Emergency physicians want their cake and they want to eat it too. Many go into emergency medicine thinking it's all emergencies and critical care. I know I did. My pre-med younger self even thought once that draining a pilonidal abscess seemed liked an emergency and pretty cool. Ha. We all like emergent pathology, but usually only for a few hours. We like resuscitation, but usually not the required patience of detail-oriented, longitudinal care of critical illness over a week. At the same time, we want compensation more in line with the more highly compensated medical specialities. We are only willing to take a paycut commensurate with not working 60 hour work weeks in perpetuity, because we'd rather only work 30-40 hours/week by naively tolerating more nights, weekends and holidays. We were in our 20s and only live once though, so hey, it will be epic. Outlook and priorities change with time, perspective and wisdom.
The only fix is to reduce the number one cause of burnout while still maintaining high compensation. Seeing a sea of worried well while we desire solely resuscitation leads to burnout. However, the catch 22 is that if we don't see the worried well, and don't take care of those befallen to a broken medical system, then we won't be highly compensated. The only answer is to find a way to make emergency departments take care of emergencies, yet still compensate EPs highly for their training and willingness to staff an ED 24/7. Will this happen? Highly doubtful. Therefore, the devalued field will suffer from burnout and replacement of those burned out by a steady supply of awe-struck graduates only for the cycle to repeat itself. They start out as trail running, rock climbing, microbrew fanatics slinging in central lines and intubating just as smoothly as skiing power, only to find themself pushing their own Diltiazem drips on a poles around the ED while continuing to see patients wondering if they're going to experience their own mid-shift STEMI prior to achieving FIRE.
I think this might also just speak to a broader problem in society today. We don't value those that work for a paycheck. Our country rewards those that have their money work for them, increasingly making those that clock in and out stuck owing their souls to the company store. Nurses, techs, restaurant servers, garbage men and many others are quitting in droves. When people are given the opportunities of Medicaid, disability and stimulus checks, they understandably gladly take it and give their middle finger to the system that forsook them. I say this without trying to make this overtly political. Many of these are good ideas in theory that try to help those in need, but really are just sticking bandaids on the problem of the growing inequality gap. Everyone else also just wants their cake and to eat it too. Many didn't sacrifice their 20s to get a half chewed on cupcake though. They aren't as beholden to the path they are on and can walk away at a moment's notice without lost years of their lives. So what's the fix? Heck if I know. It's not 16 tons, but I'm going out in the sun to do a bunch of yard work and manual labor. I'm going to enjoy every minute of it pretending I'm free! Then I'm going to begrudgingly drag myself back to my next block of night shifts where I'll be bludgeoned down by an onslaught of alcoholics/drug addicts, suicidal but "can I have a turkey sandwich and how long until I can leave so I make it home in time for my favorite TV show, because you know your TV isn't working in here," oldies falling down with skin tears but off to the ED from the dementia unit by ambulance there and back for a CT(s) just to be sure, people hyperaware of their bodies requesting a million dollar, non-emergent workup and a specialist consultation because you don't know emergencies like mine, and others who have a really high pain tolerance so something must be seriously wrong. I'd almost rather accidentally cut my arm off (non-dominant of course) with my battery powered chain saw and collect the disability.
The ED is a microcosm and reflection of society. The messy, complicated place in the hospital without an easy fix. We are problem solvers though. If there is a fix for our burnout and we can find it, perhaps it will also offer a fix to a broken medical system and a struggling society. The question is how do we find that fix while we still care enough before we each individually walk off into our golden years that seem to come to early when we still have a lot of life yet to live.
