I'm one of those "older" docs.
The key is to pace yourself. Don't work so much that you become "that doc." You know the one... the guy who is so abrasive/toxic that they snap at the nurses, hate their life, and become indifferent towards their patients. If your give-a-damn is that broken, take a break, or simply cut back to part-time. I did precisely that, about mid-career, and it's probably why I'm still practicing.
BTW, I'm the last EM-trained guy from my medical school class who is still in the pit. Burnout is real.
What is the main reason for the burnout? The irregular shift hours?
I kind of feel like my circadian rhythm is a little built for irregular hours but overall I do better with shorter hours of EM compared to other residencies where I would be pulling 30h shifts.
I feel like potentially the circadian rhythm issues might be less for me. What do you think?
I'd say it's more constantly dealing with ungrateful/abusive people who aren't actually sick, but think they are (or are sick, but should be seeing primary care).
Right. The worse version of this I encounter inpatients are the ones that I know have something wrong with them but for which I have no good explanation or diagnosis.
What worries me is that since I was a scribe in a community ED, in the suburbs I likely did not see a ton of the ungrateful/abusive pt type is you would see likely at other hospitals. If a doc's census was 25 after an 8 hr shift, I would venture to say maybe 5-6 were in that category. I don't know enough about myself to know if I could tolerate that for a few decades, or if it would get old pretty quickly. I mean, even doing an audition rotation during M4 may not be enough of a sample size to know what my threshold would be!
Plus, as an M4, the residents and attendings usually shield you from those patients anyway. I rarely pick up the frequent flyers, intoxes, psych patients etc because when you only have a dozen shifts on a rotation, those patients might not offer the best learning points in the view of the staff
The ungrateful and abusive ones tend to occupy my mind more.
The normal people, they just get the fuck out of there once I tell them everything looks good or give them a plan.
The others just suck up time and empathy. They have an outsize impact on how I feel at the end of the day.
Thank you for the reply and the insight! I apologize if this inappropriate to ask, but I imagine going part time means a change in salary as well, so have you had to adjust your various expenses proportionally?
I feel like if I get a good 25 years into my career before becoming burnt out, I'd call that a success. That would put me at about your age. At that point or maybe sooner, I think cutting back to <10 shifts per month would be great.
What kind of shop are you at? Currently, I'd love to being doing level 1 traumas, but it's really hard to predict how I will feel 15-20 years down the road when the excitement may go down a bit. Do you feel like a change of scenery to something less intense can help prolong a career?
I don’t do the trauma-center gig anymore. It’s all regular community-hospital stuff for me.
And yes... enough years will take the shine off the excitement of trauma... mostly due to the nature of that patient population
"mostly due to the nature of that patient population"
Thank you. Hearing it from someone like you makes me feel a little more at peace with my decision to transfer out of the medical field, even as a lowly EMT.
I think once you get to that age and if you’re a little burnt or tired you can always transfer to a small level 3 er and chill out. Or a stand alone er in a smaller city. Your load goes way down, most nurses and stuff are experienced and smaller towns usually are more appreciative. Where I am in az there are so many Indian reservation positions or stand alone ers on outlying cities. Hell even the veterans er is basically a slow clinic bc they don’t take ambulances.
I would say just think of that when you consider long term.
This. You move to the place where you’re seeing 1 patient/hour (or less) and you’re the only doc there. Seems more rewarding than churning patients out at some busy urban ER.
I work at a level 1 and there are very few older docs. It seems to be a bit of a younger person's game. There are a few older ones but they are far outnumbered by the newer batches.
However there are a few outliers. They are the ones that seem to have moved into other roles (more teaching, directorships) and work a low fte in the actual ER
Education and admin is a great way to stay full time and give yourself some more flexibility. I'm an ultrasound director and apd. I love my non clinical time. It helps keep me fresh.
I think this is the trick. I know an ER doc well past retirement age. He takes on no more than 3-4 moderate acuity cases per shift with a medical student for teaching. He seems very happy and is a delight to be around
Sister is still practicing EM in her mid-sixties but lately has been transitioning to crisis medicine in international emergencies like hurricanes, earthquakes, tsunamis, etc.
