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This job's bad for you
Started by Birdstrike
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you're by far the most negative person on this forum regarding EM. i just have a question. sounds like you dropped out of EM awhile and every chance you get, you discuss cons/pitfalls/downsides/etc about EM.
i want to mention that i fully respect your opinions. but if you dislike this field so much, why do you spend so much time on this forum? you left this field im assuming a few years ago? then why hang around and keep your mind thinking about EM by talking about EM repeatedly in forums. i dont get it...would seem to me that if you dislike something so much, you should then dedicate your time to other things you do enjoy instead of lingering around and taking every chance you have to tell people why you dislike the field so much (and simultaneously reminding yourself of something that is negative in your life..)
i want to mention that i fully respect your opinions. but if you dislike this field so much, why do you spend so much time on this forum? you left this field im assuming a few years ago? then why hang around and keep your mind thinking about EM by talking about EM repeatedly in forums. i dont get it...would seem to me that if you dislike something so much, you should then dedicate your time to other things you do enjoy instead of lingering around and taking every chance you have to tell people why you dislike the field so much (and simultaneously reminding yourself of something that is negative in your life..)
I'm not gonna speak for Birdstrike. He can answer his own questions about himself...
... but without squeaky wheels like him, there'd be few (if any) people left to stand up and try to change the things about EM that (across the board), people tend to talk alot about, but do nothing about. For too long, everyone has had this "passive" attitude about EM (and medicine in general), and it's gotten us backed into a corner of Press-Ganey and malpractice nonsense. If everyone is mum about it, it will never change.
... but without squeaky wheels like him, there'd be few (if any) people left to stand up and try to change the things about EM that (across the board), people tend to talk alot about, but do nothing about. For too long, everyone has had this "passive" attitude about EM (and medicine in general), and it's gotten us backed into a corner of Press-Ganey and malpractice nonsense. If everyone is mum about it, it will never change.
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I also shudder to think that maybe the only way things ever will change is if we all "vote with our feet" and up and leave the specialty/practice altogether. We can't "go on strike", after all.
Personally speaking, I'm looking into the non-clinical career/alternative career options for later on in my life, too. I'm aware of the fact that I'm a mere mortal, and probably can't keep up this game for longer than (x) amount of years (yet to decide what 'x' is yet).
Personally speaking, I'm looking into the non-clinical career/alternative career options for later on in my life, too. I'm aware of the fact that I'm a mere mortal, and probably can't keep up this game for longer than (x) amount of years (yet to decide what 'x' is yet).
What's the alternative? Someone has to work there overnight. Sure there are things that make it less painful, like putting a few shifts together so you aren't flipping back and forth. But if a say a quarter of the shifts out there are overnights, you are working nights a quarter of the time.
Unless we start telling people that we don't treat shananigans overnight. Just tell them "we don't deal with 2 weeks of vaginal discharge, med refills, pain you've had for a month etc at 3am."
We could staff the place with a nurse and an MD, both of whom could sleep most of the night.
Unless we start telling people that we don't treat shananigans overnight. Just tell them "we don't deal with 2 weeks of vaginal discharge, med refills, pain you've had for a month etc at 3am."
We could staff the place with a nurse and an MD, both of whom could sleep most of the night.
Casino shift scheduling is one alternative.
Also, there are good and bad ways to schedule overnights. If you get 72 hours off after a string of overnights, they tend to be much more tolerable than if you're required to come back for a day shift 24 hours later. The more we act like Birdstrike, hopefully, the more this kind of scheduling will be considered standard, and the less it will be considered a special request.
The more you act like Birdstrike, the more likely you are to be divorced and out of work (not that he is, but it's playing the numbers - I think he has quite a forgiving wife).
There are good and bad ways to do nights. Dedicated 'nocturnists' make it more pleasant all-around, but the surefire way to make everyone miserable is to go "night, night, off, morning, morning", or the reverse.
They did that to me twice this month. Maaan, what a drag.
I was more referring to the PG/medicolegal circus that Birdstrike is regularly vociferous about with my last post.
They did that to me twice this month. Maaan, what a drag.
I was more referring to the PG/medicolegal circus that Birdstrike is regularly vociferous about with my last post.
