What's the single worst thing about our job? (Pick only one)

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I gotta go with having to call around to get an acceptance. It's painful.

 

[valianteffort]

I think the major thing that really ruins my shift is patients that don't understand the concept of the emergency room aka to rule out EMERGENCIES. I work in a highly affluent area which is just not the clientele I prefer. Back when I worked inner city downtown, this was a rarity. Ultimately, I think we are all in the field (for the most part) to help people and I try not to disappoint. However, we will not be able to solve your 3 year long troubles with abdominal pain after you have seen GI ,cardio, rheum and endocrine whom have all told you it is unexplained. Telling this to the patient, then to the mother and father whom walk in after your explanation, then to grandpa ,etc is a real killer. Then patients will be upset that they spent xxx amount of money for 'no reason'. No maam, you have reassurance there isn't an emergency. Truly stuff like this wears on me the most.

 

[BoardingDoc]

Similar to @valianteffort I think the worst part is the 5% of my patients who take up 25% of my time because of some combination of anxiety, entitlement, or just plain stupidity where I am unable to discharge them in a timely fashion.

"Doc, bed 8 has more questions and is refusing to leave until they see you again"

Patient: Some question that I already answered 3 times.

Me: No, I don't know why your right middle toe has been tingling for the past 6 months. Yes, your tests look fine. You need to followup with your PCP or any number of the specialists whom you've already seen for this exact same issue, just like I said the last time I left this room. Yes, I heard that you want an MRI of your foot. No, you can't have one here today.... etc... etc.... etc.

Sometimes I'll tell the nurse to let the patient know that I'm very busy seeing sick people and I'll come back and talk to them, but that it might take up to an hour. I then simply never go back and wait until they leave of their own volition. This obviously only works when I have the bed to spare.

 

[JacobMcCandles]

Misaligned expectations on the patient's part.

 

[bky3c]

I know this isn't what you asked, but maybe it sort of is in a roundabout way... I've had a handful of (usually young male) patients ask (usually during lac repair) what's the worst thing I've ever seen in the ER. I know they're expecting some sort of gruesome, exciting story about trauma like they've seen on tv, but my answer is, "Dead babies." Shuts 'em up real quick.

 

[WhatJobDoIPick]

Similar to @valianteffort I think the worst part is the 5% of my patients who take up 25% of my time because of some combination of anxiety, entitlement, or just plain stupidity where I am unable to discharge them in a timely fashion.

"Doc, bed 8 has more questions and is refusing to leave until they see you again"

Patient: Some question that I already answered 3 times.

Me: No, I don't know why your right middle toe has been tingling for the past 6 months. Yes, your tests look fine. You need to followup with your PCP or any number of the specialists whom you've already seen for this exact same issue, just like I said the last time I left this room. Yes, I heard that you want an MRI of your foot. No, you can't have one here today.... etc... etc.... etc.

Sometimes I'll tell the nurse to let the patient know that I'm very busy seeing sick people and I'll come back and talk to them, but that it might take up to an hour. I then simply never go back and wait until they leave of their own volition. This obviously only works when I have the bed to spare.

New job has a patient sat incentive. Therefore now I kinda care about patient sat. But only to a point. Certain patients you know if you put the little extra elbow grease in they will be very happy. Certain patients are lost from the get go. I put minimal customer service time into these as they have zero ROI. Instead I look to see if they carry a chart diagnosis of an ICD 10 code I can use to exclude them from receiving a survey.

 

[throway134]

Caveat not in the field anymore, and no intention of returning.

For me the worst part was the feeling before a shift, and no matter how much time I had before that shift it started ~ halfway to being back.

If I was off 3 days it usually started 1.5 days out, if I was off 7 days (rare, I probably worked too much) it started 2-3 d out.

