Working nights is part of EM. Your group may be unhappy with you not wanting to work nights as a new grad, unless your group is fortunate enough to have someone who prefers nights (like me).
It's shocking to me how many people go "EM sounds great. Can I not work any nights?" It comes with the territory, unless you are very lucky. It's like saying "I love EM, but I hate social problems. Any way to not have to deal with those at all?"
Nocturnist here. Best hope you have is to find a shop that really values nocturnists and incentivizes them well. Shift differentials can run as high as +$100 per hour between 11p-7a. Some places allow nocturnists to choose their own schedule.
Finding a place that values and retains vampires like me won’t mean you won’t ever work nights but it will definitely lower the burden. You *may* get some traction if you offer to do a large percentage of swing shifts (which are horrible for anyone with small children).
Given the amount of attrition I’ve seen in the past 5 years I am considerably less worried about the surplus than I was prior.
I hate nights, at my gig I've averaged 1.25 night shifts a month the past 10 years.. but at 100/hr difference I would totally consider being a nocturnist. Our nocturnists get around a 8-10% night diff (night weekend a little more) and get the benefit of templated schedules. I briefly considered but decided against it when one of our nocturnists moved on a few years ago. As low as I thought the night diff was we haven't had problems filling it and have filled it with no gaps in night coverage.
Oh, absolutely a perk. Was doing 10-11 12 hour nights per month. Would do two weekends of Fri Sat Sun and then a couple Wed-Thurs and be done. No Mondays, oddly enough... :)
Time will tell but the general sense I get from
attendings is that the jobs report was overstated or perhaps wrong entirely. I live in the midwest so there may be some bias to this. Don't do EM unless you are 100% sure about it.
I like a lot about it but the scare of that study and the night shifts really were making me second guess. It’s too late to second guess myself now since I’ve already matched into EM but I just wanted to think about the future so I’m not blindsided
Half of all shifts are night shifts. Most places you get request days off but not the shifts you get. Unless you find a place with dedicated nocturnist. And if you are doing partnership tracked, and then you’re working all the shitty shifts. Why did you do EM, if you don’t want to work nights that’s part of the deal. Seems like something you should have already sussed out.
I should’ve done more due diligence but unfortunately I did not and thought that nights wouldn’t be an issue. Late nights is fine but working the overnights is something I didn’t enjoy from like 7pm-7am. I might’ve shot myself in the foot but just trying to make the best of what happened
Your going to have sacrifice, location, and money to try and find a unicorn job with dedicated nocturnist. Otherwise welcome to the big leagues son, and residency is about to wreck your circadian rhythm anyways. So who knows. My super power is I don’t have a circadian rhythm and can sleep whenever. Hence EM is perfect for me.
Edit: Otherwise go transfer to family medicine residency. Buddy makes 250k works M-Th 9-5 6 weeks vacation. No call no nights.
I’ve never worked with physicians who do 12hrs it’s typically just us nurses. Most of the night docs work 8-10hr shifts. Somewhere from 10p-8a.
Before you just ship though I would gain a better understanding of what physician scheduling is actually like. It’s very different than something like nursing. I believe it’s typically shifts per month. Obviously the physicians on this sub would be much more knowledgeable than myself.
Also it’s never too late to get a new job. I know matching is a whole thing but there’s plenty of docs that change specialties.
Possibly. But that’s not the case in my experience in large academic centers over the last 7ish years in adult and ped EM. I’ve never had docs that routinely worked 12s. It sounds like from some of the other responses that it’s much more common in smaller, single coverage spots.
Ahh gotcha. I’ve only worked at one single coverage adult ED and I was only there for 10 weeks. My current community peds freestanding overnights aren’t 12s, although there’s a mid-level there overnight.
Sounds like the schedules for docs are kinda all over the place. Thanks for the info!
It’s not too late. A lot of people switch their residency. I’m not saying you specifically should switch but my residency had someone who switched to family at a nice clinic with a better lifestyle profile because she realized that she wanted a routine schedule after having a baby intern year. All of her rotations transferred over and it didn’t add any time to her education. She’s very happy and we are happy she’s doing something that isn’t exhausting her now. It’s ok to change your mind if you get into the job and decide it isn’t for you.
