Would you recommend EM?

[Pigg-O-Stat]

Yes.

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[Angry Birds]

Despite all the gloom and doom on this forum, my own personal experience has been that I make a lot of money per hour and have many days off in the month. Although I wouldn't do medicine again at all if I went back in time, if I had to do medical school, then I'd probably pick EM again.

I might just have a unicorn job though, which I plan to hold onto forever.

 

[GonnaBeADoc2222]

Despite all the gloom and doom on this forum, my own personal experience has been that I make a lot of money per hour and have many days off in the month. Although I wouldn't do medicine again at all if I went back in time, if I had to do medical school, then I'd probably pick EM again.

I might just have a unicorn job though, which I plan to hold onto forever.

How many kids do you have?

 

[BoardingDoc]

How many kids do you have?

Gonna go ahead and assume the answer is zero. Then again, who knows. Birds could be like emergent who says he has kids. That said, emergent also says he works 4 days a month which kinda obviates the issue.

 

[Rekt]

Despite all the gloom and doom on this forum, my own personal experience has been that I make a lot of money per hour and have many days off in the month. Although I wouldn't do medicine again at all if I went back in time, if I had to do medical school, then I'd probably pick EM again.

I might just have a unicorn job though, which I plan to hold onto forever.

The “for” argument for EM is always the same and cracks me up.

“I think emergency medicine is great because I have I don't have to do it very much!”

Do emergency medicine if you want weekly homicidal threats against you and your staff, police dumping off meth heads and alcoholics so it’s not their problem, constant revolving door of “psych” patients that are beyond unfixable(plot twist: 99% of the time it’s drugs!), constant barrage of patients that take zero accountability for their health and can barely walk to the bathroom at baseline wanting you to fix all their problems, grown ass adults screaming like children for their pain meds or because the call light isn’t immediately answered, daughter from California syndrome dropping off 98 year old grandpa Joe at 2am demanding an MRI for chronic lightheadedness, Jabba the hut nursing home dumps most with missing limbs and dementia, seeing an uncountable amount of 20-40 year olds with neon hair, neck tattoos, and dirty pajamas with extremely vague chest or abdominal pain that’s really just somatization of mental illness or childhood abuse, critical drug shortages, staffing shortages, complete ED nursing turnover every 6-18mo because it’s such a beat down, boarding, corporations, incompetent administration, absurd metrics not based in reality (I resuscitated a dying young peds pt with brain tumor hypoxic arrest from aspiration and i got a extremely positive patient eval saying i saved their kid but it was 8/10 instead of 9 so it counted as a negative), incompetent mid levels, VIPs that have already called 8 consultants before they got there because ER docs are too dumb to do anything, absolute sheer disrespect from every other physician in the hospital and outpatient too (not that any of them could even last 30 minutes in a real ED without pissing their pants), decreasing pay yearly (because you essentially start at your max and you’re never getting a raise with inflation) increasing post Covid litigation, your employment contract being handed around like a hooker in Vegas, and most importantly the market that WILL be flooded in the next 8 years, etc

Could go on for ages. There’s no reason to do EM. I used to have the immature thoughts of hurr durr clinic is boring, 9-5 is boring, etc. you know what sounds better than anything right now? 250-400k working 9-5 where most of the dregs of society are filtered out and you can fire any that make it through.

I’m about to shatter my 400k golden handcuffs less than two years out and hold up a big middle finger to the decomposing future of EM and cut my shifts in half or more. I’m sure I’ll “love” EM too doing it 6-8x a mo

 

[RustedFox]

The “for” argument for EM is always the same and cracks me up.

“I think emergency medicine is great because I have I don't have to do it very much!”

Do emergency medicine if you want weekly homicidal threats against you and your staff, police dumping off meth heads and alcoholics so it’s not their problem, constant revolving door of “psych” patients that are beyond unfixable(plot twist: 99% of the time it’s drugs!), constant barrage of patients that take zero accountability for their health and can barely walk to the bathroom at baseline wanting you to fix all their problems, grown ass adults screaming like children for their pain meds or because the call light isn’t immediately answered, daughter from California syndrome dropping off 98 year old grandpa Joe at 2am demanding an MRI for chronic lightheadedness, Jabba the hut nursing home dumps most with missing limbs and dementia, critical drug shortages, staffing shortages, complete ED nursing turnover every 6-18mo because it’s such a beat down, boarding, corporations, incompetent administration, absurd metrics not based in reality (I resuscitated a dying young peds pt with brain tumor hypoxic arrest from aspiration and i got a extremely positive patient eval saying i saved their kid but it was 8/10 instead of 9 so it counted as a negative), incompetent mid levels, VIPs that have already called 8 consultants before they got there because ER docs are too dumb to do anything, absolute sheer disrespect from every other physician in the hospital and outpatient too (not that any of them could even last 30 minutes in a real ED without pissing their pants), decreasing pay yearly (because you essentially start at your max and you’re never getting a raise with inflation) increasing post Covid litigation, your employment contract being handed around like a hooker in Vegas, and most importantly the market that WILL be flooded in the next 8 years, etc

Could go on for ages. There’s no reason to do EM. I used to have the immature thoughts of hurr durr clinic is boring, 9-5 is boring, etc. you know what sounds better than anything right now? 250-400k working 9-5 where most of the dregs of society are filtered out and you can fire any that make it through.

I’m about to shatter my 400k golden handcuffs less than two years out and hold up a big middle finger to the decomposing future of EM and cut my shifts in half or more. I’m sure I’ll “love” EM too doing it 6-8x a mo

Quoted for truth.

I like it a lot more now that I only work 4 shifts a month.

 

[Mount Asclepius]

I sometimes wonder if EM is golden handcuffs for those of us who maybe shouldn't have picked medicine in the first place, or alternatively if EM just broke us in ways unlike other specialties. Maybe we were more meant for medicine than everyone else, but our idealism was crushed by the system and such close interaction with a general society that we didn't really know in advance.

Eventually almost everyone stops working when the further value add of money and employment is over shadowed by freedom of time. Most in EM will 'burn out' quicker than others in the house of medicine or compared to other fields. The correct answer for EM burn out is to work less. It doesn't seem that should have to be the correct answer though. The golden handcuffs also make it hard. The time value of money emphasizes making more early instead of stringing along a dying career.

