General surgeon vs Emergency medicine

[azaleaanx]

Do general surgeon have all the knowledge from what the emergency medicine doctor learned or do general surgeon knows what to do next based on what emergency doctor explained?

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[ParachuteAdams]

 

[HighPriest]

A general surgeon knows literally everything an emergency medicine doc knows about surgery. And then some.

 

[WedgeDawg]

Whenever I'm about to do something, I think, 'Would an Emergency Medicine Doctor do that?' And if they would, I do not do that thing.

 

[Apollyon]

Whenever I'm about to do something, I think, 'Would an Emergency Medicine Doctor do that?' And if they would, I do not do that thing.

Good dig! Thanks, buddy! "I have no mind. I'm the village idiot!"

(West Side Story, 1961, in case you didn't know)

 

[HighPriest]

Not me. If I could work 10-12 shifts per month, I’d be down for that.

 

[LucidSplash]

I recently convinced some of our ED docs that it is ok to put a figure of 8 suture in a bleeding fistula, admit to hospitalist, make the patient NPO after midnight, and let me know in the morning. One of my proudest moments so far in practice.

 

[longhaul3]

I recently convinced some of our ED docs that it is ok to put a figure of 8 suture in a bleeding fistula, admit to hospitalist, make the patient NPO after midnight, and let me know in the morning. One of my proudest moments so far in practice.

But how do you get the hospitalist NP not to call you to come take a look in the middle of the night? You know, just to make sure everything's ok.

 

[Smurfette]

I recently convinced some of our ED docs that it is ok to put a figure of 8 suture in a bleeding fistula, admit to hospitalist, make the patient NPO after midnight, and let me know in the morning. One of my proudest moments so far in practice.

All this means is none of these docs will ever be working on days you are on call and one of these patients come in.

 

[migm]

if the patient needs admitting, why can't you admit the patient with a previously bleeding fistula to your service?

 

[LucidSplash]

if the patient needs admitting, why can't you admit the patient with a previously bleeding fistula to your service?

I could, but I’m at an outlier hospital and the practice pattern here, established long before I arrived, was to admit patients to hospitalist and be a consultant.

 

[LucidSplash]

But how do you get the hospitalist NP not to call you to come take a look in the middle of the night? You know, just to make sure everything's ok.

If it’s not actively bleeding and the ED doc already talks to me they typically don’t. And if they insist, I have the resident go in. Academic-affiliated at an outlier is my ideal practice setting. I get to teach and have the benefit of having residents, without the nonsense that can go on at a big academic center.

 

[Wordead]

if the patient needs admitting, why can't you admit the patient with a previously bleeding fistula to your service?

Because the hospitalist is there anyway and the vascular surgeon has a full day the next day it makes more sense for the nurses to bother the hospitalist instead of waking up the vascular surgeon?

 

[TypeADissection]

I am fortunate enough to be joining a practice where all my patients if they are coming in for elective cases (EVAR, CEA, bypasses) will also have a vascular medicine trained physician attached to help manage the other co-morbidities. This saves me from the phone calls about HTN and blood sugars. Somewhere along the way the hospital figured out that it was more profitable to keep us as vascular surgeons in the OR operating, while allowing our VM colleagues to manage the other issues and resulted in decreased 30 day readmission rates. I'm very ready to leave academia and it'll be nice to have capable help in the absence of residents.

In regards to the OPs question, you serious bro? GS has nothing to do with EM. They're not even remotely similar. On one hand, you have shift work and on the other, you have something where you don't even think about going home until all the work is done. Moreover, if you do your residency in a hospital that also has an EM residency attached to it - you will grow to despise their existence. You just will. During my rural surgery rotation we would work at a small hospital and take call with a DEM that did not have residents, and I cannot tell you how different the interactions were in a positive sense. It was collaborative, had minimal bullsh*t and we actually worked together to help patients. Then I come back to the mothership and the moment an EM resident pages me I'm dropping F-bombs at a prodigious rate.

 

[ACSurgeon]

if the patient needs admitting, why can't you admit the patient with a previously bleeding fistula to your service?

