EM schedule/lifestyle

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EctopicFetus said:
I do believe that once obamacare is fully implemented this would be illegal since I believe one of the provisions is that medicaid has to pay at least medicare rates. Therefore if for ICD-10 code x medicare would pay $50 i DONT see how medicare in Wash state could keep doing this.
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By cronyism and "states rights" or some other thing. Or, conversely, this will be a model for ACA v2.0 and everyone will deal with it. You better believe I'll be moving somewhere if this becomes a national law.
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Dr.McNinja said:
Vote with your feet. Neurosurgeons in West Virginia did.
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Please explain further.

I - of course could - google+ it, but my computer is dead and I'm reading/typing on am iPhone...which isn't as friendly towards research

HH
 
Dr.McNinja said:
By cronyism and "states rights" or some other thing. Or, conversely, this will be a model for ACA v2.0 and everyone will deal with it. You better believe I'll be moving somewhere if this becomes a national law.
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It is my understanding that under the ACA medicaid reimbursement will have to be at least at the level of medicare.

http://www.kaiserhealthnews.org/Sto...-cut-medicaid-payments-doctors-hospitals.aspx

To entice more physicians to accept Medicaid patients, the law raises rates for primary care doctors in 2013 and 2014 to match those paid by Medicare, the federal health program for the elderly. States, on average, currently pay Medicaid providers about 72 percent of what Medicare pays.
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What they dont get is no one wants medicare reimbursement rates either.
 
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I think burnout is directly proportional to how much/how many shifts you are working a month. That's when I experience it most in myself. After a few days off, I'm usually ready to jump right back in.

I think the specialty is perfect for a select group of individuals (myself included), but the only thing I probably hate and didn't realize would become such an issue is shift work and alternating circadian disruption. I think I must have shift work disorder because I truly feel worse than my college hungover days when I switch from nights to days or vice versa. I feel nauseated, pounding headache and can't stand the jarring physiologic effects. I get really mean during those in between days.

Personally, I love working nights and prefer them greatly over days. After residency, I'd love to be the "graveyard" guy who grabbed up all the night shifts. I truly wouldn't mind it and wouldn't have to swap so frequently during the month.

24h turnarounds just suck for people like me. I hate it when I see one of those on my schedule. Other people seem to take the flip flopping much better than my body does.
 
BJJVP said:
Nightshift,

I was very similar to you as a med student. I wanted to do surgery but realized I didn't have enough passion for it to work 60hrs a week and take call for the rest of my career. My GF at the time convinced me EM was for me because of lifestyle. Nights and weekends don't bother me. Also, I liked the thought of being jack of all trades, doing resuscitations and using medical treatments in addition to doing procedures. At the time, it sounded like ER doctors were the only "real doctors." Plus (I'm ashamed to admit this), telling people you're an ER doctor just sounded cool.

It's been 7 years since graduating and there are things I wish I knew:

1) Being jack of all trades is overrated. It sucks to be a smart guy with the answers your whole life only to be relegated to the role of the non-specialist people go to just because they have to. I know people will say that you are the specialist in resuscitations but really, many of these pts had no real chance for long term/meaningful survival and the fact that they made it to the ICU only to die later doesn't make me feel that good. To top it off, you often get second guessed by the ICU folks who consider themselves the real specialists in treating crashing pts.

2) I didn't realize how much I would miss out on by not doing something that provides definitive care more often. I would love to go to work everyday and walk out of the OR to tell a pts family that everything went well and that the pt will get better. Nowadays, I still love going in to sedate a pt, do a procedure and then telling the family or pt that everything went well. However, while doing that I have to worry about moving the meat and who else is crashing in the ED.

Also, nobody remembers the name of the ER doctor that reduced their shoulder, shocked them out of VF, intubated them when they had bad pneumonia, etc. On the other hand, pts always remember the name of the ortho that scoped their knee, cardiologist that rx'd amiodarone, pulmonologist that bronched them and extubated them. I get pts coming in to the ER all the time asking if Dr So and So, who did their hernia surgery 20 years ago, is still practicing.

3) All the other BS regarding press ganey, crazy pts, drug seekers, being dumped on by others, medicolegal risk, etc. You can see these topics on a weekly basis on this forum and so I will not go further.

