Income, benefits, compensation thread

[JacobMcCandles]

Is it if they are making $275+/hr? Is 15 days/month (12 hrs) soul crushing in EM?

Soul crushing AND unsustainable.

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[JacobMcCandles]

Sorry this may be incorrect math on my part but does this mean if you worked 40hr a week youd gross like $544,000?

EM doesn’t work like other fields. Few people are going to be able to sustain a 40 hour week average. I say average because nobody in EM works 40 hours every week.

 

[FormerNFLQB]

EM doesn’t work like other fields. Few people are going to be able to sustain a 40 hour week average. I say average because nobody in EM works 40 hours every week.

But the math was correct? Sorry for the stupid questions.

EM keeps coming up on my list of specialties I am considering but everyone on this forum and even some of my mentors in the field have said to stay away from it.

My predicament is that I feel IM is going to deal with some of the same bullcrap going on in EM and there has been less acuity on my IM rotation. I enjoy thinking on my feet and the few cases of actual emergent cases that came into the ER during my 5 years as a scribe.

I guess a main concern I have is the salary tanking due to the scope creep etc.

 

[cyanide12345678]

Sorry this may be incorrect math on my part but does this mean if you worked 40hr a week youd gross like $544,000?

Nope.

Full time is 13 x 12 hr monthly shifts.

So 375k from hourly. Plus 50k annual bonus for full time (i thought it was 40k but i was off). So 4 x 12.5k quarterly payments.

Gross = 425k

Kind of getting an extra 25k/yr for the next 3 years because they are incredibly low staffed and are attempting to retain people.

So limited time gross = 450k if i worked 1872 annual hours.

Plus cme, and the usual w2 benefits.

 

[FormerNFLQB]

Nope.

Full time is 13 x 12 hr monthly shifts.

So 375k from hourly. Plus 50k annual bonus for full time (i thought it was 40k but i was off). So 4 x 12.5k quarterly payments.

Gross = 425k

Kind of getting an extra 25k/yr for the next 3 years because they are incredibly low staffed and are attempting to retain people.

So limited time gross = 450k if i worked 1872 annual hours.

Plus cme, and the usual w2 benefits.

Ahhh that’s where I got messed up, I assumed you were getting $40k quarterly (I was kinda in shock lol).

That makes more sense. Thank you!

 

[cyanide12345678]

Wouldn't go that far. I'd rather work a 12 seeing 1.2 pph then a 8-10hr shift seeing 2+ pph. Plus I get more days off working 12s.

Yes. I’m credentialed at 3 sites. One place is 1.8-2 pph, very high acuity and ~ 40 ish percent admission rate. 8 hour shifts

And then my two rural 1.1 pph sites. 12 or 24 hour shifts. One of them closes soon. But i have a very very strong preference for the rural site. Both literally pay the same too. I don’t know why anyone would see more patients for the same pay.

 

[FormerNFLQB]

Nope.

Full time is 13 x 12 hr monthly shifts.

So 375k from hourly. Plus 50k annual bonus for full time (i thought it was 40k but i was off). So 4 x 12.5k quarterly payments.

Gross = 425k

Kind of getting an extra 25k/yr for the next 3 years because they are incredibly low staffed and are attempting to retain people.

So limited time gross = 450k if i worked 1872 annual hours.

Plus cme, and the usual w2 benefits.

Do you feel you could work more at another facility during the other 2 weeks you have off or another side gig if you wanted?

 

[cyanide12345678]

Do you feel you could work more at another facility during the other 2 weeks you have off or another side gig if you wanted?

Lol spoken like a med student.

NO.

I’m going part time starting October to 10 shifts per month. Taking roughly a 90k pay cut.

So no I’m not interested in working on my days off. Absolutely not. I don’t ‘love’ work. There are better things in my life than work.

 

[cyanide12345678]

Do you feel you could work more at another facility during the other 2 weeks you have off or another side gig if you wanted?

If your motivation for EM is how much money you’ll make, then pick orthopedic surgery, dermatology, anesthesiology, ophthalmology, ent, or urology.

 

[FormerNFLQB]

Lol spoken like a med student.

NO.

I’m going part time starting October to 10 shifts per month. Taking roughly a 90k pay cut.

So no I’m not interested in working on my days off. Absolutely not. I don’t ‘love’ work. There are better things in my life than work.

Haha. Thank you!

 

[FormerNFLQB]

If your motivation for EM is how much money you’ll make, then pick orthopedic surgery, dermatology, anesthesiology, ophthalmology, ent, or urology.