- because the ESRD patient has a million medical problems that I don’t want to be called about
- because it never made sense to me to admit a patient without seeing them. There’s a hospitalist at the hospital and I’m at home trying to get rest before another long day. if the ED missed something at 10 pm, someone else should notice it before the next morning.
- because nurses will call on average 3 times per admission. Once to tell you the patient arrived the floor. Once to ask for orders even though they’re already signed and held and they just didn’t look. And a third time to tell you something that doesn’t matter at all. So, if an on call surgeon gets woken up by the ED/IM doc about this consult once, that’s ok. To add 3 more interruptions to my sleep is not. Some nights you get 5+ consults. I’d be up all night if I admitted all these patients and have a full day the next day.

 

[ACSurgeon]

I am fortunate enough to be joining a practice where all my patients if they are coming in for elective cases (EVAR, CEA, bypasses) will also have a vascular medicine trained physician attached to help manage the other co-morbidities. This saves me from the phone calls about HTN and blood sugars. Somewhere along the way the hospital figured out that it was more profitable to keep us as vascular surgeons in the OR operating, while allowing our VM colleagues to manage the other issues and resulted in decreased 30 day readmission rates. I'm very ready to leave academia and it'll be nice to have capable help in the absence of residents.

In regards to the OPs question, you serious bro? GS has nothing to do with EM. They're not even remotely similar. On one hand, you have shift work and on the other, you have something where you don't even think about going home until all the work is done. Moreover, if you do your residency in a hospital that also has an EM residency attached to it - you will grow to despise their existence. You just will. During my rural surgery rotation we would work at a small hospital and take call with a DEM that did not have residents, and I cannot tell you how different the interactions were in a positive sense. It was collaborative, had minimal bullsh*t and we actually worked together to help patients. Then I come back to the mothership and the moment an EM resident pages me I'm dropping F-bombs at a prodigious rate.

the difference between EM and surgery is vast. The shift model approach not being an important one. Acute care and trauma has some version of shift work, albeit sometimes in stretches of days at a time.

the real difference is the type of patient each specialty sees and the type of management they provide. A surgeon provides definitive recommendations/treatments of surgical diseases. An ER doctor see a much wider variety of problems and treats some conditions, begins the work up for other conditions (then hands off to admitting service), and at other times just stabilizes an undifferentiated dying patient and sends them to the ICU for ongoing work up and management.

if you’re trying to decide between EM and surgery, you have to experience both, and decide what role you want in treating patients, what kinds of diseases you want to see, what type of continuity (or lack there of) and sure lifestyle of nature of schedules.

 

[deleted547339]

Do general surgeon have all the knowledge from what the emergency medicine doctor learned or do general surgeon knows what to do next based on what emergency doctor explained?

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I’ll assume you’re not trolling for a moment. I’m EM and CCM trained and spent an inordinate amount of times in surgical icus in fellowship.

The knowledge base overlaps in areas but is vastly different. Neither is “smarter” or “more knowledgeable,” simply different. Knowledge of surgical pathology is only a very small subset of core competencies for EM; and knowledge of emergent surgical conditions is only a small subset of surgical knowledge and skill sets. Want to know everything about the anatomy of the abdomen and how to care for very specific problems from start to finish (an oversimplification, I know)? do gen surg. Want to know something about everything and rapidly get rid of patients? Do EM. One has a knowledge base that is a mile wide and an inch deep while one has a knowledge base that is an inch wide and a mile deep.

As far as a surgeon knowing what to do next, it depends. 99%+ of the time I call a surgeon, there’s not a question. I’m calling because 1) the patient needs an operation either imminently or referral to their clinic for scheduling 2) a post-op patient is in the ER for a complication 3) I can’t sell it to a hospitalist without the surgeons blessing (I’m at an academic center). It’s rare that I’m calling saying “I don’t know, I need help” - we live in the days of real time 256 slice CT scanners.

The “average” lifestyle of EM is probably better than the “average” surgical lifestyle, but the lifestyle of surgeons seems to have a high variability based on subspecialty and practice setting. I know some surgeons who live in the hospital and some that have office based practices who have a pretty cush lifestyle. EM is EM is EM. Surgery is not just surgery - Cardiac surgery is very different from breast surgery.

The average EM salary is pretty close (although probably a hair lower) than the average surgeon. The upside seems to be a lot higher for surgery. Both fields are paid (for the most part) by working. It’s hard to scale either. It’s not like derm or ophtho where you could open a clinic and then expand.

EM is generally employed by contract groups or hospitals. Surgical specialties have some small groups but are becoming more frequently hospital employees, particularly acute care, trauma, etc.