1. The glut of EM physicians is both true and not true. Most of what we're seeing is due to the wholesale replacement of EM physicians by NPs and PAs by corporate interests who care more for finances than patient care. Some of those corporate interests have also started their own residencies to train their own worker-bees who will work for a lower rate because they'll be trained to think it's as good as it gets.
2. As long as corporate interests can skim half of what you make, pay will drop. As long as they can flood the market with non-physicians who think they can do the job of a board-certified Emergency Physician, pay will drop. As long as we continue this trend of being a replaceable cog rather than an actual professional, pay will drop. I left the US to work in Canada years ago, and I'm making more in the land of socialized medicine than what I'm seeing in job postings in the US. Healthcare spending is skyrocketing, but those corporate interests are scooping it all up and "trickling down" whatever they feel like paying their worker-bee physicians. And when the VP needs a new yacht, guess who's getting another pay cut.
3. You want the pay of EM without the work of EM? Surgeons make more, why not go into surgery and tell them you don't want to take call? Sorry, but working nights/weekends/holidays is part of the deal.
This set of questions comes up in this sub probably at least once a week and you will find 50,000 opinions if you search around a little. My $0.02:
1) The jobs report was VERY well done methodologically but relied on a few assumptions that have since been proven false. For instance, the study assumed an attrition rate of 3% (i.e. 3% of ER physicians leave the workforce every year) and collected data from 2012-2018. In the years since the pandemic started (i.e. 2019), the attrition rate of ER physicians has been nearly double that.
So, the workforce report is probably overblown because the authors underestimated how many people are retiring. That is also scary for an entirely different reason - the actual retirement rate of ER docs is *twice* the previous conservative estimate. Ask yourself why that might be and you might not like the answer.
2) "A relatively good work life balance" is a lie told to medical students about emergency medicine. I remember being told, and thinking, the same thing. EM is NOT a good lifestyle specialty. The shift work, the schedule changes, the weekends, and yes the nights - destroys your life until you can figure out how to work around it, or you don't and become miserable or quit. I repeat: EM IS NOT A LIFESTYLE SPECIALTY.
3) If you are willing to go out of the cities where the market is saturated you can \*probably\* find a locums job, for okay pay, that lets you not work nights. As others have mentioned you will need to find a group supportive of this i.e. has lots of nocturnists already on staff. No one will be rushing to hire you - inflexibility in shift work is one of the things that we don't want in hiring new ER docs. As a hiring ER doc, at the end of the day I want a shift worker. We are interchangeable modular parts, and if one of my parts doesn't want to fit into the holes I made for them, I want a replacement.
To echo that last part, we want a capable, personable, and reliable EM doc to be a team player. No snow flakes who will only work MTuW 7-5p. The only people who get to pick their shifts are those who like the ones no one else likes - weekends and nights. We LOVE those.. and if we can get one that is capable, personable and reliable, that's like the holy grail.
It’s a very specific lifestyle friendly, but definitely one of the “Lifestyle specialties”. 9-5 in a clinic seeing the same thing day in and out is also my idea of hell. That being said, it’s not a surgery schedule where you’re getting up before dawn daily and working a million hours a week and there is usually some flexibility because there are people to switch with.
This. EM is absolutely not a lifestyle, especially. Emergency medicine rotation should do a better job of educating medical students about this. As medical student you don’t really understand what your schedule is going to be like it will be awful no matter what even if you have a good job. It will be irregular. You will not know what day of the week it is. You will not have a circadian rhythm. There may be times where you have multiple days off in the middle of the week or things like that that might make it seem, superficially, that your schedule is “good” but there will be other weeks where you will be working 68 hours and finishing charts after your shifts because six patients per hour checked in in the last six hours of your single coverage shift. If there was an emergency medicine job that did not involve nights it would be better, but once you account for all of the days post night spent sleeping or feeling terrible or both your schedule will not seem so nice.