No, the amount of money isn’t the draw towards EM. It’s the once in a while actual emergencies that you can actually make a difference and save a life.

 

[cyanide12345678]

No, the amount of money isn’t the draw towards EM. It’s the once in a while actual emergencies that you can actually make a difference and save a life.

True emergencies are surprisingly rare in emergency medicine

 

[FormerNFLQB]

True emergencies are surprisingly rare in emergency medicine

Oh I know. I think out of my 5 years we had less than 10 actual emergencies.

 

[FormerNFLQB]

True emergencies are surprisingly rare in emergency medicine

I feel like they’ve been ever rarer on IM service though 😂

 

[bravotwozero]

Oh I know. I think out of my 5 years we had less than 10 actual emergencies.

If acuity is your thing, you’re much better off doing critical care…

 

[FormerNFLQB]

If acuity is your thing, you’re much better off doing critical care…

I’m doing an elective in it but from talking to the CCM doc at my facility he just manages vents all day and is the surgeons servant.

 

[JacobMcCandles]

Plan on full time being more in the 1500-1600 hours per year range.

 

[RustedFox]

Do you feel you could work more at another facility during the other 2 weeks you have off or another side gig if you wanted?

I can answer that for him.
Jesus, man. No.
You have zero bandwidth left for much of anything.

 

[FormerNFLQB]

I can answer that for him.
Jesus, man. No.
You have zero bandwidth left for much of anything.

Seems to be the same consensus with my mentors in the field. Was just curious haha

 

[BoardingDoc]

I feel like they’ve been ever rarer on IM service though 😂

Figure out what the day to day job is for any field you're interested in and see if you like that. Utterly ignore the cool 5% that any field does, as that crap doesn't happen day to day.

Do you hate handing out B Blockers? Don't go into cards.
Do you hate giving vaccines and treating URIs with overly anxious parents? Don't go into peds.
Do you hate dealing with chronic non emergencies presented by the bottom 10% of humanity? Don't go into EM.
Etc etc.

 

[FormerNFLQB]

Figure out what the day to day job is for any field you're interested in and see if you like that. Utterly ignore the cool 5% that any field does, as that crap doesn't happen day to day.

Do you hate handing out B Blockers? Don't go into cards.
Do you hate giving vaccines and treating URIs with overly anxious parents? Don't go into peds.
Do you hate dealing with chronic non emergencies presented by the bottom 10% of humanity? Don't go into EM.
Etc etc.

Noted, I just feel the same "Meh" patients the ED gets the Hospitalists see as well. I like the bread and butter so far of IM just wish there was more acuity in it. Who knows. Thank you to everyone who responded to me. I didnt mean to turn this post into something it wasnt intended for.

 

[emergentmd]

Any amount of 12 hour shifts in the ED is soul-crushing.

I have only done about 10, 12 hr shifts my whole career and they are soul crushing.

Doing back to back is a bear. 10 hrs is my max, 7 hrs are the best.

 

[emergentmd]

My predicament is that I feel IM is going to deal with some of the same bullcrap going on in EM and there has been less acuity on my IM rotation. I enjoy thinking on my feet and the few cases of actual emergent cases that came into the ER during my 5 years as a scribe.

Outpt IM/hospitalists is more soul crushing than EM. Disagree, but there are more hospitalist zombies than any other hospital specialty.

But to your question, makin 500K/yr as an EM doc is not difficult.

I know of a job around the Houston area that pays 350/hr and still can't fill spots. If you can do 40hr/wk x 52 then you are at 725k/yr. They do bonuses too. Get close to a million if you do part time and them pick up all the bonus shifts.

BTW, are you guys seeing sign on bonuses? This was all but no existent but now seems like the level of desperation is back to an all time high. One cold call stated 100k sign on bonus but alas, they could not even come close to my step back into the hospital rate.

 

[FormerNFLQB]

Outpt IM/hospitalists is more soul crushing than EM. Disagree, but there are more hospitalist zombies than any other hospital specialty.

But to your question, makin 500K/yr as an EM doc is not difficult.

I know of a job around the Houston area that pays 350/hr and still can't fill spots. If you can do 40hr/wk x 52 then you are at 725k/yr. They do bonuses too. Get close to a million if you do part time and them pick up all the bonus shifts.

Yea, thats the consensus I have seen on IM. No one seems thrilled with their job. There is a privately owned group that I scribed for that the CEO is a very close friend who has already told me they would hire me post graduation (not counting eggs before they hatch).