I just recently reflected to a fellow partner that I still haven't quit or left for anything else as I don't think there is anything else out there that is better for me at the current moment. Not sure how long I'll last, but on I keep plodding in the snow storm.

 

[CoolDoc1729]

I think the experience of community EM is both totally different than academic EM, and also cumulatively exhausting over months and years. Even if you were able to shadow a community EP, it’s not the same when you are bearing all the responsibilities with inadequate time and resources and it’s not the same at year 5 or 10 as shift 3. I genuinely enjoy most of my shifts, but I also feel damn lucky that it worked out because the experiences are so different. I think if someone enjoys academic EM the chance of liking community EM is maybe 25%. And most jobs are in the community.

And everything that has been said above is absolutely true.

We are treated like McDonald’s workers by administration and by patients. Do you like to fly under the radar? Are you able to let insults from patients and other physicians slide off? How about demands for unnecessary testing or treatments?

The circadian stuff is difficult. I have a set schedule only because I selected the set schedule of weekend midnights. As my kids get older this is already becoming less realistic. I coached one of my kids activities, but couldn’t stay all day for the tournament, for example.

I’ve never been a psychiatrist or an FP but they both sound like better options for what you want to accomplish IMHO.

 

[thegenius]

Have you ever read this forum that you are posting on?

The answer you are seeking has been revealed approximately 4,956,772 times.

LMAO

that was the first thing I thought of when I read the first sentence of OP's post.

Just read the next thread down.

 

[thegenius]

(1) I am also really interested in access to healthcare and am aware of how many uninsured people (and unfortunately many people of color) use the ED for care, so I find that will be fulfilling (I am also of color). I also like continuity of care, and worry that I will miss that, but have been told that you often do see the same people over again.

The other thing I was debating was Psychiatry and (2) found that I loved the Psych ED, but worry that I will miss the bread and butter of medicine. An attending at my university mentioned that they see A LOT of psych cases in the ED, so I feel like I'd still get exposure.

(1) oh my god

(2) OH MY GOD!!!

 

[thegenius]

The truth is very few people can have a life long career in EM, or even a couple decades long. You may have interest in it now, but let me tell you a decade of seeing vaginal discharge and MeMa’s that families refuse to take home wears on you. Yea, there are STEMIs and codes and central lines and chest tubes, but that is less then 5% of what I do. If am on honest with you, what EM docs do doesn’t matter for the majority of their time. You aren’t saving lives, you’re a waiter working at a ****ing restaurant.

A EM residency trains you for the 5% of what you will see. The rest of the 95% is complete and utter soul sucking bull****. Imagine training for a job 10+ years and only using your training less than 5% of the time. This specialty is a joke and an embarrassment and should not be terminated before poor souls like you get sucked into it.

OP...this is true. 100% true.

 

[Angry Birds]

Gonna go ahead and assume the answer is zero. Then again, who knows. Birds could be like emergent who says he has kids. That said, emergent also says he works 4 days a month which kinda obviates the issue.

I have kids. And yeah I work very few days per month. Key to happiness.

 

[RustedFox]

(1) oh my god

(2) OH MY GOD!!!

I know, right?
These statements reveal that the OP still has the time or energy to think about them, because they don't actually practice the medicine.

 

[dchristismi]

I'm a woman.
I got out.
I am Nonna by marriage (no biological children - when would I have had time for that?? Besides, steps and grands are easier. And oh, spent my 20s and 30s working my @ss off, and coding children made me realize that I didn't want to walk around with my heart on the outside.)

Reading these replies makes me shudder. I did it full time in the pit for about 12 years and "retired" into HPM.
I do HPM for 0.8 FTE now, bring in 200K with full benefits, and although I'm fast and efficient (and ooh, so touchy-feely), you COULD NOT PAY ME ENOUGH TO GO BACK TO THE HELL HOLE THAT IS EM. Golden handcuffs aren't quite the right phrase... because there is so much gaslighting. So much gaslighting. The system lies. The system treats EM docs like battered spouses. Oh baby, I'm so sorry I scheduled you like that. I didn't mean to flip you from nights to days with only 24 h off. It was a one off. It won't happen again. Baby, I love you. No one loves you like I do. Can you please, pretty please pick up these 4 x12s in a row? Dr Smith had a family emergency... there's no one else to cover... And oh, there was a problem with the scribe company and the scanner is going to be down all shift, but you'll be fine, right? You can do it, right? And then it happens again. And again. And again. And that what management is saying. Not even the patients. And you can ask Fox what he thinks about that...

 

[RustedFox]

I'm a woman.
I got out.
I am Nonna by marriage (no biological children - when would I have had time for that?? Besides, steps and grands are easier. And oh, spent my 20s and 30s working my @ss off, and coding children made me realize that I didn't want to walk around with my heart on the outside.)

Reading these replies makes me shudder. I did it full time in the pit for about 12 years and "retired" into HPM.
I do HPM for 0.8 FTE now, bring in 200K with full benefits, and although I'm fast and efficient (and ooh, so touchy-feely), you COULD NOT PAY ME ENOUGH TO GO BACK TO THE HELL HOLE THAT IS EM. Golden handcuffs aren't quite the right phrase... because there is so much gaslighting. So much gaslighting. The system lies. The system treats EM docs like battered spouses. Oh baby, I'm so sorry I scheduled you like that. I didn't mean to flip you from nights to days with only 24 h off. It was a one off. It won't happen again. Baby, I love you. No one loves you like I do. Can you please, pretty please pick up these 4 x12s in a row? Dr Smith had a family emergency... there's no one else to cover... And oh, there was a problem with the scribe company and the scanner is going to be down all shift, but you'll be fine, right? You can do it, right? And then it happens again. And again. And again. And that what management is saying. Not even the patients. And you can ask Fox what he thinks about that...

The number one cause of burnout is...

... the patient.

 

[Arcan57]

The truth is very few people can have a life long career in EM, or even a couple decades long. You may have interest in it now, but let me tell you a decade of seeing vaginal discharge and MeMa’s that families refuse to take home wears on you. Yea, there are STEMIs and codes and central lines and chest tubes, but that is less then 5% of what I do. If am on honest with you, what EM docs do doesn’t matter for the majority of their time. You aren’t saving lives, you’re a waiter working at a ****ing restaurant.