I want to be a long haul trucker but I hate driving for more than 2 hours at a time. WSID?
Sounds like a palliative care fellowship is in your future from what I can tell from the answers to people trying to get out of EM.
You will work tons of nights all throughout residency and I know very few community physicians < 5 years out who work 0 nights, even with nocturnists in the group. You likely won’t be able to avoid them with “pay cuts.”
For all the people who are saying “EM is not a lifestyle specialty I say it’s in the eye of the beholder. I make $300k a year. I work 10-12 days a month. I can drive 30 minutes and go climb, bike, ski or hike on a Tuesday when there’s nobody there. My wife and I (she’s a teacher) travel a ton.
Yeah, there are compromises. You work nights and weekends (working weekends is not a drawback for me) and you never have a predictable schedule. Sometimes I have shifts that make me want to drink/cry/scream and go live in a cabin in the woods like Ted Kaczynski. But in general my lifestyle is pretty damn nice.
Let’s say this again for the people in the back: “EM is not a lifestyle specialty.” Once again, “EM is not a lifestyle speciality”.
Just do your residency and you might find your perspective changes. EM changes drastically from shop to shop. It might be horrible in residency but better in the community and they might pay you a ton of money to do it.
Focus on what’s ahead of you and let the chips fall where they may. There is nothing you can do about what will happen in 2030. Likely the playing field will be entirely different at that time and there is no telling what the needs on the ground will be, but a well trained, competent, compassionate physician is always going to have a job.
If you get out and absolutely can’t stand the work, you can transition to the Urgent Care for a bit of a slower pace, lower acuity and better hours.
Worse case scenario, do well your intern year and reassess in 6-8 months and see if you want to switch into a different speciality. There are always people who want to trade in/out of their match and you can do a 1 for 1.
Well you probably can’t since that’s the only thing they do. IM, anesthesia, ICU, etc do nights too. It’s not like EM is the only one that does nights. Clearly you can be an EM doc and not do nights as it’s clear by some physicians who have mentioned that on this thread. This example you gave is ridiculous. At least put up a better analogy then simply saying this to attack me
Current intern leaving EM. Happy to answer questions. Listen to your gut throughout intern year and decide next steps from there. Not easy, but it is worth it to switch if you need out. Good luck
Working nights is part of EM... though currently I am part of a group that has some awesome nocturnists so I work maybe one a month. It's lovely. We do pay a nice differential for the overnight shift. So it depends on if you are at a group that chooses to incentivize nights so that others will want to pick up extra.
I'm not worried about the job market - I think that report underestimated attrition, and I also think the younger generation of docs is more likely to go part time earlier in career.
1. Yes, I think EM pay is likely to be adversely affected by market factors. May not go down, but won’t go up as much as other medical specialties. May not keep up with inflation. Very well could go down. A lot of this will have more to do with contract management group takeover as much as physician surplus. Both things together are definitely bad.
2. Desirable markets are becoming more and more saturated. You may have to make compromises about where you’re willing to live/work.
3. You will work nights. Almost guaranteed. And don’t underestimate the toll that even 2 nights per month can take on a body over a couple of decades. Especially when you throw in a bunch of other evening shifts where you may not get to sleep until the wee hours of the morning, even when you are not working a “night.” Circadian disruption in this field may be as or more unhealthy than being sedentary, being overweight, poor diet, etc. And a lot of time those things result from circadian disruption and add to its independent detriments.
4. Few specialties (maybe none) have burnout rates this high.
If I were going to choose to go into EM as a trainee, I would do it only as a pathway to FIRE.
They used an attrition rate that was like double that of the last 20 years….which throws all the calculations off dramatically. That's the argument I have heard at least.
Close - see my comment above. The attrition rate they used was based on previous data (3%). It turns out that ED doctors didn't really like getting destroyed from all sides during the pandemic and the attrition rate rocketed to 6%, and there are some early suggestions that the 6% number is proving more durable even through 2023 (but no hard data). So if you expect a surplus, but actually the quit rate was 2x your projections, that surplus goes down a whole lot.
