Would you recommend EM?

[GonnaBeADoc2222]

The 30,000 foot view advice I can give, is to choose a specialty / practice environment where you are independent from a hospital in order to render your services.

Only then can you achieve true independence to practice how you want and avoid whatever corporatist / woke policies du jour the hospital wants to impose.

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[p1acebo]

The 30,000 foot view advice I can give, is to choose a specialty / practice environment where you are independent from a hospital in order to render your services.

Only then can you achieve true independence to practice how you want and avoid whatever corporatist / woke policies du jour the hospital wants to impose.

Until you are bought out or pushed out by said corporatist eating up the market.

 

[cyanide12345678]

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.

We’re just easier to replace. And it will get easier and easier to replace us as the true effects of doubling residencies over the last 6 years takes effect. 3100 interns for 2023, won’t feel that until 2026.

Interesting story:

A few weeks ago, i called the big mothership regarding a transplant patient that needed to be transferred.

Transplant surgeon was very nice on the phone, accepted the patient and then said to the transfer nurse, ‘this patient needs to be here today. She better not be coming in tomorrow’ - the transfer nurse truly was intimidated by him - she kept saying ‘yes sir. Yes sir. Yes sir. Absolutely. She will be here immediately’.

Normally it can take 24-48 hours for stable patients to get a bed at the mothership. Patient was stone cold stable.

After the surgeon hangs up, i asked the transfer nurse, ‘so do you really think we will get a bed today’.

She said, ‘100% - immediately. Otherwise all hell will break loose.’

Now that was someone indispensable to the hospital and the entire system.

Be that guy 🤣

 

[VA Hopeful Dr]

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.

Oh trust me, we hear about it

 

[RoyBasch]

After the surgeon hangs up, i asked the transfer nurse, ‘so do you really think we will get a bed today’.

She said, ‘100% - immediately. Otherwise all hell will break loose.’

Now that was someone indispensable to the hospital and the entire system.

Be that guy 🤣

This is really sound advice.

As an ER physician I have been reminded in at least 1000 different ways over the course of my career I/we are NOT "that guy."

 

[crop]

I have been practicing EM for 5 years in a SDG making around 400k. I just made partner two years ago. For me the money is not worth it anymore and I could not be more ecstatic to have been accepted into a palliative medicine fellowship which is where my passion lies. Money is not everything and you realize that early on in your career…no matter what you do as a physician you will make a nice salary. To me seeing 2.5 to sometimes 4 pph during busy shifts with pans ordering tests and imaging so you do not miss something because of the volume, single coverage nights, having to constantly transfer patients from my smaller community site has sucked the life and joy of em out of me. The constant shift switching and being constantly “jet lagged” is just not healthy. I am sick of the ed being a dumping ground for primary care docs and other specialists that “cannot see their patients.” I am sick of dealing with administrators that have no idea what it means to practice medicine on the front lines but they want to dictate how you practice medicine. I am disgusted by how year after year our compensation is decreasing because of greedy insurance companies and the government. I am sick of truly needy and unappreciative patients and their family members that want you to diagnose and fix everything (this is an er not a doctor house clinic!). I could go on. The only way I could do em as a career is if I cut down to 28hours or less a month but even then I would still not be happy. Although there are great things about this specialty I do regret going down this pathway as a medical student. Procedures and resuscitations can be fun but they loose their luster quickly as an attending. All I can say is that I am excited for my next chapter.

 

[thegenius]

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

Interesting...many psychiatrists charge $400-$600/hr in the Bay Area where I live (as I've priced out several child psychiatrists) so to make $500/hr they must not have that much overhead. In fact..there is little overhead with a psych practice.

 

[WorkNoteEmergency]

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

Ha, the bitterness persists but anger fades as I get further away. Maybe I’ll read something here to trigger me some time and post a longer one. Last time I talked to my old director, there were 16 open shifts in December (only 4 shifts per day at my old shop) but I gave that little thought as I planned out my Christmas holiday like a normal person.

I am mostly WFH part time in a medtech start up. Occasional patient meetings from my home office but majority is consulting on the tech development. It’s about half the hourly salary but enough to cover expenses and let my borderline adequate retirement funding grow unmolested a little longer. As you can imagine huge adjustment as the work is always there, so its different having some work to do every day but hey it’s not - solo night shift critically ill patient, 3 new patients checked in and nobody wants to to take transfers - kind of stress. It’s really cool to take part in building something rather than just show up and see x/pph for 10 hours.