If prestige matters to you, do surgery. Outside of the hospital, everyone thinks EM is the coolist job in the world. Inside the hospital, it’s varied. At private hospitals, people like EM because it is a referral source and keeps you asleep at night. In academic centers, you often get crapped on by people with less knowledge than you. As alluded to above, you often get attitude from junior residents who can’t see the same 10,000 ft view that you can as the attending. You also often have an intern or junior resident talking to an intern or junior resident which is set up to have misunderstandings.

On a related note, hospitals view EM and (some) surgeons differently. You COME TO a hospital because of a CT surgeon or surgical oncologist. They can bring patients in the door. Patients come to the hospital based on proximity or reputation and GET an ER doc, acute care surgeon or trauma surgeon. These aren’t docs you seek and are usually viewed as a line item for hospitals. (Hint: hospitals don’t care if line items are happy or well paid).

 

[filter07]

Can't admit to your service if you don't have a service

 

[Splenda88]

if the patient needs admitting, why can't you admit the patient with a previously bleeding fistula to your service?

Because we (hospitalists) are at the service of our dear surgeons....

 

[LucidSplash]

Because we (hospitalists) are at the service of our dear surgeons....

That’s unfortunate that you feel that way. I’m sorry if you’ve been mistreated by your surgeons. We have a pretty collegial symbiotic relationship where I am.

 

[Splenda88]

That’s unfortunate that you feel that way. I’m sorry if you’ve been mistreated by your surgeons. We have a pretty collegial symbiotic relationship where I am.

I have not been mistreated by surgeons. I am not happy when I am babysitting patients for other services. Surgery and neurology are the biggest offenders where I am.

 

[LucidSplash]

If y

I have not been mistreated by surgeons. I am not happy when I am babysitting patients for other services. Surgery and neurology are the biggest offenders where I am.

All my patients are admitted to a hospitalist; however I would not call it babysitting. Given my patients have multiple (usually poorly-controlled) comorbidities, it makes sense to have someone trained to manage those medical comorbidities coordinating that side of care. I can do it, but admittedly not as well as as someone who is IM trained IMHO. It makes for better outcomes, shorter LOS, fewer complications. And, as noted above, it is fiscally efficient for the hospital, who employs me, to maximize the time I spend in the OR or in clinic or in woundcare clinic.

if you feel what you are doing is babysitting instead of a valuable contribution to patient care, you might need to find another job. And I would again apologize if your surgeons don’t make it clear that they value your contribution to their practice and their patients.

 

[HighPriest]

I feel similarly when I have four consecutive patients in my clinic who have basic, single-episode, uncomplicated sinus infections that respond to the first antibiotic I put them on.

“Why did the PCP send this person to me? I’m not a primary care provider, and this is a primary care issue!”

Or when I get sent literally every case of facial cellulitis (not abscessed).

Why?

Then I remember that this is my job and I get paid to do it, and that not every single patient will be an interesting case, and that those PCPs sometimes send me good stuff too.

 

[longhaul3]

I have not been mistreated by surgeons. I am not happy when I am babysitting patients for other services. Surgery and neurology are the biggest offenders where I am.

What kind of patients do you babysit on behalf of neurology? Everywhere I've been they do a lot of babysitting of their own. Or do they not have their own service where you are?

 

[kitsunepixie]

This is thanks to TV. I don't know how many kids I meet who want to be "an ER surgeon"

 

[kitsunepixie]

I'm peds, but our patients typically get admitted to either ICU or Hospitalist and we consult. It works very well for us. Now, since we started a pediatric residency, the residency is wanting to admit all the other surgical services too.

 

[TypeADissection]

Because we (hospitalists) are at the service of our dear surgeons....

Ooh. I love it when you talk dirty. Go on...

 

[Splenda88]

All my patients are admitted to a hospitalist; however I would not call it babysitting. Given my patients have multiple (usually poorly-controlled) comorbidities, it makes sense to have someone trained to manage those medical comorbidities coordinating that side of care. I can do it, but admittedly not as well as as someone who is IM trained IMHO. It makes for better outcomes, shorter LOS, fewer complications. And, as noted above, it is fiscally efficient for the hospital, who employs me, to maximize the time I spend in the OR or in clinic or in woundcare clinic.

if you feel what you are doing is babysitting instead of a valuable contribution to patient care, you might need to find another job. And I would again apologize if your surgeons don’t make it clear that they value your contribution to their practice and their patients.

