punkedoutriffs

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I mean attendings, more specifically gen surg attendings, since I've gotten the impression that residents are pretty burnt out on average. But that's just it, is attending work/life that much better? I mean you've got attending hospitalists/EMs who work 1/2 the hours you guys do and they're burnt out. Just trying to understand.
 

wjs010

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I mean attendings, more specifically gen surg attendings, since I've gotten the impression that residents are pretty burnt out on average. But that's just it, is attending work/life that much better? I mean you've got attending hospitalists/EMs who work 1/2 the hours you guys do and they're burnt out. Just trying to understand.
My brother is a surgeon and I think part of the reason actually is that life after residency is easier as far as hours. He said residency was hell but in practice he can work however much he wants.
 
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punkedoutriffs

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Yea I've heard that before but that still doesn't remove the fact that a seemingly a good amount of surgeons still work like 60-80 hrs/wk after residency. Again that's 2x the hours of a hospitalist who works 7-on-7-off 12 hrs/day or an EM who works 3-12hr shifts/wk.
 

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I can see EM guys getting burnt out even with 3 12's a week. Think about how many non-emergent patients they see, the "I want it now/what's taking so long/this is an ER" attitude, and the frequent fliers.
 

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I can see EM guys getting burnt out even with 3 12's a week. Think about how many non-emergent patients they see, the "I want it now/what's taking so long/this is an ER" attitude, and the frequent fliers.
Clearly you haven't had to round on some of the rocks that live on general surgery services. Some of our patients get to be very needy and are hard to get rid of.

I think the reason is more mind set and expectations. As a general surgery resident, you work 70-90 hrs/week, you work more ~28 hr shifts than most, and your work ethic is such that you take pride in working hard. Not to forget that expectations are always high, you'er never allowed to complain, and the first half of residency (or more) you get beat on pretty good by those senior to you. When you go into practice and work significantly less hours than residency, become your own boss, and you actually get paid for your hard work, it doesn't seem bad.
I'm not entirely sure why EM has the burn out rates that it does. I've heard many reasons but none are convincing. I wonder if the burn out rate in EM would be lower if they had a more intense residency before going into practice working ~12 days/month.
 

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I think lazymed is spot on.

EM doesn't have a monopoly on needy patients. Ever spent anytime with a woman with breast cancer? :eek: They are the sole reason why, although I work fewer hours than my GS colleagues, they tell me they'd "rather have 1000 GS patients than 1 breast patient".

Burn out is highly subjective. Its most likely a combination of personality type, expectations, availability of resources to do one's job, patient population and work load; multiple chronic stressors (which can include non-professional issues as well) over a period of time lead to burn-out. Surgeons wear their workaholism like a badge of honor, so long hours are not the sole predictor of burn out. If you enjoy what you do, have the resources to do it well, and enough time to do it, burn out may not be a problem.
 

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I'm not entirely sure why EM has the burn out rates that it does.
Everyone is going to say this is a flame war, but my honest opinion is that it's because of two reasons: 1) their attitude and 2) overnights. Number two is fairly self-explanatory, but basically I think any job where you mandatorily are working overnight (not just "on call" but that's when you work) is difficult to maintain for your entire life. At some point, I imagine that just gets old. Number one is evident when you talk to EM guys. Most of what they focus on is how they have tons of time off and how their lifestyle is so great. If your focus is "how little I have to be at work," then that eventually makes you tired of being at work.
 

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I would also step back and point out that burn out IS an issue in surgery, just as it is in any field of medicine.

To act as though our work ethic makes us immune from burn out and emotional fatigue is highly naive.
That's also true. I think lots of surgeons experience burn-out, but just not to the point of quitting.
 
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wjs010

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Everyone is going to say this is a flame war, but my honest opinion is that it's because of two reasons: 1) their attitude and 2) overnights. Number two is fairly self-explanatory, but basically I think any job where you mandatorily are working overnight (not just "on call" but that's when you work) is difficult to maintain for your entire life. At some point, I imagine that just gets old. Number one is evident when you talk to EM guys. Most of what they focus on is how they have tons of time off and how their lifestyle is so great. If your focus is "how little I have to be at work," then that eventually makes you tired of being at work.
That's an interesting way to look at it. Hmm
 

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I mean attendings, more specifically gen surg attendings, since I've gotten the impression that residents are pretty burnt out on average. But that's just it, is attending work/life that much better? I mean you've got attending hospitalists/EMs who work 1/2 the hours you guys do and they're burnt out. Just trying to understand.
There is burnout in every medical specialty, and nobody is completely immune.