It reminded me intensely of the feeling I had before a fight when I was younger and dumb enough to think that was a good recreational activity. I would start constantly cycling through worst case scenarios I had seen and might see e.g. dead baby (or worse yet almost dead baby who might be saved), pregnant trauma pt, shoulder dystocia or twins or footling breech, jet ventilation for peds, etc

I also took 1-2 d to “come down” after a shift

That’s why I don’t do that anymore

 

[watermanMD]

Entitled, rich ppl. This burns me to a crisp. Annoyed when you don’t find something wrong. Expecting you to call their doctor and XYZ specialist. What do you mean you’re not admitting me for a colonoscopy, they couldn’t schedule me one for 3 weeks and I’ve had this abdominal pain for 2 months? 3 CT abdomens in 3 weeks. 3 negative work ups. Sure here’s XYZ test even though I’m fighting a losing battle for my press ganey and satisfaction bonus. These mother****ers constantly turning their nose up makes me most toasty.

 

[valianteffort]

Entitled, rich ppl. This burns me to a crisp. Annoyed when you don’t find something wrong. Expecting you to call their doctor and XYZ specialist. What do you mean you’re not admitting me for a colonoscopy, they couldn’t schedule me one for 3 weeks and I’ve had this abdominal pain for 2 months? 3 CT abdomens in 3 weeks. 3 negative work ups. Sure here’s XYZ test even though I’m fighting a losing battle for my press ganey and satisfaction bonus. These mother****ers constantly turning their nose up makes me most toasty.

IDK why but this sounded like a poem to me. Could be made into a haiku or something. Well said

 

[Tenk]

Dead children.

Sorry but nothing even comes close.

 

[The Knife & Gun Club]

For me it’s the fighting with other docs to get a dispo. It’s the perfect cocktail of lack of respect for EM docs knowledge base, systemic dysfunction, and patient dissatisfaction.

The other day I spent 12 hours trying to get a dispo for a young female who speaks only an obscure foreign language, has no PCP/insurance, and is 10 weeks pregnant with intractable pain in a 12cm unterine fibroid. GYN says it’s not related to the pregnancy and no operative intervention for the fibroid so not their problem, but they recommend and MRI and gen surg consult because it sounds like she has an appy. Move heaven and earth, get the MRI, radiology says indeterminate but likely appy. Gen surg does not think radiologist is correct, says no appy just artifact, recommends discharge or admit to medicine for intractable pain.

Meanwhile the girl has taken 4 doses of morphine, still crying, vomiting up everything. Medicine won’t admit because she’s pregnant and MRI says appy, it should be managed by OB or GS both of whom have signed off and refuse to admit.

I have at least a couple of these a weak and are always miserable.

 

[skougess]

For me it’s the fighting with other docs to get a dispo. It’s the perfect cocktail of lack of respect for EM docs knowledge base, systemic dysfunction, and patient dissatisfaction.

The other day I spent 12 hours trying to get a dispo for a young female who speaks only an obscure foreign language, has no PCP/insurance, and is 10 weeks pregnant with intractable pain in a 12cm unterine fibroid. GYN says it’s not related to the pregnancy and no operative intervention for the fibroid so not their problem, but they recommend and MRI and gen surg consult because it sounds like she has an appy. Move heaven and earth, get the MRI, radiology says indeterminate but likely appy. Gen surg does not think radiologist is correct, says no appy just artifact, recommends discharge or admit to medicine for intractable pain.

Meanwhile the girl has taken 4 doses of morphine, still crying, vomiting up everything. Medicine won’t admit because she’s pregnant and MRI says appy, it should be managed by OB or GS both of whom have signed off and refuse to admit.

I have at least a couple of these a weak and are always miserable.

Would very much agree. I have noticed that the days that I discharge most of my patients, I tend to leave work happy. The days that are consult/admit heavy, I tend to leave work feeling burnt out.

I don’t love difficult/unreasonable patients, but for some reason that doesn’t burn me out nearly as much as regular consultant interaction.

 

[AlmostAnMD]

That everyone at every level knows what the problems are

But financial interests keep all parties involved from fixing it

Preventable deaths are unfortunate, but profits are much, much more important. I don't know how we arrived at that conclusion, but we did, and it's the new norm driving every complaint in this topic

 

[thegenius]

Misaligned expectations on the patient's part.