I disagree with the statement that burnout was a thing of the past. I see it in myself and many others.

I know that #1 and #2 make me sound kind of narcissistic but I think you need to consider them. I used to tell myself that I don't need respect from other doctors or patients. I used to think getting lots of time off to do cool things, stay in shape and spend time with family was all I cared about. They are great, but I do feel like I missed out on certain things professionally by not going into surgery or some other more focused/narrow field.

If I could do it again, I probably would still do EM. In all honesty, I don't like any part of medicine enough to sacrifice my other interests just to work over 50hrs a week. And, for the hrs I work, I make really good money. BUT, having the proper expectations is extremely important and I just hope that people pursuing EM don't have the same unrealistic expectations that I did 7 yrs ago.
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ouch
 
BJJVP said:
Nightshift,

I was very similar to you as a med student. I wanted to do surgery but realized I didn't have enough passion for it to work 60hrs a week and take call for the rest of my career. My GF at the time convinced me EM was for me because of lifestyle. Nights and weekends don't bother me. Also, I liked the thought of being jack of all trades, doing resuscitations and using medical treatments in addition to doing procedures. At the time, it sounded like ER doctors were the only "real doctors." Plus (I'm ashamed to admit this), telling people you're an ER doctor just sounded cool.

It's been 7 years since graduating and there are things I wish I knew:

1) Being jack of all trades is overrated. It sucks to be a smart guy with the answers your whole life only to be relegated to the role of the non-specialist people go to just because they have to. I know people will say that you are the specialist in resuscitations but really, many of these pts had no real chance for long term/meaningful survival and the fact that they made it to the ICU only to die later doesn't make me feel that good. To top it off, you often get second guessed by the ICU folks who consider themselves the real specialists in treating crashing pts.

2) I didn't realize how much I would miss out on by not doing something that provides definitive care more often. I would love to go to work everyday and walk out of the OR to tell a pts family that everything went well and that the pt will get better. Nowadays, I still love going in to sedate a pt, do a procedure and then telling the family or pt that everything went well. However, while doing that I have to worry about moving the meat and who else is crashing in the ED.

Also, nobody remembers the name of the ER doctor that reduced their shoulder, shocked them out of VF, intubated them when they had bad pneumonia, etc. On the other hand, pts always remember the name of the ortho that scoped their knee, cardiologist that rx'd amiodarone, pulmonologist that bronched them and extubated them. I get pts coming in to the ER all the time asking if Dr So and So, who did their hernia surgery 20 years ago, is still practicing.

3) All the other BS regarding press ganey, crazy pts, drug seekers, being dumped on by others, medicolegal risk, etc. You can see these topics on a weekly basis on this forum and so I will not go further.

I disagree with the statement that burnout was a thing of the past. I see it in myself and many others.

I know that #1 and #2 make me sound kind of narcissistic but I think you need to consider them. I used to tell myself that I don't need respect from other doctors or patients. I used to think getting lots of time off to do cool things, stay in shape and spend time with family was all I cared about. They are great, but I do feel like I missed out on certain things professionally by not going into surgery or some other more focused/narrow field.

If I could do it again, I probably would still do EM. In all honesty, I don't like any part of medicine enough to sacrifice my other interests just to work over 50hrs a week. And, for the hrs I work, I make really good money. BUT, having the proper expectations is extremely important and I just hope that people pursuing EM don't have the same unrealistic expectations that I did 7 yrs ago.
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I've gotta say this is a really poignant post. Anyone considering EM needs to read this and Jarabacoa's reasons not to go into EM thread. For me personally I don't mind being the jack of all trades and have made my peace with my "non-specialist" role. I also don't care about not being the definitive person for things. I do greatly dislike the diminished stature on the EP in the hospital because we don't wield a big panel of paying patients or 3 mornings a week of booked, pre-approved OR time.

I am in the same boat about the "I'd still do EM but not medicine" sentiment. I also agree that burnout is a big issue. I do want to point out though that burnout now is different than it was for EM 20 years ago. Back then there was the perception and possibly the reality that docs doing EM burnt out at a much greater rate than their non-EM colleagues. Now I think that Eps burn out at the same rate as other docs but the whole field is more prone to it. My point is that if you are in medicine and considering EM I would suggest not letting the specter of burnout dissuade you. I think that burnout is now a medicine wide phenomena rather than an EM specific problem.
 
