Most of the comments are for EM. Are we really that miserable? Lol

  1. Jesus are you really in the position of having to tell family members and sometimes even patients “I’ve done all I can. There’s no more blood/ pressors/ Name your understocked supply/ drug to give and I have no way to get you/ your family member to a center with the specialized care to perform definitive therapy. You/ they’re going to die here”? I’ve been in that situation a single time with a ruptured triple-A where I had to tell the family the surgeon couldn’t do anything while dumping the amount of blood in that we were and it wasn’t sustainable, and frankly futile. I’ll never forget it.

  2. Working for a democratic group is the greenest shade of shit brown grass. I’ll go back to school and become an engineer before I work for a CMG again.

  3. I'm a part of a democratic group and we are both understaffed and our census has exploded in the last 6 months. Hope yours is doing better. Could you share some vague regional info about where you practice? (Region/urban vs rural)

  4. Bro, yes. And don’t complain about it too much, let it affect how sweet and patient you are at home, or take too much “me” time to decompress or your wife will tell you you’ve “become a jerk”

  5. I love my job. I also hate structure and have weaponized ADHD. Those are probably requirements for really thriving in the ED tbh.

  6. This. EM feeds into my personality. I’m a little scociopathic and ADHD and only like people in small doses.

  7. I hate structure and loved the variety, pace, etc... Used to love the ED! Now, it is more like trying to drink from a firehose. It's way too much too fast to be able to handle it well. Not to mention the added pressure from admins, angrier patients, fewer nurses. Ugh. I am glad to know some of us will still be there in a few years. Thank you!!

  8. Yeah it really is a Type B personality specialty and I think with its increase in popularity and seen as a “lifestyle” specialty it drew a lot of Type As to it who realized the chaos and lifelong unpredictable nature of EM isn’t for them.

  9. Imo the on-shift time probably is amongst the worst of all specialties, but I do enjoy the much freer and flexible schedule outside of work.

  10. Just finished residency. Working for a private group in the Southeast that has not been mentioned so far in the comments. I have not been talked to about metrics once, if the patients wait they just wait. Pays above average, so far I can't complain.

  11. Was looking for something like this. I’m in a very similar situation. And now grateful I’m dodging a bullet of all that other stuff.

  12. I'm pretty sure primary care doesn't exist anymore. There's just a pre-recorded RN on the other end if the advice line that says, "go to the ER."

  13. Agree that private equity destroying EM. But since was posted in the Residency forum, I would think this not to be a factor in their experiences since most of the responses are probably from more academic institutions.

  14. 30 patients in the waiting room, 7 beds actually being turned over. The entirety of the rest of the department is boarders because the floors don't have enough nurses, or the rooms are sitting empty because we don't have enough nurses.

  15. The ED pretty much experiences the worst of the American healthcare system (Especially mental health) so it's not surprising.

  16. Everyone is pointing to private equity but I think that's a symptom of a bigger problem. There's too many patients and too little of everything else.

  17. I think private equity takeover is a symptom of the perverse incentives inherent to the for profit model, or I guess more the natural conclusion of them. When you turn healthcare into a machine optimized for siphoning money out to shareholders who have no stake in the communities, the lives affected, or their health outcomes this is what happens. It's a race to the bottom to cut costs and increase profits without a second thought given to the degradation in quality that necessitates. Most can see or at least sense this happening around them which drains morale. I think most would be happy seeing a lot of patients if the reason for the increased census is more patients need help and not just we've understaffed and need you to churn more patients per hour so our quarterly profits increase, i.e we've contrived these conditions to orient your labor toward servicing our shareholder greed, not your patients' health.

  18. You've got the cause and effect backwards. The idea that everything, including healthcare, has to be run like a business is the reason there's too little of everything else. More patients and less overhead (staffing, supplies, etc) means more profits and more money to pay administrators.

  19. Honestly, I picked EM because the attendings, on the whole, seemed like the most happy of the specialties I’ve seen. I still believe that after a 2 years of attendinghood. I think I made the right call 😀

  20. I’ve really noticed you guys have hobbies outside of medicine and enjoy life. It could be a reason we see people get out early. They’ve been paid well, made enough and are out enjoying total freedom.

  21. Definitely depends on the environment. My old place was great, everyone was mostly happy, burnout was rather low. My new place the turnover is so high and everyone who’s been there long enough is jaded and miserable. Total burnout. I will be leaving there ASAP

  22. Anyone have experiences they’d be willing to share anonymously working with Envision? Currently considering a position with them.

  23. No. Don’t go for them if you actually like being a physician and working with nurses to take care of patients the best way we can. If you literally don’t give a shit and want all the money, then go for it.