Gotta go now, gonna set down the iPad and pick up the Mac and work for a couple of hours!

 

[painER]

I wish this thread had been around 8 years ago when I was applying in to EM. I agree with just about everything that's been said and it really all comes down to a lack of respect.

Lack of respect from the hospital admin with their refusal to provide adequate resources to get the job done and appreciation for the sacrifices we make.

Lack of respect from the patient with their unrealistic expectations and lack of understanding of what the ED is actually for.

Lack of respect from the rest of the ED staff with how accessible we are.

Lack of respect from other specialties with their inability to acknowledge the expertise we have and delusion that they would last more than 5 minutes in a busy ED.

I can go on and on...

But what all this lack of respect comes down to is the fact that we are 100% replaceable. Now everyone is replaceable to some extent, but it's less obvious with other specialties. So for all the med students lurking on here, when choosing a specialty, yes think about what you want to do, but also think about if that specialty allows you to craft a career to make yourself less replaceable. It's near impossible to do that in EM with how EM is practiced today.

 

[FlaminHotER]

I have been practicing EM for 5 years in a SDG making around 400k. I just made partner two years ago. For me the money is not worth it anymore and I could not be more ecstatic to have been accepted into a palliative medicine fellowship which is where my passion lies. Money is not everything and you realize that early on in your career…no matter what you do as a physician you will make a nice salary. To me seeing 2.5 to sometimes 4 pph during busy shifts with pans ordering tests and imaging so you do not miss something because of the volume, single coverage nights, having to constantly transfer patients from my smaller community site has sucked the life and joy of em out of me. The constant shift switching and being constantly “jet lagged” is just not healthy. I am sick of the ed being a dumping ground for primary care docs and other specialists that “cannot see their patients.” I am sick of dealing with administrators that have no idea what it means to practice medicine on the front lines but they want to dictate how you practice medicine. I am disgusted by how year after year our compensation is decreasing because of greedy insurance companies and the government. I am sick of truly needy and unappreciative patients and their family members that want you to diagnose and fix everything (this is an er not a doctor house clinic!). I could go on. The only way I could do em as a career is if I cut down to 28hours or less a month but even then I would still not be happy. Although there are great things about this specialty I do regret going down this pathway as a medical student. Procedures and resuscitations can be fun but they loose their luster quickly as an attending. All I can say is that I am excited for my next chapter.

Ditto

Fcuking travesty what our speciality has become

Med students on here: STAY AWAY

 

[FlaminHotER]

We’re just easier to replace. And it will get easier and easier to replace us as the true effects of doubling residencies over the last 6 years takes effect. 3100 interns for 2023, won’t feel that until 2026.

Interesting story:

A few weeks ago, i called the big mothership regarding a transplant patient that needed to be transferred.

Transplant surgeon was very nice on the phone, accepted the patient and then said to the transfer nurse, ‘this patient needs to be here today. She better not be coming in tomorrow’ - the transfer nurse truly was intimidated by him - she kept saying ‘yes sir. Yes sir. Yes sir. Absolutely. She will be here immediately’.

Normally it can take 24-48 hours for stable patients to get a bed at the mothership. Patient was stone cold stable.

After the surgeon hangs up, i asked the transfer nurse, ‘so do you really think we will get a bed today’.

She said, ‘100% - immediately. Otherwise all hell will break loose.’

Now that was someone indispensable to the hospital and the entire system.

Be that guy 🤣

Exactly!

 

[FlaminHotER]

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

This right here needs to be pinned/sticky on the top of this em forum.

 

[The kitchen sink]

I wish this thread had been around 8 years ago when I was applying in to EM. I agree with just about everything that's been said and it really all comes down to a lack of respect.

Lack of respect from the hospital admin with their refusal to provide adequate resources to get the job done and appreciation for the sacrifices we make.

Lack of respect from the patient with their unrealistic expectations and lack of understanding of what the ED is actually for.

Lack of respect from the rest of the ED staff with how accessible we are.

Lack of respect from other specialties with their inability to acknowledge the expertise we have and delusion that they would last more than 5 minutes in a busy ED.

I can go on and on...