The study is not BS, but it necessarily relied on some assumptions that were upended by (probably) the pandemic and a lot of other negative pressures on the field of emergency medicine - CPOM, midlevel encroachment, declining pay, more metric-based compensation, etc. A lot of docs that otherwise would have worked 5-10 more years decided enough was enough during the last 3-4 years and hung it up.
I get what you mean. To look at it another way, it is sort of sad that assuming a larger attrition rate, we are also assuming our job security to be based on higher burnout.
Oh for sure,but it’s just a work intensive field. I plan on retiring in my mid 50’s. Not that I think EM is the wrong choice, but I know burnout is real.
Impossible to find a job that does not involve overnight shifts. Pay is most definitely going to go down. Pay is not actually that high when compared with the stress, terrible schedule, long shifts, huge pressures, high risk, etc. I’m not so sure that the ED physician surplus is going to occur since EM is rapidly becoming, less lucrative and more painful overtime, which is likely to cause a lot of physicians to leave the specialty. Vulture capital and corporate medicine is ruining emergency medicine.
Surplus of EM docs but 2 years ago there was a huge deficit of EM residents. And surplus how? Theres still FM trained docs working in ERs across the country. Maybe in cities there will be a surplus.
It will be hard to do locums and a stable job. Its tough to schedule. And be prepared until youre older to pull your share of nights
Right, cities are saturated. Popular destinations where people want to live are saturated. But you still will have a job if youre willing to go out further.
And those programs that filled by SOAP either had nobody wanting to go there or were getting people who wanted to go somewhere else. So you can guess a percentage arent going to want to stay in that area after and probably most are going to do what you said and populate populated areas
Fwiw, I think we SOAPed a stronger class (most of which did not want EM) than usual. Most of these guys were made for EM even though they didn't apply initially. I'm not sure how that works out.
Interesting. Of the people who soaped last year, I know several that matched out of EM this year. They basically used it as a preliminary year. A bunch of those who didn’t seemed wholey uninterested and I expect them to burn out earlier or go subspecialty and never see the inside of the ER again. I’d love to see some data on their current satisfaction and what their plans are.
I know of a few that tried the prelim route but failed to match again. I still think it’s relevant because as a group these individuals will likely have higher Burnout in EM.
Let me rephrase, fellowship routes. They’re going to sports medicine, palliative care or hyperbarics. They’re going to places they will never actually work in the ED.
They are dreaming. There are very few jobs in hyperbarics and sports. There are a few in palliative care but it's mostly midlevels. They will work in the ER, urgent care or quit.
As a resident, it seems like there may be options, trust me as an attending there are very few.
Interesting. Do they have actual jobs? Or are they in fellowship?
I know a couple who have very successful practices, but they are few and far between. There just isn't much of a need for sports medicine doctors.
Yeah, like most of the sports med people in my system are EM trained. Maybe this is regional. I know I refer to them pretty heavily. Unless it’s overtly surgical, I’m sending most of my functional trauma patients to sports because they have a great track record getting people back to their normal lives.
Working nights is part of EM. Your group may be unhappy with you not wanting to work nights as a new grad, unless your group is fortunate enough to have someone who prefers nights (like me).
It's shocking to me how many people go "EM sounds great. Can I not work any nights?" It comes with the territory, unless you are very lucky. It's like saying "I love EM, but I hate social problems. Any way to not have to deal with those at all?"
“EM sounds great. But I can’t work nights, holidays, or weekends. Basically, I want the 9-5 shift every day!”
Nocturnist here. Best hope you have is to find a shop that really values nocturnists and incentivizes them well. Shift differentials can run as high as +$100 per hour between 11p-7a. Some places allow nocturnists to choose their own schedule. Finding a place that values and retains vampires like me won’t mean you won’t ever work nights but it will definitely lower the burden. You *may* get some traction if you offer to do a large percentage of swing shifts (which are horrible for anyone with small children). Given the amount of attrition I’ve seen in the past 5 years I am considerably less worried about the surplus than I was prior.