A EM residency trains you for the 5% of what you will see. The rest of the 95% is complete and utter soul sucking bull****. Imagine training for a job 10+ years and only using your training less than 5% of the time. This specialty is a joke and an embarrassment and should not be terminated before poor souls like you get sucked into it.

Your post makes me think back to that scene in Generation Kill where the Recon Marines are tallying up all the time and money spent turning them into death ninjas that can operate in any environment with no support. And they're being used to seige a walled town with Humvees, a mission for which they are overqualified to perform and simultaneously underequipped to actually do. Don't know why that conversation comes to mind, but it does.

 

[RustedFox]

Your post makes me think back to that scene in Generation Kill where the Recon Marines are tallying up all the time and money spent turning them into death ninjas that can operate in any environment with no support. And they're being used to seige a walled town with Humvees, a mission for which they are overqualified to perform and simultaneously underequipped to actually do. Don't know why that conversation comes to mind, but it does.

I need to watch Generation Kill again.
Too bad it's hard as hell to find streaming anywhere - I actually looked for it a few weeks back.

 

[Arcan57]

I need to watch Generation Kill again.
Too bad it's hard as hell to find streaming anywhere - I actually looked for it a few weeks back.

Should be on Max

 

[WorkNoteEmergency]

If I could do it over again, I’d pick something else. I lasted 15 years but the last 3 were 2/3 full time. Fewer shifts were not the answer for burnout for me. I tried working a couple shifts per month for a few months but found I couldn’t stand that even; not worth it.

I started out on another long rant but I’ll take a pass. I will add to the list of what’s wrong with EM. Who out there has to read their own X-rays at night? They make us get help to push propofol but hey don’t miss that widened mediastinum on a cxr but don’t order too many CT’s either. I know we won’t pay an ultrasound tech to work at night but don’t order too many CT’s. I know hospitalist asked you to order that CT before admitting but don’t order too many CT’s. What an extra $20/hr isn’t enough night shift differential?

OK I guess a small rant.

 

[RustedFox]

If I could do it over again, I’d pick something else. I lasted 15 years but the last 3 were 2/3 full time. Fewer shifts were not the answer for burnout for me. I tried working a couple shifts per month for a few months but found I couldn’t stand that even; not worth it.

I started out on another long rant but I’ll take a pass. I will add to the list of what’s wrong with EM. Who out there has to read their own X-rays at night? They make us get help to push propofol but hey don’t miss that widened mediastinum on a cxr but don’t order too many CT’s either. I know we won’t pay an ultrasound tech to work at night but don’t order too many CT’s. I know hospitalist asked you to order that CT before admitting but don’t order too many CT’s. What an extra $20/hr isn’t enough night shift differential?

OK I guess a small rant.

1. Long rant requested.
2. What do you do now?

 

[sylvanthus]

Everyone has been super helpful, I think I kept wondering if the bad stories I was hearing about EM was just outliers and that it would be different for me and worth it, but it really does seem like it is not a sustainable career path and considering I can see myself doing something else and being happy, that is something I will strongly think about.

Everyone always thinks they will be the excpetio . This is especially true of med students.

 

[sylvanthus]

The “for” argument for EM is always the same and cracks me up.

“I think emergency medicine is great because I have I don't have to do it very much!”

Do emergency medicine if you want weekly homicidal threats against you and your staff, police dumping off meth heads and alcoholics so it’s not their problem, constant revolving door of “psych” patients that are beyond unfixable(plot twist: 99% of the time it’s drugs!), constant barrage of patients that take zero accountability for their health and can barely walk to the bathroom at baseline wanting you to fix all their problems, grown ass adults screaming like children for their pain meds or because the call light isn’t immediately answered, daughter from California syndrome dropping off 98 year old grandpa Joe at 2am demanding an MRI for chronic lightheadedness, Jabba the hut nursing home dumps most with missing limbs and dementia, critical drug shortages, staffing shortages, complete ED nursing turnover every 6-18mo because it’s such a beat down, boarding, corporations, incompetent administration, absurd metrics not based in reality (I resuscitated a dying young peds pt with brain tumor hypoxic arrest from aspiration and i got a extremely positive patient eval saying i saved their kid but it was 8/10 instead of 9 so it counted as a negative), incompetent mid levels, VIPs that have already called 8 consultants before they got there because ER docs are too dumb to do anything, absolute sheer disrespect from every other physician in the hospital and outpatient too (not that any of them could even last 30 minutes in a real ED without pissing their pants), decreasing pay yearly (because you essentially start at your max and you’re never getting a raise with inflation) increasing post Covid litigation, your employment contract being handed around like a hooker in Vegas, and most importantly the market that WILL be flooded in the next 8 years, etc

Could go on for ages. There’s no reason to do EM. I used to have the immature thoughts of hurr durr clinic is boring, 9-5 is boring, etc. you know what sounds better than anything right now? 250-400k working 9-5 where most of the dregs of society are filtered out and you can fire any that make it through.

I’m about to shatter my 400k golden handcuffs less than two years out and hold up a big middle finger to the decomposing future of EM and cut my shifts in half or more. I’m sure I’ll “love” EM too doing it 6-8x a mo

Holy balls this was epic.

 

[Brigade4Radiant]

compare this to the psych thread lol

 

[RustedFox]

Holy balls this was epic.

I know!

@Rekt

Holy smoke, that was a TERRIFIC post!

 

[cyanide12345678]

Oh baby, I'm so sorry I scheduled you like that. I didn't mean to flip you from nights to days with only 24 h off

Yeah…..ive been scheduled back to back 7 shifts that alternated between days and nights.

Day then night then day then night and so on.

 

[GonnaBeADoc2222]

I think if I had to work nights I'd have been out 3 years ago.

 

[Angry Birds]

The “for” argument for EM is always the same and cracks me up.

“I think emergency medicine is great because I have I don't have to do it very much!”