Thanks for suggesting what I should be doing with my life...

 

[Splenda88]

What kind of patients do you babysit on behalf of neurology? Everywhere I've been they do a lot of babysitting of their own. Or do they not have their own service where you are?

'Admit to medicine for stroke workup'

 

[LucidSplash]

Thanks for suggesting what I should be doing with my life...

If I came off as condescending, I apologize, it was not intended as such. I was simply pointing out that if you find your job, on balance, to be unsatisfying or frustrating more often than fulfilling, there are other jobs out there. That might be another hospitalist position with a more collegial interplay between specialties or not hospitalist medicine at all.

You came into a surgery thread with a soft innuendo at being taken advantage of by surgeons and have been treated fairly kindly despite that. You voiced being unhappy about something that, if done properly, is to the benefit of patients. I’m not sure I can be faulted for suggesting you look into other options after you voiced your discontent.

 

[LucidSplash]

'Admit to medicine for stroke workup'

Do stroke rule out patients not usually have complex medical comorbidities including HTN, DM, CAD, etc? I don’t know that neurologists get training in managing those chronic conditions. They don’t even do a prelim year of medicine as far as I’m aware. And beyond that most stroke management ends of being medical management of comorbidities. I’m unclear why you don’t feel you have a pivotal role to play for these patients.

 

[Splenda88]

If I came off as condescending, I apologize, it was not intended as such. I was simply pointing out that if you find your job, on balance, to be unsatisfying or frustrating more often than fulfilling, there are other jobs out there. That might be another hospitalist position with a more collegial interplay between specialties or not hospitalist medicine at all.

You came into a surgery thread with a soft innuendo at being taken advantage of by surgeons and have been treated fairly kindly despite that. You voiced being unhappy about something that, if done properly, is to the benefit of patients. I’m not sure I can be faulted for suggesting you look into other options after you voiced your discontent.

I still am a resident and I like what I do. Of course, there are aspects of my job I would change if I could. The physicians (including the surgeons) I interact with are very collegial. I am sure there are aspects of their jobs that they might not like.

Well, we all complain and SDN is the perfect place to have a catharsis

 

[Splenda88]

Do stroke rule out patients not usually have complex medical comorbidities including HTN, DM, CAD, etc? I don’t know that neurologists get training in managing those chronic conditions. They don’t even do a prelim year of medicine as far as I’m aware. And beyond that most stroke management ends of being medical management of comorbidities. I’m unclear why you don’t feel you have a pivotal role to play for these patients.

They can consult IM for these complex co-morbid conditions

 

[LucidSplash]

They can consult IM for these complex co-morbid conditions

This sounds more like a complaint about what gets taken by IM and what gets taken by the hospitalists at your institution. Not the surgeons or Neuro specifically.

The fact that you’re still a resident makes a lot of sense. If you end up as a hospitalist, a lot of these “annoying babysitting” admits end up being easy $$ RVUs. These types of consults bugged me as a resident too. I remember as trauma chief having a loud disagreement in the middle of the night with an ortho resident over being made to admit a 20 year old patient with a pubic rami fracture that was non op and ortho said could be discharged until they couldn’t walk and needed to be admitted for pain control.

Now that I’m an attending, the uncomplicated DVT, asymptomatic “incidentally found” artery stenosis, etc are easy to knock out and take very little effort but help keep adding up the RVUs. And they make good relationships with the hospitalists and such. I still get frustrated sometimes, but mostly your perspective changes when you are getting paid.

Hang in there, it will get better.

 

[HighPriest]

That’s the thing. These cases stink as a resident because you don’t see the point. And, to be fair, as a resident there really isn’t a point in your admitting patients from other services....except 2: 1-it probably is better for the patient. I bet if I told you what I do for poorly controlled hypertension, you’d laugh. But I’m frankly not the guy to get a patient’s hypertension under control. I don’t keep up on new drugs for HTN, or current standards of care. I have too much else to concentrate on. (I’m using HTN as an example of a broader issue if that isn’t obvious). This is the thing I also think about when I see a sinus patient on his fifth course of z-pack chased with doxycycline. I think “WTF were they thinking?” Then I realize that they’re probably not reading the journal of rhinology on a regular basis.
2-it gives you some perspective on what life is like for a hospitalist. This is the way things are going, and for financial reasons as well as patient safety, I don’t see them going any other way for a long, long time. Hospitalists admit for other services. They’re in house. I’m usually not. I don’t admit -EVERYTHING- to them, but tbh my threshold isn’t that high. So, I yeah nobody should tell you what to do with your life. Just, you know, learn from your experiences as a resident. Wanting it to “not be the way it be” won’t change it.

