unhappy?!

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glorfindel said:
3) I am happy because I am not an EM doc. I'm a person with varied interests who happens to practice emergency medicine as a career. I like EM, but also politics, athletics, certain kinds of novels, legal issues, financial policy, environmental policy, etc. I do other things besides EM, and in any given month, these things may be (often are) more important to me than EM.
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THIS.

EM is just a job. Its how you bring home the cash. Life is really everything else.
 
SeekerOfTheTree said:
Don't you dare say that to a surgeon. You will instantly die from an aneurysm.
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But, you'll be in luck since every academic GS is gods gift to humanity, so they'll take care of that for you out of the sheer goodness of their heart and unmistakable brilliance of their everexpanding mind.
 
I too love my job. Let me clear some things up for the residents and med students.

For the most part to be happy in EM you have to have outside interests. I know it sounds weird but it would be hard to be happy and work in EM (academics, clinical, admin) 60 hours per week. This is just expected in GS, Nsurg and others. EM offers opportunities to pursue your outside interests.

Me personally, as someone who grew up lower middle class work is a cash cow. My place of employment is a moderate true democratic EM group in AZ. Our income is good and honestly this is one of the things that leads to my satisfaction with work. Money of course is not the end all and frankly my job is "easy". We staff 3 hospitals, have a trauma center, see high acuity and for the most part have great relationships with the hospitalists and consultants. We earned respect and now we are getting the payoff.

In my group of 40 docs I can summarize those who are unhappy in a few categories.
1) My lifestyle demands X dollars and I have to work way more than I want to attain that (ina group where our income is in the top decile in EM)
2) My skills have eroded and I fear sick patients
3) I am old and slow and sometimes feel overwhelmed at work (our group avg is less than 2 pph).

How I fight this:
I live in a home where my annual income greater than what I paid for my large home. I drive a 8 year old Mazda. I dont waste my money.

I work on the sides where I tend to care for sicker patients.

I work hard, I expect to work hard when I show up and I have learned how to manage my time at work.

The group stress is from the unknown. We have run the numbers and people are worried about 20-35% pay cuts for the same amount of work. This is significant as people have budgeted for kids college etc.

Dont become a financial slave to your job and you can then enjoy your job.
 
glorfindel said:
I'm pretty happy, approx 5 years out of residency. I chalk it up to:

1) I didn't ever "fall in love with medicine." I always looked at medicine as just one option among many, and I have always seen medicine as a job. It's a lot easier to be satisfied with your job than it is to be satisfied with your "calling" or your "destiny." There's far less potential disappointment, when you realize that most shifts are just moving the meat. Sure, it's a pain trying to satisfy a bunch of entitled patients (and administrators), but there is no magical job in which you are spared from interacting with *******s.

At least I don't have a supervisor looking over my shoulder all day long, trying to micromanage every decision I make. THAT's what I wanted to avoid in a job, and in EM, I've succeeded. Happy!

2) I like my job because it offers the possibility of continuing improvement and it is difficult to to completely master. I'm a much better ER doc now than I was when I graduated, and this feeling of improvement makes me happy. Every month I can pick an area of my practice and focus on improving it. That part of my job is fun. Since I graduated, my focus areas have included a) dealing with consultants that feel it's OK to act like *******s, b) central lines and intubations, elegance above mere competence, c) diagnosing abdominal pain with H and P, before the imaging comes back, c) efficient, speedy, and effective charting, d) the neuro exam. In the near future I'm going to be focusing on regional ultrasound-guided nerve blocks.

I'm a proponent of Cal Newport's "craftsman mentality." http://calnewport.com/blog/ Forget passion -- job satisfaction comes from autonomy and mastery and stuff like that. EM is ripe with these opportunities.

3) I am happy because I am not an EM doc. I'm a person with varied interests who happens to practice emergency medicine as a career. I like EM, but also politics, athletics, certain kinds of novels, legal issues, financial policy, environmental policy, etc. I do other things besides EM, and in any given month, these things may be (often are) more important to me than EM.