Do emergency medicine if you want weekly homicidal threats against you and your staff, police dumping off meth heads and alcoholics so it’s not their problem, constant revolving door of “psych” patients that are beyond unfixable(plot twist: 99% of the time it’s drugs!), constant barrage of patients that take zero accountability for their health and can barely walk to the bathroom at baseline wanting you to fix all their problems, grown ass adults screaming like children for their pain meds or because the call light isn’t immediately answered, daughter from California syndrome dropping off 98 year old grandpa Joe at 2am demanding an MRI for chronic lightheadedness, Jabba the hut nursing home dumps most with missing limbs and dementia, critical drug shortages, staffing shortages, complete ED nursing turnover every 6-18mo because it’s such a beat down, boarding, corporations, incompetent administration, absurd metrics not based in reality (I resuscitated a dying young peds pt with brain tumor hypoxic arrest from aspiration and i got a extremely positive patient eval saying i saved their kid but it was 8/10 instead of 9 so it counted as a negative), incompetent mid levels, VIPs that have already called 8 consultants before they got there because ER docs are too dumb to do anything, absolute sheer disrespect from every other physician in the hospital and outpatient too (not that any of them could even last 30 minutes in a real ED without pissing their pants), decreasing pay yearly (because you essentially start at your max and you’re never getting a raise with inflation) increasing post Covid litigation, your employment contract being handed around like a hooker in Vegas, and most importantly the market that WILL be flooded in the next 8 years, etc

Could go on for ages. There’s no reason to do EM. I used to have the immature thoughts of hurr durr clinic is boring, 9-5 is boring, etc. you know what sounds better than anything right now? 250-400k working 9-5 where most of the dregs of society are filtered out and you can fire any that make it through.

I’m about to shatter my 400k golden handcuffs less than two years out and hold up a big middle finger to the decomposing future of EM and cut my shifts in half or more. I’m sure I’ll “love” EM too doing it 6-8x a mo

I am not denying that working a regular ER doc’s job would make me want to kill myself. That’s exactly why I exerted a lot of effort in finding the unicorn job that I have and minimizing my days of work.

All I am saying is that my particular unicorn of a job allowed me a financial and time freedom that I don’t think I could have attained in another medical specialty. So yes, I’d do it again.

But I am an outlier. And I make less overall money than most ER docs in order to reduce my shifts. But the shifts I do work, I get paid a great rate.

So I don’t think my post is either here or there.

I should also state that I’ve brainwashed myself in the last year or so to make myself happy with my job. It’s helped me a lot to do so.

 

[GonnaBeADoc2222]

I'd like to also note that most of the frustrations of my work would cost admin zero to little to improve. They're mostly workflow, culture, and equipment issues. Admin gives zero ****s though, or are incompetent (not sure which is worse), so therefore nothing gets fixed.

 

[TooMuchResearch]

Very undecided third year medical student deciding what specialty to go into because I have found that I like A LOT

EM physicians what do you think about your work-life balance with shift work and salary compensation?

I am a women, who is interested in having a family so wanting to make sure I can still accomplish that.

I have heard a lot of mixed things about the burnout, but I find that in each of my rotations I find myself most intrigued by the high urgency/acute care cases. I love chaos and having to run around my entire shift (thanks ADHD). I can't help but feel like EM is meant for me but am just so worried about my life in residency and as a physician.

I am also really interested in access to healthcare and am aware of how many uninsured people (and unfortunately many people of color) use the ED for care, so I find that will be fulfilling (I am also of color). I also like continuity of care, and worry that I will miss that, but have been told that you often do see the same people over again.

The other thing I was debating was Psychiatry and found that I loved the Psych ED, but worry that I will miss the bread and butter of medicine. An attending at my university mentioned that they see A LOT of psych cases in the ED, so I feel like I'd still get exposure.

So long-winded to say, would you recommend EM ? Thoughts about your work-life balance with shift work and salary compensation? (I don't need to have 3 vacation homes, but will have a lot of loans and wish to never struggle with money despite childhood. But would like time to be able to enjoy having money as well lol)

Hi, I only read the post title. Answer is hard no.

 

[Apollyon]

Yeah…..ive been scheduled back to back 7 shifts that alternated between days and nights.

Day then night then day then night and so on.

Could you volunteer to be beaten with a rubber hose, instead, just to get it over with? Same result.

 

[The Knife & Gun Club]

Very undecided third year medical student deciding what specialty to go into because I have found that I like A LOT

EM physicians what do you think about your work-life balance with shift work and salary compensation?

I am a women, who is interested in having a family so wanting to make sure I can still accomplish that.

I have heard a lot of mixed things about the burnout, but I find that in each of my rotations I find myself most intrigued by the high urgency/acute care cases. I love chaos and having to run around my entire shift (thanks ADHD). I can't help but feel like EM is meant for me but am just so worried about my life in residency and as a physician.

I am also really interested in access to healthcare and am aware of how many uninsured people (and unfortunately many people of color) use the ED for care, so I find that will be fulfilling (I am also of color). I also like continuity of care, and worry that I will miss that, but have been told that you often do see the same people over again.

The other thing I was debating was Psychiatry and found that I loved the Psych ED, but worry that I will miss the bread and butter of medicine. An attending at my university mentioned that they see A LOT of psych cases in the ED, so I feel like I'd still get exposure.

So long-winded to say, would you recommend EM ? Thoughts about your work-life balance with shift work and salary compensation? (I don't need to have 3 vacation homes, but will have a lot of loans and wish to never struggle with money despite childhood. But would like time to be able to enjoy having money as well lol)

Just some thoughts re: underserved. I love working with the underserved. Not sure why but I really enjoy the IVDU population.

That said I HATE seeing them in the ED. They’re annoying, needy, and often highly manipulative in the department.

I went into EM thinking I wanted to work with this population and realized very quickly the ED Is not a place that’s set up to help these people. If you actually like serving the underserved the ER will make you sad due to being unable to mobilize the resources necessary in the time allowed for an ED visit.

Now I do ICU but have a free clinic for IVDU patients that I cover part time. Do bupe inductions, HIV/HCV meds, addiction counseling, and wound care. It’s all for free and none of it requires an EM background. I would’ve been better served doing IM or FM working with this population.

It makes me happy and is something you can do from many routes within medicine. Just because underserved patients utilize the ED at high rates doesn’t mean you should work in an ER it care for them. Do something we’re care goals and resources align and care for the underserved in your off time if it makes you happy.

