Why is reddit so full of rainbows and butterflies regarding EM?

[Anesthesia_Guy]

Because the more of us that speak out, the more we can effect the choices of those to come after us.

Duh.

That moves the needle.

McCandless isn't some boomer jackass and actually thinks about the future.

*affect

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[AlvinKamara]

Answering original question:

1. Inexperience. Most of these ppl are young
2. Male skew. Ask a woman with young kids how her early em career is going.
3. Young, single skew. Most people with young families don’t have time to
4. Cope. It’s hard to come to terms with a bad decision
5. Lack of better options: there are two types of em resident. The one who could have done ortho, ent, radiology but chose EM. These are the residents at top em programs. Then there are the residents who didn’t do well on steps or hail from bad med schools whose only realistic options were em, peds, IM, fm, path. If you’re in the latter group, em seems like a decent decision when weighed against those alternatives. The guy that chose em over radiology is probably having a lot more regrets.

 

[RustedFox]

What if you're like Christopher Multasanti and the "regularness of life is too hard" and you need something in the ER to keep you in check and make you feel alive.

Tongue and cheek comment, recently saw the sopranos, and thinking about EM as something I want to pursue. Yeah, roast me about how I thinking about making a poor life choice.

View attachment 376132

Unclear on what any of this means.

 

[cyanide12345678]

Answering original question:

1. Inexperience. Most of these ppl are young
2. Male skew. Ask a woman with young kids how her early em career is going.
3. Young, single skew. Most people with young families don’t have time to
4. Cope. It’s hard to come to terms with a bad decision
5. Lack of better options: there are two types of em resident. The one who could have done ortho, ent, radiology but chose EM. These are the residents at top em programs. Then there are the residents who didn’t do well on steps or hail from bad med schools whose only realistic options were em, peds, IM, fm, path. If you’re in the latter group, em seems like a decent decision when weighed against those alternatives. The guy that chose em over radiology is probably having a lot more regrets.

I swear no. 5 is my life. So much regret about not picking something better when i could have had.

 

[emergentmd]

If you’re in the latter group, em seems like a decent decision when weighed against those alternatives. The guy that chose em over radiology is probably having a lot more regrets.

I chose EM over radiology/Anesthesiology and have no regrets given my path/lifestyle. The thoughts of doing a 5 yr residency plus 1+ fellowship was a hard pill to swallow. Plus sitting in a dark room for 8 hrs and just looking at film seems miserable for me unless I did interventional. Radiology makes great money but talk about being on a hamster wheel.

 

[BoardingDoc]

I chose EM over radiology/Anesthesiology and have no regrets given my path/lifestyle. The thoughts of doing a 5 yr residency plus 1+ fellowship was a hard pill to swallow. Plus sitting in a dark room for 8 hrs and just looking at film seems miserable for me unless I did interventional. Radiology makes great money but talk about being on a hamster wheel.

I'm curious as to whether you'd have the same opinion were you still an average pit doc. You took steps to escape what most of us on here think of as EM. I suspect most of the posters here feel very much like they're on the hamster wheel you speak of.

 

[ScepticSkeksis]

Interesting perspective. As I said I enjoy work. That being said if the money dried up I’m out. If a cmg took over I’m also out.

Imo working for a cmg or low pay (my definition) would lead to tremendous unhappiness at work.

Maybe I’m wrong and cmg land won’t be that bad I don’t want to hate it before I leave.

I’ve also never seen a cmg posted job and been like man that money looks good. Closest I have ever seen was a recent locums offer I got 275/hr. 24s fairly local to me and 13 patients a day.

I still said Nfw. The money isn’t great obviously but for the unit of work it’s not bad. I could Go there and do a bunch of other work there but I still couldn’t justify it to myself.

Working for a CMG isn't bad if the pay is decent. The key to survival is to do the minimum (see other thread). Stop picking up patients 1-2 hours before the end of your shift, don't stay late, don't do extra procedures/evaluations upstairs, don't attend hospital meetings.

 

[EctopicFetus]

I'm curious as to whether you'd have the same opinion were you still an average pit doc. You took steps to escape what most of us on here think of as EM. I suspect most of the posters here feel very much like they're on the hamster wheel you speak of.

It’s why it’s important to work to FI ASAP.

What I’ve learned from talking to my residents and reflecting on my own thoughts when I was younger is that it always seems easier when someone else did it.

If we focus on the results we miss the story and the path and the risks that were taken.