And also, yeah, this is a fine place to let off steam. But everyone here is a physician. They’re going to try to solve your problem for you. It’s the way they’re wired.

 

[deleted547339]

Yea. Similarly, I’m an ER and ICU doc. It used to really piss me off when someone would send a patient to the ER to be admitted rather than just direct admit them. The fact of the matter is that 1) they can keep going in their X, Y, Z clinic that may be a revenue generator 2) I’m here 3) sometimes things that are super obvious to you may not be to someone else (the other side of the dunning Kruger model)

Not all of EM is lysing PEs, subtle STEMIs that arrest and go to the cath lab and chest tubes in trauma patients. Not all of CCM is multi-system organ failure or ARDS. At the end of the day, it’s a job. I don’t buy into this BS of it’s a calling. Don’t get me wrong - I have a great job - it provides me intellectual stimulation, occasionally meaningful work and a high salary, but it’s still a job. Writing an H&P and getting a head CT on that patient from neurosurgery clinic bills a level 5 visit and is an easy dispo. The fact of the matter is that every specialty has this. I’m sure neurosurgeons don’t get excited to put in a ventric, or hospitalists with a demented granny drop off, or IR with a port placement, or gen surg with an I&D or.....you get the point.

As all hospital employees are currently acutely aware: it’s very important for your health system to be in the black. That means keep your CT surgeons operating, your oncologists giving chemo and your IR docs doing whatever they do Monday through Thursday 9-3. Chest pain and DKA pay the bills. Next patient.

 

[TypeADissection]

I don’t buy into this BS of it’s a calling. Don’t get me wrong - I have a great job - it provides me intellectual stimulation, occasionally meaningful work and a high salary, but it’s still a job...

...That means keep your CT surgeons operating, your oncologists giving chemo and your IR docs doing whatever they do Monday through Thursday 9-3. Chest pain and DKA pay the bills. Next patient.

I think this a hard concept for a lot of people to get. I'm not sure if it's the way over glorification on TV but too many people think this is a calling of sorts, when it's really just another job. In many ways, as physicians we are at the highest end of "blue collar" workers, where if we don't work and bill - we don't have a job anymore. Having worked in a corporate environment before all this, there are many other jobs out there that pay in the 6-figures where you actually don't have to provide any tangible evidence of having done anything if you're really good at bullshi**ing. I never looked at what I do as something that defines me nor this sacred calling. As @TimesNewRoman very well stated, it's just a job - I'm just fortunate enough that it provides a level of intellectual and technical satisfaction that I probably can't find in any other vocation. Cheers.

 

[Splenda88]

I think this a hard concept for a lot of people to get. I'm not sure if it's the way over glorification on TV but too many people think this is a calling of sorts, when it's really just another job. In many ways, as physicians we are at the highest end of "blue collar" workers, where if we don't work and bill - we don't have a job anymore. Having worked in a corporate environment before all this, there are many other jobs out there that pay in the 6-figures where you actually don't have to provide any tangible evidence of having done anything if you're really good at bullshi**ing. I never looked at what I do as something that defines me nor this sacred calling. As @TimesNewRoman very well stated, it's just a job - I'm just fortunate enough that it provides a level of intellectual and technical satisfaction that I probably can't find in any other vocation. Cheers.

Most of us are afraid to say that in front of our colleagues due to fear of being labeled as not caring... Most of the physicians that I am close with are open to say that to me privately, but would not dare to say that in front of other physicians... I guess we have to put on a show that everything in our life revolves around medicine.
.