 

[Fox800]

I'm early-mid career. I had a strong background in EMS and thought it was EM or nothing.

I would not recommend EM again.

I took a "dream job" in a hot area, then got burned out seeing 30+ patients on an 8 hour shift, single coverage, overnights at a busy trauma center. Staying 1-2.5 hours over to transition care, write notes, etc because the RVU model meant partners were super weird about sign-outs.

My partners who had been at the group 10+ years longer than me would stop seeing patients 90-120 minutes before shift change. I remember veteran docs saying things like "I just can't see any more, man" - seeing that they left me walking in to 9 roomed patients at 0600 with folks already in the waiting room. Cool, guess I"ll try to see 10 patients in my first hour. One other one would put his hands up and say "I saw my 20 patients (2.5 PPH) - I have to go home some time".

Night shifts are rough. It was unpleasant coming off of them as a resident, it's hell as at attending when your body gets less able to adjust back to days, it takes longer and longer over time. Pay has been flat for the past 5-10 years ($200-275/hr at most groups). No cost of living adjustments for inflation/rising housing costs, no raises, even through COVID. Eternally being told to do more with less. You can easily find yourself being bullied to do the work of 1.5-2 FTEs and be paid the same as your group was 10 years ago despite rising inflation. You're tied to the hospital and have no room to negotiate pay or anything, really. If you or your group piss of the hospital, say goodbye to your position or your group's contract - you'll be replaced by a CMG.

You have. No. Bargaining. Power.

I was hoping to get something, anything, out of COVID. Pay raise, student loan forgiveness, tort reform/EMTALA reform. Nothing. Same pay, worse crap, higher volumes, more stress, meaner patients, fewer nurses and hospital beds.

Everyone is meaner/more bitter: docs, hospitalists, nurses, consultants, and patients.

The only way I've been able to stick it out is by going PRN at a few places and not working nights or weekends and getting total schedule control. That's not realistic for a lot of people.

 

[Fox800]

We were heroes during COVID. We saw all comers while the specialists did virtual consults and admins jerked off at home. We intubated COVID patients with little to no PPE sometimes. Now, we are trash.

My expertise and behavior are constantly questioned by patients, other physicians, nurses, chaplains, you name it, and even the most innocuous "incidents" get you dragged to the principals office. Everyone second guesses, until it's time to "just send them to the ED."

Violence is rampant. Admin does little to protect us.

I haven't even talked about midlevels.

This is so true.

Volumes are through the roof and physicians want to work less, so staffing sucks and they want you to do the work of 1.5-2 docs but pay you for 1 FTE.

I'm still seeing certain places "refuse" to see patients that have COVID. In December 2023. Nearly four years after COVID broke out, every HCW has to be vaccinated, and HCWs aren't required to mask. You can have influenza or RSV, totally cool. Whatever, keep dumping them in the ED.

Our security is a joke. I'm just lucky to live somewhere where the local population is a bit less violent/angry than most of the US and tends to respect healthcare workers. Our "security" guards carry radios, they don't even have OC/handcuffs. Nothing. Call 911.

I enjoy dealing with RN and NP idiocy not-infrequently. This week it was an RN "refusing" to give fentanyl but was comfortable giving morphine to a stable adult with abdominal pain. Thanks, you're not a physician and you don't get to make that decision. We hired an experienced NP from wherever VA/DC that's running around spouting "well at [busy hospital in VA] we did it this way so _________" - that's cool, I don't care. We do it this way here.

I don't care about your midlevel "experience". I don't care that you saw high-acuity complaints "independently" at your last job (AKA the staffing was so bad that the physicians couldn't see every patient). I care that you're not dangerous, you don't generate more work for me, and I don't have to go behind you and fix your mistakes. Stop giving 60 mg Toradol to everyone. Stop giving antibiotics for URIs. Stop giving albuterol to CHF exacerbations. Stop getting non-contrast head CTs as your sole imaging study for dizziness. Yes, adults with vague chest/abdominal/neck/shoulder pain need EKGs. Stop strep testing infants. Stop doing strep swabs AND COVID/flu swabs on the same patient. Stop getting lumbar spine x-rays. Stop ordering head CTs for pediatric head trauma that's low-risk by PECARN. It never ends.

 

[Janders]

“Stop doing strep swabs AND COVID/flu swabs on the same patient”

Oh but I do that sometimes. If child/young adult and primary c/o is Sore Throat but covid/flu is rampant (like… now)… totally grab both swabs at one time.

 

[Janders]

I’m in my… 13th year?

I’m not regretful that I chose it, the past few years have been rough but I’ve worked for a long time in a group with total billing/pay transparency, lots of ability to independently hire/fire PAs, make our own overnight stipends, change schedule stuff, even modify our shift numbers/length. In the end its our pile of money to divide up how we like. This is much better than just getting $x/hr from Walmart, Inc. I’ve moonlit a number of places around here, and each place has its unique issues. I’ve dropped to about 80% FTE clinically as I do more and more admin stuff. I’ve been blessed to have some incredible coworkers.

All that said, I’m VERY happy I have saved and invested aggressively, as I don’t think I could do this until the age of 65. Hell, if I make it at the same pace I’m on ‘til 50, I’d be surprised.

Every year we see more patients, with less support, for functionally less money (especially if you factor in inflation).

I’ve had a good run, I think I can make it to the finish line… but its going to involve going half time or transitioning to alternative work, not 16 clinical shifts a month until social security kicks in. So, given a Time Machine I wouldn’t necessarily go back in time and slap the **** out of MS3 me. I think I could do something better with the Time Machine. However, if I was halfway through medical school in 2023 instead of 2005… I would NOT chose EM as my top choice. The trajectory is just not good.

 

[RoyBasch]

I love chaos and having to run around my entire shift (thanks ADHD). I can't help but feel like EM is meant for me but am just so worried about my life in residency and as a physician.

What does "chaos" mean to you and why do you love it?

I would describe examples of chaos I experience on shift as trying to have a quick but thorough risk vs. benefit conversation with a critically disabled stroke patient regarding usage of lytics with them and their family but getting continually harassed that the pscyh/agitated delirium patient needs additional sedation/restraint before someone gets hurt. I do not feel my decision making for the critical patient is enhanced by chaos and now I have to make a very tough clinical decision with added interruption.