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Try 7 times in one month.
THAT is why the scheduler should not give the squeaky wheel any extra benefits - the others suffer for it.
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Yes, but only those on the EM forum.
I like your posts and find them very informative. Reading posts like this convinced me to be more politically active since first year. Don't leave.
Birdstrike, I pray that someone with a username like "LastMinEMROLQS" isn't the person who makes you quit SDN.
I appreciate that you bring up things I perhaps don't worry about yet in my (probably not too much) younger than you years.
I appreciate that you bring up things I perhaps don't worry about yet in my (probably not too much) younger than you years.
You may be right, but our propositions are not mutually exclusive.
Agreed. In fact, I think that reasonable turn-around should trump social days off.
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SDN is a waste of time, I can't disagree. But please don't let the aforementioned post be the reason you leave.
This has been known for years in the fire service. There was an article several years ago that figured a 25 year career would shorten your lifespan about 10 years due to the sleep disturbances and constant bursts of adrenaline just from hearing the alarms sound. Recently there have been articles showing that even those who have left the game still have a mild reactions to the sound of an alarm going off, and can continue to suffer the negative consequences (I find myself getting slightly anxious every time the fire alarm in the hospital goes off because it sounds so similar to the station alarm in the house I used to work at).
birdstrike, i fully agree with this statement. i just asked a question on an open forum that I was genuinely wondering about. many people respect and have read your opinions when we made our decision to enter EM (that includes myself). i don't spend nearly enough time on this forum nor even have anything close to an established status here for you to leave on behalf of one my (very few) posts.
Emergency medicine is tough.. As discussed here and elsewhere there is often a major disconnect between premed,med students, residents and early attendings compared to the guys who have been attendings for 2+ years.
What was easy without a family is now hard. what was easy without outside responsibilities is tough.
Student loans are due, kids have events you dont want to miss and your spouse yearns for a normal(er) schedule.
I am not here to defend birdstrike but the guy understands the crappy parts of our job and shines the light on things that would make the job easier.
I thank him for his posts. I think most EM docs look to find a way out before others.. one has to consider why.
In my group which is a relatively high paying group people are and have been looking on ways to get out. Investments, other semi medical fields (med spa, laser hair etc), This is what I have been hearing. This from a practice that sees under 2pph.
Birdstrike sees that things need to change.
What was easy without a family is now hard. what was easy without outside responsibilities is tough.
Student loans are due, kids have events you dont want to miss and your spouse yearns for a normal(er) schedule.
I am not here to defend birdstrike but the guy understands the crappy parts of our job and shines the light on things that would make the job easier.
I thank him for his posts. I think most EM docs look to find a way out before others.. one has to consider why.
In my group which is a relatively high paying group people are and have been looking on ways to get out. Investments, other semi medical fields (med spa, laser hair etc), This is what I have been hearing. This from a practice that sees under 2pph.
Birdstrike sees that things need to change.
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deleted6669
in my group we have several md and pa nocturnists(including me) who do the vast majority of nights and are well compensated for doing so. the trick is keeping the same schedule on days off. I am much happier doing all nights, seeing fewer(but sicker pts) and making more money than alternating shifts randomly, never sleeping well and having to see administrators on most of my shifts. in fact that may be one of the biggest benefits of nights; only folks who really are needed are there at night, thus no managers, folks telling you no coffee at your desk or counting how many times you wash your hands, joint commission reps, etc
I actually see my family more working all nights than I did on rotation. kids sleep while I work, I sleep when they are at school. my wife keeps my schedule.
I actually see my family more working all nights than I did on rotation. kids sleep while I work, I sleep when they are at school. my wife keeps my schedule.
Birdstrike would say (and we would all agree) that THIS is the non-consequential nonsense that needs to change. Nobody should have to 'hide-out' on night-shifts to have a right to a coffee-cup within arms-reach.
If it "doesn't matter" on the night shift, then it "doesn't matter" on the day shift.
I get into this debate frequently with acquaintances/friends/family/colleagues on a number of levels. The bottom line remains:
There are things that do exist, and things that don't exist. If you want to live your whole life worried about the things that don't exist, then you need to reconsider your next breath.