As an attending surgeon, you have more control over your hours and your workload. However, you still feel many external pressures. Perhaps doing what you love makes you more tolerant of long hours, etc.

My brother is an EP. I would opine that the night shifts (as you get older) are a big factor in ER burnout.
 
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punkedoutriffs

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There is burnout in every medical specialty, and nobody is completely immune.

As an attending surgeon, you have more control over your hours and your workload. However, you still feel many external pressures. Perhaps doing what you love makes you more tolerant of long hours, etc.

My brother is an EP. I would opine that the night shifts (as you get older) are a big factor in ER burnout.
Maybe surgeons also don't have Press Ganey scores to deal with? Cuz reading some of those threads have really turned me off to EM.
 

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Maybe surgeons also don't have Press Ganey scores to deal with? Cuz reading some of those threads have really turned me off to EM.
Don't kid yourself. We all deal with that B.S. For inpatient physicians, it's called HCAHPS.
 

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That's life. If you're looking for a specialty where you don't get hammered for patient satisfaction, you need to do something where either you're in private practice exclusively (meaning, yes, patients "judge" you in the form of not coming back, but at least you don't have administrators making idiotic and arbitrary rules about it) or you don't have much direct patient interaction (e.g., Radiology, although they still have surveys about other physicians being satisfied by their services or patients being helped promptly when asking for copies of their films or whatever).
 

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I'm not entirely sure why EM has the burn out rates that it does. I've heard many reasons but none are convincing. I wonder if the burn out rate in EM would be lower if they had a more intense residency before going into practice working ~12 days/month.
No. While it doesn't have the length of the surgical specialties, most EM programs are quite intense for their duration. My busiest off service days (neurosurgery ICU, trauma, ortho, SICU, MICU) still didn't hold a candle to what my average shift as a PGY-3 in the ED was like. While there is a period of adjustment (especially for grads of 3 yr programs) upon becoming an attending, I haven't seen that self-perceived knowledge deficiencies are a significant factor in burnout and almost everyone in EM works less as a resident than as an attending so it's hard to argue they aren't prepared for the workload of being an attending.

The EM burn-out issue has more to do with a sense of personal efficacy. Like most acute care specialties, we tend toward high rates of emotional exhaustion and depersonalization (both of which are worsened during night shifts). Which means a lot of us are leaning on a sense of personal accomplishment in order to avoid completely burning out. Multiple factors make a sense of accomplishment an unstable base in emergency medicine. It's rare that we see the end result of our care (my most spectacular saves usually are still intubated and sedated when they leave the ED), there's always some doctor that's going to complain about your care even when it's good/excellent, we have no ability to help a significant minority of the patients we see (chronic problem requiring testing not available in ED + not sick enough to admit +no resources to get outpt follow-up) or (minor self-limited but annoying symptoms for which there is no effective treatment + anger over wait to discover this).

Then there are the adrenaline junkies who loved residency but are figuring out that as you get more competent at something the adrenaline doesn't spike as high and the (still minority but they definitely exist) docs that went into it as a lifestyle specialty and realized that 1) the ED is an horrifically annoying place to be if you don't like the work and 2) working 40-50% nights and weekends is so much easier to do when you don't have school age children. A lot of docs have the time off they do not because that itself was the goal, but because the downtime is what lets them build enough of a buffer to survive the emotional toll of the ED.

Every doc I've seen quit or downscale significantly has had their own tipping point but these are probably the broadest trends.
 

wjs010

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No. While it doesn't have the length of the surgical specialties, most EM programs are quite intense for their duration. My busiest off service days (neurosurgery ICU, trauma, ortho, SICU, MICU) still didn't hold a candle to what my average shift as a PGY-3 in the ED was like. While there is a period of adjustment (especially for grads of 3 yr programs) upon becoming an attending, I haven't seen that self-perceived knowledge deficiencies are a significant factor in burnout and almost everyone in EM works less as a resident than as an attending so it's hard to argue they aren't prepared for the workload of being an attending.