4) I'm happy because I'm not overcommitted financially. Well, sure, I've got humongous student loans that I'm working to pay off, but my monthly financial obligations are easily covered by my professional income. I didn't run off after residency and buy the biggest house I could talk my way into a loan for. I'm still waiting on the M3 BMW I've lusted after for years. I don't have a cable bill, 'cause most of the good stuff on cable, I can watch a day or two later on Hulu or Youtube.

5) I don't work too much. Too much work makes me miserable, so I avoid doing that.

EDIT: oh, and coffee. Lots and lots of hot, black coffee.
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'

you just described the exact person I think i am, and the exact type of physician I will likely be..it's kinda nice to see this. I have a brother who is in general surgery..even though what he does is quite amazing, I NEVER hear him even mention work or anything related to it when we hang out...its just like whatever..job is a job and he's interested in it, but after, it's time to do other things. BTW, if you really like strong coffee, go to www.sendex.net. My old lady is Brazilian and we drink Pilao every day...stuff is the best! You can order it online. It's brazilian coffee but based in Florida I think . enjoy
 
glorfindel said:
I'm pretty happy, approx 5 years out of residency. I chalk it up to:

1) I didn't ever "fall in love with medicine." I always looked at medicine as just one option among many, and I have always seen medicine as a job. It's a lot easier to be satisfied with your job than it is to be satisfied with your "calling" or your "destiny." There's far less potential disappointment, when you realize that most shifts are just moving the meat. Sure, it's a pain trying to satisfy a bunch of entitled patients (and administrators), but there is no magical job in which you are spared from interacting with *******s.

At least I don't have a supervisor looking over my shoulder all day long, trying to micromanage every decision I make. THAT's what I wanted to avoid in a job, and in EM, I've succeeded. Happy!

2) I like my job because it offers the possibility of continuing improvement and it is difficult to to completely master. I'm a much better ER doc now than I was when I graduated, and this feeling of improvement makes me happy. Every month I can pick an area of my practice and focus on improving it. That part of my job is fun. Since I graduated, my focus areas have included a) dealing with consultants that feel it's OK to act like *******s, b) central lines and intubations, elegance above mere competence, c) diagnosing abdominal pain with H and P, before the imaging comes back, c) efficient, speedy, and effective charting, d) the neuro exam. In the near future I'm going to be focusing on regional ultrasound-guided nerve blocks.

I'm a proponent of Cal Newport's "craftsman mentality." http://calnewport.com/blog/ Forget passion -- job satisfaction comes from autonomy and mastery and stuff like that. EM is ripe with these opportunities.

3) I am happy because I am not an EM doc. I'm a person with varied interests who happens to practice emergency medicine as a career. I like EM, but also politics, athletics, certain kinds of novels, legal issues, financial policy, environmental policy, etc. I do other things besides EM, and in any given month, these things may be (often are) more important to me than EM.

4) I'm happy because I'm not overcommitted financially. Well, sure, I've got humongous student loans that I'm working to pay off, but my monthly financial obligations are easily covered by my professional income. I didn't run off after residency and buy the biggest house I could talk my way into a loan for. I'm still waiting on the M3 BMW I've lusted after for years. I don't have a cable bill, 'cause most of the good stuff on cable, I can watch a day or two later on Hulu or Youtube.

5) I don't work too much. Too much work makes me miserable, so I avoid doing that.

EDIT: oh, and coffee. Lots and lots of hot, black coffee.
Click to expand...

Thanks for such a great post.
Means a lot to a currently beat down intern.
 
Ive been out of residency for over 20 years. Ive worked community and academic sides. For the last 5 years Ive been divided between the university shop, the VA and working in the field on a helicopter. Also spend some time on the national and international lecture circuit. Each day is different. I really like going to work, I also have a great family. Cant imagine retiring until Im in my mid 60s. I think the key is some sort of variety within EM. If you are just a few years out of residency and eagerly are anticipating retirement or just some way to make a living other than EM - you screwed up. You picked the wrong profession
 
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ABBY109 said:
Ive been out of residency for over 20 years. Ive worked community and academic sides. For the last 5 years Ive been divided between the university shop, the VA and working in the field on a helicopter. Also spend some time on the national and international lecture circuit. Each day is different. I really like going to work, I also have a great family. Cant imagine retiring until Im in my mid 60s. I think the key is some sort of variety within EM. If you are just a few years out of residency and eagerly are anticipating retirement or just some way to make a living other than EM - you screwed up. You picked the wrong profession
Click to expand...