THIS
+1

 

[thegenius]

Dead children.

Sorry but nothing even comes close.

You know...thankfully I've never had a child DIE on me...they've come in dead though. much easier to handle in that case.

 

[throway134]

Dead children.

Sorry but nothing even comes close.

The noises that come from the parents after probably do, assuming they weren’t the cause, but that probably counts as part of a lump sum of general crapiness

 

[JacobMcCandles]

Dead children.

Sorry but nothing even comes close.

I took it as what is the worst thing you have to deal with on a daily basis.

 

[The Knife & Gun Club]

I took it as what is the worst thing you have to deal with on a daily basis.

Yea dead kids are probably the worst thing we ever have to see but luckily is pretty darn rare. And I would argue that seeing those occasional terrible things is part of what you sign up for being an EM doc. Most of us do still take some pride in being trained to act even in those horrible situations.


But dealing with manipulative patients with misaligned expectations and motivations, or consultants with god complexes and paper then egos is pretty universally .

 

[HemorrhagicShock]

Truly nothing is worse than having to simp to consultants with less than zero respect for you and your specialty as the par for the course approach required to get STANDARD OF CARE medicine to your patient.

EM isn't medicine, it's a SALES and MARKETING job.

Sell this patient's problem to a consultant
Sell BS studies, labs, and CT scans to the patient
Sell the admit to the hospitalist
Sell the discharge reasoning to the patient's angry daughter
Sell your soul to the devil

 

[xaelia]

For me it’s the fighting with other docs to get a dispo. It’s the perfect cocktail of lack of respect for EM docs knowledge base, systemic dysfunction, and patient dissatisfaction.

The other day I spent 12 hours trying to get a dispo for a young female who speaks only an obscure foreign language, has no PCP/insurance, and is 10 weeks pregnant with intractable pain in a 12cm unterine fibroid. GYN says it’s not related to the pregnancy and no operative intervention for the fibroid so not their problem, but they recommend and MRI and gen surg consult because it sounds like she has an appy. Move heaven and earth, get the MRI, radiology says indeterminate but likely appy. Gen surg does not think radiologist is correct, says no appy just artifact, recommends discharge or admit to medicine for intractable pain.

Meanwhile the girl has taken 4 doses of morphine, still crying, vomiting up everything. Medicine won’t admit because she’s pregnant and MRI says appy, it should be managed by OB or GS both of whom have signed off and refuse to admit.

I have at least a couple of these a weak and are always miserable.

Truly nothing is worse than having to simp to consultants with less than zero respect for you and your specialty as the par for the course approach required to get STANDARD OF CARE medicine to your patient.

EM isn't medicine, it's a SALES and MARKETING job.

Sell this patient's problem to a consultant
Sell BS studies, labs, and CT scans to the patient
Sell the admit to the hospitalist
Sell the discharge reasoning to the patient's angry daughter
Sell your soul to the devil

It's not all sunshine and roses in the ED in NZ, but this entire category of issues is dramatically curtailed.

1) Generally, the only senior doctors on the floor are the ED docs – so most of our calls for admission/consultation are being taken by a registrar, and the hierarchy of medicine in the British system means it's drilled into them to at least see the patient first before declining/complaining.
2) In a situation where it's between a couple different services, this can obviously get messy and need to get escalated up the tree to the senior doctors for the consulting services – but the ED is mostly outside the process, and these other services negotiate the next steps in care for the patient between themselves, without troubling us (other than the patient taking up a bed space for an eternity).

I never, ever dread going to work.

 

[EmergentMagician]

Truly nothing is worse than having to simp to consultants with less than zero respect for you and your specialty as the par for the course approach required to get STANDARD OF CARE medicine to your patient.

EM isn't medicine, it's a SALES and MARKETING job.