As some other attendings have stated to have the proper expectations, but what does one do when they've read ALL the expectations, fully aware of what the field entails, but after say 5 years of graduating they don't like the reality of the field when they thought before it wasn't a big deal?

For example, at this point (as an M4 narrowing down my ROL), I'm completely fine being the jack of all trades and not being the go to guy and not being remembered 20 years down the road by my patients, but what if in 10 years my views on that change? That's the only thing I'm afraid about.
 
docB said:
I've gotta say this is a really poignant post. Anyone considering EM needs to read this and Jarabacoa's reasons not to go into EM thread. For me personally I don't mind being the jack of all trades and have made my peace with my "non-specialist" role. I also don't care about not being the definitive person for things. I do greatly dislike the diminished stature on the EP in the hospital because we don't wield a big panel of paying patients or 3 mornings a week of booked, pre-approved OR time.

I am in the same boat about the "I'd still do EM but not medicine" sentiment. I also agree that burnout is a big issue. I do want to point out though that burnout now is different than it was for EM 20 years ago. Back then there was the perception and possibly the reality that docs doing EM burnt out at a much greater rate than their non-EM colleagues. Now I think that Eps burn out at the same rate as other docs but the whole field is more prone to it. My point is that if you are in medicine and considering EM I would suggest not letting the specter of burnout dissuade you. I think that burnout is now a medicine wide phenomena rather than an EM specific problem.
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Wow. Why would anyone want to pursue EM as anything but a last resort after reading that list.
 
Birdstrike said:
My point was this. I do think that the federal government knows that many foreign born, and foreign trained medical graduates (not all, but mainly from very large population, poor countries where doctors earn much less) will come to the US and work for significantly less than most American born doctors, US- or foreign trained. They've been doing this for decade to help fill the shortage of Primary Care physicians. We are not immune to outsourcing.
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Otherwise, this is completely true.

When I was a med student, there were many FMGs at the hospital where I was doing my IM. I asked one from India if there was any brain-drain with so many graduates coming here, and she said not at all - 100K graduate every year in India - with 4x the population, they graduate 6x as many as here in the US.
 
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LoveandHate said:
Wow. Why would anyone want to pursue EM as anything but a last resort after reading that list.
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Because despite of all that many of us remain convinced that if you are stuck on the sinking ship of American medicine it'll be best to be practicing EM on the way down.
 
Birdstrike,

I agree wholeheartedly. Unfortunately, I feel as if we are getting screwed so hard it isnt even funny. The current practice environment is getting much much worse and states are really coming after us.

We are bound by EMTALA and here in the phoenix area there is rarely a wait due to the stand alone ERs that have opened up. Sadly, I dont know how many people will stand up. almost all are obliged to their families first. If my only option is to make 50k less my choice is to leave and hope the new job is better. While moving as a single person might be easy, it isnt when you are married, have 2 kids and a slew of friends.

I hope that balance billing, this washington BS and other ridiculous laws dont come to me. I donate to NEMPAC, I am active in my state ACEP and thats what I can do. Worsening of the current enviroment may mean a more hard line approach but right now it is wait and see.
 
Just one thing I want to add for the med students reading this thread that applied for EM and are thinking "what the F did I just get myself into...?". Keep in mind that all of us become jaded after working in a career for awhile. I was that way in my last career and now that I'm out, miss parts of it though I certainly wouldn't pursue it again. I think medicine, and any specialty for that matter is no different. Those of us finishing our training have bright eyes and although many of us are more aware of the disadvantages of the specialty that perhaps we weren't aware of as med students, are still excited about our choice and have a positive outlook for the next few years. I have no doubt that in about 10 or so, I'll be more jaded and disillusioned, which is only natural and a fact of life.