It's great to hear someone this positive about EM. But I think your last line misses a huge point. Yes, there area few "screw ups" that just picked the wrong profession. That happens in any profession. Regardless, outside of the world of physicians, it's normal to make major career changes more than once in a lifetime. Yet as a physician, you're supposed to pick your job at age 26, and not change it at all for thirty to forty years? That's a very hard thing to do, and especially hard to do in EM. Someone like you, 20+ years into it, that hasn't struggled with any significant burnout, is the exception to the rule. I feel like I picked the right profession in choosing EM. I feel that it was perfect for 10 years. Then life changed around me, I changed, and the fit was not so perfect anymore.

http://www.managedcaremag.com/sites/default/files/imported/1209/1209.burnout_fig3.png


EM is at the top of this graph for a reason (JAMA 2012). It's not made up. It's not a "myth." It's not a vestige of the early days of EM where everyone was a "burnout" from some other field, destined to burnout again. EM can be tough, and it's not for wimps. We all knew that going in, but there are real problems that need to be addressed. If it was only a few freak outlier burnouts, that would be one thing. But when you've got 60-70% of people in a specialty (and 40-50% of physicians as a whole) reporting significant burnout, there are issues that need to be addressed.

Is it just that the younger generation just "screwed up" and picked the wrong profession? Are 60-70% just a bunch of wimps that need to suck it up? Maybe. But resting on that misses the opportunities to fix what could be improved.

Why is everyone so afraid to admit, there are systemic things within EM than can and should be improved, to make the profession better?
 

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gman33 said:
...
Means a lot to a currently beat down intern.
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I still remember my intern-self crying in the stairwell at 3am one night during a CCU rotation, in December, with a co-intern who was rotating in the MICU. I was swearing over and over again "I am NOT going to be like that [micu fellow], he's so one dimensional if he turned sideways he'd disappear, the little pr***."

Anger got me through both medical school and residency, it sure did. 😉

Intern year can suck a**.
 
Reading this gem from Birdstrike's link:

"A spokeswoman for America’s Health Insurance Plans advised us that we should instead be writing about how excited medical directors are to go to work every day to face the challenges of the health reform era, about how much they love their jobs."

More evidence that if the person speaking to you is a "spokesperson" for some lobbying group, you should probably discount heavily everything that comes out of their mouth.
 
EctopicFetus said:
I too love my job. Let me clear some things up for the residents and med students.........
.....Dont become a financial slave to your job and you can then enjoy your job.
Click to expand...

I think that last statement by EF sums up largely the happy vs unhappy.

I could live in a million dollar+ house, I could go buy a brand new Ferrari... I could work enough shifts 'extra' each month to cover that. But then, I am working that much more.

We can live well below our means but still live VERY well! My family can fly on Southwest to Beverly Hills for the weekend and Priceline a room; or we could charter a jet and stay in a Bungalow at the BH Hotel. One I can afford with a few hours of work, the other would take several shifts....
 
glorfindel's #4 is key... once you've met a few docs who seem to be still working for the $$, you'll know what burnout looks like.
 
glorfindel said:
Reading this gem from Birdstrike's link:

"A spokeswoman for America’s Health Insurance Plans advised us that we should instead be writing about how excited medical directors are to go to work every day to face the challenges of the health reform era, about how much they love their jobs."

More evidence that if the person speaking to you is a "spokesperson" for some lobbying group, you should probably discount heavily everything that comes out of their mouth.
Click to expand...

This proves that speech centers can survive when the much of the rest of the brain has been killed.
 
Loon said:
This proves that speech centers can survive when the much of the rest of the brain has been killed.
Click to expand...

That quote is pretty hilarious. I only linked that article for the graph. I hadn't even read it, actually. That's why I edited it out once I found the graph by itself, but glorfindel quoted it in 5 seconds flat. Glad you picked that nugget of political correctness out of there for our entertainment.

