EM for the long run

[EMscout]

Snowcanyon- I think some of your comments are misguided. for instance, admin being non-clinical. Completely disagree. You can work on clinical pathways, QA projects etc. You can impact your own practice, your colleagues practice and the clinical outcome of your patients.. you can also impact and optimize your scheduling if you wish.

I always viewed EM as a canvas to paint on. It provides a guaranteed income, but you can develop your own niche/colors that allows you to practice for well beyond “10 years”.

[EndoRobert]

How do you know no one will take your nights/weekends/holidays till you try? That’s my thought as well. I believe our anesthesia provider’s going rate is $4500 for one partner to take another’s weekend.

To make this relevant to the OP, live will below your means early in your career so you can pay to work less later.

But my impression is even in the best group setups you’re still gonna work a high percentage of weekends, nights, holidays, especially as your total shifts drop. I seem to recall from his twitter that WCI worked back to back weekends or something like two weekends out of three. But that was all he worked for the month!

[MPMD]

snowcanyon wrote:

Yes, I understand what you are saying. While I don’t think my job cares if I pay Bob $1000, they do care that we all work a certain number of nights.

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Are you overestimating this concern?

This is a classic case where I would ask forgiveness rather than permission. If you are employed I really doubt your hospital cares about shift distribution as long as the shifts are covered.

It sounds like you have almost nothing to lose by trying to give away nights for a premium at least. The worst they can do is tell you to stop but they aren't going to fire you over it. Your small internal free market might set a price at which you become a popular guy who will pay money to give away nights that other people don't mind that much!

I hate nights but I would probably take this deal once a month if someone was willing to trade a shift with me + pay me an extra $1k to take their night. That's right around where it would become worth it to me.

[Complete_newbie]

First thread I see after logging in after a while and...

Eh people posting here are a minority IMHO. They have time to log in and post, stands to reason they have comfortable jobs where they are happy.

A LOT of physicians aren't happy with their jobs. Reasons are multiple.

From a neutral non-medical point of view, doctors aren't great at diversifying "outside of medicine" skills. How can they if they toil away in med school for x years and in residency for y years (yes...insert ortho jokes here). So they sort of feel trapped in their jobs.

I got nothing in terms of advice to snowcanyon, but I do think one should expand beyond medicine ASAP. Have side hobbies, gigs, and think broad and wide. Don't just make medicine/your job define your routine. Usually this leads to more opportunities and career altering changes (for the positive).

[snowcanyon]

Yes, I understand what you are saying. While I don't think my job cares if I pay Bob $1000, they do care that we all work a certain number of nights.

Sure. EM is great for many people. I never said it wasn't. I just think people need to hear all sides. And there are a lot of bad jobs and a fair amount of burnout in EM.

[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.

[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.

[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]

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?

[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.

 

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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.

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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.

[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.

[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

[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.

[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.

[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.

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Correct yes thanks for clarification.