But what all this lack of respect comes down to is the fact that we are 100% replaceable. Now everyone is replaceable to some extent, but it's less obvious with other specialties. So for all the med students lurking on here, when choosing a specialty, yes think about what you want to do, but also think about if that specialty allows you to craft a career to make yourself less replaceable. It's near impossible to do that in EM with how EM is practiced today.

I think a ‘lack of respect’ is ultimate driver of burnout among many professions

It takes some courage to admit you feel this way

There are so many factors contributing to lack of respect in our profession but right now it has been fully exacerbated within EM

As an IM subspecialist I try to work with my EM colleagues but I admit it is hard to tunnel vision out of my expectations because it never feels like enough work up has been done and they want answers…. Divide and conquer has decimated our profession

 

[bronx43]

We’re just easier to replace. And it will get easier and easier to replace us as the true effects of doubling residencies over the last 6 years takes effect. 3100 interns for 2023, won’t feel that until 2026.

Interesting story:

A few weeks ago, i called the big mothership regarding a transplant patient that needed to be transferred.

Transplant surgeon was very nice on the phone, accepted the patient and then said to the transfer nurse, ‘this patient needs to be here today. She better not be coming in tomorrow’ - the transfer nurse truly was intimidated by him - she kept saying ‘yes sir. Yes sir. Yes sir. Absolutely. She will be here immediately’.

Normally it can take 24-48 hours for stable patients to get a bed at the mothership. Patient was stone cold stable.

After the surgeon hangs up, i asked the transfer nurse, ‘so do you really think we will get a bed today’.

She said, ‘100% - immediately. Otherwise all hell will break loose.’

Now that was someone indispensable to the hospital and the entire system.

Be that guy 🤣

You don't even have to be THAT guy. I think most people would gladly be the outpatient private practice doc who has 100% autonomy.
The staff that you and your partners employ will essentially act like the transfer nurse in this scenario.
It's not about the size of your castle... just that you're the king of it.

 

[RustedFox]

I had the same thought.
We've had some "failures to launch" at a few sites. I expect more.

I think a lot of these new grads are going to be so unprepared that they won't be able to work in most ERs and will opt for urgent care or slow low volume sites. At one of my sites (pretty standard 2 PPH community site), I noticed two new physicians quit after 1 shift. One actually quit after the orientation shift. And they weren't even new grads; they were both more experienced than me.

 

[Emapp20177]

Hiring is going to be really difficult going forward. EM is new to IMGs and people desperate for a match at any residency spot.

 

[EMhawkeye]

Will also mean less job security for people already working.

 

[Brigade4Radiant]

I think a lot of these new grads are going to be so unprepared that they won't be able to work in most ERs and will opt for urgent care or slow low volume sites. At one of my sites (pretty standard 2 PPH community site), I noticed two new physicians quit after 1 shift. One actually quit after the orientation shift. And they weren't even new grads; they were both more experienced than me.

Because after Covid it just isn’t worth it. 2 pph is still tough it’s the nature of EM how many psychiatrists quit on their first day?

 

[HemorrhagicShock]

I genuinely think some of these posts need to be stickied at the top of the EM subforum.

** This thread should be REQUIRED READING for any medical student who is considering EM. **

You know who I really feel bad for? That specific breed of medical student who got their start scribing in EM, or maybe was an EMT/paramedic for years, and used that as the motivation to go to medical school. They all "go back to EM" after superficially checking out other specialties, and it unfortunately takes them another 7 or so years (including residency) to realize that their entire motivation was based on false pretenses.

The other group of ER docs I feel bad for are the ones that had the scores, IQ, and EQ to choose any specialty (I am totally fellating myself here but I count myself in this group) yet still chose EM. I have nobody to blame but myself, but I completely bought the idea that EM was cool, sexy, and a lifestyle specialty. And it was for maybe a minute or two, but by that time you're halfway through PGY2 with eyes on the attending prize.

I could have been a dermatologist... celebrating Christmas in St. Lucia with my extended family (on a family trip that I bought and paid for with my practice's bonus payout this year), but instead, I'm sitting here wondering how angry I'll get over ED staff wanting to socialize during the Christmas Eve and Christmas swing shift when I'm tasked with seeing 2.5-3.0 PPH.

All while my family waits for me to get home, likely late, to open Christmas presents while I'm too post-shift burned to truly enjoy it

EM is objectively the worst specialty in medicine.

 

[The kitchen sink]

I genuinely think some of these posts need to be stickied at the top of the EM subforum.