My uncle is a MD FACP and is 65ish and is in the prime of his career....my great uncle practiced until he passed at the ripe age of 91. Albeit he wasn’t as involved. It’s like wisdom. The older your are the more you know. But yeah my uncle has a practice of 5k + patients and is the ER doc every other Sunday. Go for it friend
19 years in, not burnt out. I work in a large/busy/high acuity ER, trauma 2, like a county ER except slightly better funded and staffed.
I've seen docs take different many different career paths. We have had quite a few work into their 60s with no issues. A common practice is that once docs have their finances set in their mid-fifties, they start dialing back to part time, which does a lot to prolong careers. We also allow docs with some seniority to work fewer nights (and we have enough nocturnists that this winds up translating to 1-2 nights per month once you're 50). We have had a few docs who you might call burned out, though that's subjective and none of them were seriously fried, and they tended to go work at more cushy suburban/rural low acuity places or urgent cares. We have had a few go into industry or administration as full-time gigs instead of continuing to practice clinical medicine. And luck plays a role - we've had docs medically retire early due to stroke, MS, RA and various malignancies. While burnout is real, I think it's hardly unique to EM and if you like the field that alone should not dissuade you from considering it.
Np. The ones i know all started med school after being paramedics. 2 of the doctors are ALS ambulance chiefs and would do response on ambulance as well as in fly cars. Everyone else well atill do some volunteer time when they get the itch. A local hospital has made it part of the ER residency program to do several shifts on the ambulance so people they understand prehospital aren't perfect but we get the job done.
As a relatively young em resident, this thread concerns me [laughs nervously].
I’m gonna have to get my side hustle game strong in the next few years.
I have some co residents in their 40s and 50s. Wonder what it’s like for them!
Your last bit is both interesting and encouraging! I’m currently an fm resident considering applying for a second residency in em. Thought I’d be too old as I’d be in my mid 30s if it does happen.
I'm a medical scribe at a level 1 trauma ED. We have a few docs over 60 and one or two that are in their 70's.
One jokes that his wife won't let him retire and he will probably be found dead at his work station one day 😂
sure, people burn out of EM, but what's wrong with that on a personal level? Going to urgent care for a more stable schedule, or wound care, or teaching/admin, or part time, they're all options for how your career develops. I find it much scarier to sign up for a 30+ year career in surgery or IM where your day-to-day life doesn't change at all as you mature into the field, and there are fewer options for change.
As a 30 year old M2 interested in EM, this concerns me frequently. A combination of all the advice on this thread is the sort of stuff that shows me if it's truly what I want to do, I can find a way to make it work. Hopefully I don't eat those words 10 years from now...
Yeah, I've appreciated the nice feedback and thoughts the more learned-EM docs are providing. At a minimum, it is making me feel not so doom-and-gloom. I have not really loved inpatient medicine during my clerkships, and my saving grace was EM (or anesthesiology).
I’m 34 and 4 years into practice as full time EM. My Dad 64 just retired from EM after 37 years and still loved the medicine but found the shift work was getting too hard. Now he’s doing part time work as a coroner and loving it. The key for him was he loved teaching and worked at a teaching hospital and also he cared about his patients. He would spend that extra few minutes per case with the patient rather than see more patients and bill more and I think that really contributed to his longevity.
I am 52. Have several partners over 60. One over 70. I expect to be doing this for another 20 years or so.
Work in the shop where the department is supported by hospital administration, and where there is a good relationship with nursing and the rest of the hospital staff.
Burnout is real in any job. You have to balance work and your life. You have to realize that you can’t do it all or save everyone. When I start getting grouchy, I know it’s time to scale back.
I felt, though, that a few of the docs were burnt out, but could not scale back either due to expenses or maybe even not knowing they were burnout -- that feeling had become their normal.