I would describe chaos as trying to transport a critical respiratory failure/septic shock patient but getting continual denials from multiple EMS agencies as they deem it too "unsafe" to drive in snow and ice (the exact same weather I drove through to get to work in the ER in the first place). Again, the care of this patient is not enhanced by "chaos" and I do not enjoy my care being compromised.

I would say my goal as a practicing emergency physician is to MINIMIZE chaos in the ER as much as possible. Nobody likes that guy on shift who cant keep a lid on things. Good ER physicians keep things steady throughout the shift and keep things running smoothly.

My point is, some chaos is unavoidable, but I try to allow as little as possible and I generally view it as a negative so I find it very odd you "love" it.

I am also really interested in access to healthcare and am aware of how many uninsured people (and unfortunately many people of color) use the ED for care, so I find that will be fulfilling (I am also of color). I also like continuity of care, and worry that I will miss that, but have been told that you often do see the same people over again.

Uninsured and underprivileged patients (of color and not of color) need care from every specialty. When I see a homeless diabetic with infected decubitus ulcers and osteomyelitis I will start antibiotics and admit the patient. Ultimately they will need many specialists to help them. Internal medicine will admit, endocrine will manage the diabetes, infectious disease will direct the antibiotic therapy, a general surgeon may have to perform a diverting ostomy to keep stool off the wounds, and definitive care to cover the wounds with a flap will ultimately require--believe it or not--a plastic surgeon. I would argue these other specialties have a more important role than I do as an ER physician in the care of this patient.

Whether you take care of underprivileged patients or not has more to do with your chosen practice environment within a specialty than between specialties. A lot of uninsured trauma disfigured patients need plastic surgeons. A lot of patients with significant auto-immune skin diseases need dermatologists. If you choose to practice as a plastic surgeon or dermatologist at an inner city hospital or a cash-only cosmetic clinic ensconced in a wealthy enclave will be up to you.

The other thing I was debating was Psychiatry and found that I loved the Psych ED, but worry that I will miss the bread and butter of medicine. An attending at my university mentioned that they see A LOT of psych cases in the ED, so I feel like I'd still get exposure.

We see a lot of psych patients, we don't really treat them. The main intervention I have to offer these patients is putting them in a locked room and having someone paid minimum wage watch them so they can't physically hurt themselves. This is not psychiatry. Real psychiatry involves more detailed diagnosis of psychiatric conditions, prescription of ongoing psychiatric medications, and then continuity of care to observe response to treatment and make continuous adjustment titrating to effect. This latter care can be very gratifying for the physician and positively life altering for the patient, but it is not something as an ER physician I have any involvement with. If you want to be a psychiatrist and treat pyschiatric disease, you will not find the skillset you develop and the interventions you have to offer psych patients as an ER physician very satisfying.

 

[CoolDoc1729]

“Stop doing strep swabs AND COVID/flu swabs on the same patient”

Oh but I do that sometimes. If child/young adult and primary c/o is Sore Throat but covid/flu is rampant (like… now)… totally grab both swabs at one time.

I had Flu A and strep in a single patient last night. A rather punky looking 6 year old ☹️

 

[Mount Asclepius]

A certain percentage of people are carriers of GAS. Just because you are a carrier doesn’t mean your pharyngitis is necessarily due to GAS especially if a viral etiology is identified. Empiric testing of all sore throats leads to unnecessary antibiotic overuse.

I do think though that viral respiratory panels lead to decreased visits. When someone is told what specific viral illness they have, I think they are less likely to have a return visit than if they are just empirically diagnosed with a viral URI. Sadly people trust tests more than they trust physicians.

 

[The kitchen sink]

What does "chaos" mean to you and why do you love it?

I would describe examples of chaos I experience on shift as trying to have a quick but thorough risk vs. benefit conversation with a critically disabled stroke patient regarding usage of lytics with them and their family but getting continually harassed that the pscyh/agitated delirium patient needs additional sedation/restraint before someone gets hurt. I do not feel my decision making for the critical patient is enhanced by chaos and now I have to make a very tough clinical decision with added interruption.

I would describe chaos as trying to transport a critical respiratory failure/septic shock patient but getting continual denials from multiple EMS agencies as they deem it too "unsafe" to drive in snow and ice (the exact same weather I drove through to get to work in the ER in the first place). Again, the care of this patient is not enhanced by "chaos" and I do not enjoy my care being compromised.

I would say my goal as a practicing emergency physician is to MINIMIZE chaos in the ER as much as possible. Nobody likes that guy on shift who cant keep a lid on things. Good ER physicians keep things steady throughout the shift and keep things running smoothly.

My point is, some chaos is unavoidable, but I try to allow as little as possible and I generally view it as a negative so I find it very odd you "love" it.

Uninsured and underprivileged patients (of color and not of color) need care from every specialty. When I see a homeless diabetic with infected decubitus ulcers and osteomyelitis I will start antibiotics and admit the patient. Ultimately they will need many specialists to help them. Internal medicine will admit, endocrine will manage the diabetes, infectious disease will direct the antibiotic therapy, a general surgeon may have to perform a diverting ostomy to keep stool off the wounds, and definitive care to cover the wounds with a flap will ultimately require--believe it or not--a plastic surgeon. I would argue these other specialties have a more important role than I do as an ER physician in the care of this patient.

Whether you take care of underprivileged patients or not has more to do with your chosen practice environment within a specialty than between specialties. A lot of uninsured trauma disfigured patients need plastic surgeons. A lot of patients with significant auto-immune skin diseases need dermatologists. If you choose to practice as a plastic surgeon or dermatologist at an inner city hospital or a cash-only cosmetic clinic ensconced in a wealthy enclave will be up to you.

We see a lot of psych patients, we don't really treat them. The main intervention I have to offer these patients is putting them in a locked room and having someone paid minimum wage watch them so they can't physically hurt themselves. This is not psychiatry. Real psychiatry involves more detailed diagnosis of psychiatric conditions, prescription of ongoing psychiatric medications, and then continuity of care to observe response to treatment and make continuous adjustment titrating to effect. This latter care can be very gratifying for the physician and positively life altering for the patient, but it is not something as an ER physician I have any involvement with. If you want to be a psychiatrist and treat pyschiatric disease, you will not find the skillset you develop and the interventions you have to offer psych patients as an ER physician very satisfying.