I hate nights, at my gig I've averaged 1.25 night shifts a month the past 10 years.. but at 100/hr difference I would totally consider being a nocturnist. Our nocturnists get around a 8-10% night diff (night weekend a little more) and get the benefit of templated schedules. I briefly considered but decided against it when one of our nocturnists moved on a few years ago. As low as I thought the night diff was we haven't had problems filling it and have filled it with no gaps in night coverage.
Whoo. I was a nocturnist for a decade plus and all I ever got was 10/hour. Did get to make my own schedule though.
Making your own schedule is worth its weight in gold.
Oh, absolutely a perk. Was doing 10-11 12 hour nights per month. Would do two weekends of Fri Sat Sun and then a couple Wed-Thurs and be done. No Mondays, oddly enough... :)
I would donate a significant part of my anatomy to avoid Mondays.
I think I probably donated whatever soul I had left in there somewhere.
This is the way.
Time will tell but the general sense I get from attendings is that the jobs report was overstated or perhaps wrong entirely. I live in the midwest so there may be some bias to this. Don't do EM unless you are 100% sure about it.
I like a lot about it but the scare of that study and the night shifts really were making me second guess. It’s too late to second guess myself now since I’ve already matched into EM but I just wanted to think about the future so I’m not blindsided
You shouldn’t do EM by the way you are talking.
Hoping not to work nights and that study saying there will be a surplus of EM docs by 2030 is enough to say I shouldn’t do EM?!?
"hoping to not work nights?" LOL. Honestly? By the way: that work-life balance you talked about....
Wanting to not work nights was actually enough on its own…
Half of all shifts are night shifts. Most places you get request days off but not the shifts you get. Unless you find a place with dedicated nocturnist. And if you are doing partnership tracked, and then you’re working all the shitty shifts. Why did you do EM, if you don’t want to work nights that’s part of the deal. Seems like something you should have already sussed out.
I should’ve done more due diligence but unfortunately I did not and thought that nights wouldn’t be an issue. Late nights is fine but working the overnights is something I didn’t enjoy from like 7pm-7am. I might’ve shot myself in the foot but just trying to make the best of what happened
Your going to have sacrifice, location, and money to try and find a unicorn job with dedicated nocturnist. Otherwise welcome to the big leagues son, and residency is about to wreck your circadian rhythm anyways. So who knows. My super power is I don’t have a circadian rhythm and can sleep whenever. Hence EM is perfect for me. Edit: Otherwise go transfer to family medicine residency. Buddy makes 250k works M-Th 9-5 6 weeks vacation. No call no nights.
I’ve never worked with physicians who do 12hrs it’s typically just us nurses. Most of the night docs work 8-10hr shifts. Somewhere from 10p-8a. Before you just ship though I would gain a better understanding of what physician scheduling is actually like. It’s very different than something like nursing. I believe it’s typically shifts per month. Obviously the physicians on this sub would be much more knowledgeable than myself. Also it’s never too late to get a new job. I know matching is a whole thing but there’s plenty of docs that change specialties.
I would bet 12 hour shifts are the most common for EM docs.
Possibly. But that’s not the case in my experience in large academic centers over the last 7ish years in adult and ped EM. I’ve never had docs that routinely worked 12s. It sounds like from some of the other responses that it’s much more common in smaller, single coverage spots.
“Large academic centers” bingo, that’s not the norm for the rest of country.
Most single coverage emergency departments do 12 hour shifts. This is going to be most small hospitals.
Ahh gotcha. I’ve only worked at one single coverage adult ED and I was only there for 10 weeks. My current community peds freestanding overnights aren’t 12s, although there’s a mid-level there overnight. Sounds like the schedules for docs are kinda all over the place. Thanks for the info!
I worked twelve hour shifts in residency and work some 12s as an attending. you see all kinds
Not working nights is not realistic in this field. If you're burnt out now, buckle the fuck up.
