomenal, the EMR is great, the pph is < 2, the attending staffing is high. I am waaaaay less stressed out. I also get to teach residents which is cool. Yes, the place has its problems here and there, but overall, it's a unicorn job.

If I were advising a medical student now, I would probably say to try to pick a specialty that allow you the lowest reliance on hospitals and insurance companies as possible. Derm (although increasingly being bought up by private equity) and cash only outpatient psych some to mind. Would never in a million years choose anesthesia at this time as their situation is far worse than EM's right now.

@TheSingularity

Can you elaborate on this? I'm a Psych PGY-1 who also applied and interviewed in EM. After 1 month of residency I am not sure I enjoy psychiatry and have been thinking of switching to Anes and re-applying to the match this year. Seems like Anes is a good gig with hot job market right now.

 

[RustedFox]

This is exactly how I felt as a PGY-1. Fast foreword 7 or 8 years, after being buried under a non-stop Niagara Falls of high-speed, non-stop, pressure-cooked, variety circus of chaos while chronically jet-lagged, I remember saying to myself, “I’d give anything right now to be bored.” I got to the point I remember telling friends, “I’d lay brick 40 hours per week if I could do it and keep my salary.” EM got to the point where the thought of predictable and routine manual labor started to feel comforting.

Fast forward another 7 or 8 years, and I’m much happier doing something that I absolutely 100% would have rejected as “too boring,” 20 years before.

OMG.

So much this, and I'm only 10 years out.


The number-one cause of burnout is....

the patient.


...


Seriously, when the "Karen" meme became a thing, I wanted to kick myself in the ass for not having already thought of it.
There is no more "Emergency Medicine" unless you work in a high-volume, high-acuity environment, or a low-volume, critical access environment.
Everything else is just "Hospital Customer Service" and "Would you like a CT with that, ma'am?"

Its funny; this actually happened to me a week or two ago:
2:41 AM.
66 year old fat male, obvious vasculopath. I can see the CABG scar from across the department.
Chest pain. surPRISE!
I walk in the room.
"Hello, Mister Roberts, I'm RustedFox. I'm here to help. Hello, Mrs.Roberts. I'm going to take excellent care of your husband."
(I actually said that nonsense, because I'm "Customer-Service-Centric".
Mrs. Roberts threw a cellphone in my face without even returning a greeting.

"Heeeah! Befourah you do ANYTHING to MY HUSBAND, you've gonna talk with our daughter in NURSING SCHOOL in CONNECTICUT."

I'm sorry madam, that's against policy. I'm here to help. I -

"Nope! I want another dawktah. Get another one! (there is not one available) Then get your supervisah!"

PLUS, there was the shift last week where the day before I would have to come in two hours early because "we have no PA coverage".

Oh, this is MY fault, now?

You could get PA coverage.

You just don't want to pay to incentivize PA coverage. We have plenty. A simple shift bonus would cover the shift. But instead; administration's solution was "just whip the galley slaves harder".

No respect.

Not from patients.
Not from families.
Not from administration.

Its no longer EMERGENCY MEDICINE.

Its CONVENIENCE MEDICINE with a CUSTOMER SERVICE FELLOWSHIP.

RustedFox out.

 

[Frazier]

Good luck.

 

[SamtheWise]

If you have to ask, just do anesthesia. All the same cool procedures and resuscitations, none of the narcotic seeking hassle. You do EM because you're too punk rock to be able to stand any other field of medicine. If you at all wonder whether EM is for you or not, just do something else, because it's not for you.

 

[Mbekweni]

Lots of doom and gloom on this forum. It's a good job and as good of a job as any I have heard about from my immediate friends and family. I enjoy the medicine of EM but also the time off and flexibility of schedule. I am anticipating that 120+ hours a month, nights and weekends are going to get harder and harder as other have alluded to. I recommend finding a good practice with fair pay but not chasing the high $/hr at the expense of career longevity. I am also trying to pick up more admin roles and experimenting with telemedicine for some added income in low stress, M-F 9-5 times to add the balance. Also focusing on saving as much as I can as early as I can in case reimbursement continues to drop, though to be honest, with the exception of April-June COVID volume and pay cut my income has been rising substantially every year. CMG contracts will likely continue to be leaner and leaner.