Since you guys are commenting on it, here's the link which is somewhat off topic, FWIW. It talks about burnout specifically amongst medical directors (thought that was a cushy job. Guess not).

http://www.managedcaremag.com/archives/1209/1209.burnout.html
 
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You guys and anesthesia guys seem so cool and practical. I wonder if there's evidence there or if its just my little anecdote, but I would like to train and work with the likes of some of you fellas and avoid those who you guys say have burnt out. Misery is a strong company and I wouldn't want to work with it
 
RustedFox said:
Replying to Glorfindel (didn't want a 'long-quote').

Cable ? Maaan, if it weren't for NHL network and the History Channel... I'd be there with you. I do like my "local news", too.

Coffee. Double-maaan. I used to be one of these guys that was like - "Starbucks ? Pfft. No way can I justify over three dollars for a cup of coffee... that's for those Seattle d!ckheads that are too cool for everything else. Now, I refuse to drink anything else. Its a clearly superior product.

See, detractors ? I can be wrong. 🙂
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LOL, I'm from Seattle. Funny, and sorta true.
 
Birdstrike said:
That quote is pretty hilarious. I only linked that article for the graph. I hadn't even read it, actually. That's why I edited it out once I found the graph by itself, but glorfindel quoted it in 5 seconds flat. Glad you picked that nugget of political correctness out of there for our entertainment.

Since you guys are commenting on it, here's the link which is somewhat off topic, FWIW. It talks about burnout specifically amongst medical directors (thought that was a cushy job. Guess not).

http://www.managedcaremag.com/archives/1209/1209.burnout.html
Click to expand...

When I've had a tough day, and I'm feeling beat-down, I often think "At least I don't have [insert medical director]'s job."

He works no overnights, few weekends, and makes more money than I do...but he has to deal with administrators and nurse managers every darn day.
 
WilcoWorld said:
When I've had a tough day, and I'm feeling beat-down, I often think "At least I don't have [insert medical director]'s job."

He works no overnights, few weekends, and makes more money than I do...but he has to deal with administrators and nurse managers every darn day.
Click to expand...

The medical directors they are talking about are insurance company peeps. But yeah, ED director is right at whatever the opposite of the sweet spot between lifestyle and pay is called. My current director works half weekend shifts (8 shifts/month) and has turned around the ED completely. And admin is still somewhat unhappy with her availability and thinks she should work less clinically.
 
JShephard said:
Medscape did an extensive physician happiness survey. EM was among the top 3 if I remember.

The complaints of medicineis in all fields. EM isnt a bottom tier happiness specialty.

This sounds like the post I read with EM being sued the most, when in reality it wasnt even top 10 in being sued.
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do you have the data for that? rate of different physicians being sued?? id like to read it - thanks!
 
RustedFox said:
Just had my grade latte for the day. Goddamned delicious.
Click to expand...

RF my man, WTF would you pay $3 for a coffee from 'Bucks? Black as Castrol motor oil is the ONLY way to go. I want my coffee so dark I need a f*cking spoon because its essentially coffee bean pudding.

And ya, as far as big-chain coffee goes...Starbucks>>>>>everything else. That being said, for those who like it at home....any french-pressed organic ultra dark roast = priapism.
 
Note, I do not consider an $6 triple-caramel-machiatto-swirly-tazo-frappe-lattucino as coffee. That is a "beverage" for people of which can often be described as per RFs earlier statement.
 
DreamingTheLive said:
RF my man, WTF would you pay $3 for a coffee from 'Bucks? Black as Castrol motor oil is the ONLY way to go. I want my coffee so dark I need a f*cking spoon because its essentially coffee bean pudding.

And ya, as far as big-chain coffee goes...Starbucks>>>>>everything else. That being said, for those who like it at home....any french-pressed organic ultra dark roast = priapism.
Click to expand...


You might as well be pouring battery acid onto your gastric mucosa. Let me know how that works out for you once you hit thirty. 🙂

... and yes, french-press homebrew FTW.
 
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i only drink "coffee beverages"... being an ex-athlete with lots of orthopedic issues killed my stomach by college. if it isn't more than half non-lactose milk or soy, i can't tolerate it.

actually those new cold green coffee starbucks packets are pretty darn good... a cold non-coffee tasting, non-soda caffeinated drink? perfect!
 