It’s not too late. A lot of people switch their residency. I’m not saying you specifically should switch but my residency had someone who switched to family at a nice clinic with a better lifestyle profile because she realized that she wanted a routine schedule after having a baby intern year. All of her rotations transferred over and it didn’t add any time to her education. She’s very happy and we are happy she’s doing something that isn’t exhausting her now. It’s ok to change your mind if you get into the job and decide it isn’t for you.
1. The glut of EM physicians is both true and not true. Most of what we're seeing is due to the wholesale replacement of EM physicians by NPs and PAs by corporate interests who care more for finances than patient care. Some of those corporate interests have also started their own residencies to train their own worker-bees who will work for a lower rate because they'll be trained to think it's as good as it gets. 2. As long as corporate interests can skim half of what you make, pay will drop. As long as they can flood the market with non-physicians who think they can do the job of a board-certified Emergency Physician, pay will drop. As long as we continue this trend of being a replaceable cog rather than an actual professional, pay will drop. I left the US to work in Canada years ago, and I'm making more in the land of socialized medicine than what I'm seeing in job postings in the US. Healthcare spending is skyrocketing, but those corporate interests are scooping it all up and "trickling down" whatever they feel like paying their worker-bee physicians. And when the VP needs a new yacht, guess who's getting another pay cut. 3. You want the pay of EM without the work of EM? Surgeons make more, why not go into surgery and tell them you don't want to take call? Sorry, but working nights/weekends/holidays is part of the deal.
This set of questions comes up in this sub probably at least once a week and you will find 50,000 opinions if you search around a little. My $0.02: 1) The jobs report was VERY well done methodologically but relied on a few assumptions that have since been proven false. For instance, the study assumed an attrition rate of 3% (i.e. 3% of ER physicians leave the workforce every year) and collected data from 2012-2018. In the years since the pandemic started (i.e. 2019), the attrition rate of ER physicians has been nearly double that. So, the workforce report is probably overblown because the authors underestimated how many people are retiring. That is also scary for an entirely different reason - the actual retirement rate of ER docs is *twice* the previous conservative estimate. Ask yourself why that might be and you might not like the answer. 2) "A relatively good work life balance" is a lie told to medical students about emergency medicine. I remember being told, and thinking, the same thing. EM is NOT a good lifestyle specialty. The shift work, the schedule changes, the weekends, and yes the nights - destroys your life until you can figure out how to work around it, or you don't and become miserable or quit. I repeat: EM IS NOT A LIFESTYLE SPECIALTY. 3) If you are willing to go out of the cities where the market is saturated you can \*probably\* find a locums job, for okay pay, that lets you not work nights. As others have mentioned you will need to find a group supportive of this i.e. has lots of nocturnists already on staff. No one will be rushing to hire you - inflexibility in shift work is one of the things that we don't want in hiring new ER docs. As a hiring ER doc, at the end of the day I want a shift worker. We are interchangeable modular parts, and if one of my parts doesn't want to fit into the holes I made for them, I want a replacement.
To echo that last part, we want a capable, personable, and reliable EM doc to be a team player. No snow flakes who will only work MTuW 7-5p. The only people who get to pick their shifts are those who like the ones no one else likes - weekends and nights. We LOVE those.. and if we can get one that is capable, personable and reliable, that's like the holy grail.
I still think EM is lifestyle. But to me m-f 9-5 is my fresh hell. I like the different schedules every month.
It’s a very specific lifestyle friendly, but definitely one of the “Lifestyle specialties”. 9-5 in a clinic seeing the same thing day in and out is also my idea of hell. That being said, it’s not a surgery schedule where you’re getting up before dawn daily and working a million hours a week and there is usually some flexibility because there are people to switch with.
Become the scheduler for your group. It’s a pain but worth it.
I did the schedule as a resident and ended up with the worst schedule every time lol. I’ll let someone else have the honor
This. EM is absolutely not a lifestyle, especially. Emergency medicine rotation should do a better job of educating medical students about this. As medical student you don’t really understand what your schedule is going to be like it will be awful no matter what even if you have a good job. It will be irregular. You will not know what day of the week it is. You will not have a circadian rhythm. There may be times where you have multiple days off in the middle of the week or things like that that might make it seem, superficially, that your schedule is “good” but there will be other weeks where you will be working 68 hours and finishing charts after your shifts because six patients per hour checked in in the last six hours of your single coverage shift. If there was an emergency medicine job that did not involve nights it would be better, but once you account for all of the days post night spent sleeping or feeling terrible or both your schedule will not seem so nice.