Just keep in mind that I hear these types of stories from just about every specialty. Take surgery for instance. Sure, it might be nice to have the instant gratification of taking out someone's GB with acute cholecystitis and them having a wonderful post op outcome who always remembers you and sends you a Christmas ham. I'm not so far out from my surgery and trauma rotations that I don't remember all the nasty, sick, post op patients that were diabetic with poor wound healing and seemed to stay in the hospital forever. Nor do I envy the surgeon when I see patients with chronic pain in the ED who blame all the surgeons who have operated on them for their chronic pain syndrome and have been "X" times to his office complaining and he never gives me any answers and I'm here in the ED for help with my pain and can you set me up with a surgeon for a second opinion, etc.. Can you imagine operating on some of these histrionic, multiple comorbidity patients with unrealistic expectations who show up in your clinic and you are forced to see over and over again? Believe me, there's no way in hell I'd go through that. THAT is the advantage of no continuity of care. Any surgeon will admit that these patients are many and are headaches. My dad was an ENT and the bane of his existence was vague ENT related, "headachy" women who frustrated their PCP's to no end and got referred over to him and he could find nothing wrong with them but was forced to see them over and over again. He enjoyed his specialty, but was jaded just as we all are (or will become) with enough time practicing medicine.

There's no panacea in medicine. You have to focus on the positive and try not to get distracted by the negative in order to drag yourself out of bed and come into work with a positive attitude. After one career already, I consider this a ubiquitous phenomenon that just about any career driven person has to deal with on a daily/yearly basis.

EM has pro's and con's just like any other specialty. There's no way you're going to avoid the con's, in whatever you pick. Just make sure there are enough pro's that you can focus on to keep yourself with a positive attitude for the majority of your life. If you can't, then pick something that allows you the flexibility of plenty of free time outside of medicine to draw your happiness from. In that case, EM also is a great choice. Surgery sure doesn't provide that flexibility.
 
Thank you. I needed to hear that before my shift today.


Groove said:
Just one thing I want to add for the med students reading this thread that applied for EM and are thinking "what the F did I just get myself into...?". Keep in mind that all of us become jaded after working in a career for awhile. I was that way in my last career and now that I'm out, miss parts of it though I certainly wouldn't pursue it again. I think medicine, and any specialty for that matter is no different. Those of us finishing our training have bright eyes and although many of us are more aware of the disadvantages of the specialty that perhaps we weren't aware of as med students, are still excited about our choice and have a positive outlook for the next few years. I have no doubt that in about 10 or so, I'll be more jaded and disillusioned, which is only natural and a fact of life.

Just keep in mind that I hear these types of stories from just about every specialty. Take surgery for instance. Sure, it might be nice to have the instant gratification of taking out someone's GB with acute cholecystitis and them having a wonderful post op outcome who always remembers you and sends you a Christmas ham. I'm not so far out from my surgery and trauma rotations that I don't remember all the nasty, sick, post op patients that were diabetic with poor wound healing and seemed to stay in the hospital forever. Nor do I envy the surgeon when I see patients with chronic pain in the ED who blame all the surgeons who have operated on them for their chronic pain syndrome and have been "X" times to his office complaining and he never gives me any answers and I'm here in the ED for help with my pain and can you set me up with a surgeon for a second opinion, etc.. Can you imagine operating on some of these histrionic, multiple comorbidity patients with unrealistic expectations who show up in your clinic and you are forced to see over and over again? Believe me, there's no way in hell I'd go through that. THAT is the advantage of no continuity of care. Any surgeon will admit that these patients are many and are headaches. My dad was an ENT and the bane of his existence was vague ENT related, "headachy" women who frustrated their PCP's to no end and got referred over to him and he could find nothing wrong with them but was forced to see them over and over again. He enjoyed his specialty, but was jaded just as we all are (or will become) with enough time practicing medicine.

There's no panacea in medicine. You have to focus on the positive and try not to get distracted by the negative in order to drag yourself out of bed and come into work with a positive attitude. After one career already, I consider this a ubiquitous phenomenon that just about any career driven person has to deal with on a daily/yearly basis.

