Work life balance and when to say no

[abds]

You're going to burn out spectacularly if you continue to work that much in EM.

Serious question because I don’t know EM schedules outside of this post, but is 40-45 hours a week so much in EM that “spectacular” burnout is certain?

Is under 30 more common as in OP’s group?

[CordMcNally]

Serious question because I don’t know EM schedules outside of this post, but is 40-45 hours a week so much in EM that “spectacular” burnout is certain?

Is under 30 more common as in OP’s group?

Yes. Most jobs will have an hourly minimum for the year. Of that, they’ll typically want a monthly minimum or at least close. If you want to take a week long vacation then you need to work your shifts in the remaining days of the month. You work days, evenings, nights, weekends, holidays, etc. There’s a constant disruption in your circadian rhythm. Plus, the work is typically incredibly high stress. You get to deal with all the egos in the hospital. You get to deal with all the dumps and someone getting told to just go to the ER. You get to deal with Press Ganey which is worthless and encourages bad medical care. You get to deal with the family who hasn’t seen or talked to grandma in two years but are bringing her in on a Sunday morning because she’s just “not the same”. You’re judged on customer service and not good medicine. You get to deal with a high amount of underlying psychiatric issues even though they’re presenting with what appear to be medical issues. You get interrupted every 45 seconds to read an EKG, take a phone call, etc. You get to deal with all the Monday morning quarterbacking in QI committees. Hospital issues flow downhill and will significantly impact your department’s flow and there’s nothing you can do about it.

EM is a young person’s game. Working an average of 40 hours a week over the course of 52 weeks, assuming you want to take any vacations, is going to be a career killer if you do it long. 1300-1600 hours per year is probably the sweet spot for a prolonged career.

[Tim]

“EM is a young person’s game. Working an average of 40 hours a week over the course of 52 weeks, assuming you want to take any vacations, is going to be a career killer if you do it long. 1300-1600 hours per year is probably the sweet spot for a prolonged career.”
This is helpful from the perspective of a 40 hour work week, 2080 hours in a year. There are hours consumed due to the scheduling at a minimum.

[Hoopoe]

Exactly. I heard the phrase DOMA in residency. Day Off My ******************. Ie post night shift and switching circadian rhythms. I actually work a mix of 8,9,12 and 24 hour shifts so the 24s at the slower rural place can give 4-7 hours of down time (but good luck trying to reliably sleep for all that time as that is not sequential time off). But I usually sleep at least a few hours on an overnight so my 170-190 hours are by no means the same as a busy big city ER. I would say it “feels” like 140-150 and I work about 13-14 days a month clinically (plus DOMA time of course) in addition to admin. That said I also feel it’s not sustainable and I would be horribly burnt out doing this schedule for 20 years. That said, doing it for 2-3 and having 4-5MM in the bank at 40 sounds very appealing. 15-20MM at 50 and having an MI the next day is less so.

Having kids is a good time to cut back a bit (no kids now but trying). I think the main question of whether to grab the intangible extra moments and time in my late 30s as well. Free weekday off with the spouse, an extra few day trips here and there, likely a bit more rested and more attentive to exercise etc.

[HikingDO]

Yes. Most jobs will have an hourly minimum for the year. Of that, they’ll typically want a monthly minimum or at least close. If you want to take a week long vacation then you need to work your shifts in the remaining days of the month. You work days, evenings, nights, weekends, holidays, etc. There’s a constant disruption in your circadian rhythm. Plus, the work is typically incredibly high stress. You get to deal with all the egos in the hospital. You get to deal with all the dumps and someone getting told to just go to the ER. You get to deal with Press Ganey which is worthless and encourages bad medical care. You get to deal with the family who hasn’t seen or talked to grandma in two years but are bringing her in on a Sunday morning because she’s just “not the same”. You’re judged on customer service and not good medicine. You get to deal with a high amount of underlying psychiatric issues even though they’re presenting with what appear to be medical issues. You get interrupted every 45 seconds to read an EKG, take a phone call, etc. You get to deal with all the Monday morning quarterbacking in QI committees. Hospital issues flow downhill and will significantly impact your department’s flow and there’s nothing you can do about it.

EM is a young person’s game. Working an average of 40 hours a week over the course of 52 weeks, assuming you want to take any vacations, is going to be a career killer if you do it long. 1300-1600 hours per year is probably the sweet spot for a prolonged career.

Wow, I thought family med was bad, you make ER sound like ************************.