 

[Doctor_Strange]

Just remember OP, the same 5 people have been commenting on threads like this for the past 5 years or so with basically the same views. And probably only 1% of all board-certified EM docs use this forum to begin with. Like, I saw the title of this forum and I already knew who to expect and what to expect. I'm not invalidating their experiences or comments, but it is not like we have a great sample size of respondents. What I am trying to say is, you really won't find the answers you are looking for on this forum. Best place to start is an EM rotation and talking to docs in person. I did that -- I asked the same questions you did, I voiced the same concerns you did, and with a little trepidation but lots of awareness, I'm jumping in this fall applying EM.

 

[alpinism]

I wouldn't say this entire forum is all doom and gloom. If anything I think it's one of the few places that provides a clear picture of both the positives and negatives of life out in the real world after finishing residency. While its certainly helpful to speak with EM docs in person during clinical rotations you have to remember that most only work academics which is very different than being out in the community and in addition most aren't going to tell some random med student that they just met that they regret choosing to become an EM physician.

 

[Torsion]

Just remember OP, the same 5 people have been commenting on threads like this for the past 5 years or so with basically the same views. And probably only 1% of all board-certified EM docs use this forum to begin with. Like, I saw the title of this forum and I already knew who to expect and what to expect. I'm not invalidating their experiences or comments, but it is not like we have a great sample size of respondents. What I am trying to say is, you really won't find the answers you are looking for on this forum. Best place to start is an EM rotation and talking to docs in person. I did that -- I asked the same questions you did, I voiced the same concerns you did, and with a little trepidation but lots of awareness, I'm jumping in this fall applying EM.

As of right now I believe there continue to be great paying jobs in well-supported work environments in a variety of attractive cities that can be attained with a little bit of legwork and a willingness to be flexible. When it came time to submit my rank list I favored well-established training programs run by or associated with SDGs who are well supported by there hospitals and have a history of hiring their own into partnership tracks. That may sound too good to be true but I ranked enough of these types of programs to fill a good third to half of my rank list. You just have to do some research and also not have a hatred for vast swaths of the US. I'm very happy with where I've ended up and believe this strategy will pay dividends down the road when I sign my first contract. I believe this because graduating residents have been quite happy with what they've obtained, including jobs within the SDG itself.

 

[Doctor_Strange]

I wouldn't say this entire forum is all doom and gloom. If anything I think it's one of the few places that provides a clear picture of both the positives and negatives of life out in the real world after finishing residency. While its certainly helpful to speak with EM docs in person during clinical rotations you have to remember that most only work academics which is very different than being out in the community and in addition most aren't going to tell some random med student that they just met that they regret choosing to become an EM physician.

I would agree, except this was at a community program and some docs were adjunct and felt more than comfortable telling me some hard truths of the business side of EM which I appreciated. Plus, I've remained friendly with several EM docs from my time as a scribe who also have offered sound advice -- and a fair bit of warning too. All this to say, that SDN is but a narrow slice of the diverse experiences of those who work in EM.

 

[CajunMedic]

I can share a couple of mine as a resident. I came in to medical school, and then EM from a career in EMS, so I was already jaded and had lower expectations on how things were.