EM has pro's and con's just like any other specialty. There's no way you're going to avoid the con's, in whatever you pick. Just make sure there are enough pro's that you can focus on to keep yourself with a positive attitude for the majority of your life. If you can't, then pick something that allows you the flexibility of plenty of free time outside of medicine to draw your happiness from. In that case, EM also is a great choice. Surgery sure doesn't provide that flexibility.
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Groove said:
Just one thing I want to add for the med students reading this thread that applied for EM and are thinking "what the F did I just get myself into...?". Keep in mind that all of us become jaded after working in a career for awhile. I was that way in my last career and now that I'm out, miss parts of it though I certainly wouldn't pursue it again. I think medicine, and any specialty for that matter is no different. Those of us finishing our training have bright eyes and although many of us are more aware of the disadvantages of the specialty that perhaps we weren't aware of as med students, are still excited about our choice and have a positive outlook for the next few years. I have no doubt that in about 10 or so, I'll be more jaded and disillusioned, which is only natural and a fact of life.
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I have to respectfully disagree with this one. I am only 7 months out of residency, but I feel like I reached the light at the end of the proverbial tunnel and suddenly the power went out. The environment in Washington state (see other thread) is such that I would encourage any student or resident to think long and hard about moving/practicing here. It has nothing to do with the medicine itself (I love the medicine!), but whether I can viably practice medicine in this state. I can't say if this *situation* will be nipped in the bud, or if the rest of the country will go this way eventually. But it's real, and I think you have to know what you're getting into.

Of course, part of me thinks, these students/residents are in it this far - why ruin it for them? But if this post in any way inspires folks to get involved with their local chapters, then at least I've done a little good, I suppose.
 
Birdstrike, you're a good person. Lots of things getting me down lately. I think you might have a second calling as a life coach :)
 
I work both at an academic shop (Carolinas), and with a private group. Appx 14 shifts a month, and yes there is crappy stuff, but also yes, I love my job.

I don't care if you're the pilot of a jet, a firefighter, a stripper, ALL jobs have their crap. Some article last year had it pegged at around 90% of Americans dislike their jobs.

Lastly, agree with voting with your feet. When we grow a pair, and actually act, then we can expect results, until then you can pay lip service to whomever you like, nothings going to change for the better.

...if you ever get down, visit a third world country and see how much crappier life COULD be. Work 7 days a week, 12hrs a day, for basically water and a dirt hut....
 
TysonCook said:
...if you ever get down, visit a third world country and see how much crappier life COULD be. Work 7 days a week, 12hrs a day, for basically water and a dirt hut....
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This times a million. Nothing like witnessing how the bottom-rung lives to give you some perspective.
 
Daiphon said:
this may be the new McFattypants. d=)

well said, DMJ!

-d
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I can't take the credit. Someone else said it before me in reference to EM/IM and I'm just continuing the tradition, in the spirit of FMF.
 
Hey folks,

I've really been weighing the pro's and con's of a career in EM lately, and I was hoping a bunch of the veterans on this forum could provide some insight being as though I'm an outsider looking-in at this point.

Pro's:
--Variety of the work, both cerebral and procedural at the same time.
--Shift work. I love helping patients, really do. But....I also really LOVE my life away from medicine/hospital and I don't see any other field of medicine that affords the type of leeway that EM does.
--I kind of enjoy "working patients up" and running through the DDx in my head
--Short residency. Not sure if I want to "suck it up" for another 6-8 years in a surgical/IM subspecialty fellowship track. Sure, some may say it's only 6-8 years of your life and that you should just "man-up" and get through them....Don't really agree with this. Life is very precious, slogging through 80-110 hour weeks for 7 consecutive years with the idea that things will someday get easier....sounds like a recipe for regret.
--Reimbursement seems pretty good right now

Cons:
--the dark-side of shift work: Shifting from Days-to-Nights and vice-versa and the toll this has on your body. really, this is the only BIG negative for me personally with EM, but I'd really like to know ways that physicians/democratic groups combat this dilemna.
--Lot's of "crappy" patients. Meh, not too big a worry here, I got thick skin, this is more of a nuisance than anything
--Perhaps moderately susceptible to encroachment/replacement by "cheaper" options for hospitals in the future...i.e., mid-levels.
--rumors of big-time drops in Reimbursement or an "oversaturation" of the EM market for physicians in 10+ years. Again, just rumors, but always something to consider.....
 