Sell this patient's problem to a consultant
Sell BS studies, labs, and CT scans to the patient
Sell the admit to the hospitalist
Sell the discharge reasoning to the patient's angry daughter
Sell your soul to the devil

You just connected some synapses and helped me better understand my negative feelings in EM.

The sales and marketing aspect, or said differently, the waiting tables at Denny's aspect

 

[bky3c]

You just connected some synapses and helped me better understand my negative feelings in EM.

The sales and marketing aspect, or said differently, the waiting tables at Denny's aspect

Me too. I've always thought that being in sales would be my version of hell, and it never occurred to me that that's what EM is.

 

[WhatJobDoIPick]

THIS
+1

I've been finding that setting expectations early helps.

"We're probably not going to find the reason why XYZ symptom happened to you today but we're going to make sure you're safe and try to make you more comfortable while you're here."

This seems to work 99% of the time. If it doesn't , the interaction was likely fuxxored from the start and there was no way you were going to win.

"Man I wish I could get you that MRI but I'm not allowed."

I like saying "I'm not allowed" because it puts the situation into terms the 9 to 5 muggles who have a "boss" can understand.

 

[Angry Birds]

Caveat not in the field anymore, and no intention of returning.

For me the worst part was the feeling before a shift, and no matter how much time I had before that shift it started ~ halfway to being back.

If I was off 3 days it usually started 1.5 days out, if I was off 7 days (rare, I probably worked too much) it started 2-3 d out.

It reminded me intensely of the feeling I had before a fight when I was younger and dumb enough to think that was a good recreational activity. I would start constantly cycling through worst case scenarios I had seen and might see e.g. dead baby (or worse yet almost dead baby who might be saved), pregnant trauma pt, shoulder dystocia or twins or footling breech, jet ventilation for peds, etc

I also took 1-2 d to “come down” after a shift

That’s why I don’t do that anymore

I would have this feeling when I worked at an urban hospital with crazy volumes and high acuity. It went away when I switched to a low volume place and also as I became more experienced. I would never work at such a place.

 

[namethatsmell]

I think the major thing that really ruins my shift is patients that don't understand the concept of the emergency room aka to rule out EMERGENCIES. I work in a highly affluent area which is just not the clientele I prefer. Back when I worked inner city downtown, this was a rarity. Ultimately, I think we are all in the field (for the most part) to help people and I try not to disappoint. However, we will not be able to solve your 3 year long troubles with abdominal pain after you have seen GI ,cardio, rheum and endocrine whom have all told you it is unexplained. Telling this to the patient, then to the mother and father whom walk in after your explanation, then to grandpa ,etc is a real killer. Then patients will be upset that they spent xxx amount of money for 'no reason'. No maam, you have reassurance there isn't an emergency. Truly stuff like this wears on me the most.

Similar to @valianteffort I think the worst part is the 5% of my patients who take up 25% of my time because of some combination of anxiety, entitlement, or just plain stupidity where I am unable to discharge them in a timely fashion.

"Doc, bed 8 has more questions and is refusing to leave until they see you again"

Patient: Some question that I already answered 3 times.

Me: No, I don't know why your right middle toe has been tingling for the past 6 months. Yes, your tests look fine. You need to followup with your PCP or any number of the specialists whom you've already seen for this exact same issue, just like I said the last time I left this room. Yes, I heard that you want an MRI of your foot. No, you can't have one here today.... etc... etc.... etc.

Sometimes I'll tell the nurse to let the patient know that I'm very busy seeing sick people and I'll come back and talk to them, but that it might take up to an hour. I then simply never go back and wait until they leave of their own volition. This obviously only works when I have the bed to spare.

Misaligned expectations on the patient's part.

These three comments fit together perfectly and are among my least favorite parts of working in the trenches.
But seeing patients in clinic now vs the ED...I really do get why John Q Public can (inappropriately) view the ED as a wonderland where all their dreams will come true...compared to my boring clinic.