I dont know that I want my quality of life to be terrible just to make a boat load lol.

 

[emergentmd]

Yea, thats the consensus I have seen on IM. No one seems thrilled with their job. There is a privately owned group that I scribed for that the CEO is a very close friend who has already told me they would hire me post graduation (not counting eggs before they hatch).

I dont know that I want my quality of life to be terrible just to make a boat load lol.

I have been out of the pit for about 5 yrs. I worked in a functional hospital, probably a top tier functional hospital. Even with this, the happiest hospital specialty was EM compared to the on call docs.

Hospitalist, GS, OB were all miserable b/c they had to come to the hospital. The ones that can tag IM over the phone were overall pleasant which is obvious b/c its a phone call then back to their lives. These other schmucks who had to drop everything and come in a 11p-5am, were all miserable.
The level of unhappiness was by far the hospitalists. They were always busy. From 7pm, they were single coverage for the whole hospital. I remember starting my consult off by saying, "sorry man, but I have another", knowing they are already 5 behind.

 

[FormerNFLQB]

I have been out of the pit for about 5 yrs. I worked in a functional hospital, probably a top tier functional hospital. Even with this, the happiest hospital specialty was EM compared to the on call docs.

Hospitalist, GS, OB were all miserable b/c they had to come to the hospital. The ones that can tag IM over the phone were overall pleasant which is obvious b/c its a phone call then back to their lives. These other schmucks who had to drop everything and come in a 11p-5am, were all miserable.
The level of unhappiness was by far the hospitalists. They were always busy. From 7pm, they were single coverage for the whole hospital. I remember starting my consult off by saying, "sorry man, but I have another", knowing they are already 5 behind.

Yea I am between a few (GS, Neuro, IM, and EM) and will narrow it down in the next few months. The doom and gloom of EM has it as the last on my list though LOL.

 

[Splenda88]

I have been out of the pit for about 5 yrs. I worked in a functional hospital, probably a top tier functional hospital. Even with this, the happiest hospital specialty was EM compared to the on call docs.

Hospitalist, GS, OB were all miserable b/c they had to come to the hospital. The ones that can tag IM over the phone were overall pleasant which is obvious b/c its a phone call then back to their lives. These other schmucks who had to drop everything and come in a 11p-5am, were all miserable.
The level of unhappiness was by far the hospitalists. They were always busy. From 7pm, they were single coverage for the whole hospital. I remember starting my consult off by saying, "sorry man, but I have another", knowing they are already 5 behind.

Interesting.

I am a hospitalist and on my week, there are 3 hospitalists that think hospital medicine is better than even sliced bread.Their attitude is that "chest pain" call card; GI bleed, call GI. Patient is going bad, dump him/her into the intensivist lap..

For the most part, the people I work with like hospital medicine. Two of them even went as far to say they are overpaid (350k) for what they do. These two guys are quick and usually done by 1-2pm and spend the rest of their time on the computer watching the stock market.

 

[FormerNFLQB]

Interesting.

I am a hospitalist and on my week, there are 3 hospitalists that think hospital medicine is better than even sliced bread.Their attitude is that "chest pain" call card; GI bleed, call GI. Patient is going bad, dump him/her into the intensivist lap..

For the most part, the people I work with like hospital medicine. Two of them even went as far to say they are overpaid (350k) for what they do. These two guys are quick and usually done by 1-2pm and spend the rest of their time on the computer watching the stock market.

I’ve noticed this and it’s why I am considering IM. Literally the shift is from 7a-7p the attending gets there at 8 and leaves by 2.

Another reason IM is higher than EM is the option to do a fellowship to become a specialist.

 

[Splenda88]

I’ve noticed this and it’s why I am considering IM. Literally the shift is from 7a-7p the attending gets there at 8 and leaves by 2.

Another reason IM is higher than EM is the option to do a fellowship to become a specialist.

When it comes to lifestyle, I think hospital medicine (HM) is great. We have a guy who just transitioned from outpatient M-F to HM after doing outpatient for 4-5 years. He keeps saying every day what took him so long.

 

[FormerNFLQB]

When it comes to lifestyle, I think hospital medicine (HM) is great. We have a guy who just transitioned from outpatient M-F to HM after doing outpatient for 4-5 years. He keeps saying every day what took him so long.

Yea one of my preceptors does week on week off and has a side gig where he does 3 hours of work on his off week an makes an extra $50,000 lol.