[VentAlarm]

Exactly. I heard the phrase DOMA in residency. Day Off My ******************. Ie post night shift and switching circadian rhythms. I actually work a mix of 8,9,12 and 24 hour shifts so the 24s at the slower rural place can give 4-7 hours of down time (but good luck trying to reliably sleep for all that time as that is not sequential time off). But I usually sleep at least a few hours on an overnight so my 170-190 hours are by no means the same as a busy big city ER. I would say it “feels” like 140-150 and I work about 13-14 days a month clinically (plus DOMA time of course) in addition to admin. That said I also feel it’s not sustainable and I would be horribly burnt out doing this schedule for 20 years. That said, doing it for 2-3 and having 4-5MM in the bank at 40 sounds very appealing. 15-20MM at 50 and having an MI the next day is less so.

Having kids is a good time to cut back a bit (no kids now but trying). I think the main question of whether to grab the intangible extra moments and time in my late 30s as well. Free weekday off with the spouse, an extra few day trips here and there, likely a bit more rested and more attentive to exercise etc.

You already gave up your 20s getting here….

[CordMcNally]

Wow, I thought family med was bad, you make ER sound like ************************.

There’s certainly trade-offs but it’s far from the lifestyle specialty some people think it is. I’m lucky that I’m compensated very well. If something were to drastically happen to my compensation then I’d probably cut back significantly and just become a clock-in, clock-out person instead of being heavily involved in the business aspect of it.

[huruta]

Husband is an ER doc so while he lives it, I live with it. He's always worked the minimum to be full-time in his group (twelve 8-hour shifts per/mo or 96 hours). It's not 4 shifts a month but not the huge number of hours you are doing now. Is there a middle way?

[abds]

Yes. Most jobs will have an hourly minimum for the year. Of that, they’ll typically want a monthly minimum or at least close. If you want to take a week long vacation then you need to work your shifts in the remaining days of the month. You work days, evenings, nights, weekends, holidays, etc. There’s a constant disruption in your circadian rhythm. Plus, the work is typically incredibly high stress. You get to deal with all the egos in the hospital. You get to deal with all the dumps and someone getting told to just go to the ER. You get to deal with Press Ganey which is worthless and encourages bad medical care. You get to deal with the family who hasn’t seen or talked to grandma in two years but are bringing her in on a Sunday morning because she’s just “not the same”. You’re judged on customer service and not good medicine. You get to deal with a high amount of underlying psychiatric issues even though they’re presenting with what appear to be medical issues. You get interrupted every 45 seconds to read an EKG, take a phone call, etc. You get to deal with all the Monday morning quarterbacking in QI committees. Hospital issues flow downhill and will significantly impact your department’s flow and there’s nothing you can do about it.

EM is a young person’s game. Working an average of 40 hours a week over the course of 52 weeks, assuming you want to take any vacations, is going to be a career killer if you do it long. 1300-1600 hours per year is probably the sweet spot for a prolonged career.

I hear your points but many of us have very stressful work, such as most surgeons. Other specialties also deal with patient satisfaction in the form of online ratings, which directly affect referrals, volume, and income. We also have to manage referring doctors, and basically suck up to them, to get continued referrals. Most of us have paperwork and committees that interfere with our patient care and non-patient care hours. We also have call, etc, and aren’t really ever actually off. Even when not on call I get calls from referring providers and even ERs almost every day including on days off and even vacation. I’m not trying to start a pissing match, I just think it’s disingenuous to imply that your work is intrinsically harder than the average physician.

That said, I overlooked the overnight shifts. That would be hard the older one gets and I can see how that translates to more hours per week than actually worked. I could switch back and forth with ease in residency but I’m not 40 yet and I certainly don’t want to do it anymore.

[CordMcNally]

I hear your points but many of us have very stressful work, such as most surgeons. Other specialties also deal with patient satisfaction in the form of online ratings, which directly affect referrals, volume, and income. We also have to manage referring doctors, and basically suck up to them, to get continued referrals. Most of us have paperwork and committees that interfere with our patient care and non-patient care hours. We also have call, etc, and aren’t really ever actually off. Even when not on call I get calls from referring providers and even ERs almost every day including on days off and even vacation. I’m not trying to start a pissing match, I just think it’s disingenuous to imply that your work is intrinsically harder than the average physician.

That said, I overlooked the overnight shifts. That would be hard the older one gets and I can see how that translates to more hours per week than actually worked. I could switch back and forth with ease in residency but I’m not 40 yet and I certainly don’t want to do it anymore.

I don't think working in the ED is necessarily more intrinsically difficulty than other specialties and I readily admit that many of the problems in EM affect other aspects of medicine but there's a reason that EM averages towards the low end of hours per week and is also almost always towards the top of burnout. There is a lot that goes on in an ED that many areas of medicine don't realize and vice versa.