EM for the long run

[snowcanyon]

Thanks @MPMD

EM works for many, but the average career in clinical EM is what, ten years? Med students might want to be advised to pick a career with a 20 or 30 year horizon. The exit strategies aren't great, as MPMD notes. Unless you are comfy with admin, Urgent Care, or entrepreneurship, LeanFire or night shifts into your fifties, EM can be rough.

Remember EM fellowships rarely cut down on EM time significantly. I don't know anyone who does FT ultrasound, dive, or wilderness, although I'd love to hear from people who do. The fellowships (including critical care) are slick marketing, IMHO.

[wonka31]

There is nonclinical medicine outside of admin. You may consider educating yourself about other options.

[Kamban]

MPMD wrote:

For perspective at the moment there is 1 dive chamber in metro Chicago.

Click to expand...

You must be vastly underestimating the numbers for Chicago. Our tiny small metro area probably 1/10 the size of Chicago has 4 hyperbaric chambers and we are 3 hours from the coast. All owned by wound centers attached to hospital systems.

In fact our whole state has half the population of metro Chicago and we have 10 listed chambers in the state.

[wonka31]

I think MPMD is referring to chambers for acute hyperbaric therapy for CO poisoning, dive dive emergencies, etc.

There are far more chambers in the Chicago area for wound care, but only one center does acute care in it.

[MPMD]

For the lurkers it's not really true that the average career in EM is 10 years. That would mean that people were exiting clinical medicine in their early 40s if not even slightly before. That is definitely not the case.

It's fair to say that you don't meet an overwhelming number of passionate EM docs who are 55+. They are out there but yeah it does start to drop off.

I think it all comes down to a couple things:

1) Make sure you are picking this specialty for the right reasons and that you have the personality for it (see prior posts)

2) Get good training and don't engage in a race to the bottom to see how easy your residency can be. I have been amazed by some new grads I have worked with that seem constitutionally incapable of seeing 2 pts/hr. Going to be tough to have a long happy career if you can't do the job.

3) Educate yourself financially, get out of debt, and save early so if you want to cut back you can. The most unhappy docs I've met are the ones who desperately want to cut back and simply cannot for financial reasons.

[MPMD]

wonka31 wrote:

I think MPMD is referring to chambers for acute hyperbaric therapy for CO poisoning, dive dive emergencies, etc.

There are far more chambers in the Chicago area for wound care, but only one center does acute care in it.

Click to expand...

Correct yes thanks for clarification.

[The White Coat Investor]

MPMD wrote:

For the lurkers it’s not really true that the average career in EM is 10 years. That would mean that people were exiting clinical medicine in their early 40s if not even slightly before. That is definitely not the case.

 

Click to expand...

I'm in a group where no one ever leaves. Pay is pretty good, you can buy your way out of nights, and the patients per hour is as low as any ED I know of. We're got docs from 30 to 60+. At 43, I'm about halfway up the seniority chart (not that seniority gets you anything here.) While I'm sure there are plenty of docs who would like to punch out of EM/work after 10 years, that's hardly the average career in my experience.

Of my graduating 2006 residency class of 10, 9 are still practicing EM and the other is practicing functional medicine. One does a large percentage of admin work for the VA, one took a year off completely to be a dive instructor but is now back practicing full time, and I work half time so I can run WCI. Four of us (including me) did academics for a few years but I think we're all now out of it. I think that's a more accurate picture of the EM workforce than "a 10 year average career in EM." That would suggest that half of us are out of EM already and I'd say only one or two of us is really out.

[G]

@snowcanyon... "clinical folk"...? So you want to take care of patients...and not work crumby hours...and not work weekends/holidays...and get paid...and (presumably) do it on arrival to new job.

Again, please read this comment with the tone of friendliness, but I think you are kidding yourself if you think you're going to find that gig ANYWHERE, even outside of medicine. Let alone taking care of human beings who have a propensity for needing health attention at a time that (let's face it) you could always be doing something with your family.

I make money doing wilderness medicine. But yeah, the pay is crap. Guess what, so are the hours, so are the weekends.

I just reread this whole thread. The gig you are describing reminds me of Dr S, who would come into the hospital every weekday for various morning surgical boards, then to the ER to teach the interns/students how to really do an H&P, then to noon conference, and at some point he would disappear, presumably to spend the afternoon with his wife. The "problem" from your viewpoint is that he was paid with respect and fond memories.

He was a volunteer.

[snowcanyon]

@G and  WCI-

I think one of the big issues is that most groups (before my current gig I did locums for a bunch) aren't equipped for docs to buy their way out of nights and weekends, and IME locums gigs tend to want their nights and weekends covered. If my gig allowed this, I'd be pretty happy. But mine doesn't, and most of the ones in areas I've considered don't, either. You guys are lucky to be in situations that are more flexible. And that's awesome. It's proven, for whatever reason, hard for me (and others) to find.