** This thread should be REQUIRED READING for any medical student who is considering EM. **

You know who I really feel bad for? That specific breed of medical student who got their start scribing in EM, or maybe was an EMT/paramedic for years, and used that as the motivation to go to medical school. They all "go back to EM" after superficially checking out other specialties, and it unfortunately takes them another 7 or so years (including residency) to realize that their entire motivation was based on false pretenses.

The other group of ER docs I feel bad for are the ones that had the scores, IQ, and EQ to choose any specialty (I am totally fellating myself here but I count myself in this group) yet still chose EM. I have nobody to blame but myself, but I completely bought the idea that EM was cool, sexy, and a lifestyle specialty. And it was for maybe a minute or two, but by that time you're halfway through PGY2 with eyes on the attending prize.

I could have been a dermatologist... celebrating Christmas in St. Lucia with my extended family (on a family trip that I bought and paid for with my practice's bonus payout this year), but instead, I'm sitting here wondering how angry I'll get over ED staff wanting to socialize during the Christmas Eve and Christmas swing shift when I'm tasked with seeing 2.5-3.0 PPH.

All while my family waits for me to get home, likely late, to open Christmas presents while I'm too post-shift burned to truly enjoy it

EM is objectively the worst specialty in medicine.

I feel for you my friend

EM friends, what are your ‘outs’ career wise?

 

[FlaminHotER]

celebrating Christmas in St. Lucia with my extended family (on a family trip that I bought and paid for with my practice's bonus payout this year), but instead, I'm sitting here wondering how angry I'll get over ED staff wanting to socialize during the Christmas Eve and Christmas swing shift when I'm tasked with seeing 2.5-3.0 PPH.

God this hits home so much

 

[emergentmd]

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.

20+ years EM here. 51 yrs old. Young me loved the busy ER, 45 yr old me got a taste of FSER and fast forward 6 yrs and I will never go back to the hospital again even at 1k/hr. You heard it right, I would not go back for 1k/hr.

If you can get into FSER in a physician owned group, this is your ticket. Docs are clamoring to get in, but the ship has essentially sailed unless you got in early or know someone to sell to you. Now, ever new site is bought up by current owners who want more shifts. Buy in is relatively cheap, you have true ownership, you see less than 1pph with most just UC stuff, and make 2-3x more than for a CMG if you get a successful site. Every doc who jumped from the hospital know how lucky they are.

I work 6 shifts/mo by ownership, but many months end up working 4 as there are hungry owners who pick up my shifts. This month, I am working 3 b/c its the holidays.

FSERs are glorified UC with about 10-15% ER stuff which is a great mix. There are the occasional shoulder reduction, cardiac CP, chest tube which is actually fun instead of seeing sick patients daily which is a drag.

I would say FSER is what EM should be not the chaotic multiple crash understaffed facilities with admin/CMGs breathing down your neck with metrics.

Yeah, I am a lucky one who got in very early.

I would not recommend EM unless a new grad is happy to work 6-8 shifts a month and make 200K. Set that floor low to avoid burn out and be flexible to do locums which is hot right now. If you can work more, go ahead but do not go in thinking 14 shifts for 350K is easy. IT IS NOT.

But in reality, I would not recommend medicine in general. I know many specialists who constantly complain how crappy their job is. Anesthes, GS, OB, etc. They all complain of decreased reimbursement, crappy admin, surgery schedule, etc. They ALL complain just as much as EM.

I have no idea why SDN have so many unhappy EM docs compared to other specialists because from my hospital/personal experience, most docs are unhappy.

This is the golden advice, avoid anything that requires you to be connected to the hospital.

 

[Old_Mil]

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 ?

With regards to the EM psych component...

Do you like cats?

How about rabid cats?

 

[The Knife & Gun Club]

Interesting...many psychiatrists charge $400-$600/hr in the Bay Area where I live (as I've priced out several child psychiatrists) so to make $500/hr they must not have that much overhead. In fact..there is little overhead with a psych practice.

My stepdad is pediatric psychology. If you build up a good referal base in a well-to-do area you can make bank.

He charges $2000/hr for face time with the patient and then does an hour or two more of work after that writing reports, talking to parents, schools, etc.

Overhead is next to nothing - a nondescript office building with some fun painted walls and some toys as well as office supplies. A few low wage employees that do motivational coaching that he trained in house and bills for in cash.