The ED: has high ceilings, bright lights, lots of things that go beep and boop, and people to take their blood and their pictures..."ALL IN ONE PLACE MAN THIS IS JUST LIKE TV (!)"
My clinic: muted lightening, mundane clip-art style stuff on the walls, and no electronics making cool (to them) noises. It doesn't exactly inspire patients to think that "everything is going to finally happen here today."
And of course ED waiting room time + copay>>> Clinic waiting room time + copay

It's an abysmal setup of heightened patient expectations that has the average ED doc already fighting an unfair uphill battle before they even meet the patient.


We need an Australian-style ad campaign to educated what the ED is really for and flat-out shame people who try to make it into the "Everything Department"

 

[cyanide12345678]

I would have this feeling when I worked at an urban hospital with crazy volumes and high acuity. It went away when I switched to a low volume place and also as I became more experienced. I would never work at such a place.

Used to have that feeling at my first job out for the first 6 months.

Occasionally get that feeling after a long vacation now since i just don’t want to go back to the grind.

The worst thing for me is not seeing my kids on my work days because of a 12 hour shift with a 1 hour commute each way. I leave before they wake up, and usually am back after their bedtime. I know i could work somewhere closer or higher volume where it’s not 12 hour shifts - but then the grind of emergency medicine becomes worse with higher volumes. Rural medicine itself isn’t that bad otherwise.

 

[GatorCHOMPions]

Caveat not in the field anymore, and no intention of returning.

For me the worst part was the feeling before a shift, and no matter how much time I had before that shift it started ~ halfway to being back.

If I was off 3 days it usually started 1.5 days out, if I was off 7 days (rare, I probably worked too much) it started 2-3 d out.

It reminded me intensely of the feeling I had before a fight when I was younger and dumb enough to think that was a good recreational activity. I would start constantly cycling through worst case scenarios I had seen and might see e.g. dead baby (or worse yet almost dead baby who might be saved), pregnant trauma pt, shoulder dystocia or twins or footling breech, jet ventilation for peds, etc

I also took 1-2 d to “come down” after a shift

That’s why I don’t do that anymore

The peri-shift "Dread" @Rekt

 

[thegenius]

I've been finding that setting expectations early helps.

"We're probably not going to find the reason why XYZ symptom happened to you today but we're going to make sure you're safe and try to make you more comfortable while you're here."

This seems to work 99% of the time. If it doesn't , the interaction was likely fuxxored from the start and there was no way you were going to win.

"Man I wish I could get you that MRI but I'm not allowed."

I like saying "I'm not allowed" because it puts the situation into terms the 9 to 5 muggles who have a "boss" can understand.

Totally agree I tell people upfront that I'm unlikely to find anything, just like you. And I even tell them that's a good thing.
And i say that "not allowed" stuff too, or I'll say "that's not a service we offer" or "I can't get it done"

Basically managing patient expectations is the number one thing that has made me a better doctor.
Number two is making them laugh and joking and giving the impression that I care. I spend more time with patients on average as compared to the other docs. Decreased bouncebacks, increases compliance, and reduces lawsuits.

 

[Mount Asclepius]

Patients. They are the worse part. Misaligned expectations are a significant aspect as discussed above.

I really considered Radiology, which would have avoided the worst part of medicine. I couldn’t imagine spending most of my time looking at a screen… I spend the majority of my ED shifts looking at a screen 🤦‍♂️

Occasionally though patients are the best part. The straightforward patient that just wants reassurance not ACS. The critically ill patient that feels they are an inconvenience and apologizes for taking time away from other patients. The patient with an amazing life story. Ever meet someone who has circumnavigated the globe in an airplane (there aren’t too many of them)? Rarely guiding parents through the sudden death of a child. It’s terrible, but powerful. Most don’t get to experience those events. I feel it allows for a better understanding and appreciation of life as you realize how many take life for granted which can suddenly be unexpectedly fleeting.