  24. Envision is terrible. You will really feel that they only care about the numbers and the bottom line. I think the only corporate group I know of in which people are happy is CEP.

  25. I work for an Envison group and it’s quite nice actually. Good coverage, good compensation. This is at a larger SE hospital though. I’ve heard bad things about other areas of the country

  26. Been with them 3 years, 2 different sites. They're ok, nothing terrible. They don't try to influence how I practice medicine (aside from the usual CMS stuff), no crazy meetings to having to go for "training", etc etc. They pay the correct amount on time. When I was on W2, benefits were pretty decent. My local leadership people are docs too that work clinically and very approachable.

  27. I like my job. It’s tough but I like it. I wish some things worked better but still don’t want to do anything else.

  28. This is true. Good to keep in mind that not everyone is having a bad time in EM, but your much more likely to hear about the bad than the good.

  29. I train in a large L1 trauma center and I have multiple attendings in their 60s. One of them is 75 and only retiring next year because his credentials are expiring. Maybe being a part of a democratic group helps.

  30. That's about the only place they tend to thrive. Outside academics, it's a lot more stressful, worse hours, less job security.

  31. I’m EM/IM but I don’t have a CMG at my hospital - or even a DMG. All ED attendings in our hospital are hospital employees. I think that makes a MASSIVE difference. We have to get lectures about what it’s like in the RVU-focused systems, and I don’t like it.

  32. This is a subject very near and dear to me. For my entire career The Money has alway been putting pressure on me and every other ER doctor to Go Faster. Unfortunately, since the rate limiting step is usually not me but slow labs, slow radiology, poor staffing, and soul-crushing bureaucracy there's not a whole lot I can do about it. They bluster and threaten but I have never been fired from a job for working at my own pace. In fact, I have never made any effort to work any faster despite nearly fifteen years of threats from the many ERs in which I have worked as a contractor and nothing bad has happened. In reality, most ER doctors in a typical ER will see two patients per hour. Yeah, there are a few outliers and occasionally the stars align and you can move some patients but I know the numbers and it's mostly 1.8 to 2.3. As long as you're in that range your owners can go fuck themselves.

  33. Another aspect of EM a lot of people don’t understand is that historically it’s been largely popular bc of it being a “lifestyle” specialty or at least a specialty west as a full time attending you could still have half the month off (or even more). My attendings as scribes were all old and loved it. I remember one telling me even at full time he felt like being a doc only felt like it consumed 1/3 of his life. You can’t say that for many other specialties as full time. These docs that are bailing on EM at 50 would’ve probably left inpatient medicine all together by 35 lol.

  34. Just a resident but couldn’t imagine doing anything else. Every inpatient off service rotation is absolute misery to me and can’t wait to go back to ED. 8-9hr shift and home with still a decent amount of energy. Not always gunna be that way but while I’m young that’s what I want. Not 5-6 days a week of 12hr days and tons of charting/paperwork when I get home.

  35. Yes, EM is terrible. I think a few minority want to only do EM but, for most people, I can't imagine why a highly educated person, who went through college/mcat/med school/usmle, would torture themselves by doing a specialty like EM. Your sleep schedule is screwed for life and private equity is on a warpath to dilute your specialty/pay by opening up piss poor programs. Sign me up!

  36. Plus it's kind of a weak specialty as specialties go. General Surgery, Gastroenterology, Electrophysiology to name a few? Narrow, unique set of skills and knowledge. Emergency Medicine? Most competent internists and family physicians can do it with a little extra training and familiarity with a few procedures. You just have to have a cool head and be able to clear out legions of minor care patients without dropping the ball on the really sick ones. Plus our academic side is weak. Embarrassing. We do research to see whether we should wear sterile glove while sewing lacerations in the ER. Big deal.

  37. New attending but most of my residency experience was covid. I thought I’d like attending-hood more but I don’t. I’m tired of constantly being told of modules to complete, press gainey scores, disgruntled patients, staffing issues, disgruntled consultants who feel the need to belittle their colleagues….and I can go on and on. Maybe my experience is a little different but already looking for a way out of EM.

  38. I sympathize. You just have to learn how not to give a fuck. Yeah, I have modules and compliance courses and stupidity thrown at me by my Big Bureaucratic Octopus Bureaucracy. I just do all that crap on "company time." If it's a requirement for the job then it is a compensated activity, like charting. Your rapacious private equity masters always try to pressure you to do your charting on your own time but your contract says otherwise. So I just run all that stupid shit in the background. I have friend who had his scribe do it. Now there's an idea.

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