Joint commission would freak out over a non-standardized-lidded coffee cup in the "physician work area".... Now, rather than pay multiple "managers" to make sure that things are standardized and "up to code", how about you take that money and spend it defending the people who put their lives and livelihoods on the line taking care of the patients who (by their own personal irresponsibility), need our care.
I'll never forget the one shift I had as an MS-4, where the eleventeenth welfare gimme-gimme patient "demanded" this-and-that (which was clearly unrelated to their care, and would in fact be detrimental to their care) from me, and I was told by my then-superiors to 'hop-to' and make it happen.
I said to myself - "Really ? Am I paying (in taxes/tuition) for the 'privilege' of treating this individual... AND putting myself at great medicolegal risk on top of that?"
Fuuuuuck that.
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deleted6669
along those same lines I am sure many of you have heard of the "necessary staff equation":
secretly track all staff members present on nights/weekends/holidays for a year. anyone not present during any of these times by the end of the year is fluff and not needed to run a dept.
secretly track all staff members present on nights/weekends/holidays for a year. anyone not present during any of these times by the end of the year is fluff and not needed to run a dept.
If you guys think Birdstrike is negative, you should really sign up for an account at Sermo to learn how a community of practicing emergency attendings view the specialty. Especially enlightening are the posts from Caffemaven outlining his struggle with hospital administration, patient satisfaction and his eventual exodus to Canada. Look back through his 2010 posts for a chronicle of that saga.
Overall, I find that SDN is overly optimistic and somewhat naive in viewing the specialty as it exists in the community. But this view is to be expected, in that the majority of participants are students and residents. Personally, I've worked in quite a few different places as an attending (although generally in the same geographical area). Almost every emergency physician I have worked with is planning an exit strategy or a side gig to reduce their exposure to the specialty.
The administrative pressures from the hospital, CEO, contract management group, etc. are the main source of discontent, not the practice of emergency medicine or the patients. These pressures are continuing to increase and force physicians to change their practices. In my region of the country, many EM physicians are leaving hospital-based ED practices to work at freestanding EDs to reclaim some of the autonomy of practice.
One large caveat to my experience, though, is that the region I practice does not have any truly democratic EM physician run groups. All of the groups in my region are either corporately run large national management companies or closed book undemocratic local groups structured as pyramid schemes that prey on new hires. EM experiences may be much better in locations with truly democratic EM run groups.
Just my 2 cents. Take it for what it is worth.
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Pretty sure that "Caffemaven" isn't a dude.... I can be wrong here, but the "maven" suffix screams "I'm a chick".
I've said it before and I'll say it again. The guys who hate EM spend too much time doing it. Learn to live on less money AND WORK LESS. That's the key to longevity. Don't like nights? PAY SOMEONE ELSE TO DO THEM.
Good luck getting burnt out working 10 eight-hour day shifts a month. It's pretty hard to get burnt out when you can take a week-long trip and a three day weekend every month and still only work every other day.
And yes, small democratic groups are the way to go. Too bad there might not be very many 10 years from now.
The problem is emergency doctors can't seem to learn how to live on $100-150K. If you can, you can work half time and still retire early. I had a colleague complain to me today that he is currently spending more than he's earning. He works 17 shifts a month! He makes at least 50% more than me. Where's it going? Figure that out and you'll figure out how to not only survive, but thrive in the ED for 2 or 3 decades.
Good luck getting burnt out working 10 eight-hour day shifts a month. It's pretty hard to get burnt out when you can take a week-long trip and a three day weekend every month and still only work every other day.
And yes, small democratic groups are the way to go. Too bad there might not be very many 10 years from now.
The problem is emergency doctors can't seem to learn how to live on $100-150K. If you can, you can work half time and still retire early. I had a colleague complain to me today that he is currently spending more than he's earning. He works 17 shifts a month! He makes at least 50% more than me. Where's it going? Figure that out and you'll figure out how to not only survive, but thrive in the ED for 2 or 3 decades.
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Pretty sure he's a guy, and 'maven' is Yiddish without gender specification.
Like I said in my original post, I could be wrong.
But he may wanna rethink that handle, just for that reason.