I remember in my old group guys talking about how the hospital would pay their billed charges so they didn’t have to deal with insurance and how they made more money in the 90s than at that time and work was easier etc.

While no one is more down on the future of em than me there will be people who figure it out. There will be people who are successful.

Yes it sucks. Yes I think it was better before but frankly some em docs will do better than emergent and anyone else on this forum.

The path is clear imo. Earn a bunch, find a way to accelerate the growth of savings and repeat. Mistakes will be made, the key is that you keep trying. Eventually yoy will find a win. Don’t waste time on the failures other than learning from what went wrong.

 

[emergentmd]

I'm curious as to whether you'd have the same opinion were you still an average pit doc. You took steps to escape what most of us on here think of as EM. I suspect most of the posters here feel very much like they're on the hamster wheel you speak of

When I left full time EM 4 yrs ago, I still loved the job and could have done it for another 20 yrs. Things have changed a lot since I got out; before it got bad esp with covid. To say I was fortunate is an understatement.

So to answer your question, I did not regret the decision when I left hospital EM but the answer could be diff if I went through Covid. With that said, I am generally a positive person who can take alot before being unhappy b/c I know what being very poor was. Nothing I could have went through as a doctor would been anything close to what my parents went through.

 

[emergentmd]

Working for a CMG isn't bad if the pay is decent. The key to survival is to do the minimum (see other thread). Stop picking up patients 1-2 hours before the end of your shift, don't stay late, don't do extra procedures/evaluations upstairs, don't attend hospital meetings.

Alot of truth to this. I always left my shift right when new guy came and did the minimum. I got hyper efficient at work and felt like I worked 25% less but saw 25% more than my partners.

 

[odyssey2]

I swear no. 5 is my life. So much regret about not picking something better when i could have had.

Out of curiosity, what would you have picked instead if you could go back in time?

 

[cyanide12345678]

Out of curiosity, what would you have picked instead if you could go back in time?

Pm&r vs psych vs anesthesiology vs urology

Radiology is too damn boring but those who can do it, great for them.

My resume was set up for urology with 3 first author publications in the specialty. Though i would probably make a terrible surgeon because i lack attention to detail and get really bored of repetitive tasks. At least if i ever have to suture anything in ER, I’m very very annoyed of it lol

 

[GonnaBeADoc2222]

Pm&r vs psych vs anesthesiology vs urology

Radiology is too damn boring but those who can do it, great for them.

My resume was set up for urology with 3 first author publications in the specialty. Though i would probably make a terrible surgeon because i lack attention to detail and get really bored of repetitive tasks. At least if i ever have to store anything in ER, I’m very very annoyed of it lol

Ask the Uro guys you know about the CMS cuts they took the past 5 yrs.

Also, it's a brutal residency

 

[bravotwozero]

They’re still doing quite well for themselves.

 

[TrailRun]

Pm&r vs psych vs anesthesiology vs urology

Radiology is too damn boring but those who can do it, great for them.

My resume was set up for urology with 3 first author publications in the specialty. Though i would probably make a terrible surgeon because i lack attention to detail and get really bored of repetitive tasks. At least if i ever have to store anything in ER, I’m very very annoyed of it lol

When I graduated, psych paid among the least in medicine, had no idea what PM&R was, anesthesia had all the worries of encroachment…. things sure do change. I think I would’ve chosen something that allows for practice in two different environments (ie family, peds, or IM could all be hospitalists or outpt, although peds gets to do a fellowship for it). Even anesthesia can do legit OR Vs easy outpt stuff like basic sedation for
IVF retrieval

 

[cyanide12345678]

Ask the Uro guys you know about the CMS cuts they took the past 5 yrs.

Also, it's a brutal residency

What about the 100 percent increase in residency positions in EM in the last 7 years?

Urology protects its supply of physicians and are still doing very well, especially if you just do procedures like turp instead of very time consuming robotic cases. A urologist who was on the white coat investor as a guest for making 1-1.2M a year, he happened to be my local urologist in northwest ohio at my last job. He only did TURPs and stones. That’s it.

All surgical residencies are brutal, which is why I chickened out. In my words then, EM was the fastest way to become a millionaire. It did exactly that.

 

[psychemdoc]

What about the 100 percent increase in residency positions in EM in the last 7 years?

