Tell me why I SHOULD still pursue EM

[Apollyon]

Every time I see this thread, I think of "Tell Me Why", by the Beatles. Huh.

---

Members don't see this ad.

 

[Laradd]

Aside from having 6 digits salary, you can also serve people through it.

 

[thegenius]

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.

I don't think twice about it anymore. At least I try not to.

You gotta remember the majority of the people who want these things have pretty miserable lives. They work two minimum wage jobs and one of the "perks" they get is to go to the ER (without co-pay) at 10:30 PM on Tue to get their sprained wrist checked out after waiting around for 3 hours. I would much rather make 200K / year, have high co-pays, a good education, have normal health insurance, and know not to come to the ER for 97% of the stuff I see.

I still grumble under my breath when they come in, but its just not worth burgeoning angst over this. I still tell them "oh I don't think you have an emergency, but I'll just run a test to make sure" and walk out of there as soon as I can. I make money, they are happy, and I wasted some tax payer money.

I would love for this to change, but my desire of having an ER that immediately charges $100/visit at triage before being seen for all but the obvious real medical emergencies is never going to happen. (And if it did, I would lose income.)

 

[Brigade4Radiant]

The thing is I work to live so yeah the press ganney sucks and we are big on “customer satisfaction” but I make 300 an hour and have a scribe that I don’t have to pay for so I tolerate it.

It also helps that I don’t work many nights because nights have perks (only work one weekend for a nocturnist and make your schedule)

Also I’m pursuing financial independence as a goal and afterwards my do something like Hospice where it isn’t hard to get a fellowship in and offers quality of life and practically no litigation stress

 

[CliveStaples]

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).

To actually answer you:

1) There is insane breadth to the field. Maybe it's because I went to a strong/respected EM program and am now in the community, but I do feel I am professionally respected by my peers for my expertise in resuscitation and the breadth of my knowledge.

2) I went in with similarly noble intentions, but I have to admit that taking care of the dregs of society does not really give me much satisfaction any more. I get satisfaction from taking care of the working poor (I work at a place that picks up a population of very poor, rural farming types) who are generally not very "Kareny" and usually give a lot of "whatever you say Doc, you're the expert." Taking care of IVDUers and chronic pain is not something that I get any enjoyment out of at all, however. I suppose the only "dregs" that I still sometimes enjoy taking care of are the incarcerated, who are generally polite.

3) While there is a lot of doom and gloom about the future of the finances of our field (and I certainly do not hold any expectation that salaries will continue to rise like they have on average) it still remains the most lucrative of the 3 year residencies and more lucrative than many of the 4 year residencies. When you account for total hours spent at work, we are still very highly paid. I could not sit around and play hospitalist for 2/3rds the pay and be in the hospital twice as often as I am right now.

 

[cyanide12345678]

I could not sit around and play hospitalist for 2/3rds the pay and be in the hospital twice as often as I am right now.

You'd be surprised, some hospitalist gigs are pretty nice. My wife's residency hospital pays hospitalists 185/hr. During the night, shift they have two admitting docs apparently (according to my wife at least). In a 12 hour shift, they each sleep for 6 hours, and work hard for 6 hours. Plus excellent benefits and a freaking state pension if you work long enough -_-

Guess what the ER docs make? 185/hr there. Exactly the same.

 

[Brigade4Radiant]

You'd be surprised, some hospitalist gigs are pretty nice. My wife's residency hospital pays hospitalists 185/hr. During the night, shift they have two admitting docs apparently (according to my wife at least). In a 12 hour shift, they each sleep for 6 hours, and work hard for 6 hours. Plus excellent benefits and a freaking state pension if you work long enough -_-

Guess what the ER docs make? 185/hr there. Exactly the same.

Academics is different also a lot of hospitalists can be slammed with admissions. Also some EM docs chill while the residents do most of the work

 

[bravotwozero]

Some hospitalists have midlevels do all the admissions so they get to sleep at night.

 

[deleted1074007]

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.

That is exactly why I want to do EM

 

[RustedFox]

That is exactly why I want to do EM

Sure.
Funny as a resident.
As an attending, it ruins everything.

 

[TheSingularity]

You shouldn't pursue EM.

I left the CMG dumpster fires and now I have a unicorn job. This job can change at any time, however. Also, you won't be hired at my job.

If you're smart, you'll do something where you are not dependent on a hospital system to make money.

 

[TheComebacKid]

I find it quite interesting how us in EM really prop up the ROAD specialties. Rads/Anesthesia have faced a tight squeeze over the last decade. CRNAs, the constant threat of AI and overseas teleradiology groups, etc. It's not all rainbows in those specialties. We thought COVID really affected our revenue stream, until you look at Derm/Optho who got pretty much obliterated.

We have some horrific issues in our specialty mostly centered around topics covered in the forum ad nauseum i.e. midlevel expansion, CMG domination, residency proliferation. A lot of specialties have similar issues. The problems in our specialty are a product of a totally EFFED up system that doesn't spare anyone, including the ROAD specialties. The idea that EM is somehow siloed off from everyone else in a vacuum is just not true.