I like the lifestyle but I dont know if I would be okay with the acuity of patients. My preceptor said that sometimes they feel like the grunt of the hospital. So thats something I have to see.

 

[RustedFox]

Yea one of my preceptors does week on week off and has a side gig where he does 3 hours of work on his off week an makes an extra $50,000 lol.

I like the lifestyle but I dont know if I would be okay with the acuity of patients. My preceptor said that sometimes they feel like the grunt of the hospital. So thats something I have to see.

What's funny is that here I am, wishing I got the complexity of IM.

Acuity is cool at first, yeah. It gets very easy, very fast.

It also gets very boring. And very frustrating.

 

[FormerNFLQB]

What's funny is that here I am, wishing I got the complexity of IM.

Acuity is cool at first, yeah. It gets very easy, very fast.

I think high acuity just fits my personality well. I am very calm and collected in high stress situations. I know there can be those in many specialties though. My naiveness is glaring the further this conversation goes on and I am well aware of that lol.

 

[cyanide12345678]

I think high acuity just fits my personality well. I am very calm and collected in high stress situations. I know there can be those in many specialties though. My naiveness is glaring the further this conversation goes on and I am well aware of that lol.

Do IM. More flexibility.

Can just be a hospitality. Can further specialize into better specialties (gi, cards, oncology etc).

Can always have a chill life and do outpatient clinic as well.

Much more flexibility. EM has no flexibility. You are pretty much a pit doc unless you do a fellowship to get out, and most fellowships then make less than what a hospitalist makes except pain fellowship.

IM is a better choice. It just took me too many years to recognize that.

 

[RustedFox]

I think high acuity just fits my personality well. I am very calm and collected in high stress situations. I know there can be those in many specialties though. My naiveness is glaring the further this conversation goes on and I am well aware of that lol.

Hey, at least you're mature enough to admit: "maybe dozens of EM attendings with collectively hundreds of years of experience may know something that I don't", instead of the usual response of "you guys are ALL wrong, I'm different, you're all just burned out and can't handle it" that we so commonly get on here.

 

[FormerNFLQB]

Do IM. More flexibility.

Can just be a hospitality. Can further specialize into better specialties (gi, cards, oncology etc).

Can always have a chill life and do outpatient clinic as well.

Much more flexibility. EM has no flexibility. You are pretty much a pit doc unless you do a fellowship to get out, and most fellowships then make less than what a hospitalist makes except pain fellowship.

IM is a better choice. It just took me too many years to recognize that.

I appreciate the advice! I am thinking that is the way I am going to lean!

 

[Splenda88]

Hey, at least you're mature enough to admit: "maybe dozens of EM attendings with collectively hundreds of years of experience may know something that I don't", instead of the usual response of "you guys are ALL wrong, Im just different, you're burned out and can't handle it" that we so commonly get on here.

The issue with medicine is that most people who go into medicine did not see it as a job until reality hits them in the face.

I am not ashamed to say that I went into medicine primarily for financial security. For some strange reason, I just happen to like hospital medicine. Maybe it's because of 350k/yr and the 7days on/off working form 7:15 am to ~5pm (on average). Lol

 

[RustedFox]

The issue with medicine is that most people who go into medicine did not see it as a job until reality hits them in the face.

I am not ashamed to say that I went into medicine primarily for financial security. For some strange reason, I just happen to like hospital medicine. Maybe it's because of 350k/yr and the 7days on/off working form 7:15 am to ~5pm (on average). Lol

Here's what broke me:

You take a highly intelligent, highly functional, highly adaptable person and you put them in an environment where literally everyone is trying to get them to do the wrong thing, AND no matter what they do, they see that they can never overcome the gross incompetence of the patient themselves, AND you are RESPONSIBLE for their complete ineptitude... and your only choices are suffer the moral injury, or leave.

 

[FormerNFLQB]

Hey, at least you're mature enough to admit: "maybe dozens of EM attendings with collectively hundreds of years of experience may know something that I don't", instead of the usual response of "you guys are ALL wrong, Im just different, you're burned out and can't handle it" that we so commonly get on here.

Yea, a lot of people fail to realize the knowledge that can be had if you shut up and take in the knowledge that others are so willing to give.

 

[RustedFox]

Yea, a lot of people fail to realize the knowledge that can be had if you shut up and take in the knowledge that others are so willing to give.

Read the thread on my last lawsuit and ask yourself if you want to do EM.