I don’t foresee the Everything Department going away amidst American expectations of wanting everything now. The financial pressures of American capitalism will continue to drive healthcare in the wrong direction. The dread is real. It’s not fear of seeing the sick patient for most with experience though. It’s the dread of the tense interactions, the charting, the system failures and not being able to poop when you want to after your coffee finally wakes you up. Occasionally experiencing the best in the worst parts of EM - the patients - is all you can hope for.

 

[Kryptocoin]

The single worst thing about EM ? It's like trying to decide which form of death do you prefer: Cyanide? drowning? hanging? Death by a thousand cuts?


If you'd ask the single best thing about EM, then for me the list becomes incredibly short: 100% schedule control. That's it.

 

[TooMuchResearch]

For me it’s the fighting with other docs to get a dispo. It’s the perfect cocktail of lack of respect for EM docs knowledge base, systemic dysfunction, and patient dissatisfaction.

The other day I spent 12 hours trying to get a dispo for a young female who speaks only an obscure foreign language, has no PCP/insurance, and is 10 weeks pregnant with intractable pain in a 12cm unterine fibroid. GYN says it’s not related to the pregnancy and no operative intervention for the fibroid so not their problem, but they recommend and MRI and gen surg consult because it sounds like she has an appy. Move heaven and earth, get the MRI, radiology says indeterminate but likely appy. Gen surg does not think radiologist is correct, says no appy just artifact, recommends discharge or admit to medicine for intractable pain.

Meanwhile the girl has taken 4 doses of morphine, still crying, vomiting up everything. Medicine won’t admit because she’s pregnant and MRI says appy, it should be managed by OB or GS both of whom have signed off and refuse to admit.

I have at least a couple of these a weak and are always miserable.

Did either service evaluate the patient?

 

[pkwraith]

Patient satisfaction is the root of most evils.

Misaligned expectations? "We've ruled out the emergencies, follow up with your doctor." Discharge
Medicaid abuse? "You don't have an emergency. Stop using the emergency department for this." Discharge. Eventually they'll get the hint.
Wanting **** that they don't need or unnecessary admsision? "Sorry, we don't do that." Discharge.
=Less patient satisfaction radiation, significantly less overutilization, more efficient workflow, less stress, more control over your practice.

 

[RustedFox]

"The number one cause of burnout is the patient."

 

[HemorrhagicShock]

Did either service evaluate the patient?

🤣🤣🤣

What do you think?

 

[cyanide12345678]

The single worst thing about EM ? It's like trying to decide which form of death do you prefer: Cyanide? drowning? hanging? Death by a thousand cuts?


If you'd ask the single best thing about EM, then for me the list becomes incredibly short: 100% schedule control. That's it.

Okay im going to break away from my normal pessimism from EM and add a few good things about EM:

1) schedule control if you know what you want 3-4 months in advance.
2) 3 year residency. I mean i was burned out by year 3 already and ready to make some real money, can’t imagine going through 5-7 years of resident lifestyle.
3) when you’re off, you are truly off.

 

[cyanide12345678]

"The number one cause of burnout is the patient."

Amen brother.

 

[Angry Birds]

"The number one cause of burnout is the patient."

I’m working rural hospital and don’t mind the patients. They are actually nice.
Might be the better part of the job.

Okay im going to break away from my normal pessimism from EM and add a few good things about EM:

1) schedule control if you know what you want 3-4 months in advance.
2) 3 year residency. I mean i was burned out by year 3 already and ready to make some real money, can’t imagine going through 5-7 years of resident lifestyle.
3) when you’re off, you are truly off.

I’m not a fan of medicine in general and wouldn’t have done it but I still think EM was a good choice for me based on what you said here. Additionally, I think rural EM is so much better, especially if you can find a high paying gig like I have.

 

[gutonc]

I’m working rural hospital and don’t mind the patients. They are actually nice.
Might be the better part of the job.

I'm not EM but I changed to a rural CAH job from an urban academ-ish place last year and while it's not all rainbows and unicorns, the patients are never the biggest problem anymore.