The EM burn-out issue has more to do with a sense of personal efficacy. Like most acute care specialties, we tend toward high rates of emotional exhaustion and depersonalization (both of which are worsened during night shifts). Which means a lot of us are leaning on a sense of personal accomplishment in order to avoid completely burning out. Multiple factors make a sense of accomplishment an unstable base in emergency medicine. It's rare that we see the end result of our care (my most spectacular saves usually are still intubated and sedated when they leave the ED), there's always some doctor that's going to complain about your care even when it's good/excellent, we have no ability to help a significant minority of the patients we see (chronic problem requiring testing not available in ED + not sick enough to admit +no resources to get outpt follow-up) or (minor self-limited but annoying symptoms for which there is no effective treatment + anger over wait to discover this).

Then there are the adrenaline junkies who loved residency but are figuring out that as you get more competent at something the adrenaline doesn't spike as high and the (still minority but they definitely exist) docs that went into it as a lifestyle specialty and realized that 1) the ED is an horrifically annoying place to be if you don't like the work and 2) working 40-50% nights and weekends is so much easier to do when you don't have school age children. A lot of docs have the time off they do not because that itself was the goal, but because the downtime is what lets them build enough of a buffer to survive the emotional toll of the ED.

Every doc I've seen quit or downscale significantly has had their own tipping point but these are probably the broadest trends.
That is extremely depressing.
 

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I feel a lot of surgeons are resistant to burnout because we love what we do and get a great sense of accomplishment in helping people get better. Yes there are frustrations (e.g. difficult patients, bs consults, institutional hurdles, ect.), but in the end we tend to love what we do and that helps keep us going. I wouldn't last 5 minutes in IM (non-compliance) or neurology (pseudoseizures) but fixing problems like pus, bowel incarceration, or bleeding in the surgical setting is extremely rewarding. That keeps me going personally when times are hard.
 

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Once again, Arcan57 nailed it on the head. I personally appreciate you stopping by the surgery forums to provide some occasional outside perspective.

One thing that I've seen on a hospital/system level is that administrators view certain doctors simply as warm bodies needed to staff an ER or OR rather than unique, talented persons of value. Specifically, it seems that EPs and anesthesiologists get treated this way in some environments :):cough CHI::), and contracts can go to the lowest bidder rather than the most qualified group. If EPs use a sense of personal efficacy as a shield from burnout, do you think this environment, where adminstrators and consultants alike are indifferent to the EP's personal effort or accomplishment, is a large contributor to burnout?



I feel a lot of surgeons are resistant to burnout because we love what we do and get a great sense of accomplishment in helping people get better. Yes there are frustrations (e.g. difficult patients, bs consults, institutional hurdles, ect.), but in the end we tend to love what we do and that helps keep us going. I wouldn't last 5 minutes in IM (non-compliance) or neurology (pseudoseizures) but fixing problems like pus, bowel incarceration, or bleeding in the surgical setting is extremely rewarding. That keeps me going personally when times are hard.
I can't tell if you're being facetious or not. I think internists and neurologists would snicker if we tried to explain to them that we are unique in that we love what we do, and feel good about making patients better.
 

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Once again, Arcan57 nailed it on the head. I personally appreciate you stopping by the surgery forums to provide some occasional outside perspective.

One thing that I've seen on a hospital/system level is that administrators view certain doctors simply as warm bodies needed to staff an ER or OR rather than unique, talented persons of value. Specifically, it seems that EPs and anesthesiologists get treated this way in some environments :):cough CHI::), and contracts can go to the lowest bidder rather than the most qualified group. If EPs use a sense of personal efficacy as a shield from burnout, do you think this environment, where adminstrators and consultants alike are indifferent to the EP's personal effort or accomplishment, is a large contributor to burnout?
I think it is. We're taught from day one in residency to get our lovin' at home because we're not going to get it at work. And the generally work-avoidant nature of most residents (when it comes to patients they haven't seen yet) gets us pretty used to not being our consultants' darlings. The c-suite side of things is more difficult (at most shops). Being forced into a doctor/provider duality were we're expected to be the captain of the ship (if something bad happens to an individual patient) but also a cog in the machine (that's a slight change in numbers on a spreadsheet away from being replaced) can make all 3 elements of burnout worse. Some shops do a good job of shielding doctors from the emphasis on metrics, some shops pass the corporate culture unfiltered down to the line docs. Being told to see 2.5-3+ pph while being slapped on the wrist for every bad patient sat survey is a solid recipe for burnout.

