I know that the EM burnout myth revolves around those docs who are EM trained and those that aren't. I know that the convention says that EM trained docs don't suffer the same burnout because its just "what they do." I can accept all of that but there are some real issues with shift work as people age. It's been shown time and time again that shift work shortens your life expectancy. What I'd like to know, especially from veteran EM docs, is what kind of concessions or adjustments do you make as you grow older? This particular issue is my greatest worry right now as I contemplate EM as a career. Will I still be up for working nights when I'm 45, 55, or 65? I assume that as time goes along most cut back on their shifts and pick up more administrative duties, but I'd like to hear from people who know what happens.
Age and EM
- Thread starter Soup
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I don't really believe that it is the shift work that shortens one's life. I believe that most shift work is done by people who are likely less educated, more likely to participate in smoking and drinking, and less likely to hit the gym after work. These are the typical blue collar jobs that people do right out of high school and thus the sample of people studied is flawed. I guarantee that if you don't smoke, don't drink, and work out routinely, that you will live the same length as any non-shift worker.
Soup said:
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Corpsman brings up some good points. I would also add that one needs to consider what shift(s) the individual is working -- 2nd or 3rd, and is it a consistent schedule or all over the place?
I just wrote a really long post answering this question. Apparently it got lost when I posted it, more or less at the exact same time that corpsman posted his. So I'm going to blame him! 
The health risk is real, age-adjusted cardiac risk is x2 the first decade and x3 the second. Everybody has quit or died by the third. This was a factory shift work study as Corpsman has suggested. Note that it was a retrospective cohort adjusted for cardiac risk factors. It was rolling forward one week shifts. This is really bad for your circadian rhythm. You'll learn all about this in residency.
. Best advice: work only one night shift at a time (so you don't reset your clock). Failing that work no less than 3 weeks at a time so you completely switch over. Do not become the prince/queen of darkness and work only nights. It makes your partners very happy, but it messes up your family relationships, your professional growth and you become chronically sleep deprived (getting about 5.5hrs/day.) The other health suggestions that corpsman makes are undoubtedly helpful.
I tell my graduates that each of them has number of patients, specific to them, that they can see in a career. They can front load them at a high acuity/volume place to make money quickly. If so they will be cutting back pretty soon. Or they can choose a low or medium volume place and work at that rate for a long time.
The administration/teaching thing is helpful, but I can tell you it has it's own high stress. Also, it's not open to everybody.
As for your question abut holding up for a career, I've been doing EM since I entered residency 28 yrs ago. I work 9-12 8.5 hrs monthly with 1-2 nights. I do about 100-120 hrs of admin/teaching/research monthly. It works out to 50-60 hours. I worked the same # of hours when I was younger, with more of it clinical. I'm 55, still in good health and can't imagine retiring. I rarely get excited in resuscitations and my pulse never races anymore. I don't raise my voice when the team hasn't got it together. I still learn something new everyday, and it's been a bad day if it was only one thing. That's good news for you, you'll never have a reason to be bored. I could see a career adjustment in a few years to the medical student teaching end.
By comparison, Debby and I went to our 35th high school class reunion 2 years ago. A much higher proportion of our class had retired than of my contemporaries in our specialty.
About life expectancy, when I was a freshman medical student (1972) I used to read the obits in JAMA. It was amazing, it seemed to me that almost all of the docs listed there died in their 50s. They had been on call solo their entire professional life, being the GPs or Surgeons for an entire community. Today, with adjustments to night call/continuous call, group practice etc, Docs live normal lifespans.
If you overwork (whatever that is for you personally), you'll get exhausted, depressed and burn-out. I think if you follow the rules about circadian rhythm and you don't overwork, you'll have a good life and a good career.
Cheers, bkn
now let's just hope this thing posts.
The health risk is real, age-adjusted cardiac risk is x2 the first decade and x3 the second. Everybody has quit or died by the third. This was a factory shift work study as Corpsman has suggested. Note that it was a retrospective cohort adjusted for cardiac risk factors. It was rolling forward one week shifts. This is really bad for your circadian rhythm. You'll learn all about this in residency.
. Best advice: work only one night shift at a time (so you don't reset your clock). Failing that work no less than 3 weeks at a time so you completely switch over. Do not become the prince/queen of darkness and work only nights. It makes your partners very happy, but it messes up your family relationships, your professional growth and you become chronically sleep deprived (getting about 5.5hrs/day.) The other health suggestions that corpsman makes are undoubtedly helpful.I tell my graduates that each of them has number of patients, specific to them, that they can see in a career. They can front load them at a high acuity/volume place to make money quickly. If so they will be cutting back pretty soon. Or they can choose a low or medium volume place and work at that rate for a long time.
The administration/teaching thing is helpful, but I can tell you it has it's own high stress. Also, it's not open to everybody.
As for your question abut holding up for a career, I've been doing EM since I entered residency 28 yrs ago. I work 9-12 8.5 hrs monthly with 1-2 nights. I do about 100-120 hrs of admin/teaching/research monthly. It works out to 50-60 hours. I worked the same # of hours when I was younger, with more of it clinical. I'm 55, still in good health and can't imagine retiring. I rarely get excited in resuscitations and my pulse never races anymore. I don't raise my voice when the team hasn't got it together. I still learn something new everyday, and it's been a bad day if it was only one thing. That's good news for you, you'll never have a reason to be bored. I could see a career adjustment in a few years to the medical student teaching end.
By comparison, Debby and I went to our 35th high school class reunion 2 years ago. A much higher proportion of our class had retired than of my contemporaries in our specialty.
About life expectancy, when I was a freshman medical student (1972) I used to read the obits in JAMA. It was amazing, it seemed to me that almost all of the docs listed there died in their 50s. They had been on call solo their entire professional life, being the GPs or Surgeons for an entire community. Today, with adjustments to night call/continuous call, group practice etc, Docs live normal lifespans.
If you overwork (whatever that is for you personally), you'll get exhausted, depressed and burn-out. I think if you follow the rules about circadian rhythm and you don't overwork, you'll have a good life and a good career.
Cheers, bkn
now let's just hope this thing posts.
BKN said:
Thanks everyone for the great info. This is the exact kind of thing that I am looking for. BKN's experience sounds like what I envision as a best case scenario (he's also the age at which I worry that these issues will become relevant). Does anyone know how typical this might be? Is BKN the rule or the exception? What advice does anyone have for balancing family with a career in EM? Sacrifices have to made in any medical field, but what do EM docs do that's successful for them and their family?
Soup said:
Refer to para 6 of my post. I wasn't just talking about me. There is a lifelong study of ABEM diplomates, so far the rate of retirement is similar to other specialties (although we are still a little younger as a group than other specialties).