 

[dozitgetchahi]

Okay im going to break away from my normal pessimism from EM and add a few good things about EM:

1) schedule control if you know what you want 3-4 months in advance.
2) 3 year residency. I mean i was burned out by year 3 already and ready to make some real money, can’t imagine going through 5-7 years of resident lifestyle.
3) when you’re off, you are truly off.

That “5-7 years of resident lifestyle” is an incredibly hard pill to swallow for those specialties.

When I was on my surgery rotation at the end of my third year in medical school, both myself and one of my friends in my class dealt with some really douchebaggy surgery interns. At one point my friend goes “look, when we get off this rotation, you’re gonna do fourth year of medical school. And then you’re gonna do internal medicine residency. And then after you start working as an attending, these douchebags will STILL be surgery residents.”

 

[qwerty89]

Entitled, rich ppl. This burns me to a crisp. Annoyed when you don’t find something wrong. Expecting you to call their doctor and XYZ specialist. What do you mean you’re not admitting me for a colonoscopy, they couldn’t schedule me one for 3 weeks and I’ve had this abdominal pain for 2 months? 3 CT abdomens in 3 weeks. 3 negative work ups. Sure here’s XYZ test even though I’m fighting a losing battle for my press ganey and satisfaction bonus. These mother****ers constantly turning their nose up makes me most toasty.

One thing about socialized medicine is that outside of private and/or cash paying patients, all the remaining patients end up reimbursing the same.

Right now hospitals and docs are incentivized to cater to every whim of rich entitled people because they get $$$. You work in upper middle class neighborhoods because they pay more because they have a better "payor mix" because they have more wealthy patients.

If everyone is the same the sweet spot would be working class Americans and immigrant populations. Less fuss and pushback, more respect, and same income.

 

[allantois]

I think the major thing that really ruins my shift is patients that don't understand the concept of the emergency room aka to rule out EMERGENCIES. I work in a highly affluent area which is just not the clientele I prefer. Back when I worked inner city downtown, this was a rarity. Ultimately, I think we are all in the field (for the most part) to help people and I try not to disappoint. However, we will not be able to solve your 3 year long troubles with abdominal pain after you have seen GI ,cardio, rheum and endocrine whom have all told you it is unexplained. Telling this to the patient, then to the mother and father whom walk in after your explanation, then to grandpa ,etc is a real killer. Then patients will be upset that they spent xxx amount of money for 'no reason'. No maam, you have reassurance there isn't an emergency. Truly stuff like this wears on me the most.

There has been total medicalization of every aspect of American life: constant commercials that tell you to consult your doctor or go to the nearest ED for any trivial issue. People show up expecting that all of their life's issues can be solved, they can be provided with a note to get them out of their troubles and that somehow insurance is supposed to cover any and every expense, procedure or intervention most of which are only done for medicolegal reasons anyway

 

[RustedFox]

I’m working rural hospital and don’t mind the patients. They are actually nice.
Might be the better part of the job.

I'm rural right now, too. The number one cause of burnout is still the patient.

 

[Kryptocoin]

Okay im going to break away from my normal pessimism from EM and add a few good things about EM:

1) schedule control if you know what you want 3-4 months in advance.
2) 3 year residency. I mean i was burned out by year 3 already and ready to make some real money, can’t imagine going through 5-7 years of resident lifestyle.
3) when you’re off, you are truly off.

Right.

I'm actually much happier these days as I'm getting close to my FIRE number thanks to the stock market that has been hot the last 3 years. I guess the cure for EM pessimism is achieving FI?

 

[cyanide12345678]

I’m working rural hospital and don’t mind the patients. They are actually nice.
Might be the better part of the job.



I’m not a fan of medicine in general and wouldn’t have done it but I still think EM was a good choice for me based on what you said here. Additionally, I think rural EM is so much better, especially if you can find a high paying gig like I have.

Yeah i found a side gig where I’ve negotiated $295/hr for a 7500 annual volume ER. Going to do 2-3 shifts there. It’s going to be great $/patient seen. Might do more if i really like the place.