DreamingTheLive said:
Hey folks,

I've really been weighing the pro's and con's of a career in EM lately, and I was hoping a bunch of the veterans on this forum could provide some insight being as though I'm an outsider looking-in at this point.

Pro's:
--Variety of the work, both cerebral and procedural at the same time.
--Shift work. I love helping patients, really do. But....I also really LOVE my life away from medicine/hospital and I don't see any other field of medicine that affords the type of leeway that EM does.
--I kind of enjoy "working patients up" and running through the DDx in my head
--Short residency. Not sure if I want to "suck it up" for another 6-8 years in a surgical/IM subspecialty fellowship track. Sure, some may say it's only 6-8 years of your life and that you should just "man-up" and get through them....Don't really agree with this. Life is very precious, slogging through 80-110 hour weeks for 7 consecutive years with the idea that things will someday get easier....sounds like a recipe for regret.
--Reimbursement seems pretty good right now

Cons:
--the dark-side of shift work: Shifting from Days-to-Nights and vice-versa and the toll this has on your body. really, this is the only BIG negative for me personally with EM, but I'd really like to know ways that physicians/democratic groups combat this dilemna.
--Lot's of "crappy" patients. Meh, not too big a worry here, I got thick skin, this is more of a nuisance than anything
--Perhaps moderately susceptible to encroachment/replacement by "cheaper" options for hospitals in the future...i.e., mid-levels.
--rumors of big-time drops in Reimbursement or an "oversaturation" of the EM market for physicians in 10+ years. Again, just rumors, but always something to consider.....
Click to expand...

OMG you sound like me
 
Pro's:
--Variety of the work, both cerebral and procedural at the same time. Not as cerebral as you think. Many patients are cookbook once you see them a bunch. Once in a while you really start to think about things and figure out something interesting. I think this is true for all of medicine.
--Shift work. I love helping patients, really do. But....I also really LOVE my life away from medicine/hospital and I don't see any other field of medicine that affords the type of leeway that EM does.I see your response below.. YOu see both sides of this game
--I kind of enjoy "working patients up" and running through the DDx in my head
--Short residency. Not sure if I want to "suck it up" for another 6-8 years in a surgical/IM subspecialty fellowship track. Sure, some may say it's only 6-8 years of your life and that you should just "man-up" and get through them....Don't really agree with this. Life is very precious, slogging through 80-110 hour weeks for 7 consecutive years with the idea that things will someday get easier....sounds like a recipe for regret. Also they dont always get that much easier. One of the trauma docs I work with told me that he works more and harder now than he ever did in residency. Its about money making time now.
--Reimbursement seems pretty good right now

Cons:
--the dark-side of shift work: Shifting from Days-to-Nights and vice-versa and the toll this has on your body. really, this is the only BIG negative for me personally with EM, but I'd really like to know ways that physicians/democratic groups combat this dilemna. Well night shift differential. My group has 8 docs who cover nights. That leave 32 docs most of which never work nights and a few who do maybe 2 a month if they cant trade out. Literally looking at Jan outside of the 8 night docs we have 3 of the other 32 who even have a single night shift.
--Lot's of "crappy" patients. Meh, not too big a worry here, I got thick skin, this is more of a nuisance than anythingThis is personality dependent but no matter how thick your skin some of these interactions will bother you. If you are human this is the case. It wears on some more than others but believe me it will bother you. Maybe not in years 1-4 but definitely at years 15-20
--Perhaps moderately susceptible to encroachment/replacement by "cheaper" options for hospitals in the future...i.e., mid-levels.Depends on your system. The midlevels can be seen as a way to increase your income without much added work.
--rumors of big-time drops in Reimbursement or an "oversaturation" of the EM market for physicians in 10+ years. Again, just rumors, but always something to consider.....rumors of big time drops in medical reimbursement all together. EM is not unique in this. Regarding oversaturation what does it matter if you have a job in a stable democratic group?
 