The other significant issue for personal efficacy for EPs is that we are in a perpetually resource poor environment, as staffing the ED with the nurses, techs, and equipment to handle the high-end of patient volumes is prohibitively expensive. So in an environment that measures length of stay in minutes, it may take an hour+ for the patient to get the meds I ordered or we may spend a couple of days without any gyn speculums because the nurse supervisor in charge of supply ordering was too busy rounding on patients to improve customer satisfaction to notice we were low. Imagine every 4th-5th case not having a scrub nurse/tech, only having privileges at that hospital, and still being expected to finish the case in a timely fashion so your average still looks good when compared to a nationwide ranking of all surgeons regardless of practice location.
 

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And the generally work-avoidant nature of most residents (when it comes to patients they haven't seen yet) gets us pretty used to not being our consultants' darlings.
Just noting that this is a common belief of the EM people, that the reason people get angry at them is because other people are lazy. I only say this because, for the people who are med students or pre-med, you're basically getting a very skewed perspective of reality. For example, the notion that only a few EM physicians are focused on lifestyle in the prior post or that the reason for burnout is that they don't get to see the endpoint of their labor. That's an odd statement to make because -- don't take my word for it, ask people you know going into EM -- they don't want to follow patients chronically and one of the big selling points (to them) is that they can deal with a patient and then never (theoretically) see them again. It's basically putting a lot of spin on the specialty viewpoint.
 

Arcan57

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Just noting that this is a common belief of the EM people, that the reason people get angry at them is because other people are lazy.
Not what I said. Please don't try and support your position by incorrectly generalizing my words.

I only say this because, for the people who are med students or pre-med, you're basically getting a very skewed perspective of reality. For example, the notion that only a few EM physicians are focused on lifestyle in the prior post or that the reason for burnout is that they don't get to see the endpoint of their labor. That's an odd statement to make because -- don't take my word for it, ask people you know going into EM -- they don't want to follow patients chronically and one of the big selling points (to them) is that they can deal with a patient and then never (theoretically) see them again. It's basically putting a lot of spin on the specialty viewpoint.
Med students have a skewed view of EM as do many non-EM docs. The students look into it for what they perceive to be it's advantages over other specialties. It's not competitive as derm/plastics/optho. It has a fantastic $$$/length of training ratio. It's acute care. It's a lifestyle specialty.

Some of these are accurate (it's not top tier competitive and we make good money for the training time), some aren't.

Students tend to like acute care because you get the feeling of helping someone now and most of the chronic care they're exposed to is in a deeply broken system with populations that are largely unable to fulfill outpatient plans of care. Just because you like acute care doesn't mean the lack of follow-up prevents burnout. This is something that's unique to EM because every other specialty that has significant patient contact expects to have meaningful closure of their patient encounter (the trend towards admitting only nocturnists and other in-patient shift work is eroding some of the exclusivity and it will be interesting to see what the data shows, although personal observation has indicated a fairly fast churn in those positions). And I do get regular patients that come to my "clinic". There are 15 or so patients that I see monthly and another 100ish that I see 4x+/year. And I'm well aware of what a poor primary care physician I make.

It's a lifestyle specialty other then the guaranteed nights and weekends and the circadian shifts (do you like call or nightfloat better?).

In my current group of docs, I'd say probably 2/12 have lifestyle as their primary motivation. In my prior group, none of the docs had lifestyle as a primary motivator. In residency it was 2/12. There may have been a sea change in students going into EM residencies since I graduated, but if so I'm not seeing it on the other side when they're interviewing for jobs. Compensation is asked about in depth by every interviewee (and is fiercely compared between jobs) while number of shifts/distribution of nights/weekends comes up probably 1/4 to 1/5 of the time.