 

[deleted547339]

I think this a hard concept for a lot of people to get. I'm not sure if it's the way over glorification on TV but too many people think this is a calling of sorts, when it's really just another job. In many ways, as physicians we are at the highest end of "blue collar" workers, where if we don't work and bill - we don't have a job anymore. Having worked in a corporate environment before all this, there are many other jobs out there that pay in the 6-figures where you actually don't have to provide any tangible evidence of having done anything if you're really good at bullshi**ing. I never looked at what I do as something that defines me nor this sacred calling. As @TimesNewRoman very well stated, it's just a job - I'm just fortunate enough that it provides a level of intellectual and technical satisfaction that I probably can't find in any other vocation. Cheers.

Yea, I think a big part of this comes from my faith and my family. I get my loving at home. I have a faith that supersedes medicine although it does prescribe that I should work diligently and care for my patients (which is admittedly hard at times). I really like my job, but I don’t think I’ll look back in 30 years and be upset I didn’t get more grant funding or get a job as chair.

Like you said, as a doc, particularly as an ER, I feel like a really highly paid blue collar worker - I know there is some prestige factor, but it often doesn’t feel like that inside the hospital and I feel more comfortable having a beer with some of the nurses than I do shooting the breeze with my old neighbors in a more affluent neighborhood who were mostly VC, I-bankers, etc.

Again, it’s a GREAT job. I make enough that I have no worries financially and retirement is a question of when not if, I sometimes am intellectually challenged (although sometimes it does feel like I’m just trying to make as many widgets as possible), I get to alleviate suffering and occasionally save a life, I get to develop a level of mastery not often appreciated in many fields, etc. As I reflect, it is truly a great job - but it’s one component of what makes me happy, not the thing that makes me happy.

 

[deleted547339]

Most of us are afraid to say that in front of our colleagues due to fear of being labeled as not caring... Most of the physicians that I am close with are open to say that to me privately, but would not dare to say that in front of other physicians... I guess we have to put on a show that everything in our life revolves around medicine.
.

Nah man. I straight up told my previous medical director that my job is fourth behind my faith, family and health when I interviewed. Obviously, he hired me anyway and we see most things eye to eye.

I think shared world view is important. I’m not saying diversity isn’t often important, but having an aligned world view makes things like this work better. If my boss saw his job as a calling and I see it as a job, that would be a problem, or vice versa. We both see it as a job and find honor in doing a job well, but we both had lines in the sand we wouldn’t cross.

 

[TypeADissection]

Most of us are afraid to say that in front of our colleagues due to fear of being labeled as not caring... Most of the physicians that I am close with are open to say that to me privately, but would not dare to say that in front of other physicians... I guess we have to put on a show that everything in our life revolves around medicine.

I hear what you're saying. There is definitely a level of "politicking" that goes into navigating your way through residency/fellowship. You gotta extract from your time in training the things that are going to help you while vicariously learning from some of the attendings who are natural bunglers. Maybe it's because I worked a career before going into medicine but my tolerance for bullsh*t is really really low. There was a strong push for me to stay on as faculty after I finished and to be honest I wanted none of it. They were looking for a "dump guy" to just eat the **** cases no one else wanted to do and toss all the ECMO salad for CTS and the groin complications that followed. But as we all know, I can't say that to my PD or chief (who I actually really like). So I still "interviewed" for the position and when I decided to go somewhere else I said it was because 1. I knew myself and the career path I wanted did not involve research or any involvement with academia and 2. this lead to me not having my goals aligned with the over-arching theme of the university and that to continue forward would not provide me any personal or professional satisfaction.

I was honest by not leading them along and stood my ground. Every environment of practice has a rat race component to it and I determined very early on that I didn't want to run the one in academia. They were all pretty pissed initially but they got over it and afterwards started going out of their way to make sure I had what I needed going into the private world. My PD arranged for me to sit down with our coder so that I could bill appropriately for cases, or write a better progress note that captured necessary billing components, or small chats in his office on how to improve efficiency in the outpatient world so that my H&P's had what I needed when I got to the OR with the patient a month later. So be true to yourself and your goals. Your program will either respect that (as they should) or they'll be dicks (in which case just bide your time, get what you need and be the better attending when you're done). Cheers.