A lot of what you said is true

But IM to only admit and call consults? No wonder admin are replacing us with midlevels…

an IM hospitalist physiciancan manage all of these things without consulting endocrine for diabetes mgmt or ID for antibiotic therapy right off the bat… order the correct diagnostic studies…
That statement really minimizes their role in medicine

 

[RoyBasch]

A lot of what you said is true

But IM to only admit and call consults? No wonder admin are replacing us with midlevels…

an IM hospitalist physiciancan manage all of these things without consulting endocrine for diabetes mgmt or ID for antibiotic therapy right off the bat… order the correct diagnostic studies…
That statement really minimizes their role in medicine

In my opinion being the primary admitting service for a complex patient requiring multiple specialists doesn’t seem to be a minimal role in the care of a patient.

I’m pretty confident at most multi specialty hospitals osteomyelitis will be managed with the assistance of infectious disease specialists if they are available. The patient will likely require management of ongoing iv antibiotic for weeks after hospitalization so connection with a specialist who has an outpatient clinic is helpful. But if you feel confident enough in your ID knowledge to manage this patient independently and then coordinate their discharge antibiotic care, more power to you. That being said the hospitalists I work with at our multi specialty center would consult 100% of the time for this patient and I have no negative judgements about that.

Consultation with endocrine may depend on the severity/complexity of the diabetes, but again following up on my cases I see them consulted frequently. Many hospitalist a request I call/order the endocrine consult for them as well.

I feel the quality of my institutions hospitalist is good. I do understand they are seeing large volumes of patients and offloading micromanagement of problems onto specialists is important for their workflow as well. I understand at a smaller facility with lower volume and fewer specialists available a sturdy hospitalist might work more of those issues independently.

That being said, I also do some work at a small hospital and usually the hospitalist there request I transfer this type of patient to a higher level of care for specialist involvement…

 

[The kitchen sink]

In my opinion being the primary admitting service for a complex patient requiring multiple specialists doesn’t seem to be a minimal role in the care of a patient.

I’m pretty confident at most multi specialty hospitals osteomyelitis will be managed with the assistance of infectious disease specialists if they are available. The patient will likely require management of ongoing iv antibiotic for weeks after hospitalization so connection with a specialist who has an outpatient clinic is helpful. But if you feel confident enough in your ID knowledge to manage this patient independently and then coordinate their discharge antibiotic care, more power to you. That being said the hospitalists I work with at our multi specialty center would consult 100% of the time for this patient and I have no negative judgements about that.

Consultation with endocrine may depend on the severity/complexity of the diabetes, but again following up on my cases I see them consulted frequently. Many hospitalist a request I call/order the endocrine consult for them as well.

I feel the quality of my institutions hospitalist is good. I do understand they are seeing large volumes of patients and offloading micromanagement of problems onto specialists is important for their workflow as well. I understand at a smaller facility with lower volume and fewer specialists available a sturdy hospitalist might work more of those issues independently.

That being said, I also do some work at a small hospital and usually the hospitalist there request I transfer this type of patient to a higher level of care for specialist involvement…

That’s true.

Unfortunately I don’t blame them either. Medicine has become unforgiving. If anything goes wrong with the case, medicolegally, they will say why didn’t involve so and so specialist ?

And yeah with large volumes of patients to ensure the swiss cheese model you may invite many consultants to be involved.

 

[Fox800]

I had Flu A and strep in a single patient last night. A rather punky looking 6 year old ☹️

Or they're an asymptomatic carrier of Strep, which something like 15-20% of school-aged children are. Strep doesn't cause rhinorrhea and a cough, and viruses can cause sore throat and pharyngitis + the other URI symptoms. If they have multiple URI symptoms besides a sore throat, it's likely a URI and not acute bacterial tonsillopharyngitis. My midlevels don't seem to understand that.

 

[dozitgetchahi]

Yup. I was just trying to educate and inform students.

I got suckered in 9 or so years ago - there was so much hype about EM then. It’s just not the same specialty i applied to back in 2015.

Every attending i talked to then couldn’t stop bragging about all the 300/hr job opportunities they have and the hundreds of recruiter emails. 10 years later, things have truly changed. It’s just a mediocre specialty

That was around the time I applied to IM. I can remember all the hubbub around EM among the folks in my class, the fascination that it was acute care and other things rolled into one, the idea that it was somehow a “lifestyle specialty” (never could understand how that made sense), etc etc. It was “getting more competitive”, people were trying to match it and going unmatched, etc.

I never could understand all the excitement surrounding it. I think it was largely just the current “hip/trendy” specialty, and as always, herd mentality took over.

 

[cyanide12345678]

That was around the time I applied to IM. I can remember all the hubbub around EM among the folks in my class, the fascination that it was acute care and other things rolled into one, the idea that it was somehow a “lifestyle specialty” (never could understand how that made sense), etc etc. It was “getting more competitive”, people were trying to match it and going unmatched, etc.

I never could understand all the excitement surrounding it. I think it was largely just the current “hip/trendy” specialty, and as always, herd mentality took over.

E-road to success was the mantra.

F that. EM doesn’t come close to that list.

 

[thegenius]

A certain percentage of people are carriers of GAS. Just because you are a carrier doesn’t mean your pharyngitis is necessarily due to GAS especially if a viral etiology is identified. Empiric testing of all sore throats leads to unnecessary antibiotic overuse.

I do think though that viral respiratory panels lead to decreased visits. When someone is told what specific viral illness they have, I think they are less likely to have a return visit than if they are just empirically diagnosed with a viral URI. Sadly people trust tests more than they trust physicians.

If they were cheap I would run them all the time. I heard it costs $1000 (roughly), or better yet insurance or the govt is billed ~$1000. Ridiculous.