 

[cyanide12345678]

I am not ashamed to say that I went into medicine primarily for financial security. For some strange reason, I just happen to like hospital medicine. Maybe it's because of 350k/yr and the 7days on/off working form 7:15 am to ~5pm (on average). Lol

I’m going to second that. I went into medicine because of financial security. And if you grow up in a Pakistani household, either you are a doctor or an engineer, otherwise you are a disappointment 🤣

Emergency medicine 3 year residency seemed like an attractive choice, highest paying 3 year specialty with the most number of days off. I didn’t think i would burn out like everyone else. I thought id be the exception - i mean i moved here with 2 suitcases as an immigrant for college. I’ve seen some rough days when i moved. Survived on ramen noodles and no money in college. I shouldn’t be burned out!!! My life is incredible compared to what it was 10-15 years ago. But for whatever reason that i cannot fully understand, I’m burned out.

Would i be happier in some other specialty? I don’t know.

 

[RustedFox]

The issue with medicine is that most people who go into medicine did not see it as a job until reality hits them in the face.

I am not ashamed to say that I went into medicine primarily for financial security. For some strange reason, I just happen to like hospital medicine. Maybe it's because of 350k/yr and the 7days on/off working form 7:15 am to ~5pm (on average). Lol

Yeah, I went into medicine for two reasons (1) "this is noble and good work", and (2) financial security. I could have just as easily been a [whatever], but it was the "noble calling" that got me.

I have learned that humans, by and large, have a really funny way of not showing any respect or appreciation when it is certainly merited; not so much thru their words, but by their deeds.

 

[GatorCHOMPions]

I’m going to second that. I went into medicine because of financial security. And if you grow up in a Pakistani household, either you are a doctor or an engineer, otherwise you are a disappointment 🤣

Emergency medicine 3 year residency seemed like an attractive choice, highest paying 3 year specialty with the most number of days off. I didn’t think i would burn out like everyone else. I thought id be the exception - i mean i moved here with 2 suitcases as an immigrant for college. I’ve seen some rough days when i moved. Survived on ramen noodles and no money in college. I shouldn’t be burned out!!! My life is incredible compared to what it was 10-15 years ago. But for whatever reason that i cannot fully understand, I’m burned out.

Would i be happier in some other specialty? I don’t know.

Your rhetorical question is what I think might be a key discussion point for EM burnout. Is it the the specialty, the person, or both? My hunch is it’s a little of both, probably something like a 70-30 split in favor of the specialty. But I think an argument can be made that a lot of the EM burnouts would be burned out in many if not all the specialties for one reason or another.

 

[emergentmd]

But I think an argument can be made that a lot of the EM burnouts would be burned out in many if not all the specialties for one reason or another.

Some people are born happy, some not. I know roofers, construction workers, cafeteria workers who are truly happy even working in the heat. They have what they need, they deal with what they have not, they have their health/family. There are docs making 5x what these people make, working in AC places, with more time off than they can imagine, but still not satisfied.

Find what is missing, and typically it is not related to work.

 

[cyanide12345678]

Your rhetorical question is what I think might be a key discussion point for EM burnout. Is it the the specialty, the person, or both? My hunch is it’s a little of both, probably something like a 70-30 split in favor of the specialty. But I think an argument can be made that a lot of the EM burnouts would be burned out in many if not all the specialties for one reason or another.

Here’s my hunch of why i believe I’m burned out.

I worked really really hard in college. Everyone else was partying, having fun, i was working full time, volunteering on top of that, building that resume for med school admission. Just grinding away for a ‘goal’. The desire to become a doctor and get into med school. It was a lot of sacrifice.

Then i got to med school. Kept grinding away. Top 1 percent board scores. Top quartile of UTSW. Basically just grinded and got all As in med school. It was all for a huge goal of becoming a doctor.

Then obviously residency happened - we all grind our lives away in residency.

And then i became a doctor. I spent a decade to get here, sacrificed so much, but what did it really get me? Over a decade of work, and what did i get in the end? Disrespectful patients? Soul crushing encounters? Circadian disruptions? Long drives where im struggling to stay awake? Long shifts where i dont see my child on the days i work?

I believe there was a lot of mismatch between expectation and reality. My younger self imagined this to be some holy grail career that i worked for a long time. But in the end, it just turned out to be just another job and my decade long expectations weren’t met. So…another hypothetical question i ask my self….was it worth me wasting away my 20s? I don’t know.