1. The breadth of knowledge will definitely be there. I've got great acuity where I'm at, so I can go from an STEMI, to a COPD Exacerbation, to a drug seeker, to a new infective endocarditis, to our favorite homeless frequent flyer, in a span of 6 hours. A lot will depend on where you do residency and eventually practice

2. As many others have said, wanting to take care of those who have fallen through the cracks is noble. However, it gets taxing after a while. You will eventually tire of the "Methamphetamine mee-maw"(yup, actually a thing) after the 3rd shift in a row they've darkened your doorstep and tried to assault one of your nurses. You can only be verbally assaulted so many times, or have the "come to Jesus" meeting with the chronic inebriate who has dedicated their life to the furtherance of the cheap beer industry and the training of medical professionals, before you just quit trying. As my current Chief resident said about our 2 campuses we rotate through "One challenges your mind, the other challenges your soul"

 

[SeekerOfTheTree]

I have posted here intermittently. I have taught students, worked with scribes, written letters for med school, etc....When scribes and students ask me how I like EM I paint a rosy picture. Most people who ask a question have their mind usually made up in my experience and what a random doc is going to say isn't gonna change their mind. I agree with alot of what others are saying. EM is not what it use to be and things have changed for the worse. I found a good place but it took alot of work. There aren't many good places left. If I didn't have the debt I would have gotten out of medicine initially and stuck to tech. You deal with a lot of crap with more uncertainty every year and it isn't worth it.

 

[SeekerOfTheTree]

When you talk to me on a shift do you think I want to open up my heart and tell you about my regrets or end the conversation and tell you things are great and go get 'em tiger. Most of us just wanna do our job and go home.

 

[Birdstrike]

Just remember OP, the same 5 people have been commenting on threads like this for the past 5 years or so with basically the same views. And probably only 1% of all board-certified EM docs use this forum to begin with. Like, I saw the title of this forum and I already knew who to expect and what to expect. I'm not invalidating their experiences or comments, but it is not like we have a great sample size of respondents. What I am trying to say is, you really won't find the answers you are looking for on this forum. Best place to start is an EM rotation and talking to docs in person. I did that -- I asked the same questions you did, I voiced the same concerns you did, and with a little trepidation but lots of awareness, I'm jumping in this fall applying EM.

 

[deleted859535]

Agree with the sentiment in some posts above. Not to argue semantics (I know you're looking for the pros of the specialty), but if you're not sure you want to do EM, then don't do EM.

High pay on hourly basis. No call. No pager. A semi not really lifestyle but somewhat lifestyle specialty if the schedule is your definition of "lifestyle." A doctor's doctor / do something with everything / jack of all trades / resuscitationist / so on.

Meanwhile, lots and lots of bull**** in the specialty, too.

You know how people say you shouldn't do surgery unless you really, really need to be a surgeon to the exclusion of other things in your life?

EM is like that in a sense. The difference is that while the comment about surgery speaks to its rigorous life and anti-lifestyle-specialty nature, saying that about EM is because it is a unique beast in the house of medicine.

You either want to do EM and know deep down that you want to do EM and compare everything to it, or you don't. If you do, good luck; we'll see you down the road. If you don't, then go do something else and never second-guess it.

(And -- as also mentioned -- SDN is not a representative sample of "real life" EM docs though many of us are real life EM docs.)

 

[The Knife & Gun Club]

This is exactly how I felt as a PGY-1. Fast foreword 7 or 8 years, after being buried under a non-stop Niagara Falls of high-speed, non-stop, pressure-cooked, variety circus of chaos while chronically jet-lagged, I remember saying to myself, “I’d give anything right now to be bored.” I got to the point I remember telling friends, “I’d lay brick 40 hours per week if I could do it and keep my salary.” EM got to the point where the thought of predictable and routine manual labor started to feel comforting.

Fast forward another 7 or 8 years, and I’m much happier doing something that I absolutely 100% would have rejected as “too boring,” 20 years before.

I always appreciate hearing your opinions on here, and I couldn’t agree more. By the time I’m 40 I don’t want to be grinding away, just me vs the chart rack and the drunk guy in hall 4 at 3am.

I’m certain I’ll be doing a fellowship - pain, CCM, maybe tox, or something as a bridge to academics.

Only concern is that with the collapse of the EM job market, more people may be trying to go the fellowship/academic route where they can trade higher pay for better improved stability.