 

[cyanide12345678]

Right.

I'm actually much happier these days as I'm getting close to my FIRE number thanks to the stock market has been hot the last 3 years. I guess the cure for EM pessimism is achieving FI?

Yeah Im coast FI at 2M net worth and 35 age. 3M fulfills our 4% rule and i think I’m only 3 years from that.

Im starting to fantasize about turning my w2 job into a PRN gig in 2-3 years and being credentialed at 3-4 places where i only work prn as i choose. Financial independence is definitely freeing.

 

[Kryptocoin]

Yeah Im coast FI at 2M net worth and 35 age. 3M fulfills our 4% rule and i think I’m only 3 years from that.

Im starting to fantasize about turning my w2 job into a PRN gig in 2-3 years and being credentialed at 3-4 places where i only work prn as i choose. Financial independence is definitely freeing.

2M at 35 is impressive. How? Married well?

 

[JacobMcCandles]

2M at 35 is impressive. How? Married well?

$2M net worth by 35 can be done in a normally performing stock market without a spouse’s help. You’ll need a good job and high savings rate. Most won’t for reasons but it’s doable.

 

[bky3c]

There has been total medicalization of every aspect of American life: constant commercials that tell you to consult your doctor or go to the nearest ED for any trivial issue. People show up expecting that all of their life's issues can be solved, they can be provided with a note to get them out of their troubles and that somehow insurance is supposed to cover any and every expense, procedure or intervention most of which are only done for medicolegal reasons anyway

This reminds me of a patient who kept yelling from his room, "I need something to calm me down!" That was when I learned there are people who externalize even something as (to me) internal as that. I kept thinking, "You do have something. It's your own brain. You can use it to calm yourself down." So many of people's problems have free, easy, non-medical solutions, but everyone wants a pill or even better, a shot.

 

[cyanide12345678]

$2M net worth by 35 can be done in a normally performing stock market without a spouse’s help. You’ll need a good job and high savings rate. Most won’t for reasons but it’s doable.

And the stock market has been abnormally above average so that’s been helpful too. Though my net worth probably would have been around 1.6-1.7 ish without my spouse - but man…my expenses would have been so so so much lower without a wife and kids. Maybe even 3k per month vs 10k/month if i didnt have a family.

 

[cyanide12345678]

2M at 35 is impressive. How? Married well?

Married alright. Wife is a family doc. She’s only been working as an attending for 2.5 years, and we both have been part time for the last 8 months. I think if i wasnt married with kids, my personal net worth would have been around 1.6-1.7m. My expenses would have been tremendously lower too.

The biggest net worth building tool was our income. I’ve been out almost 5 years now since 2019. Started making 450k, wife made 60k as a resident. 2 years of that in a very very low cost of living city with 5k/month of average expenses (rent was 1350/month for a 2 bed/2 bath apartment).

Only had 195k in total educational debt - 50k was paid as pgy3 through moonlighting (made an extra 80-90k moonlighting during pgy3). The remaining 145k was paid off by feb 2020 (8 months post graduation).

Then just kept building from there.

Made big changes starting nov 2021 after a 2 month break from working while switching jobs. Moved cities, bought a home, wife got a big girl job.

Took a 50k paycut in nov 2021 to a lower acuity and volume rural job but wife’s income went to 230k from 60k so family income increased to over 630k ish. Expenses went from 5k/month to 10k/month. Saved a lot more and invested like crazy.

Had a blockbuster year in 2023 - broke 900k in taxable income and essentially decided to cut down to part time october 2023. In 2023 net worth increased by 550k - I think i clocked in 470k of w2 income due to a retention bonus and occasional extra shifts. My wife had 230k of income. My brokerage account had short term taxable gains of 205k and my real estate investments gave me some 20k of rents.

It didnt hurt when my taxable account gained 109% in the last 2 years vs 27% for spy.

So yeah….its been a good ride.