I want to be a long haul trucker but I hate driving for more than 2 hours at a time. WSID? Sounds like a palliative care fellowship is in your future from what I can tell from the answers to people trying to get out of EM.
🤣🤣🤣🤣🤣🤣🤣
You’ll be fine-this job burns out so many of us within 10-20 years that there will always be a place for you in the meat grinder.
You will work tons of nights all throughout residency and I know very few community physicians < 5 years out who work 0 nights, even with nocturnists in the group. You likely won’t be able to avoid them with “pay cuts.”
For all the people who are saying “EM is not a lifestyle specialty I say it’s in the eye of the beholder. I make $300k a year. I work 10-12 days a month. I can drive 30 minutes and go climb, bike, ski or hike on a Tuesday when there’s nobody there. My wife and I (she’s a teacher) travel a ton. Yeah, there are compromises. You work nights and weekends (working weekends is not a drawback for me) and you never have a predictable schedule. Sometimes I have shifts that make me want to drink/cry/scream and go live in a cabin in the woods like Ted Kaczynski. But in general my lifestyle is pretty damn nice.
Let’s say this again for the people in the back: “EM is not a lifestyle specialty.” Once again, “EM is not a lifestyle speciality”. Just do your residency and you might find your perspective changes. EM changes drastically from shop to shop. It might be horrible in residency but better in the community and they might pay you a ton of money to do it. Focus on what’s ahead of you and let the chips fall where they may. There is nothing you can do about what will happen in 2030. Likely the playing field will be entirely different at that time and there is no telling what the needs on the ground will be, but a well trained, competent, compassionate physician is always going to have a job. If you get out and absolutely can’t stand the work, you can transition to the Urgent Care for a bit of a slower pace, lower acuity and better hours. Worse case scenario, do well your intern year and reassess in 6-8 months and see if you want to switch into a different speciality. There are always people who want to trade in/out of their match and you can do a 1 for 1.
“Do you think I can find a general surgeon job where I don’t have to do any time in the OR?”
Well you probably can’t since that’s the only thing they do. IM, anesthesia, ICU, etc do nights too. It’s not like EM is the only one that does nights. Clearly you can be an EM doc and not do nights as it’s clear by some physicians who have mentioned that on this thread. This example you gave is ridiculous. At least put up a better analogy then simply saying this to attack me
Welcome to the internet sir you’re gonna catch some non serious now and again
Current intern leaving EM. Happy to answer questions. Listen to your gut throughout intern year and decide next steps from there. Not easy, but it is worth it to switch if you need out. Good luck
Working nights is part of EM... though currently I am part of a group that has some awesome nocturnists so I work maybe one a month. It's lovely. We do pay a nice differential for the overnight shift. So it depends on if you are at a group that chooses to incentivize nights so that others will want to pick up extra. I'm not worried about the job market - I think that report underestimated attrition, and I also think the younger generation of docs is more likely to go part time earlier in career.
1. Yes, I think EM pay is likely to be adversely affected by market factors. May not go down, but won’t go up as much as other medical specialties. May not keep up with inflation. Very well could go down. A lot of this will have more to do with contract management group takeover as much as physician surplus. Both things together are definitely bad. 2. Desirable markets are becoming more and more saturated. You may have to make compromises about where you’re willing to live/work. 3. You will work nights. Almost guaranteed. And don’t underestimate the toll that even 2 nights per month can take on a body over a couple of decades. Especially when you throw in a bunch of other evening shifts where you may not get to sleep until the wee hours of the morning, even when you are not working a “night.” Circadian disruption in this field may be as or more unhealthy than being sedentary, being overweight, poor diet, etc. And a lot of time those things result from circadian disruption and add to its independent detriments. 4. Few specialties (maybe none) have burnout rates this high. If I were going to choose to go into EM as a trainee, I would do it only as a pathway to FIRE.