I'm looking to HPM and Occ Med or maybe Preventive in a couple of years. I'm cool with the pay cut. And even cooler with the regular hours. My guess is I'll wish I'd jumped sooner

[LizOB]

My dad is EM so I have had a front-row seat for his career. He did an EM residency in the mid 80's, when it was a pretty new thing. He worked full time EM for at least 20-25 years, though dabbling in a few admin roles and such. He was able to stop working nights at some point. A few years back he cut back to 75% then 50%, now he has resigned from his partner position and works 1 day shift/week in fast-track only and also works in a wound care clinic doing hyperbaric O2. I think he works 3-4 days/week total, can take vacation (with advance notice) whenever he wants. He's in his early 60's and has told me he doesn't need to work, but I get the sense he would be bored if he completely stopped working at this point.

I seriously considered EM (I shadowed him a bunch while a pre-med) but I discovered I really like the OR and continuity of care so OB it was.

[MPMD]

The White Coat Investor wrote:

MPMD wrote:

For the lurkers it’s not really true that the average career in EM is 10 years. That would mean that people were exiting clinical medicine in their early 40s if not even slightly before. That is definitely not the case.

 

Click to expand…

I’m in a group where no one ever leaves. Pay is pretty good, you can buy your way out of nights, and the patients per hour is as low as any ED I know of. We’re got docs from 30 to 60+. At 43, I’m about halfway up the seniority chart (not that seniority gets you anything here.) While I’m sure there are plenty of docs who would like to punch out of EM/work after 10 years, that’s hardly the average career in my experience.

Of my graduating 2006 residency class of 10, 9 are still practicing EM and the other is practicing functional medicine. One does a large percentage of admin work for the VA, one took a year off completely to be a dive instructor but is now back practicing full time, and I work half time so I can run WCI. Four of us (including me) did academics for a few years but I think we’re all now out of it. I think that’s a more accurate picture of the EM workforce than “a 10 year average career in EM.” That would suggest that half of us are out of EM already and I’d say only one or two of us is really out.

Click to expand...

I have thought from other posts that you're in kind of a unicorn group. Good on you though. I think I might actually might challenge you and contend that I might have the best EM job on earth -- extremely strong residents who do basically everything and are a joy to train, top med school that loves engagement by EM faculty, great chair, great PD, great colleagues, extremely fair compensation, very little academic pressure on the Educator track, and I usually do between 0-2 nights/mo. No one ever bothers me about P-G scores and the peer review process is very fair. Location isn't good for the shorts-on-Xmas-day crowd or outdoor enthusiasts but I'm not in either of those camps.

My class was 12 we're 7 years out and as far as I know not only is everyone still full time but everyone seems pretty happy when I run into them.

From the classes around me I think everyone is still practicing except a few people who are consultants but they didn't burn out that was kind of the plan from early on.

[G]

Snowcanyon, have you tried to get out of nights? Our premium for night shifts varies, but it is around $100/hr. Are you telling me that there is nobody in your group who would take your night shifts if you wrote them a check for $1000 each?

[snowcanyon]

For whatever weird reason, as employees we are not allowed to do this. Not only that, but I'd have a hard time getting enough day shifts if they did allow it.

I think the geographic arbitrage crowd is pretty happy with EM, and I think that QOL with EM, even more than other medical fields, varies with location. Something else for students to consider.

[G]

No. I'm saying: "Bob, I will give you a $1000 check if you take my 10p shift and let me have your 8a shift. "

And I agree with others above, dont confuse your burnout with ominous caution for students. My class all 8 of us are still working in EM...me part-time, one part-time plus research, one part-time plus ultra niche.

[Tim]

Just a “dumb observation”. Very unscientific I noticed a survey:
What is the most rewarding part of your job?

EM physicians most often named being very good at what they do as the most rewarding aspect of their job, followed by making good money and making the world a better place. Fewer EMs than other physicians cited "gratitude/relationships with patients." Very small percentages cited pride in their profession and teaching.

Orthopedists most often named relationships with and gratitude from patients as the most rewarding aspect of their job, followed by being very good at what they do and making the world a better place. Very small percentages cited teaching or pride in their profession.

Different people are motivated by different factors.

What is the most challenging part of your job?

Dealing with difficult patients was most often cited as the most challenging part of an EM physician's job, followed by "having so many rules and regulations." Fewer EM physicians cited concern over being sued, and very few named having to work long hours or difficulties getting fairly reimbursed as challenges.

Given the current upheaval in the healthcare system, it is no surprise that having so many rules and regulations, difficulties with getting fair reimbursement, and dealing with electronic health records were cited most often in response to the question of what is the most challenging part of an orthopedist's job.
30% EM were over 55 yr old and 36% were 40 to 55 yrs.
Hours were not a factor.
It would seem the career dissatisfaction might be due to match of personality rewards matching with the job.

Motivation on being good at what you do and getting paid well is 50% for EM. If one’s desire for money or using skills fade, not a whole lot of reasons for enjoying work.
I would think a combination of personality/motivating tests would be a better feedback in choosing a career instead of observing a few attendings and guessing about fit.
There is nothing wrong with any motivator, it’s pretty high for EM relative to others. Even a chart of rewarding and challenging impacts would help.

Interesting that EM is thought of as a ten year career.