Why I Quit Emergency Medicine

[Tipsy McStagger]

Link to article

Did anybody read this article by Dr. Mohseni?

no matter how good of a physician you are, you are going to miss certain things, you are going to make mistakes, and certain things are going to happen to your patients that nobody could predict or prevent.

We also learn, unfortunately, that society is not OK with that. Society wants somebody to blame. Family members want somebody to blame. Hospitals want somebody to blame. Society expects perfection. Physicians aren't human; they don't make mistakes.

The part that stood out to me specifically. It eats away at me day by day.

Work faster, make everybody happier, document more, and, oh, yeah, don't ever make a mistake.

The crux of my overall dissatisfaction.


What are your thoughts?

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[bravotwozero]

If you’ve been around this forum long enough, you’ll notice that people have complained about pretty much everything the author mentioned in this article...

That being said, some work environments are better than others. Do not work at a HCA hospital. You WILL be abused. 100% guaranteed.


Sent from my iPhone using Tapatalk

 

[thegenius]

Link to article

Did anybody read this article by Dr. Mohseni? The part that stood out to me specifically. It eats away at me day by day. The crux of my overall dissatisfaction. What are your thoughts?

I have these feelings too. They are not as profound, but I have them as well.

It's a depressing view on medicine, and remember that it's also easy to write an uplifting story as well. Every time you get a patient note thanking you for saving their loved-one is an uplifting story. You may not have been able to save Grandma 25 years ago with the technology then, but you recognized her life-threatening condition today and did something to save her life.

I wish I had the ability to work 10 days/month and see 1.5 pph. I won't make that much money but I would be happier and be a better doctor. I would probably do things that I can't do working 16-18 days/month seeing 2.2 pph as I do currently. Like make the extra effort to get more collateral from other hospitals, make that extra call to the outpatient physician to coordinate care, or frankly just sit and talk with the patient more. Out of all the times I get a "thank you I can't believe how helpful you were", I bet 50% of them was just me spending more time with the patient.

Reading this article, it's hard to not to think about a terrible society we live in at-large.

 

[thegenius]

I'm not sure he has all his facts correct...he writes

"Not only does emergency medicine rank among the highest lawsuit rates of all specialties, but we also deal with the unintended complications from every other specialty."

ER is actually right smack in the middle of lawsuit rates. (NEJM)

 

[BJJVP]

I'm not sure he has all his facts correct...he writes

"Not only does emergency medicine rank among the highest lawsuit rates of all specialties, but we also deal with the unintended complications from every other specialty."

ER is actually right smack in the middle of lawsuit rates. (NEJM)

I have heard that EM has one of the higher rates of lawsuits as well. I only scanned the article but I believe they excluded physicians after they were sued once. I wonder if the rates would look differently if they did not do this. Also, we work less hours and probably have a smaller pt encounter number (2.5 pts/hr vs 4pts per hour in a clinic setting). Therefore, on a per pt encounter basis, maybe our lawsuit rates would appear worse? Not sure.

 

[thegenius]

I have heard that EM has one of the higher rates of lawsuits as well. I only scanned the article but I believe they excluded physicians after they were sued once. I wonder if the rates would look differently if they did not do this. Also, we work less hours and probably have a smaller pt encounter number (2.5 pts/hr vs 4pts per hour in a clinic setting). Therefore, on a per pt encounter basis, maybe our lawsuit rates would appear worse? Not sure.

Yea I don't know. I've always heard that EM was near the top but when I did research on it back in the day, I really couldn't find much to substantiate it.

TeamHealth says that there is a lawsuit in ER about 1/40,000 cases (and they tout that TH ER docs are 50% less)

 

[BoardingDoc]

I'm not sure he has all his facts correct...he writes

"Not only does emergency medicine rank among the highest lawsuit rates of all specialties, but we also deal with the unintended complications from every other specialty."

ER is actually right smack in the middle of lawsuit rates. (NEJM)

I also get journalfeed. Useful daily blurbs... most of the time. Every 5 days or so the interpretation of the article in question isn't on point, and on occasion is grossly inaccurate.

 

[Frazier]

Link to article

Did anybody read this article by Dr. Mohseni?

The part that stood out to me specifically. It eats away at me day by day.

The crux of my overall dissatisfaction.

What are your thoughts?

Very real stuff. It is unfortunate how the system works from departmental to societal.

It is easy to work at a more leisurely pace, where you can take more time to review results, think over the work-up, less likely to miss stuff or have a slip, build rapport with patient and their family... its easy as increasing physician coverage hours = less PPH = less compensation (ie more docs in the pot, same total revenue = less pay per doc).

Most docs don't want to sacrifice their income, so they accept 2.5 pph as a reasonable work environment.

Would ED docs be willing to see half the patients for half the income? (Simplified.)

Those jobs already exist and are generally poo-poo'ed with "my time is worth more than that" or "I enjoy having to only work 12 days per month".

Pick your poison

 

[painemdoc]

If you’ve been around this forum long enough, you’ll notice that people have complained about pretty much everything the author mentioned in this article...

That being said, some work environments are better than others. Do not work at a HCA hospital. You WILL be abused. 100% guaranteed.


Sent from my iPhone using Tapatalk

And do Not apply to HCA specialty/residency

 

[Groove]

Here, you forgot this.

 

[Backpack234]

Interesting read until the end when it looked more like an ad for CirrusMD as an alternative to EM. But maybe that's just my cynicism talking.

This is the second EM doc I've read about going from EM to virtual primary care. Is that really a viable strategy?

 

[bravotwozero]

Not right now. No telling what the future holds though.

I don’t think patients are very happy with virtual visits, from what I can tell.