Urology protects its supply of physicians and are still doing very well, especially if you just do procedures like turp instead of very time consuming robotic cases. A urologist who was on the white coat investor as a guest for making 1-1.2M a year, he happened to be my local urologist in northwest ohio at my last job. He only did TURPs and stones. That’s it.

All surgical residencies are brutal, which is why I chickened out. In my words then, EM was the fastest way to become a millionaire. It did exactly that.

Psych and PM&R are finally getting more attention and getting more competitive but that is long over due for such stellar lifestyle specialties. Psych especially which has every possible setting and lifestyle option from shift work to hourly to round n go. Inpatient vs outpatient. I really don’t understand why it isn’t more popular. Very solid longevity. Low burnout probably due to strong locus of control. Still for the longest time only IMGs were filling a significant percentage of those spots and US MD/DOs were just not biting.

 

[Splenda88]

The contrary to your point is that SDN sometimes paint gloomy picture.

I probably would have never become a hospitalist if I trusted what were being said in SDN

 

[EctopicFetus]

What’s interesting is you can find people in all specialties that are happy and unhappy with their choice.

I think the interesting question is perception of other folks and whether or not people would encourage their kids to go into their specialty.

For example im EM by best friend is an optometrist. Both of us have had good success. Both of us wouldnt encourage our kids to do what we did.

EM is/was the right specialty for me. I enjoy my shifts, im annoyed by the hospital and their silly stuff. That being said if I could see what happened in my career and went back to med school match day i would have said this is a great ride im about to be on.

 

[GonnaBeADoc2222]

What about the 100 percent increase in residency positions in EM in the last 7 years?

Urology protects its supply of physicians and are still doing very well, especially if you just do procedures like turp instead of very time consuming robotic cases. A urologist who was on the white coat investor as a guest for making 1-1.2M a year, he happened to be my local urologist in northwest ohio at my last job. He only did TURPs and stones. That’s it.

All surgical residencies are brutal, which is why I chickened out. In my words then, EM was the fastest way to become a millionaire. It did exactly that.

Not disagreeing EM is crap, but grass isnt greener.

My buddy in academic Uro (academic I know) makes less than I do in EM, works more hours, and has an iron clad noncompete so cannot escape without uprooting this children.

A private practice uro making 1 to 2 M isn't the norm. Also no one wants to live in Ohio.

 

[BoardingDoc]

Not disagreeing EM is crap, but grass isnt greener.

My buddy in academic Uro (academic I know) makes less than I do in EM, works more hours, and has an iron clad noncompete so cannot escape without uprooting this children.

A private practice uro making 1 to 2 M isn't the norm. Also no one wants to live in Ohio.

Yep. I seriously looked at pain for a while. Went so far as to meet informally with the pain program director at my local hospital who was a friend of a friend. My takeaway from that meeting and with talking with other docs in my area is that pain is really saturated around me. As a result, I could hustle for ~2100 hrs/yr in pain and make ~50k less than I make in ~1500 hrs/yr in EM. Just didn't seem worth it, and I wasn't willing to move to an area where the numbers made more sense.

 

[JacobMcCandles]

I think it’s pretty normal for most people to not necessarily encourage their kids to go into their occupation, medicine or otherwise.

I agree with @EctopicFetus that if you let medical school me look at present me’s life then medical school me would be ecstatic. ER doc, work less than most people I know while making more, good schedule flexibility that is unmatched for being available during days I need to, pretty close to fat FIRE while less than 10 years out, opportunity to do things outside of medicine that I enjoy and make me happy, etc.

With that said, EM is underpaid as a specialty. But, for me, it’s a good fit.

 

[sloh]

Yep. I seriously looked at pain for a while. Went so far as to meet informally with the pain program director at my local hospital who was a friend of a friend. My takeaway from that meeting and with talking with other docs in my area is that pain is really saturated around me. As a result, I could hustle for ~2100 hrs/yr in pain and make ~50k less than I make in ~1500 hrs/yr in EM. Just didn't seem worth it, and I wasn't willing to move to an area where the numbers made more sense.

You made a smart decision. Pain fellowships pretty much worthless here in SoCal from a financial perspective haha.

 

[Mofasa]

Just want to add that not all "young uns" taste the rainbow/sunshine. I was only able to tolerate 2 years of abuse from EM before throwing the towel. I finished HPM fellowship and now practice full time palliative. It is not all rainbows and sunshine in the palliative world either, but I am definitely grateful every day that I got out.

