I absolutely do. But I think my interpretation of doing the best that I can for patients might be a bit different than yours. By your definition, there's no bounds on how much work should be put in. By the elitist standard, which I understand is not precisely what you put forth--one would never do anything during residency except work.
Correct, the main point of residency IS to do almost nothing but work and study. This is my problem: People seem to come to emergency medicine not expecting this. I appreciate that with most other residencies they do not tolerate this kind of weak sauce and it doesn't seem to be expected by the applicants/residents. People seem to have the misunderstanding that emergency medicine is a kind of medicine on easy-mode or half-ass kinda thing.
I think you over-estimate yourself. You think you can get equal results with less work than everyone else in training and in practice. You aren't talking about tending to your mental-health and balancing your life-work, you are talking about training and working less than HALF of most physicians. I am telling you, you will not be good if you do this. You don't have some special gift or knack for this, you need the reps like everyone else.
You use the term "Elitist Standard" in a pejorative way, but you are correct, I am elitist. We physicians are the elite. That's why we as physicians are at the top of the health care clinical hierarchy. This isn't a position that we have a divine right to. We EARN this position by taking the smartest students and giving them the most rigorous training. They are then the individuals who have the best knowledge and skills, which other people do not have. That is why people look to us for leadership and guidance.
The idea of wanting to be a clinical leader but not wanting to put in the work to actually deserve that responsibility is a mid-level provider mindset.
In other words, bodybuilder Ronnie Coleman put it best when he said "Er'yone wanna be a bodybuilder, but nobody wanna lift no heavy goddam weights."
This would translate to an enormous number of presentations seen by the time beginning day 1 solo.
Correct. This is how you get good. And you need to be good on day 1 solo. Practice has no training wheels, you are expected to come out that gate fully-formed and ready to provide excellent standard of care to your patients.
I suspected this to be the root of what most are saying here. But isn't this the case in any specialty? It's certainly the case anywhere that your contract is predominantly efficiency/RVU-based. No doubt the stakes are high in EM but it would surprise me if the expectation to perform highly out of the gate is not uncommon across other specialties.
You are correct, being slow and inefficient will probably limit how much revenue you can generate for yourself and your practice, which may be a risk to your job security in any specialty. I think you are starting to see why they are very few part-time early career physicians across specialties. That being said, what is unique to emergency medicine is being slow and inefficient are actually patient safety and personal liability issues in this specialty. You ARE responsible for the patient in the waiting room who dies waiting to be seen because you couldn't get to them fast enough.
This. I really like the breadth of FM but was advised to look into EM because of the high hourly rate with similar patient diversity to FM. It's challenging right now for me to believe I could remain interested in a narrow subspecialty of medicine for a long career. I dislike way too few things and getting good at one area then moving on to a related lateral niche is exactly my personality.
With the backdrop of having the freedom to work < 1,000 hrs one year then > 2,500 in another while making out alright salary/hourly--what should I look into in order to sidestep the Birdstrike Multiplier?
All in all, I know it seems like I'm beating on you a little bit, and I apologize for that. Ultimately I think you are actually doing something very wise, which is asking the right questions and being introspective about what you want out of your career and how to get that. I genuinely do applaud that. I think you are coming to the realization EM may not be right for you, and that's great. There are a lot of other specialties out there.