 

[HighPriest]

Yup. I think there's a generational divide too. I find that a lot of older guys say that medicine is their life and mean it, whereas most of the people my generation or younger enjoy what they do well enough, but it's a job. I definitely feel that way. I like what I do. It's a good job. I agree whole heatedly with what was said about with it being essentially a highly paid blue collar job. and I also had a career before medical school and have very little time for BS. For example, when I'm done seeing patients in clinic or done operating in the OR - I'm gone, man. I have no desire whatsoever to hang around and see what might show up. My time is valuable to me, and once I'm not generating revenue, I have better things to do. I never skip out on work, mind you. I just hate wasting my time more than anything.
I have two very old partners who are totally different. They're at the office at 0600 even on days they don't have clinic scheduled. They regularly pop in just to see if there's any extra work to be done. I don't. Clinic starts at 0730, and I am there at 0725. Enough time to fill my coffee beforehand. And you will NEVER see me hanging out to catch work. The senior partners regularly tell people that they're "available at any time, even if (I'm) not on call. You can call my cell phone and I'll answer." And I have to follow that up with "not me. If I'm on call, I'm there for you. If I'm not, you'd better have a really good reason for calling me." I give my personal number to certain people who need it (OR director, med and radiation oncologists for things that really need expediting.) That's all.
I balance that by always answering calls quickly when I'm on, always working patients in when I'm in clinic (almost always), and almost never being behind in workflow. But this is a job. Do not bother me when someone else is taking call. That's why we have a call schedule.

 

[LucidSplash]

I think I’m somewhere in the middle. I also worked before going back to school and considered pursuing graduate work in biomedical sciences/toxicology (I worked for a contract research company that did preclinical testing for new drug candidates) rather than med school. To me THAT was a pure job. I was salaried but generally 9-5 with a a flexible schedule. I would put in some extra hours when I had a report deadline or the client came to visit but otherwise it wasn’t like there were any kind of responsibilities after hours or the same kind of pressures in my job as a surgeon.

There’s far more BS detailing with patients than there was with even the most demanding clients in my former job. Other issues can be comparable to other careers. For surgery anyway, I think you have to really want to do THIS specifically to get enough personal satisfaction out of helping patients in this specific way to make up for some of the less savory and enjoyable parts of the career. I can’t speak for other specialties because I only have experience with mine.

That being said, I don’t see myself as a missionary or anything now. There is a level of compensation below which I would not do this. A level of demand on my personal life above which I would find another job, but I accept there is a difference in the demand I accept a surgeon that I would not in my former career.

I don’t know that there is “one right way” to view your career as a physician. There are enough practice models that most people can find something that works for them.

But I do think one needs to accept that life during TRAINING will not at all resemble the lives of your friends who are not in medicine. I think to change that you’d need everyone be willing to double the amount of time you’d spend as a resident/fellow. But it is a means to an end and I think most of us would actually not take a longer path even if it was less demanding on our personal lives. Maybe that is my surgeon bias, people in FM might feel differently but I don’t know.

 

[HighPriest]

Training has very little to do with post-residency/fellowship life. I agree with you, I value my personal time but there are definitely parts of my life that I give up simply because I'm a physician, even if I view it as a job. I have to do CME. I have to take call. I have to stay late sometimes to take care of patients. Even if I try to split as soon as the work is done, it's not 9-5. So it's a job, but it's a job with responsibility. I just have no feeling of responsibility to make myself entirely available at all times. Burnout lies that way.

I think part of that is world view. The boomer generation by and large are defined by their jobs. My generation and the millennials just...aren't. I also think that its because medicine has changed in the last 40 years. People used to do it for 1)money, 2)respect, 3)prestige, and 4)the intellectual challenges. Maybe not in that order, but those were the perks.

Today, the money is still very good, but it's much harder to obtain than it used to be. My partners definitely didn't start out their careers seeing 40 patients/day. Respect is still there, but lets be honest, in a world where everyone with google thinks they're a medical expert the respect is not as good. Same with prestige. I'd say 50% of the time people are impressed you're a doctor, and 50% of the time they think you're just a money hungry charlatan (which is ironic because, again, the money isn't as easy as it used to be). The intellectual stimulation is still there. if anything it's significantly more challenging. The amount you have to know now to finish an ENT residency is way, way more than what you needed 30 years ago. Just no question about that. My senior partners don't take re-certification exams either. And now you have the fairly significant counterbalances of a more litigious society, a mountain of paperwork or worse - hunt and peck EMRs, - WebMD to contend with, insane insurance plans, etc., etc. I don't think you'll see a generation who lives for their careers again. Maybe just individuals who do so. Insane, soon-to-be on SSRI individuals.