When did you see the writing on the wall? I ask, because I recall you being one of the ones pushing back, when I was saying some of the things you're saying, a decade ago. What changed your mind?
I starting getting out of the game 5 yrs ago, completely out 2 yrs ago. I will say my EM history was blessed.
1. Started EM 20 yrs ago when Docs had control, nurse admin would take into consideration our opinions. Docs could do not wrong and it was almost impossible to fire an EM doc. I can tell you stories that will shock some with how hard it was to get rid of an EM doc. The docs owned our own group, made our own decisions, told admin what was best and listened most of the time. 7 yrs ago we were "forced" to be bought out.
2. Obama care hit. Everyone sees the obvious impacts but do not see the subtle metric impacts/rules/EMRs/carrier restraints, etc
3. Things started to go downhill after the buy out and we became a widget. I stayed for 2 yrs b/c of our buyout agreement but I could see the righting on the wall after the buy out. I was the department chief and knew crap that most never see. I soon left after the buy out.
4. Endured 2 yrs as a line doc and jumped ship right at yr 2 and switched to Locums along with investing in FSERs.
5. Locums was great 5 yrs ago b/c there was a great shortage of EM docs. As a locums I ignored all metrics, never went to any mtgs, picked the shifts I wanted to work, Got paid 375-500/hr. It was actually a great experience b/c I just practiced medicine and ignored all of the other metrics crap that the full timers had to deal with. They were hiring such crappy docs and I was essentially untouchable b/c I was a strong clinician.
6. Locums went to the crapper 2 yrs ago and no way was I going to pick up shifts for $275/hr even as a part timer. Switched fully to FSERs.
7. I now have probably the best EM job in the world. I get paid many times more/hr than line docs, in some months it is almost obscene. I am an owner, make whatever medical decisions I want, have no metrics, no admin to worry about, see 1 pph at the most efficient environment you will ever work in, taking care of mostly compliant/educated/healthy pts that actually care about their health. I can't remember the last time I saw poorly controlled diabetic with renal failure/chf/neuropathy who had no clue what meds they were on. Image a work place where you can do a PE full workup, CP eval, Abd pain eval with CT under 60 min. Pt checks in, I see them @ 5 min, orders placed, blood drawn already, labs completed @20 min, CT completed @30min, and report back @40min.
EM was still great until about 2 yrs ago. I still think its a good field and makes good money. New docs wont care b/c that is what they are used to. Older docs are who have the most complaints.
