Anyone that says EM isn't high in burnout is either blowing smoke up yours for recruiting purposes or kidding themselves. The unrelenting pace, heaped onto the acuity of the sick and dying, heaped onto circadian-crushing shift changes, heaped onto administrators that apply pressure over a door-to-doctor time that jumped 2 minutes in one month after you walked out of a room notifying an unsuspecting mom and dad their 4-year-old angel choked to death on a grape while with the baby sitter and there was a damn thing you do due to change it, takes it's toll. There's very little else like it.
Furthermore, the "lifestyle" isn't a lifestyle choice. The oft-coveted "limited-shift schedule" med students talk about, is absolutely not a cushy choice, is a survival adaptation that evolved to make the torturous circadian rhythm disruptions tolerable. To work any more is intolerable.
You'll get spit on and have your life threatens by people you're trying to help, a lot more than a radiologist. You'll have people laugh in your face about having no inention of paying your bill, a lot more than a pathologist. Constantly being the safety net for every doctors office, closed methadone clinic, after hours std clinic and psych ward, and failing healthcare system can take its toll. Every other specialty has a pressure release valve when the insanity boils over, the insane patient gets too violent, or the walk-ins over flow.
It's you. The ER.
Many surgeons find it tolerable to work 60 hr per week. Lots of family practice docs find it tolerable to work 50 hr per week. I don't know any EP that worked that pace for very long that didn't end up in the nuthouse, cath lab or rehab. ER docs don't put in "normal doctor hours" because...
You just can't. Sure, "Just work 10 days a month," everyone will say. But in today's customer-serviced obsessed environment combined with ER doc shortage during the crumbling of a healthcare system there will be increasing pressure to work more than you want at most locations. The emergencies are often seen as an annoying distraction from the primary duty of cranking as many healthy-sick "customers" through the checkout lines to meet someone else's monetary goals.
EM is a great, terrible, crazy, exciting, boring, bloody, smelly, rewarding, draining, euphoric, soul-crushing rolled up ball of every specialty that's nothing like any other specialty. If you can't make peace with the insanity of it, the insanity will make pieces of you.
You may love it, you may hate it. You may love it and simultaneously hate it. You may love it then learn to hate it. But it'll never be banking, accounting, librarian work, microdermabrasion or a desk job that consists of nothing but a series of meetings. Normal jobs are a whole different animal. There's no comparison. They're not even in the same building as EM. Read the stickies and the "EM burnout," "12 reasons no to go into EM," and "Medicine sucks" threads. Take note that the 9-5er "no call" specialties have no such threads. EM may be great for you. And the things that are great about it also are the exact things that make it the most likely to burn out.
Why don't people leave EM? The same reason soldiers don't walk off the battle field when the bullets start flying by, because:
They can't.
In the military, you can't opt out of the bullets when the bombs start to blow. In EM, you can't opt out of the pace, the nights, the holidays or the senseless tragedies. Why will EM always be the most burn out prone AND deadly popular? The same reason the military still manages to get people to sign up to get shot at, and the circus always fills its seats:
1-The hero factor.
2-Adrenaline rushes are intoxicating.
3- Crazy-weird-bizzare stuff can be wildly entertaining...if you've never seen it before.
Why so negative, Birdtrike? Why don't you talk about the upside, the pros? Why focus on the negative?
Well, because the OP asked. EM has its advantages, the selling points and an upside to offer balance. Everyone knows the Hollywood swashbuckling pirate-hero version of EM, and the daily sales pitch from the residency recruiters. On the other hand, the ashes of burnout are in the back room under the rug, to be dealt with later, to be ignored, suppressed, to be owned by the weak, the wimps and those that "can't stand the fire." You're not supposed to believe they're real. Once you commit to a specialty, especially EM, the cost of changing in time, inconvenience, life upheaval not to mention cost is big. Know what you are getting into, and know how you are going to deal with it.
EM is great for certain people. It may be perfect for some people for a certain period of time, but not necessarily for an entire career. But burnout is the norm. It may come and go, just for a few minutes due to exhaustion at 4am on a long stretch of nights, or after the third death notification of a shift, only to disappear for a while after a few days away from the job. It may only rear its head when a person is in a group they don't like or working more hours than they want. Or it may be pervasive, heavy and difficult to shake permeating someone's whole life.
There's great things about EM. It's a profoundly honorable career choice.
But it sure as hell ain't easy.