EctopicFetus said:
Pro's:
--Variety of the work, both cerebral and procedural at the same time. Not as cerebral as you think. Many patients are cookbook once you see them a bunch. Once in a while you really start to think about things and figure out something interesting. I think this is true for all of medicine.
--Shift work. I love helping patients, really do. But....I also really LOVE my life away from medicine/hospital and I don't see any other field of medicine that affords the type of leeway that EM does.I see your response below.. YOu see both sides of this game
--I kind of enjoy "working patients up" and running through the DDx in my head
--Short residency. Not sure if I want to "suck it up" for another 6-8 years in a surgical/IM subspecialty fellowship track. Sure, some may say it's only 6-8 years of your life and that you should just "man-up" and get through them....Don't really agree with this. Life is very precious, slogging through 80-110 hour weeks for 7 consecutive years with the idea that things will someday get easier....sounds like a recipe for regret. Also they dont always get that much easier. One of the trauma docs I work with told me that he works more and harder now than he ever did in residency. Its about money making time now.
--Reimbursement seems pretty good right now

Cons:
--the dark-side of shift work: Shifting from Days-to-Nights and vice-versa and the toll this has on your body. really, this is the only BIG negative for me personally with EM, but I'd really like to know ways that physicians/democratic groups combat this dilemna. Well night shift differential. My group has 8 docs who cover nights. That leave 32 docs most of which never work nights and a few who do maybe 2 a month if they cant trade out. Literally looking at Jan outside of the 8 night docs we have 3 of the other 32 who even have a single night shift.
--Lot's of "crappy" patients. Meh, not too big a worry here, I got thick skin, this is more of a nuisance than anythingThis is personality dependent but no matter how thick your skin some of these interactions will bother you. If you are human this is the case. It wears on some more than others but believe me it will bother you. Maybe not in years 1-4 but definitely at years 15-20
--Perhaps moderately susceptible to encroachment/replacement by "cheaper" options for hospitals in the future...i.e., mid-levels.Depends on your system. The midlevels can be seen as a way to increase your income without much added work.
--rumors of big-time drops in Reimbursement or an "oversaturation" of the EM market for physicians in 10+ years. Again, just rumors, but always something to consider.....rumors of big time drops in medical reimbursement all together. EM is not unique in this. Regarding oversaturation what does it matter if you have a job in a stable democratic group?
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Thank you EctopicFetus, I appreciate your candor and viewpoint (as with all your posts). Really, my only hang-up then is the night-day-night swings but I'm sure in a large democratic group there are lots of ways around this such as scheduling a week with all your nights, etc.

Is this correct?
 
DreamingTheLive said:
Thank you EctopicFetus, I appreciate your candor and viewpoint (as with all your posts). Really, my only hang-up then is the night-day-night swings but I'm sure in a large democratic group there are lots of ways around this such as scheduling a week with all your nights, etc.

Is this correct?
Click to expand...

I cant comment for all groups. My group works like this. I can ask for ANY 9 days off every month. You can truly customize your schedule. For me evenings are the hardest on my family. Coming home at 1 am isnt great for my family life.

We group our nights. Some people do runs of 3 or 4 or 5. I find that 4 is a good number for me.

I do almost all 12s. So if i do 12 12s a month thats 144 hours.. Ina 30 day month i have 18 days "off". You could do 4 on 5 off x 3.. my schedule doesnt go that way but others do.

We have a doc who works every sat sun and monday night. If you are willing to work all nights they will bend to you to keep you happy. Keep in mind most places offer a night differential as well which helps pay off those bills.
 
12 12s a month is brutal when you're in your 30s and 40s. Any 12-hour shift in the EM is crazy. The cons of EM are such big cons that I admire anyone who's willing to tolerate them. At 4am my body is shut down and in dreamland thank you very much. There's no way in hell you could pay me to work when my system is supposed to be resting.
 
Leo Aquarius said:
12 12s a month is brutal when you're in your 30s and 40s. Any 12-hour shift in the EM is crazy. The cons of EM are such big cons that I admire anyone who's willing to tolerate them. At 4am my body is shut down and in dreamland thank you very much. There's no way in hell you could pay me to work when my system is supposed to be resting.
Click to expand...

Are you going to be a chiropractor or podiatrist? Because you take call in real medical school, and it usually covers 4 am.
I agree that 12s are usually more bad than good. But working 144 hours a month for a good income is better than digging ditches 40 hours per week for less.
 
I love nights personally and would rather work 12 12s at nights than during the day.
 
I plan on staying on my night schedule at least until december. Then I will reconsider.