RustedFox said:
You might as well be pouring battery acid onto your gastric mucosa. Let me know how that works out for you once you hit thirty. 🙂

... and yes, french-press homebrew FTW.
Click to expand...

you should try to cold brew coffee sometime. it's delicious and really easy: all you need is a french press and a fridge. plus, it's much less acidic than regular coffee.

http://www.thedailybeast.com/articles/2009/08/18/coffees-dirty-little-secret.html

http://www.ourlittleapartment.com/2012/06/how-to-french-press-iced-coffee/
 
Birdstrike said:
It's great to hear someone this positive about EM. But I think your last line misses a huge point. Yes, there area few "screw ups" that just picked the wrong profession. That happens in any profession. Regardless, outside of the world of physicians, it's normal to make major career changes more than once in a lifetime. Yet as a physician, you're supposed to pick your job at age 26, and not change it at all for thirty to forty years? That's a very hard thing to do, and especially hard to do in EM. Someone like you, 20+ years into it, that hasn't struggled with any significant burnout, is the exception to the rule. I feel like I picked the right profession in choosing EM. I feel that it was perfect for 10 years. Then life changed around me, I changed, and the fit was not so perfect anymore.

http://www.managedcaremag.com/sites/default/files/imported/1209/1209.burnout_fig3.png


EM is at the top of this graph for a reason (JAMA 2012). It's not made up. It's not a "myth." It's not a vestige of the early days of EM where everyone was a "burnout" from some other field, destined to burnout again. EM can be tough, and it's not for wimps. We all knew that going in, but there are real problems that need to be addressed. If it was only a few freak outlier burnouts, that would be one thing. But when you've got 60-70% of people in a specialty (and 40-50% of physicians as a whole) reporting significant burnout, there are issues that need to be addressed.

Is it just that the younger generation just "screwed up" and picked the wrong profession? Are 60-70% just a bunch of wimps that need to suck it up? Maybe. But resting on that misses the opportunities to fix what could be improved.

Why is everyone so afraid to admit, there are systemic things within EM than can and should be improved, to make the profession better?
Click to expand...

Looks like the dermies got it right 😉
 
RustedFox said:
You might as well be pouring battery acid onto your gastric mucosa. Let me know how that works out for you once you hit thirty. 🙂

... and yes, french-press homebrew FTW.
Click to expand...

Actually, I've spoken to several GI docs about this exact point. They essentially said that anything about coffee being too acidic for the stomach is a bunch of garbage. In moderation of course.

Actually, I'd say that coffee/tea and alcohol, in moderation, are some of the best things you can do at skewing the longevity factor in your favor. Of course its the "in moderation" part that makes things interesting....i.e., like the upcoming Match Day festivities which will essentially be the NFL combine for my Liver. I can only hope that I've prepared it well.
 
DreamingTheLive said:
Actually, I've spoken to several GI docs about this exact point. They essentially said that anything about coffee being too acidic for the stomach is a bunch of garbage. In moderation of course.

Actually, I'd say that coffee/tea and alcohol, in moderation, are some of the best things you can do at skewing the longevity factor in your favor. Of course its the "in moderation" part that makes things interesting....i.e., like the upcoming Match Day festivities which will essentially be the NFL combine for my Liver. I can only hope that I've prepared it well.
Click to expand...

It makes sense when you consider that the stomach lining is designed to survie a pH of ~ 3, so unless you're drinking sulfuric acid it would be hard to drink something "too acidic".
 
Clearly, you guys are correct.

However, if you think that, having debunked the "coffee's acidity causes gastritis" theory, you've also debunked the "too much coffee causes gastritis" theory, then you're missing a step.

Signed,
Someone who balances his whole bean against his epigastric pain one sip at a time.
 
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"How do you take it?"

"Black as midnight on a moonless night."

"Pretty black."


[YOUTUBE]http://www.youtube.com/watch?v=5PcoMrwEa5o[/YOUTUBE]
 
To RF and DTL, you ladies should try some Cuban coffee, I swear you could use that instead of epi for resuscitations, v tach never tasted so good.
 
UnderwaterDoc said:
To RF and DTL, you ladies should try some Cuban coffee, I swear you could use that instead of epi for resuscitations, v tach never tasted so good.
Click to expand...