So while I don't deny that I'm trying to provide some insight into burnout (and mostly was addressing the statement that we burnout because our residencies aren't rigorous enough), I don't think I'm spinning the specialty. Happiness is a matter of balancing expectations and reality and med students/residents may benefit from thinking about some of the points I've raised. Either to help in their decision making process (students) or help them prepare to manage their burnout once in practice (residents).
 
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ruralsurg4now

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Not what I said. Please don't try and support your position by incorrectly generalizing my words.
Sorry, but "work avoidant" means "lazy." I don't know what special dictionary you use in your life, but I use an English one.

By the way, I'm not going to pick apart your post because then someone's going to say "oh, EM flame war!" but I'll just note that you state that it's a lifestyle specialty and then later claim that very few people go into it for lifestyle purposes. That's rather incongruous thinking.
 
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dpmd

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Sorry, but "work avoidant" means "lazy." I don't know what special dictionary you use in your life, but I use an English one.

By the way, I'm not going to pick apart your post because then someone's going to say "oh, EM flame war!" but I'll just note that you state that it's a lifestyle specialty and then later claim that very few people go into it for lifestyle purposes. That's rather incongruous thinking.
If you look closer you will see that he says that students think it is a lifestyle specialty, then he describes the ways that it actually is not always and indicates that many of his cohorts didn't seek EM for lifestyle reasons.

Aslo, the work avoidance he references is not saying that residents are lazy. Hardworking, busy people also wish to avoid more work (particularly work they do not consider necessary), as do sleep deprived people for whom the choice might be sleeping versus seeing another consult. There is no financial incentive for residents to see more patients so it is in their short term best interest to be a wall. Surely you have seen this phenomenon in play during residency? Or perhaps yours was a unique program where everyone welcomed every single consult they recieved in residency?
 

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If you look closer you will see that he says that students think it is a lifestyle specialty, then he describes the ways that it actually is not always and indicates that many of his cohorts didn't seek EM for lifestyle reasons.
Fair enough, although the only actual rebuttal he gives for the "misconception" that it's a lifestyle specialty is that some shifts occur on nights and weekends. I don't know about you, but I run into plenty of EM physicians who will tell you how few shifts they work per month, which he omits here. I acknowledge that doing overnight shifts starts to grate on people, however, which I also noted in my original position.

Aslo, the work avoidance he references is not saying that residents are lazy. Hardworking, busy people also wish to avoid more work (particularly work they do not consider necessary), as do sleep deprived people for whom the choice might be sleeping versus seeing another consult.
Uh, no offense, but I don't buy this as an explanation of his position. I would agree with you that there is a financial motivation for attendings to view things differently from residents, but you're really just covering for him at this point. I stand by what I said. He's not saying "residents are hard-working, busy people who just happened to avoid work but are not lazy." He's saying that they're lazy and that's why they get angry at the ER, which is a gross oversimplification of the dynamics of the ER and also glosses over other reasons that people might get mad at the ER.
 

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Uh, no offense, but I don't buy this as an explanation of his position. I would agree with you that there is a financial motivation for attendings to view things differently from residents, but you're really just covering for him at this point. I stand by what I said. ...He's saying that they're lazy and that's why they get angry at the ER
No RS4N, I'm not saying that. I originally had a long section in my initial reply regarding the phenomenon of the junior member on the totem pole answering the pager, the benefit/hassle ratio of the consult for that particular person, and its implications for interactions between the ED and consulting services. But my thought was that we're both attendings who have been on multiple different surgical services as junior residents and that there is already an understanding of those dynamics. I've witnessed multiple residents who were complete jerks on the phone, despite i's dotted/t's crossed by the consulting EP, who I know from working with them when I was on their service are both 1) reasonable even friendly people and 2) will push themselves past the point of exhaustion to care for anyone on their census.

I'm not claiming this exhausts the reasons why consulting residents don't like the EM residents calling them, but it's the most benign explanation I can come up with for being yelled at or having an inappropriate attempt at refusing the consult made when every possible thing that could have been done has been done prior to making the phone call.
 