 

[CajunMedic]

As someone with a heavy EMS background who went to medical school with the sole purpose of EM. No, would not recommend

I have been an attending for a little over 18 months in community shops and worked in one where I was core EM residency faculty. in that 18 months I have:

Been assaulted twice, Physically defended myself in one of them and still fighting from administration throwing me under the bus.
Sued a year later for a patient I saw 3 weeks into my attending career.
Gotten my teeth metaphorically kicked in on night shifts, solo coverage with greater than 2.2pph, Tubing and lining and trying to transfer out a critical brain bleed, while trying to keep the department moving while the whole damn thing burns down around me (seriously, these people here need hobbies and Pepto-Bismol). Thank God I've got great nursing staff and an ED medic who keeps me sane and supplied with Dr. Pepper and Twix!
Dealt with the stray cats that come around for Dilaudid for sore throats, thanks to previous docs that handed it out like candy. "The only thing you can have is 20 cc of GTFO."
Gone "hands on" with at least 5 violent patients because administration is so ****ing ostriched about how terrible "one bullet Barney" the lackadaisical security guard. Or the lack of security in general.
Came to work sick, managed to see 3 patients, and then got checked in as a patient. Getting an IV with a WOW pulled up to my bed and texting the charge nurse about dispositions on my patients.

There are days I would go back and do a second residency in FM, if I could afford it. I'd love to be able to do EMS medical direction full-time with minimal clinical shifts

 

[Atreides]

I was between EM and psych. I did EM. I recommend doing psych. Do not underestimate the value of having autonomy.

I was between EM and psych as well. Got two good SLOEs and also had a pre-match offer at my institution (it was a new program). I changed my mind at the 11th hour, switching to psychiatry a few weeks before ERAS was due. Seven years later, definitely made the right choice. I go into work about 2 days a month, work the rest from home. I don't have to deal with any metrics other than what I set for myself. I'm making way more money in psychiatry than I was expecting to when I made this decision. I thought I was sacrificing salary when I decided to do psych rather than EM but I'm pretty sure I'm making at least what I would have in EM, if not more. I average about $450-$500/hour after overhead for my practice.

With those numbers said, I'd caution you from making a decision based on salary. When I was making this decision, EM income was easily double psychiatry income. In seven years, things have changed drastically. In seven more years (i..e, when you finish training), it may change again in the other direction. The algorithm I was told was to pick based on which fields interest you. If there's a tie/they're close, then which fields have better lifestyle. If still a tie/close, then income.

 

[RustedFox]

I was between EM and psych as well. Got two good SLOEs and also had a pre-match offer at my institution (it was a new program). I changed my mind at the 11th hour, switching to psychiatry a few weeks before ERAS was due. Seven years later, definitely made the right choice. I go into work about 2 days a month, work the rest from home. I don't have to deal with any metrics other than what I set for myself. I'm making way more money in psychiatry than I was expecting to when I made this decision. I thought I was sacrificing salary when I decided to do psych rather than EM but I'm pretty sure I'm making at least what I would have in EM, if not more. I average about $450-$500/hour after overhead for my practice.

With those numbers said, I'd caution you from making a decision based on salary. When I was making this decision, EM income was easily double psychiatry income. In seven years, things have changed drastically. In seven more years (i..e, when you finish training), it may change again in the other direction. The algorithm I was told was to pick based on which fields interest you. If there's a tie/they're close, then which fields have better lifestyle. If still a tie/close, then income.

Pay attention to this sentence, students (if you're reading this).

 

[cyanide12345678]

As someone with a heavy EMS background who went to medical school with the sole purpose of EM. No, would not recommend

I have been an attending for a little over 18 months in community shops and worked in one where I was core EM residency faculty. in that 18 months I have:

Been assaulted twice, Physically defended myself in one of them and still fighting from administration throwing me under the bus.
Sued a year later for a patient I saw 3 weeks into my attending career.
Gotten my teeth metaphorically kicked in on night shifts, solo coverage with greater than 2.2pph, Tubing and lining and trying to transfer out a critical brain bleed, while trying to keep the department moving while the whole damn thing burns down around me (seriously, these people here need hobbies and Pepto-Bismol). Thank God I've got great nursing staff and an ED medic who keeps me sane and supplied with Dr. Pepper and Twix!
Dealt with the stray cats that come around for Dilaudid for sore throats, thanks to previous docs that handed it out like candy. "The only thing you can have is 20 cc of GTFO."
Gone "hands on" with at least 5 violent patients because administration is so ****ing ostriched about how terrible "one bullet Barney" the lackadaisical security guard. Or the lack of security in general.
Came to work sick, managed to see 3 patients, and then got checked in as a patient. Getting an IV with a WOW pulled up to my bed and texting the charge nurse about dispositions on my patients.

There are days I would go back and do a second residency in FM, if I could afford it. I'd love to be able to do EMS medical direction full-time with minimal clinical shifts

Yesterday my ER was burning . 8 patients decided to show up in an hour. Single coverage critical access shop. Full waiting room.

Got called to intubate someone crashing on the floor -_-

Came back to some very pissed off patients who didn’t feel like they got immediately seen. I hate the entitlement our ED patients have

You know i just want a relaxing gig - the excitement and stress of the ER gets old very very fast.

 

[RoyBasch]

Yesterday my ER was burning . 8 patients decided to show up in an hour. Single coverage critical access shop. Full waiting room.

Got called to intubate someone crashing on the floor -_-

Came back to some very pissed off patients who didn’t feel like they got immediately seen. I hate the entitlement our ED patients have

The unremitting rage ER patients have over wait times never ceases to amaze me. I see patients leave without being seen in fury 3-7 minutes after check in.

My average ER patient has a shorter wait time in the ER--where they arrived completely unexpectedly compared to in a clinic where they have an APPOINTMENT that was SET months to possibly a year in advance.

I frequently see ER patients immediately. I.e. patient goes back to a room so fast and I see them they haven't even been registered yet. Average wait time overall is probably less than one hour. When I go personally to see a physician in clinic, I routinely have to wait 30-90 minutes to be seen after my SCHEDULED appointment start time.

These clinics don't seem to feel one bit of compunction about their wait times even thought the patients have ****ing scheduled appointments. No apologies, no explanations. I never hear anybody bitching at specialty clinics that the wait time for an appointment is too long (frequently 6-18 months) or that the wait time once you arrive on the day of your appointment is too long. So no I don't feel any compunction about my wait times for unscheduled ER patients who almost exclusively arrive in boluses of 5-12 at a time.

To the students listening in the back, we seem to be the only specialty who get beat on by patients and admin for this kind of stuff.