He hired some junior psychologists to take the simpler cases, charges $500/hr for them, and pays them $300/hr plus generous benefits and they’re very happy.

Then a couple speech pathologists, language counselors, and occupational therapists as well that he and the other psychologists can refer to. All of this stays in house, and is paid in cash. Virtually no malpractice risk. The whole operation is benefits and payroll for ~15 employees whose incomes range from 60-150K take home but they all bill for their own services in cash which more than supports their salaries.

 

[GonnaBeADoc2222]

If you can find gig with no nights and near no expectations like I did it can be somewhat sustainable.

The work and admin culture still suck though

 

[GonnaBeADoc2222]

I genuinely think some of these posts need to be stickied at the top of the EM subforum.

** This thread should be REQUIRED READING for any medical student who is considering EM. **

You know who I really feel bad for? That specific breed of medical student who got their start scribing in EM, or maybe was an EMT/paramedic for years, and used that as the motivation to go to medical school. They all "go back to EM" after superficially checking out other specialties, and it unfortunately takes them another 7 or so years (including residency) to realize that their entire motivation was based on false pretenses.

The other group of ER docs I feel bad for are the ones that had the scores, IQ, and EQ to choose any specialty (I am totally fellating myself here but I count myself in this group) yet still chose EM. I have nobody to blame but myself, but I completely bought the idea that EM was cool, sexy, and a lifestyle specialty. And it was for maybe a minute or two, but by that time you're halfway through PGY2 with eyes on the attending prize.

I could have been a dermatologist... celebrating Christmas in St. Lucia with my extended family (on a family trip that I bought and paid for with my practice's bonus payout this year), but instead, I'm sitting here wondering how angry I'll get over ED staff wanting to socialize during the Christmas Eve and Christmas swing shift when I'm tasked with seeing 2.5-3.0 PPH.

All while my family waits for me to get home, likely late, to open Christmas presents while I'm too post-shift burned to truly enjoy it

EM is objectively the worst specialty in medicine.

This hits home.

I had the scores to do anything. Chose this trash heap.

Let myself be hoodwinked by the zeitgeist of the time - the "sexiness" of EM as you said. That plus a couple of charismatic George Clooney esque advisors led me astray.

When you're an idealistic 24 year old, you discount the impact of missing 50% weekends and holidays. You don't think night shifts are a big deal.

I still like that EM affords me the flexibility to take time off whenever, and schedule things like doctors and dentist appointments with relative ease. I like going to the gym when no one's there before an evening shift and not having to deal with the 5pm crowds.

The real play is not choosing medicine at all though. Every speciality is under the crunch unless you can do cash practice. My friend makes the same as me in engineering with just a bachelor's degree.

 

[FlaminHotER]

daughter from California syndrome dropping off 98 year old grandpa Joe at 2am demanding an MRI for chronic lightheadedness,

This what you have to look forward to, every shift for the next 10-20 years if you decide EM

 

[RustedFox]

I genuinely think some of these posts need to be stickied at the top of the EM subforum.

** This thread should be REQUIRED READING for any medical student who is considering EM. **

You know who I really feel bad for? That specific breed of medical student who got their start scribing in EM, or maybe was an EMT/paramedic for years, and used that as the motivation to go to medical school. They all "go back to EM" after superficially checking out other specialties, and it unfortunately takes them another 7 or so years (including residency) to realize that their entire motivation was based on false pretenses.

The other group of ER docs I feel bad for are the ones that had the scores, IQ, and EQ to choose any specialty (I am totally fellating myself here but I count myself in this group) yet still chose EM. I have nobody to blame but myself, but I completely bought the idea that EM was cool, sexy, and a lifestyle specialty. And it was for maybe a minute or two, but by that time you're halfway through PGY2 with eyes on the attending prize.

I could have been a dermatologist... celebrating Christmas in St. Lucia with my extended family (on a family trip that I bought and paid for with my practice's bonus payout this year), but instead, I'm sitting here wondering how angry I'll get over ED staff wanting to socialize during the Christmas Eve and Christmas swing shift when I'm tasked with seeing 2.5-3.0 PPH.

All while my family waits for me to get home, likely late, to open Christmas presents while I'm too post-shift burned to truly enjoy it

EM is objectively the worst specialty in medicine.