 

[Kr#36]

This thread turned out to be exactly what I was hoping for so thank you everyone who has posted their experiences and thoughts. The only advice I really disagree with (not just in regards to my situation but med students trying to choose a specialty in general) is the saying: "if you question EM dont do EM." In reality, the only way for any student to know what they are or are not interested in is to gather as much information, personal experience, and the personal experiences of others and apply all of that in the context of their own goals/wants. Insinuating that we should all "just know" doesn't make much sense to me.

 

[GatorCHOMPions]

This thread turned out to be exactly what I was hoping for so thank you everyone who has posted their experiences and thoughts. The only advice I really disagree with (not just in regards to my situation but med students trying to choose a specialty in general) is the saying: "if you question EM dont do EM." In reality, the only way for any student to know what they are or are not interested in is to gather as much information, personal experience, and the personal experiences of others and apply all of that in the context of their own goals/wants. Insinuating that we should all "just know" doesn't make much sense to me.

The sentiment more accurately is, if you’ve thought through EM as a career and still have questions about your potential happiness, then choose something else. It seems like you have already thought through many of the potential pitfalls that await an EP mid-career. EM will likely not work out for someone who is waffling prior to the start of training. Unless your plan all along is to bust your butt working 10 years and then FIRE. Most anyone can grind, even in EM, for 10 years or so.

Contrast this to the ROAD specialties others mentioned (rads, ophtho, anes, derm) where one can grind through a 30 year career mostly working 9-5 M-F making 400k+ even if they aren’t truly all-in or passionate about the field. There’s a reason you see many more gray hairs in those specialties than in EM.

 

[WilcoWorld]

This thread turned out to be exactly what I was hoping for so thank you everyone who has posted their experiences and thoughts. The only advice I really disagree with (not just in regards to my situation but med students trying to choose a specialty in general) is the saying: "if you question EM dont do EM." In reality, the only way for any student to know what they are or are not interested in is to gather as much information, personal experience, and the personal experiences of others and apply all of that in the context of their own goals/wants. Insinuating that we should all "just know" doesn't make much sense to me.

As the above poster said, "if you question EM don't do EM" was not how I meant my post nor do I expect applicants to just magically know EM is for them. I am all for research and reflection on decisions of this magnitude. Rather, my position is that if one researches the field, reflects on their motivations, and after that are still undecided about EM - I would not recommend EM to that person.

 

[dchristismi]

I've got to agree - the majority of us who chose it *knew* pretty quickly. You feel it or you don't. Now, if you do feel it, and are trying to be sure, that's different, because, yeah, there are a lot of downsides. Going into it with open eyes is definitely better than walking blindly into the pit, as the field has dramatically changed over just the last 10 years.

But it is a grind. I did my 12 years and subspecialized, and I'm much, much happier now. Granted, I don't have any new cocktail party stories, but I don't go to many cocktail parties these days...

 

[deleted859535]

This thread turned out to be exactly what I was hoping for so thank you everyone who has posted their experiences and thoughts. The only advice I really disagree with (not just in regards to my situation but med students trying to choose a specialty in general) is the saying: "if you question EM dont do EM." In reality, the only way for any student to know what they are or are not interested in is to gather as much information, personal experience, and the personal experiences of others and apply all of that in the context of their own goals/wants. Insinuating that we should all "just know" doesn't make much sense to me.

Disagree all you want. I'm saying what I'm saying because I did the same thing you're doing in a way, made my decision based on what I knew at the time, and have the benefit of many years of retrospection (and introspection) to say that. No doubt it's hard to pick a specialty. Nobody expects you to "just know." But in the end, you get really honest with yourself and either have the sense of gravitating towards EM, or you don't. The short take is that some specialties have more room for ambiguity and uncertainty while enjoying a high likelihood of keeping you fulfilled and happy over a full career. EM isn't quite like that. Good luck with your decision.