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I've witnessed multiple residents who were complete jerks on the phone, despite i's dotted/t's crossed by the consulting EP, who I know from working with them when I was on their service are both 1) reasonable even friendly people and 2) will push themselves past the point of exhaustion to care for anyone on their census.
Sure, but my point is a) it's sort of silly to view those events in isolation, isn't it? (i.e., the fact that the resident is angry at that moment isn't necessarily connected to that specific interaction, but you're a smart person and I'm sure you know that); and b) we could sit around and enumerate the reverse situation, where the resident has been polite even though the consulting EP has been markedly deficient. Now, we're definitely getting off topic, and I'd be happy to discuss this further via PM if you'd like, and I'm equally guilty of derailing the thread, but my point only ever was that you're presenting a one-sided account of the ER -- I've seen many an EM resident rotating off-service who isn't thrilled with getting an ER phone call, as have you.
 

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Now, we're definitely getting off topic, and I'd be happy to discuss this further via PM if you'd like, and I'm equally guilty of derailing the thread, but my point only ever was that you're presenting a one-sided account of the ER
I had thought your point was that I was saying that EM docs think people are mean to us because they're lazy and that I was being disingenuous about the factors that contribute to burnout in EM. The first position is one you've expressed in the ED forum and I'm not a fan of you twisting my words to try and support it. The second position puzzles me since I don't see any particular gain for myself in lying about what I see as the long-term unmodifiable (or virtually so) causes of EM burnout.

Step 1: Misrepresent causes of EM burnout on surgical forum
Step 2: ???
Step 3: Profit?
 

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The first position is one you've expressed in the ED forum and I'm not a fan of you twisting my words to try and support it.
You said that already and I noted that I didn't twist your words, unless you're using a special dictionary. Nothing you've said changes that.

The second position puzzles me since I don't see any particular gain for myself in lying about what I see as the long-term unmodifiable (or virtually so) causes of EM burnout.
The "gain" is just that you're standing up for your specialty, which I don't blame you for. As I said, the only thing I'm pointing out is that you're not exactly presenting things objectively, which I'm just letting students and residents know, since people read these posts and form their beliefs based on them, seeing residents and attendings as sources of knowledge.

Add: I could specify what I mean by picking apart your posts and demonstrating how they're spinning things, but I have a feeling that you would get extremely angry and I'm sure that someone would complain that I'm "flaming" EM. So rather than doing that, I'll just leave it at that. Cheers.
 
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And, back on track, I don't think I've ever seen a burned out surgeon, even if they said they were, because taking a 24 hour call at age 60 - q4 - seems tough - and, yet, I've seen more than 10 60+ surgeons that did exactly that, or better (like, q3, or on 3 or 4 nights in a row in the community). I think it's because they love to cut. At the end of the day, all the tripe is worth it if you are in the OR.
 

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I think a big part of it is that operating is fun!

There are lots of people who like the act or the idea of operating but never went into the field.

Surgeons for the most part actually enjoy that part of their job.


It's also a particularly awesome responsibility to cut someone open. Not that other medicine acts aren't.... But I think the fact people let you cut them and then the act of doing so is really fun maybe has something to do with it
 
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punkedoutriffs

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I think a big part of it is that operating is fun!

There are lots of people who like the act or the idea of operating but never went into the field.

Surgeons for the most part actually enjoy that part of their job.


It's also a particularly awesome responsibility to cut someone open. Not that other medicine acts aren't.... But I think the fact people let you cut them and then the act of doing so is really fun maybe has something to do with it
This really exacerbates my desire to operate. HRrrgghhh.... just 3.5 more years...
 

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And, back on track, I don't think I've ever seen a burned out surgeon, even if they said they were, because taking a 24 hour call at age 60 - q4 - seems tough - and, yet, I've seen more than 10 60+ surgeons that did exactly that, or better (like, q3, or on 3 or 4 nights in a row in the community). I think it's because they love to cut. At the end of the day, all the tripe is worth it if you are in the OR.
I like to think that is why there are elderly surgeons out there who still first assist (rather than that they squandered their retirement or that they don't know what else to do in life). There is a guy in the community here who is in his 80s.
 

ruralsurg4now

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I tend to think its more that they don't know what to do with their life, although that may be overly pessimistic. A lot of surgeons just work and we get relatively little time off. Add in that a lot of the older guys may be divorced or widowed and there's probably a lot of "yeah, I'm not sitting on my porch all day" thinking. I'm sure they don't mind it, since they're used to it, though.
 