In internal medicine, I admit a TON of patients overnight to an NP. The number of garbage IM residency programs that pop up all over are pretty impressive.

Pediatrics is pretty much the lowest paying specialty with a very challenging patient population (parents).

Don't even get me started on the surgery lifestyle. I find it hilarious when EM folks say things like "we have it worse because of all the flips." I would take the flips with a 50 hour work week as opposed to the 120 hour "regular schedule" for the surgeons. That's just me, I know others feel differently.

I have colleagues in urology/ENT, often thought of as the pinnacle of the lifestyle specialties. Talk to them about their call schedules, the emergent OR cases they have book to in the middle of the night, the fact that their group only has 3 docs and they are on call every third night.

For the hours we work, with the on/off schedule without call, EM is pretty competitive in terms of the most bang for your buck. And while the future isn't looking so hot for those of us in EM, I really don't think it's looking that hot for anyone else either.

The question isn't "should I pursue EM", instead it's, "should I pursue medicine". The answer to that question, IMO, is an emphatic "no". Unfortunately for most of us, that ship has already sailed.

 

[TheSingularity]

I find it quite interesting how us in EM really prop up the ROAD specialties. Rads/Anesthesia have faced a tight squeeze over the last decade. CRNAs, the constant threat of AI and overseas teleradiology groups, etc. It's not all rainbows in those specialties. We thought COVID really affected our revenue stream, until you look at Derm/Optho who got pretty much obliterated.

We have some horrific issues in our specialty mostly centered around topics covered in the forum ad nauseum i.e. midlevel expansion, CMG domination, residency proliferation. A lot of specialties have similar issues. The problems in our specialty are a product of a totally EFFED up system that doesn't spare anyone, including the ROAD specialties. The idea that EM is somehow siloed off from everyone else in a vacuum is just not true.

In internal medicine, I admit a TON of patients overnight to an NP. The number of garbage IM residency programs that pop up all over are pretty impressive.

Pediatrics is pretty much the lowest paying specialty with a very challenging patient population (parents).

Don't even get me started on the surgery lifestyle. I find it hilarious when EM folks say things like "we have it worse because of all the flips." I would take the flips with a 50 hour work week as opposed to the 120 hour "regular schedule" for the surgeons. That's just me, I know others feel differently.

I have colleagues in urology/ENT, often thought of as the pinnacle of the lifestyle specialties. Talk to them about their call schedules, the emergent OR cases they have book to in the middle of the night, the fact that their group only has 3 docs and they are on call every third night.

For the hours we work, with the on/off schedule without call, EM is pretty competitive in terms of the most bang for your buck. And while the future isn't looking so hot for those of us in EM, I really don't think it's looking that hot for anyone else either.

The question isn't "should I pursue EM", instead it's, "should I pursue medicine". The answer to that question, IMO, is an emphatic "no". Unfortunately for most of us, that ship has already sailed.

This.

EM is a slightly less stinky patch in the dumpster fire of American medicine.

My kid is gonna be an underwater welder or a lobsterman.

 

[BoardingDoc]

My kid is gonna be an underwater welder or a lobsterman.

Both of those professions have above average mortality rates. What did your kid do to you?

 

[Apollyon]

Both of those professions have above average mortality rates. What did your kid do to you?

I was just thinking the same thing. Committing the kid to a death wish?

 

[Birdstrike]

This.

EM is a slightly less stinky patch in the dumpster fire of American medicine.

My kid is gonna be an underwater welder or a lobsterman.

My kids are both going into extreme ironing. I can't say, "No." It's their passion.

 

[sylvanthus]

 

[The Knife & Gun Club]

Sure.
Funny as a resident.
As an attending, it ruins everything.

It’s really been fascinating to see this kind of drunk shenanigans happen at our county site - everyone just kind of laughs it off and gets on with their life. That had been my sole exposure to EM through all of med school and the first few months of residency.

Now at our community/SDG site I’m starting to realize how much this crap gums up the works, pisses off the normal human patients who’s opinions actually matter, and bogs down our nurses in endless Patient-call-button nonsense.

I still get a kick out of it cuz, hey, not my RVUs, not my problem. But I can see how it gets old real quick in the real world.

 

[namethatsmell]

It’s really been fascinating to see this kind of drunk shenanigans happen at our county site - everyone just kind of laughs it off and gets on with their life. That had been my sole exposure to EM through all of med school and the first few months of residency.

Now at our community/SDG site I’m starting to realize how much this crap gums up the works, pisses off the normal human patients who’s opinions actually matter, and bogs down our nurses in endless Patient-call-button nonsense.

I still get a kick out of it cuz, hey, not my RVUs, not my problem. But I can see how it gets old real quick in the real world.

Correct. If you've got a flat rate/salary at a place you won't care as much when drama slows down your department. If you've got any % skin in the game than anything keeping you from moving patients through will matter. Though it's rarely the drunks who tie you up, most are actually a minimal time suck. Rather, it's all the massive system inefficiencies that you'll have minimal control over, and have to fight against, that can be draining...