 

[thegenius]

It's OK not to know entirely either. I was deciding between IM and EM until the last minute. I liked a lot of different medical specialties actually. I wrote on this topic a year ago, there are some key things you have to want to do if you go into EM: resuscitate critically ill people, know a little bit about a lot of medicine (never an expert in a small field) and having a varying, shift work schedule that includes night shifts.

 

[Candidate2017]

I enjoyed most of the actual EM work on my off service EM rotations (even debriding maggots, but no to rectals and pelvics). But I hated the nights/weekends and constant jet lag, not being able to properly eat/drink/poop, constant dehydration and constipation, recuperate and start all over again. I can't remember how many shifts/hours I worked, it didn't seem like I was working fewer hours. Especially compared to rotations when I roll into the ED at 9:30 AM, see a handful of consults, bang out some notes and finish by lunchtime.

 

[sylvanthus]

OMG.

So much this, and I'm only 10 years out.


The number-one cause of burnout is....

the patient.


...


Seriously, when the "Karen" meme became a thing, I wanted to kick myself in the ass for not having already thought of it.
There is no more "Emergency Medicine" unless you work in a high-volume, high-acuity environment, or a low-volume, critical access environment.
Everything else is just "Hospital Customer Service" and "Would you like a CT with that, ma'am?"

Its funny; this actually happened to me a week or two ago:
2:41 AM.
66 year old fat male, obvious vasculopath. I can see the CABG scar from across the department.
Chest pain. surPRISE!
I walk in the room.
"Hello, Mister Roberts, I'm RustedFox. I'm here to help. Hello, Mrs.Roberts. I'm going to take excellent care of your husband."
(I actually said that nonsense, because I'm "Customer-Service-Centric".
Mrs. Roberts threw a cellphone in my face without even returning a greeting.

"Heeeah! Befourah you do ANYTHING to MY HUSBAND, you've gonna talk with our daughter in NURSING SCHOOL in CONNECTICUT."

I'm sorry madam, that's against policy. I'm here to help. I -

"Nope! I want another dawktah. Get another one! (there is not one available) Then get your supervisah!"

PLUS, there was the shift last week where the day before I would have to come in two hours early because "we have no PA coverage".

Oh, this is MY fault, now?

You could get PA coverage.

You just don't want to pay to incentivize PA coverage. We have plenty. A simple shift bonus would cover the shift. But instead; administration's solution was "just whip the galley slaves harder".

No respect.

Not from patients.
Not from families.
Not from administration.

Its no longer EMERGENCY MEDICINE.

Its CONVENIENCE MEDICINE with a CUSTOMER SERVICE FELLOWSHIP.

RustedFox out.

This definitely struck a chord with me. Ive recently started doing "press ganey labs" and therapeutic radiation, to avoid the ridiculous complaints. I had to sit the nurses down and tell them I am doing some ridiculous bull****, just to appears the "customers." Low and behold my patient satisfaction scores went way up. Did I provide better medicine? Hell no, worse in fact. Do the powers that be give a ****? Noooopeee, their "customers" are happy. Ugh, why I have to balance it with ICU or id lose my mind. I feel for you guys doing this **** full time.

 

[sylvanthus]

I have posted here intermittently. I have taught students, worked with scribes, written letters for med school, etc....When scribes and students ask me how I like EM I paint a rosy picture. Most people who ask a question have their mind usually made up in my experience and what a random doc is going to say isn't gonna change their mind. I agree with alot of what others are saying. EM is not what it use to be and things have changed for the worse. I found a good place but it took alot of work. There aren't many good places left. If I didn't have the debt I would have gotten out of medicine initially and stuck to tech. You deal with a lot of crap with more uncertainty every year and it isn't worth it.

Ive actually told many scribes to stay out of EM and medicine altogether if possible. If they are still interested,, I tell them to go the PA route. Buuuutt, noone listens, i can see their eyes glaze over and see their mind is already made up. Hell, Id prob ignore my ass also if I were in their shoes. Sooooo, I stopped having those conversations altogether,