See, I prescribe to this school of thought, but the thing that kills it for many is the crushing student debt that they graduate with. I'm in a pretty unique spot, economically/personally (I have crushing debt, but have no desire for 2.67 children and a 4-bedroom home in the suburbs)... but for many... EM is more than ''what they bargained for" when it comes down to having a career and a happy home-life.
Eh, he's in Canada now, so that **** flies there.
He He. Looks like I learned somethin' about Yiddish.
Canada ain't a bad joint, altogether. Sometimes, I wish the wifey were more of a coldweather person and we would spend some time up in the great white north (as it is, she complains of being cold in 72 degree/sunny weather here in the midwest, and getting her to go to a hockey game presents its own set of challenges). I had a ton of Canuck buddies in medical school. Good guys/gals, every one of 'em. Polite to a fault, as is their way.
Go Flames.
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Then you live like a resident for 4-5 years and pound out the debt. That's what I did for four years in the military. I owed $40K total when I was discharged (that was all that was left on the mortgage of the home I was living in-no student loans, car loans, or credit card loans.) Now I can work as many or as few shifts as I want. I'm working 15 now (<30 hours a week), but that'll probably drop to 12 when the new mortgage is gone.
It's beyond me how people can live on $40K as a resident, but can't live on $200K as an attending. And if you're not happy making $200K, $300K isn't going to make you any happier. Studies show money only buys happiness up to $75K per year.
Yeah; my plan is to have a modest increase in my standard of living (bigger apartment, new golf clubs, that's it) and to bang out that debt. I hear you on the "its beyond me" part.... the thing that is fortunate about me is that the things that I like to do to recreate don't cost that much money. For example, I had a week of vacation last summer (had to use it, or it went bye-bye), and every day I went to the park, hit the batting cages, played roller hockey, watched sports, and sipped lemonade. I thought to myself - "This is great. I'm ready to retire." 🙂 - In attending-land, I still plan on... batting cages, roller hockey, enjoying the park, feeding the ducks... the simple things that keep you sane and happy.
There's some movie quote about "the things you own end up owning you". I think new EM grads would do well to remind themselves of that.
THIS.
My wife and I talk about it all the time: how are we going to live and live smartly on the money we're going to be making? We're actually pretty happy with the home we have now (renting) and don't see any crazy need to buy the million dollar home. What we do want to do is to someday build the home we want where we want to, but we're willing to wait on that.
Our plan:
* pound out the student loans in the SHORTEST time frame we can manage (4-5 yrs)
* Save like bandits for the home, retirement, the "F-You and your Job" fund, and the kiddos' college money
* Rent a comparable, frugal home for a year before buying/whatever
* Pay off all of our debts soon in the above time frame, with the thought being that no debt = freedom. Freedom to pursue our goals as we see fit.
* Fill in the blanks for EvoDevo's Do-It-Yourself Empire Master Plan. Don't want to have to work in the department in 15 years. I'll work because I love it.
In the meantime, we're planning on a few "splurge" purchases:
* a nice used SUV to replace my wife's 1998 beater (I am upgrading to the 2004 Honda, sweet!)
* New-ish (not full retail price though!) furniture for a change.
And that's about it.
Oh, and I think that Birdstrike is right on. No job is perfect and LastMinEMROLQs' response is another in the tired line of "Well, if you don't like it so much, why don't you leave?"
- Saw the same attitude in the Marines
- Same thing at the first hospital that I worked in
- Same thing in graduate school
- Same thing in medical school
- Same thing in residency.
If it wasn't for guys like Birdstrike things would never improve.
Keep on keepin' on, brother.
- Saw the same attitude in the Marines
- Same thing at the first hospital that I worked in
- Same thing in graduate school
- Same thing in medical school
- Same thing in residency.
If it wasn't for guys like Birdstrike things would never improve.
Keep on keepin' on, brother.
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deleted109597
Ways to help E M are to be active. It's cliche, but working with ACEP, your state college, or your state medical society can make a difference. I'm in DC right now with the leadership and advocacy conference, meeting with staffers on Capitol Hill, trying to help the specialty.
Birdstrike is routinely right. People who try and sweep the problems under the rug do more harm than good.