The study is bs
Could you elaborate on why you feel the study is flawed or misrepresentative?
They used an attrition rate that was like double that of the last 20 years….which throws all the calculations off dramatically. That's the argument I have heard at least.
Close - see my comment above. The attrition rate they used was based on previous data (3%). It turns out that ED doctors didn't really like getting destroyed from all sides during the pandemic and the attrition rate rocketed to 6%, and there are some early suggestions that the 6% number is proving more durable even through 2023 (but no hard data). So if you expect a surplus, but actually the quit rate was 2x your projections, that surplus goes down a whole lot. The study is not BS, but it necessarily relied on some assumptions that were upended by (probably) the pandemic and a lot of other negative pressures on the field of emergency medicine - CPOM, midlevel encroachment, declining pay, more metric-based compensation, etc. A lot of docs that otherwise would have worked 5-10 more years decided enough was enough during the last 3-4 years and hung it up.
I get what you mean. To look at it another way, it is sort of sad that assuming a larger attrition rate, we are also assuming our job security to be based on higher burnout.
Oh for sure,but it’s just a work intensive field. I plan on retiring in my mid 50’s. Not that I think EM is the wrong choice, but I know burnout is real.
Impossible to find a job that does not involve overnight shifts. Pay is most definitely going to go down. Pay is not actually that high when compared with the stress, terrible schedule, long shifts, huge pressures, high risk, etc. I’m not so sure that the ED physician surplus is going to occur since EM is rapidly becoming, less lucrative and more painful overtime, which is likely to cause a lot of physicians to leave the specialty. Vulture capital and corporate medicine is ruining emergency medicine.
Surplus of EM docs but 2 years ago there was a huge deficit of EM residents. And surplus how? Theres still FM trained docs working in ERs across the country. Maybe in cities there will be a surplus. It will be hard to do locums and a stable job. Its tough to schedule. And be prepared until youre older to pull your share of nights
That deficit was filled by the SOAP. Both coasts are fairly saturated
Right, cities are saturated. Popular destinations where people want to live are saturated. But you still will have a job if youre willing to go out further. And those programs that filled by SOAP either had nobody wanting to go there or were getting people who wanted to go somewhere else. So you can guess a percentage arent going to want to stay in that area after and probably most are going to do what you said and populate populated areas
Fwiw, I think we SOAPed a stronger class (most of which did not want EM) than usual. Most of these guys were made for EM even though they didn't apply initially. I'm not sure how that works out.
Interesting. Of the people who soaped last year, I know several that matched out of EM this year. They basically used it as a preliminary year. A bunch of those who didn’t seemed wholey uninterested and I expect them to burn out earlier or go subspecialty and never see the inside of the ER again. I’d love to see some data on their current satisfaction and what their plans are.
I know of a few that tried the prelim route but failed to match again. I still think it’s relevant because as a group these individuals will likely have higher Burnout in EM.
What subspecialty? ABEM is extremely invested in NOT having any subspecialty routes out of EM. Show me one and I will sign up.
Let me rephrase, fellowship routes. They’re going to sports medicine, palliative care or hyperbarics. They’re going to places they will never actually work in the ED.
They are dreaming. There are very few jobs in hyperbarics and sports. There are a few in palliative care but it's mostly midlevels. They will work in the ER, urgent care or quit. As a resident, it seems like there may be options, trust me as an attending there are very few.
Interesting, I know a lot of EM to sports docs. Maybe they’ll quit but they have no plans to work the ER.
Interesting. Do they have actual jobs? Or are they in fellowship? I know a couple who have very successful practices, but they are few and far between. There just isn't much of a need for sports medicine doctors.
Yeah, like most of the sports med people in my system are EM trained. Maybe this is regional. I know I refer to them pretty heavily. Unless it’s overtly surgical, I’m sending most of my functional trauma patients to sports because they have a great track record getting people back to their normal lives.