Help clear this up for me - how is Cuban coffee any different than espresso?

On a related note, I got the little Italian stovetop espresso maker at target for $35 - worth every penny.
 
UnderwaterDoc said:
To RF and DTL, you ladies should try some Cuban coffee, I swear you could use that instead of epi for resuscitations, v tach never tasted so good.
Click to expand...

Thanks for the heads up, I'm always looking to broaden my coffee horizons.
 
WilcoWorld said:
Clearly, you guys are correct.

However, if you think that, having debunked the "coffee's acidity causes gastritis" theory, you've also debunked the "too much coffee causes gastritis" theory, then you're missing a step.

Signed,
Someone who balances his whole bean against his epigastric pain one sip at a time.
Click to expand...

Again, I stated this is only so if you have a HEALTHY stomach/upper GI tract. GERD, Ulcers, etc. f*cks the whole equation up. Sorry though...Stomach transplant in order to enjoy the darkness life?
 
DreamingTheLive said:
RF my man, WTF would you pay $3 for a coffee from 'Bucks? Black as Castrol motor oil is the ONLY way to go. I want my coffee so dark I need a f*cking spoon because its essentially coffee bean pudding.

And ya, as far as big-chain coffee goes...Starbucks>>>>>everything else. That being said, for those who like it at home....any french-pressed organic ultra dark roast = priapism.
Click to expand...

Once you go black you never go back. I had to do it.
 
FSU2013 said:
Help clear this up for me - how is Cuban coffee any different than espresso?

On a related note, I got the little Italian stovetop espresso maker at target for $35 - worth every penny.
Click to expand...

I don't know, all I can tell you is that I don't get the same effect from espresso that I do from Cuban coffee, maybe is a placebo effect?

I'm sure someone out there has compared the amount of caffeine between the two.
 
At least it beats being a med student...right?!
 
My Rancilio Ms Silvia espresso machine was always open before surgery pre-rounds while Starbucks and others doors were still locked ... and it was pouring out crema filled black gold from the likes of 3rd wave roasters intelli, counter culture, stumptown, four barrell, and any other roasters the hipster spirit guides were highlighting that week. Ill drink my Starbucks in a pinch, but the coffee world is wide and it doesn't take a sophisticated palate to tell the difference
 
This is probably complete blasphemy, but for me nothing beats a medium coffee from Dunkin Donuts. I drink Starbucks occasionally when a group wants to go there, but I prefer the taste from Dunkin hands down.
 
EMquest3 said:
This is probably complete blasphemy, but for me nothing beats a medium coffee from Dunkin Donuts. I drink Starbucks occasionally when a group wants to go there, but I prefer the taste from Dunkin hands down.
Click to expand...

What!?! lol, Nooo! just kidding...well, kinda.

Listen, I'm not a Starbucks zealot, I think that their prices are f*cking outrageous, and I think its kind of hilarious that they've created their own nation of devout cult followers. However, as far as big-chain coffee goes, they're roasts simply can't be beat. They're a rip-off, sure, but damn tasty and very consistent. 98% of the time you know what you're getting.

Now, I'll take a great, local true "coffehouse" any day of the week over 'Bucks, but these are hit and miss. But I'm always up for looking for that next heavenly cup of darkness.
 
DreamingTheLive said:
What!?! lol, Nooo! just kidding...well, kinda.

Listen, I'm not a Starbucks zealot, I think that their prices are f*cking outrageous, and I think its kind of hilarious that they've created their own nation of devout cult followers. However, as far as big-chain coffee goes, they're roasts simply can't be beat. They're a rip-off, sure, but damn tasty and very consistent. 98% of the time you know what you're getting.

Now, I'll take a great, local true "coffehouse" any day of the week over 'Bucks, but these are hit and miss. But I'm always up for looking for that next heavenly cup of darkness.
Click to expand...

Anyone brave enough to try this? http://www.amazon.com/dp/B006CNTR6W//ref=cm_sw_su_dp?tag=duiwath-20
 
Again ..I would like to offer you guys the best coffee in the world. Straight from Brazil. You ever been to brazil? It's amazing. The nice thing is that you dont have to go there to get it. www.sendex.net has it. I promise you will never go back. Pilao is the best!
 
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