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Arcan57 nailed it. And being the chef (aka surgeon) surely beats being the store clerk(aka Emergency Doc). I dont buy into that "love to cut 4life" bs, everything gets old.

Studies with all kinds of professions have defined that burnout is more likely in a job which a worker has high responsibility and has little control.
 

SLUser11

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And, back on track, I don't think I've ever seen a burned out surgeon, even if they said they were, because taking a 24 hour call at age 60 - q4 - seems tough - and, yet, I've seen more than 10 60+ surgeons that did exactly that, or better (like, q3, or on 3 or 4 nights in a row in the community). I think it's because they love to cut. At the end of the day, all the tripe is worth it if you are in the OR.
Just because they are willing to do it doesn't mean they're not burnt out from it. They may not have a choice, or they may feel obligated to do it. Those old surgeons are not well-oiled machines. Many of them have abused their bodies over the years, whether it's not eating right and neglecting their own health, self-medicating with food or alcohol, or suffering from worsening chronic pain (arthritis, etc) from poor ergonomics. They will often work way past an appropriate stopping point, and everyone suffers as a result (at first just the surgeon and his family, but eventually the patients as well).

For those that don't mind it, or even enjoy it, I wonder if it's because they don't know anything else. It's always been that way for them, so they don't see how unhealthy it is.
 
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Apollyon

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Just because they are willing to do it doesn't mean they're not burnt out from it. They may not have a choice, or they may feel obligated to do it. Those old surgeons are not well-oiled machines. Many of them have abused their bodies over the years, whether it's not eating right and neglecting their own health, self-medicating with food or alcohol, or suffering from worsening chronic pain (arthritis, etc) from poor ergonomics. They will often work way past an appropriate stopping point, and everyone suffers as a result (at first just the surgeon and his family, but eventually the patients as well).

For those that don't mind it, or even enjoy it, I wonder if it's because they don't know anything else. It's always been that way for them, so they don't see how unhealthy it is.
Well, as usual, your point is well-considered, and certainly possible. If they enjoy it, though, can they be considered "burned out"? If someone was demotivated and had a loss of satisfaction, and that manifested by attendance problems, inattention, and poor outcomes due to indifference, that would make sense. However, what if they still kept the call, did good surgery, and felt satisfied? None of the "old guys" I knew had a rep of becoming a butcher or death dealer, but, alternately, still had their good rep, and that from new, younger patients - not ones on whom they'd operated 20 or 30 years ago.

And, if a surgeon "burns out" at 65 years old, after a 30 year career, I am not sure that there is anything wrong with that, as long as they realize it. Lots of folks in the rat race are just looking at the finish line, even if it is 10 years down the way.
 

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Comparing a EM shift to rotating on other services is like comparing a sprint to a marathon, just doesn't make any sense and they are totally different. Chronic fatigue is much more challenging to deal with than acute fatigue.

Anyway, I think EM burnout is related to the reasons people go into it- it is so easy as a med student to get caught up in the pace, acuity and "cool"ness of the ED. However, eventually, all those factors lose some of the initial shininess and it's not so appealing any more.

A nice hours to income ratio doesn't hurt especially when as soon as you clock out you have NO ongoing care obligations for the patients you evaluated during your shift. At times I am very envious of that. However, they get no long term satisfaction in caring for a problem/patient, successfully treating them, seeing them in follow-up and then continuing to see them periodically for checkups. Treating rectal cancer is very challenging and sometimes quite upsetting but I love seeing those patients back after their loop ileostomies are closed or for their followup colonoscopy and they are doing well, back to enjoying life, spending time with family, no longer worried about the C word. I opt for the second option.

Also, can you imagine if every physician you call for a consult knows more about the condition you are calling about than you leading to constant questions about management and "why did you do this" and "why didn't you do that"? That would become VERY taxing.
 
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Wordead

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My guess is that the patients are just the worst. I couldn't imagine working with the ED patient population for a lifetime.
 

ruralsurg4now

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Anyway, I think EM burnout is related to the reasons people go into it- it is so easy as a med student to get caught up in the pace, acuity and "cool"ness of the ED.
That's the main problem, probably. Most of the people who I've met who go into it have this perception that they can "deal with anything that hits the door," but it's really not the case. So it's incoming perception versus reality.