Birdstrike is routinely right. People who try and sweep the problems under the rug do more harm than good.
Thanks for taking the time to do that!
There is one thing (or, should I say 2.67 things) that makes it hard to maintain a resident lifestyle: kids.
They shouldn't take your expenses from 40k-300k, but they will necessitate a bigger house, a second car, more food, tuition savings...
They shouldn't take your expenses from 40k-300k, but they will necessitate a bigger house, a second car, more food, tuition savings...
Yup. The wife and I could easily live within our means with plenty to spare on 20-25 hr/week pay. When you get to paving the way for your kids not having to put up with as much **** as you had to to get ahead, the finances go haywire. There's where the extra 10-15 hrs/week go. God forbid you decide to have kids during med school or residency. Our choice, of course, but we weren't getting any younger and later meant increasing risk.
I'm not opposed to people being the squeaky wheel, however, I think if you are going to bitch and moan about something, you should offer a solution at the same time. I've yet to see anyone actually offer a solution to shift work that still provides 24/7 coverage. Yeah, shift work sucks...that's part of the reason we work fewer hours than almost all essential medical specialties. We can't have bankers hours, it's the nature of the beast and I'm suspect that anyone in this field didn't expect to be working nights coming in.
If we are going to fight battles, they shouldn't be unwinnable ones.
If we are going to fight battles, they shouldn't be unwinnable ones.
None of us are asking for Banker's hours. Well, Greg Henry is, but I don't think that's a viable solution.
Personally, I've proposed Casino Shifts or a fixed amount of time off after overnights. I think the Panama Schedule is another good option.
Active Duty has proposed working less and tightening the purse strings.
Others have proposed other solutions.
Can you explain Casino shifts or the Panama shift? I looked it up and couldn't find much.
As for less hours/money, that's an option open now so I don't really see the point and bitching and moaning about it.
My complaint was that people are acting that Birdstrike is "fighting the good fight", when all he is doing is bitching about our work schedule (one of the few things actually controlled by us).
I should've included this in the original post:
Casino Shifts
The Panama Schedule: Two week blocks of all the same shift with week 1 = On M,T,W, Th. Off F, Sat, Sun. week 2 = off M, T, W, Th. On F, Sat, Sun. Everyone works 2 weeks/year of all nights - either together or separate.
I'll agree that these schedules exist if you're willing to take the jobs that offer them - that's where I got the idea. However, Birdstrike makes other points. PG scores being a terrible measure of emeregency care, but our still being beholden to it is one example. Administration's refusal to recognize that when people complain that we're taking too long to get to their ingrown toenail at 3am, the complainer ought to be informed of the definition of emergency is another. But most of all, his point is that there's no one more to blame for this than we.
Casino Shifts
The Panama Schedule: Two week blocks of all the same shift with week 1 = On M,T,W, Th. Off F, Sat, Sun. week 2 = off M, T, W, Th. On F, Sat, Sun. Everyone works 2 weeks/year of all nights - either together or separate.
I'll agree that these schedules exist if you're willing to take the jobs that offer them - that's where I got the idea. However, Birdstrike makes other points. PG scores being a terrible measure of emeregency care, but our still being beholden to it is one example. Administration's refusal to recognize that when people complain that we're taking too long to get to their ingrown toenail at 3am, the complainer ought to be informed of the definition of emergency is another. But most of all, his point is that there's no one more to blame for this than we.
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deleted65604
Why in the world would you want to pave the way for your kids? The accomplishment is in the struggle. Character is built in the crucible of adversity. What is the point of giving your kids anything if you don't give them character? Your kid wants a college education? Let them earn it. One of the greatest flaws of our current society is the lack of availability of hard work. You really have to be creative to build that work ethic in a kid. Letting them grow up in the lap of luxury, with a college fund waiting for them to burn through is a recipe for disaster. I'm not saying I'm not going to help my kid out. I'm saying they had better be at their wits end, scraping the bottom of the barrel, going balls to the wall before I kick in serious cash (at least I want them to believe that).