Count me in. My board scores were out of sight good, but I felt the "noble calling" nonsense and had to be knee-deep in the ugly parts of medicine because salvation or something.

But I chose EM and all its psychic damage.

 

[HemorrhagicShock]

Count me in. My board scores were out of sight good, but I felt the "noble calling" nonsense and had to be knee-deep in the ugly parts of medicine because salvation or something.

But I chose EM and all its psychic damage.

Tragic isn't it?

I remember having those same exact thoughts. This is a NOBLE calling, and the pull to EM was so strong. It's so weird because normally I can trust my gut feeling (it's led me in the right direction my entire life) but this time it couldn't have been more wrong.

I think about the various moments in my medical school career where things could have happened differently too. So many seemingly small moments where if I chose a slightly different path I would be in a far different place now. Chose a different mentor, elective, order of my rotations in MS3, etc. It's very interesting to look at retrospectively.

None of these thoughts are conducive to a healthy mental state, but I simply don't have the luxury of attending to them when I have kids, a mortgage, and a very niche non-transferrable skill

I will admit though that looking at my time in EM, I don't regret it, I just wish there was an easier way to transition out while keeping a similar earning power. It's been a wild ride, I always have the best stories at parties, and I've seen a greater range of humanity and pathology than most. It's the best show on earth without a doubt. But you can only marathon this series for so long...

 

[RustedFox]

Tragic isn't it?

I remember having those same exact thoughts. This is a NOBLE calling, and the pull to EM was so strong. It's so weird because normally I can trust my gut feeling (it's led me in the right direction my entire life) but this time it couldn't have been more wrong.

I think about the various moments in my medical school career where things could have happened differently too. So many seemingly small moments where if I chose a slightly different path I would be in a far different place now. Chose a different mentor, elective, order of my rotations in MS3, etc. It's very interesting to look at retrospectively.

None of these thoughts are conducive to a healthy mental state, but I simply don't have the luxury of attending to them when I have kids, a mortgage, and a very niche non-transferrable skill

I will admit though that looking at my time in EM, I don't regret it, I just wish there was an easier way to transition out while keeping a similar earning power. It's been a wild ride, I always have the best stories at parties, and I've seen a greater range of humanity and pathology than most. It's the best show on earth without a doubt. But you can only marathon this series for so long...

Yeah, my case is even worse in terms of "zealotry".
I knew early on: "No kids. I probably won't get married (I did, we neither have nor want kids). This is my life's work! God's work! It shall bring me self-actualization!"

I think I'm more durable than most on here, generally because "I have less to lose". I fell hard and mighty in 2020 and came back to the field.

 

[Old_Mil]

Count me in. My board scores were out of sight good, but I felt the "noble calling" nonsense and had to be knee-deep in the ugly parts of medicine because salvation or something.

But I chose EM and all its psychic damage.

When I go back and think of the board scores I threw away on this specialty, it is depressing. But medicine is what it is. The honorable philosophical axioms of Hippocrates have all but been purged and we are just cowboys riding with the herd on a cattle ranch named taxation.

In other news life outside medicine is great. I took an initial pay hit the first couple of years, but have now replaced my em salary plus 20%. Oh, and my sixty day paid vacation ends January 2nd.

 

[RustedFox]

When I go back and think of the board scores I threw away on this specialty, it is depressing. But medicine is what it is. The honorable philosophical axioms of Hippocrates have all but been purged and we are just cowboys riding with the herd on a cattle ranch named taxation.

In other news life outside medicine is great. I took an initial pay hit the first couple of years, but have now replaced my em salary plus 20%. Oh, and my sixty day paid vacation ends January 2nd.

If memory serves, you're an administrator - correct?

I kid.
I keeeeeed.

 

[GonnaBeADoc2222]

When I go back and think of the board scores I threw away on this specialty, it is depressing. But medicine is what it is. The honorable philosophical axioms of Hippocrates have all but been purged and we are just cowboys riding with the herd on a cattle ranch named taxation.

In other news life outside medicine is great. I took an initial pay hit the first couple of years, but have now replaced my em salary plus 20%. Oh, and my sixty day paid vacation ends January 2nd.

And yet they still require away rotations! Lollll

 

[BoardingDoc]

I am literally hiding in the break room right now so that a neurotic patient won't see me and ask another 50 asinine questions on her way out the door. Honestly, this has been the best part of my shift.