To the person who thinks it is too much.. keep in mind.. i put away 50k in retirement last yr, this yr will be 100k plus i have my rainy day fund.

Not sure where else you get this... .
 
You put "off" in quotation marks so does that mean you can still be called during the 18 days off?

How common is it to get "4 on 5 off x 3" when doing 12 12's?


EctopicFetus said:
I cant comment for all groups. My group works like this. I can ask for ANY 9 days off every month. You can truly customize your schedule. For me evenings are the hardest on my family. Coming home at 1 am isnt great for my family life.

We group our nights. Some people do runs of 3 or 4 or 5. I find that 4 is a good number for me.

I do almost all 12s. So if i do 12 12s a month thats 144 hours.. Ina 30 day month i have 18 days "off". You could do 4 on 5 off x 3.. my schedule doesnt go that way but others do.

We have a doc who works every sat sun and monday night. If you are willing to work all nights they will bend to you to keep you happy. Keep in mind most places offer a night differential as well which helps pay off those bills.
Click to expand...
 
Last edited:
tima said:
You put "off" in quotation marks so does that mean you can still be called during the 18 days off?

How common is it to get "4 on 5 off x 3" when doing 12 12's?
Click to expand...

I used "off" cause of flip days. My off days are off and no i dont get called in.

Anytime I want in my group I get the above schedule or some version of it. Consider.. I could do 4 on 6 off, 4 on 6 off 4 on and then be off the rest of the month.

Thats not unusual.. More commonly I ask for other days off and that makes my schedule different.
 
I am actually concerned for EP oversaturation. It seems like most EM residencies are attempting to increase their number of spots per year and there have been quite a few brand new residencies popping up over the last 5-10 years. Other than ACGME who approves this, has ACEP taken a look into the effects of training this many residents? We need a fine balance between supply and demand. To little supply can lead to mid-level take over, whereas to much supply can drive down salaries very quickly.

Any thoughts? Has this topic been studied? We need to be more like Derm and Neurosurgery and limit are spots, when appropriate.
 
last i heard, ACEPs projections stated that there would never be enough board certified emergency medicine physicians to staff every ED 24/7. attractive cities are often saturated because they are cool cities and because they usually have residencies within them. there will always be jobs for us. just may not be in the coolest places. salaries that we can command in the future...hard to say. based on a lot of factors.
 
Can physicians form unions? Like the teachers union?
 
No. Professions, by definition, cannot as they have specialized knowledge and the right to self-police.

As attractive as unionization might seem, we'd be more targetable by lawmakers & lose what little self-determination we have left.

Sent from my DROID BIONIC using Tapatalk
 
DrFamily7 said:
Can physicians form unions? Like the teachers union?
Click to expand...

I detest public unions.. so take it with a grain of salt.. I dont love the private unions either but there is indeed a physician union.

http://www.uapd.com/

http://www.physiciansnews.com/law/497union.html

http://www.modernphysician.com/article/20070904/MODERNPHYSICIAN/309020004

From the last link..

In a legal blow to the efforts of physician unions, the Federation of Physicians & Dentists in June agreed to stop coordinating negotiations anywhere in the country, settling a 2005 lawsuit that alleged the organization illegally drove up fees on behalf of 120 Cincinnati-area OB/GYNs, according to an antitrust settlement announced by the Justice Department.
Click to expand...
 
Sadly, the way to defeat ER docs is to divide and conquer.
 
DrFamily7 said:
Can physicians form unions? Like the teachers union?
Click to expand...

Yes, Im not sure why others think they cant. It exists, but its rare

For example I know of a FM residency (through UCSF) located in Santa Rosa, CA. From what I remember the resident said they are one of the only unionized residencies/ physicians in the country
 
docnotsopc said:
Yes, Im not sure why others think they cant. It exists, but its rare

For example I know of a FM residency (through UCSF) located in Santa Rosa, CA. From what I remember the resident said they are one of the only unionized residencies/ physicians in the country
Click to expand...

The residents at cook county were unionized as well when i was a med student.
 
I think most docs feel they are useless cause I dont believe we could collectively bargain vs medicare and since our rates are based off that then it is viewed as worthless.
 
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