 

[Prehealth1011]

Just want to add that not all "young uns" taste the rainbow/sunshine. I was only able to tolerate 2 years of abuse from EM before throwing the towel. I finished HPM fellowship and now practice full time palliative. It is not all rainbows and sunshine in the palliative world either, but I am definitely grateful every day that I got out.

Is it true there’s no inbox management to deal with? Like the outpatient IM subspecialties

 

[gutonc]

Is it true there’s no inbox management to deal with? Like the outpatient IM subspecialties

I know you didn't ask me, but outside of anesthesia and maybe straight inpatient CCM (and even then, probably not), I'm not sure there's a single medical specialty that doesn't include some amount of "inbox management".

If it makes you feel any better, in the golden olden days pre-EMR, inbox management was literally a giant pile of papers on your desk every day that you had to sort through one at a time, go pull the chart it was associated with, determine if whatever you were looking at was better/worse/same as before, then pick up an actual phone and call the patient (or referring doc) if it was worse, or call your nurse to call the patient to tell them it was better/same. Now in 3 keystrokes I can deal with 70-80% of my inbox crap. The rest gets a follow up/99215. If I can't dispatch it in a 15 second message, I'm getting paid for it.

 

[Tangerine123]

To be fair, most academic places and their faculty don’t know what community EM is like.

I'm in psych at an academic hospital, but this is true in our field too.

We have 300-ish beds in the psych department, and work basically at capacity with usually 0-2 empty beds per day. Most patients are scheduled for admission during the day by the outpatient clinic or by the ward's themselves. So some wards have waiting list of around 1 month.

Since we are always full, paramedics rarely take acute patients to us. They usually call beforehand and we refer them somewhere else. I've had a few 24 hour shifts with just 1-2 patients at our psych ER.

Most patients that come to our ER are patients that have been previously admitted at our clinic, or that are being treated by our outpatient unit. I would say, in an average 16 hour night shift we see around 3-4 patients in the psych ER. And since we are mostly full, we evaluate them and refer them to other hospitals. Depending on the case, we send them in an ambulance, escorted by the police, or in less critical cases we have print outs of how to get to the other hospitals themselves...

 

[BoardingDoc]

I'm in psych at an academic hospital, but this is true in our field too.

We have 300-ish beds in the psych department, and work basically at capacity with usually 0-2 empty beds per day. Most patients are scheduled for admission during the day by the outpatient clinic or by the ward's themselves. So some wards have waiting list of around 1 month.

Since we are always full, paramedics rarely take acute patients to us. They usually call beforehand and we refer them somewhere else. I've had a few 24 hour shifts with just 1-2 patients at our psych ER.

Most patients that come to our ER are patients that have been previously admitted at our clinic, or that are being treated by our outpatient unit. I would say, in an average 16 hour night shift we see around 3-4 patients in the psych ER. And since we are mostly full, we evaluate them and refer them to other hospitals. Depending on the case, we send them in an ambulance, escorted by the police, or in less critical cases we have print outs of how to get to the other hospitals themselves...

This sounds like how handling psych patients works in basically every ER I've ever worked in, with the exception of "EMS doesn't bring us psych patients because they know we're full." Lol, that would be nice.

 

[VA Hopeful Dr]

I know you didn't ask me, but outside of anesthesia and maybe straight inpatient CCM (and even then, probably not), I'm not sure there's a single medical specialty that doesn't include some amount of "inbox management".

If it makes you feel any better, in the golden olden days pre-EMR, inbox management was literally a giant pile of papers on your desk every day that you had to sort through one at a time, go pull the chart it was associated with, determine if whatever you were looking at was better/worse/same as before, then pick up an actual phone and call the patient (or referring doc) if it was worse, or call your nurse to call the patient to tell them it was better/same. Now in 3 keystrokes I can deal with 70-80% of my inbox crap. The rest gets a follow up/99215. If I can't dispatch it in a 15 second message, I'm getting paid for it.

Apparently epic is about to incorporate chat GPT into our inbox management.

It would be here already, but in trying to learn how doctors respond to common patient messages, chat GPT was getting too snarky in its responses.

 

[gutonc]

Apparently epic is about to incorporate chat GPT into our inbox management.

It would be here already, but in trying to learn how doctors respond to common patient messages, chat GPT was getting too snarky in its responses.

I spend twice as much time toning down my responses to patient BS than I do writing them in the first place. Hopefully they haven't been using me in the training set.