However, they get no long term satisfaction in caring for a problem/patient, successfully treating them, seeing them in follow-up and then continuing to see them periodically for checkups.
I'd agree with that, except they don't derive satisfaction from longitudinal care of patients. Everyone I've talked to just say that what they like is "seeing a patient, dealing with their problem (see above, however), and then moving on to the next person." They specifically DON'T want to see someone come back in a clinic-type situation where they get to evaluate them and make sure they're doing great.

Also, can you imagine if every physician you call for a consult knows more about the condition you are calling about than you leading to constant questions about management and "why did you do this" and "why didn't you do that"? That would become VERY taxing.
That's part of what they don't get when they say that they've done a "perfect" workup of the patient and yet someone is picking at it. It's only perfect from their standpoint.
 

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My guess is that the patients are just the worst. I couldn't imagine working with the ED patient population for a lifetime.
ED patients are everyone's patients. They see them first, but in most cases they're going to get passed to someone, even if it's an outpatient clinic physician.
 
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Wordead

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ED patients are everyone's patients. They see them first, but in most cases they're going to get passed to someone, even if it's an outpatient clinic physician.
Are you saying that patient interaction in the ED vs outpatient clinic is the same or what is your point here
 

ruralsurg4now

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Are you saying that patient interaction in the ED vs outpatient clinic is the same or what is your point here
Nah, I'm just saying that you'll interact with the same patients that they do. It won't be as many of them, or in as short a time, but very few people (except Derm or Optho) are able to avoid those patients. So when you were saying you'd go crazy seeing them, I'm just letting you know you'll see them even if you're not in EM.
 

Wordead

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Nah, I'm just saying that you'll interact with the same patients that they do. It won't be as many of them, or in as short a time, but very few people (except Derm or Optho) are able to avoid those patients. So when you were saying you'd go crazy seeing them, I'm just letting you know you'll see them even if you're not in EM.
If your population is only a few % whackos then you don't have the same population....not to mention you have the option of firing patients in private outpatient clinic; you can't turn people away from the ED.
 

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If your population is only a few % whackos then you don't have the same population....not to mention you have the option of firing patients in private outpatient clinic; you can't turn people away from the ED.
There's usually a pretty high threshold for firing patients, fyi.
 

Wordead

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There's usually a pretty high threshold for firing patients, fyi.
I have no idea what it's like anywhere else, but at my clinics the attending just sent them a letter saying they had 30 days to find a new provider, peace out. Whats the threshold for you?
 

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I have no idea what it's like anywhere else, but at my clinics the attending just sent them a letter saying they had 30 days to find a new provider, peace out. Whats the threshold for you?
I don't mean it's difficult to do it. I mean that most people don't fire patients. Sure, if I wanted to do it, I could just cut them loose, but you have to have a pretty good reason to do it. For example, if someone sued me, I'd refuse to continue treating them. You can't just fire someone because you don't like them (or, to be more precise, you could, but you probably wouldn't last very long).
 

DermViser

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I mean attendings, more specifically gen surg attendings, since I've gotten the impression that residents are pretty burnt out on average. But that's just it, is attending work/life that much better? I mean you've got attending hospitalists/EMs who work 1/2 the hours you guys do and they're burnt out. Just trying to understand.
Attending surgery physicians don't complain as much, quite honestly. I think that speaks to the work ethic of a surgeon in general. Which is why in general they are such badasses. They know that there are very few people who can do what they do. You have to understand back when they trained there were NO work hour restrictions whatsoever. They also usually don't like people who don't have the same work ethic and nose to the grindstone while at work dedication that they do. Don't believe me? Tell a general surgeon that you are going into a ROAD specialty (which is like telling them you want work-life balance), you'll nearly get laughed out of the room.

I think a lot of it also has to do with Happiness = Reality - Expectations. When the reality of someone's life is better than they had expected, they're happy. When reality turns out to be worse than the expectations, they're unhappy.
 
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DermViser

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Maybe surgeons also don't have Press Ganey scores to deal with? Cuz reading some of those threads have really turned me off to EM.
All patient based (clinical) Physicians now have to deal with patient satisfaction surveys not just EM docs. the ER is where it starts.