 

[DocEspana]

Any amount of 12 hour shifts in the ED is soul-crushing.

disagree.

Give me *full* days on and *full* days off every time and dont eat up my whole week with shifts that are too long for me to enjoy the rest of my day but still shorter than they could be. If I'm in for a penny, I'm in for a pound. If i can't spend my whole day doing what I want, let me make all the money I can and work as many hours as they will let me at once.

 

[DocEspana]

EM doesn’t work like other fields. Few people are going to be able to sustain a 40 hour week average. I say average because nobody in EM works 40 hours every week.

I mean.... I have worked 48 hours a week for the last 6 years (and was above that for a chunk of peak covid). And I'm not the only one.

I know it sounds like humblebragging and its hard to get intent online. I'm just saying it because I think we are maybe a bit *too* gloom and doom on SDN and we forget that people do exist who enjoy doing this and haven't burned out yet. And I'm not the only one (though I do know we are a minority. we aren't a *rare* minority)

edit: technically >48 hours a week for the last 10 years, since I was obviously doing that much (and more) in residency too.

 

[JacobMcCandles]

I mean.... I have worked 48 hours a week for the last 6 years (and was above that for a chunk of peak covid). And I'm not the only one.

I know it sounds like humblebragging and its hard to get intent online. I'm just saying it because I think we are maybe a bit *too* gloom and doom on SDN and we forget that people do exist who enjoy doing this and haven't burned out yet. And I'm not the only one (though I do know we are a minority. we aren't a *rare* minority)

edit: technically >48 hours a week for the last 10 years, since I was obviously doing that much (and more) in residency too.

>48 hours every week (as in you haven't taken any vacations longer than 3 days for a calendar week?) or averaged 48 hours every week? There's a difference but you'll also be in the vast minority so it's important to point that out for those lurking.

 

[CoolDoc1729]

disagree.

Give me *full* days on and *full* days off every time and dont eat up my whole week with shifts that are too long for me to enjoy the rest of my day but still shorter than they could be. If I'm in for a penny, I'm in for a pound. If i can't spend my whole day doing what I want, let me make all the money I can and work as many hours as they will let me at once.

To add another perspective … I didn’t mind 12’s either before I had kids. But now there isn’t enough time in a day for me to spend time with my family and also do the housekeeping things I need to do (I don’t mean literal housekeeping, but like .. making sure all the papers and lunches make it to school, stop to buy milk on the way home, etc).. if I work a 12 I either am away from home ALL DAY except for half an hour before bed, or I can’t be home for dinner and bedtime.

Also, approaching 40 I’m starting to feel noticeably less sharp around hour 11.

 

[FormerNFLQB]

To add another perspective … I didn’t mind 12’s either before I had kids. But now there isn’t enough time in a day for me to spend time with my family and also do the housekeeping things I need to do (I don’t mean literal housekeeping, but like .. making sure all the papers and lunches make it to school, stop to buy milk on the way home, etc).. if I work a 12 I either am away from home ALL DAY except for half an hour before bed, or I can’t be home for dinner and bedtime.

Also, approaching 40 I’m starting to feel noticeably less sharp around hour 11.

That is something I am taking into consideration is the fact that I already have a 4 year old child. Originally I wanted to do a highly competitive surgical specialty but figured spending time with my child has now become my dream, so I just want to find something I enjoy and can support my family and parents while feeling like I’m fulfilled

 

[doctalaughs]

Yea I am between a few (GS, Neuro, IM, and EM) and will narrow it down in the next few months. The doom and gloom of EM has it as the last on my list though LOL.

Do derm. I know - about the lowest “acuity” specialty that exists - but think carefully about if you actually love the “acuity” or the “satisfaction of a concrete win.” I find great satisfaction in the ~5-10 skin cancers I definitively treat each day and the ~1 melanoma I find every 1-2 weeks where I know it really impacted their health (and they are extremely greatful). Yes- some boring stuff too like every other specialty - but skin cancer falls in the “bread and butter” >25% routine that is very treatable and keeps me going. And it doesn’t hurt no nights, weekends, holidays or hours after 4pm.

I have GREAT respect for EM doctors - and sometimes wish I had the skillset to treat any undifferentiated presentation. I definitely considered it when I was a med student. But what is satisfying in your 20s/30s and without a family is 180 degrees different than your late 40s and 50s, in my own experience. I used to pull all-nighters all the time with no problem; now I’m wrecked if I get 5 hours instead of 8!