I think the key to happiness is control of your finances. My group is interesting cause the guys/gals who live frugally also seem to be the happiest. This is because a 10% pay cut still sucks but doesnt alter your life much. I am trying to set my life up this way. The problem is I have over 300k in debt. I have paid off over 50k in debt in 2011 and saved another 50k in retirement with a bit into my rainy day fund and kids college.
In about 2 years my debt payments will drop and things will lighten up. I work a lot but I still like it. I know as soon as I feel it is too much I will be able to back off my hours. Much of the unhappiness with the people I know comes from HAVING to work more than they want because they set up a life where they spend every penny..
In about 2 years my debt payments will drop and things will lighten up. I work a lot but I still like it. I know as soon as I feel it is too much I will be able to back off my hours. Much of the unhappiness with the people I know comes from HAVING to work more than they want because they set up a life where they spend every penny..
I figure if my education was paid for with mostly financial aid, my (future) children won't have that. That's where I could help. Of course only if they aren't using it as a party excuse. Otherwise, they get cut off.
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It sucks when I am not at work and I hear a sound, even for a split second, that is the same frequency as the tones where Ive worked in the past, I always get a little adrenaline jolt.
General happiness is very closely tied to how much of your own life you control, I've noticed.
This includes, as above, debts and expenses - which exert a negative outside influence.
It's also impacted by the worries associated with your wife, and then, to a much greater extent, your children. For all the happiness it brings, it exerts an overall stress on life to have your happiness tied to events outside of your control. I highly dislike this meddling in my placid equilibrium, but, so it goes.
Work, at least for me, is the least stressful - as I am relatively in control in my clinical hours, and my progression on academic responsibilities is likewise at my own internall generate discretion. Luckily, my internal motivation meshes with the external expectations quite nicely.
But, yes, sometime the job sucks - like driving home after a night shift with new onset fever, sore throat and chills. Responds, eventually, to naproxen, NyQuil, and scotch, at least.
But, short answer - for me, control is the primary factor impacting my happiness.
This includes, as above, debts and expenses - which exert a negative outside influence.
It's also impacted by the worries associated with your wife, and then, to a much greater extent, your children. For all the happiness it brings, it exerts an overall stress on life to have your happiness tied to events outside of your control. I highly dislike this meddling in my placid equilibrium, but, so it goes.
Work, at least for me, is the least stressful - as I am relatively in control in my clinical hours, and my progression on academic responsibilities is likewise at my own internall generate discretion. Luckily, my internal motivation meshes with the external expectations quite nicely.
But, yes, sometime the job sucks - like driving home after a night shift with new onset fever, sore throat and chills. Responds, eventually, to naproxen, NyQuil, and scotch, at least.
But, short answer - for me, control is the primary factor impacting my happiness.
The biggest debt that I have beside the mortgage are my loans. Take that away and I making and keeping bank. If I have the means to reduce that debt burden for my kids, why not? My retirement is the priority, since I don't want to drag my kids into my finances as I get older, but the extra will go into a 529 when I get it going.
My kids aren't spoiled - not by a long shot. But damned if I'm going to have them go through the crap I went through to get to where I am.
When talking about ways to have control over your life, less stress,etc. I haven't heard anyone mention alternate income streams in this discussion. Finding a way to generate an income stream separate from just logging more hours is huge and gives you the early financial freedom to cut your hours as you see fit. If you're used to making 300k and you can find a way to generate 100k in an alternate income stream, you can cut your clinical work load by a 1/3 and still have the same income (or keep working at your regular pace and start really adding to your savings, debt reduction, etc). This is a huge sense of control to me at least. That was one of the driving motivations for me and my partners in starting a side business in urgent care.
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deleted6669
agree. I know many folks who are crippled by their school loans. I have a 529 for my kids (which is tax deductible in my state) which I hope will pay for their entire undergrad education. grad school will require some creative financing but any head start we can give our kids to make their lives a little more easy financially down the line is money well spent.
tuition rates are increasing much faster than the rate of inflation or the increase in wages. when I went to undergrad> 20 yrs ago my in state tuition was less than 5k/yr. that same school's tuition is now around 26k/yr.(probably more, I haven't checked in a while). my point is that as a % of later earnings, my kids debt would be a lot more than mine if I don't help them out.