 

[Birdstrike]

Anything that allows one to pay the bills, while living a normal life, including sleeping when it’s dark, being awake when it’s light, avoid working nights, weekends, holidays, being on call, chronic circadian rhythm depression and demoralization by patient and administrative abuse, is a viable alternative to Emergency Medicine.

 

[Brigade4Radiant]

Also primary care requires no fellowship or additional training

 

[Arcan57]

Interesting read until the end when it looked more like an ad for CirrusMD as an alternative to EM. But maybe that's just my cynicism talking.

This is the second EM doc I've read about going from EM to virtual primary care. Is that really a viable strategy?

No, I think that's an appropriate response. It's hard to overestimate how much of the current wellness industry is a grift. Burned out docs are actually a pretty good target, although I think the most common target is still offering some sort of expensive rite of reconciliation to the institutes that are burning us out.

 

[EctopicFetus]

Not right now. No telling what the future holds though.

I don’t think patients are very happy with virtual visits, from what I can tell.

As witnessed by the collapse of tdoc stock. Telehealth is crappier care than noctor led care.

 

[cyanide12345678]

As witnessed by the collapse of tdoc stock. Telehealth is crappier care than noctor led care.

They went from 550 million to 1.1 billion in revenue last year. They are beating all revenue forecasts this year as well and will likely be around 1.8 to 2 billion in revenue this year. Stocks fluctuate. A lot of tech stocks have taken a beating this year. The biggest winners of the pandemic are seeing drops these days.

 

[EctopicFetus]

They went from 550 million to 1.1 billion in revenue last year. They are beating all revenue forecasts this year as well and will likely be around 1.8 to 2 billion in revenue this year. Stocks fluctuate. A lot of tech stocks have taken a beating this year. The biggest winners of the pandemic are seeing drops these days.

Thats one way to look at it. I don't view them as a tech company. Its a doctor on demand via facetime. I know that's simplified. Competition is out there though fragmented and there is low to no barrier to entry. They don't have a novel technology like tesla, rivian or a real tech company. Lets be honest, COVID was huge for them, the US lockdowns related to that are over. People want to go and see their doc. Telehealth will have a role but not at a $15B valuation. I am not here for the STONK tips. Maybe it goes back to 250 maybe it doesn't but the stock dumped because people don't see their future as quite as great as the company hopes. Hard to see how they get their revenue to up25-30% per year. Maybe I'm reading the tea leaves wrong though.

Some of the pandemic stocks arent going down, gamestop (idiotic stock), AMC, Tesla, Moderna, Pfizer, etc. Maybe we are watching different stocks.

 

[cyanide12345678]

Thats one way to look at it. I don't view them as a tech company. Its a doctor on demand via facetime. I know that's simplified. Competition is out there though fragmented and there is low to no barrier to entry. They don't have a novel technology like tesla, rivian or a real tech company. Lets be honest, COVID was huge for them, the US lockdowns related to that are over. People want to go and see their doc. Telehealth will have a role but not at a $15B valuation. I am not here for the STONK tips. Maybe it goes back to 250 maybe it doesn't but the stock dumped because people don't see their future as quite as great as the company hopes. Hard to see how they get their revenue to up25-30% per year. Maybe I'm reading the tea leaves wrong though.

Some of the pandemic stocks arent going down, gamestop (idiotic stock), AMC, Tesla, Moderna, Pfizer, etc. Maybe we are watching different stocks.

When I say pandemic stock, I mean a company that benefited from the pandemic. AMC became a meme stock, but its financials and economics got destroyed by the pandemic as people stopped going to cinemas. Amc stock because of cult following doesn't quite reflect reality, but with the world opening, they are benefiting and their financials should improve hence stock should improve.

I don't know what Tesla has to do with the pandemic

A large group of pandemic stocks saw their user numbers go up significantly during the pandemic as people were shut down in their homes, and as the world is opening, their users are now moving away from them slowly and their user growth is stagnant this year or declining. To name a few - zoom, pton (peloton), pintrest, teladoc, skillz. All these saw huge ramp up in number of users during pandemic, but their growth has slowed or reversed from a user usage perspective, which is reflecting in their stocks. These companies benefited from people being stuck at home and are seeming to do worse with the world opening back up.

Moderna Pfizer have third dose approved, their usage and demand isn't necessarily dropping. Their global demand is pretty up there. The longer the pandemic drags, the more likely they will be giving annual boosters for the near future.

 

[EctopicFetus]

When I say pandemic stock, I mean a company that benefited from the pandemic. AMC became a meme stock, but its financials and economics got destroyed by the pandemic as people stopped going to cinemas. Amc stock because of cult following doesn't quite reflect reality, but with the world opening, they are benefiting and their financials should improve hence stock should improve.

I don't know what Tesla has to do with the pandemic

A large group of pandemic stocks saw their user numbers go up significantly during the pandemic as people were shut down in their homes, and as the world is opening, their users are now moving away from them slowly and their user growth is stagnant this year or declining. To name a few - zoom, pton (peloton), pintrest, teladoc, skillz. All these saw huge ramp up in number of users during pandemic, but their growth has slowed or reversed from a user usage perspective, which is reflecting in their stocks. These companies benefited from people being stuck at home and are seeming to do worse with the world opening back up.

Moderna Pfizer have third dose approved, their usage and demand isn't necessarily dropping. Their global demand is pretty up there. The longer the pandemic drags, the more likely they will be giving annual boosters for the near future.

ok. im not going to argue which are pandemic stocks. We will see what teladoc is gonna do. I have been wrong on stocks before but I wouldn't buy Tdoc if I was looking for strong returns over the next 5-10 years and I'm not a risk averse person.