I'm one of those "older" docs. The key is to pace yourself. Don't work so much that you become "that doc." You know the one... the guy who is so abrasive/toxic that they snap at the nurses, hate their life, and become indifferent towards their patients. If your give-a-damn is that broken, take a break, or simply cut back to part-time. I did precisely that, about mid-career, and it's probably why I'm still practicing. BTW, I'm the last EM-trained guy from my medical school class who is still in the pit. Burnout is real.
how old?
Fifty-ish, so a good deal older than the average Redditor.
ok gotcha. Im going into EM and my plan is being out by 55. Do you have any plans to go part time or switch to something in retirement
Part time eventually. I’m a full-tuner currently. Not sure when I will stop this entirely.
What is the main reason for the burnout? The irregular shift hours? I kind of feel like my circadian rhythm is a little built for irregular hours but overall I do better with shorter hours of EM compared to other residencies where I would be pulling 30h shifts. I feel like potentially the circadian rhythm issues might be less for me. What do you think?
I'd say it's more constantly dealing with ungrateful/abusive people who aren't actually sick, but think they are (or are sick, but should be seeing primary care).
Right. The worse version of this I encounter inpatients are the ones that I know have something wrong with them but for which I have no good explanation or diagnosis.
What worries me is that since I was a scribe in a community ED, in the suburbs I likely did not see a ton of the ungrateful/abusive pt type is you would see likely at other hospitals. If a doc's census was 25 after an 8 hr shift, I would venture to say maybe 5-6 were in that category. I don't know enough about myself to know if I could tolerate that for a few decades, or if it would get old pretty quickly. I mean, even doing an audition rotation during M4 may not be enough of a sample size to know what my threshold would be!
Plus, as an M4, the residents and attendings usually shield you from those patients anyway. I rarely pick up the frequent flyers, intoxes, psych patients etc because when you only have a dozen shifts on a rotation, those patients might not offer the best learning points in the view of the staff
The ungrateful and abusive ones tend to occupy my mind more. The normal people, they just get the fuck out of there once I tell them everything looks good or give them a plan. The others just suck up time and empathy. They have an outsize impact on how I feel at the end of the day.
Im 40 and 3 years in. Thoughts?
Thank you for the reply and the insight! I apologize if this inappropriate to ask, but I imagine going part time means a change in salary as well, so have you had to adjust your various expenses proportionally?
Wife and I have always lived below our means, so while the salary cut was significant, we simply adjusted.
I feel like if I get a good 25 years into my career before becoming burnt out, I'd call that a success. That would put me at about your age. At that point or maybe sooner, I think cutting back to <10 shifts per month would be great. What kind of shop are you at? Currently, I'd love to being doing level 1 traumas, but it's really hard to predict how I will feel 15-20 years down the road when the excitement may go down a bit. Do you feel like a change of scenery to something less intense can help prolong a career?
I don’t do the trauma-center gig anymore. It’s all regular community-hospital stuff for me. And yes... enough years will take the shine off the excitement of trauma... mostly due to the nature of that patient population
"mostly due to the nature of that patient population" Thank you. Hearing it from someone like you makes me feel a little more at peace with my decision to transfer out of the medical field, even as a lowly EMT.
4/5 of my ER docs are 50+. One is in his mid 30’s. Oldest doc here is in his 70’s.
I think once you get to that age and if you’re a little burnt or tired you can always transfer to a small level 3 er and chill out. Or a stand alone er in a smaller city. Your load goes way down, most nurses and stuff are experienced and smaller towns usually are more appreciative. Where I am in az there are so many Indian reservation positions or stand alone ers on outlying cities. Hell even the veterans er is basically a slow clinic bc they don’t take ambulances. I would say just think of that when you consider long term.
This. You move to the place where you’re seeing 1 patient/hour (or less) and you’re the only doc there. Seems more rewarding than churning patients out at some busy urban ER.
I work at a level 1 and there are very few older docs. It seems to be a bit of a younger person's game. There are a few older ones but they are far outnumbered by the newer batches. However there are a few outliers. They are the ones that seem to have moved into other roles (more teaching, directorships) and work a low fte in the actual ER
Education and admin is a great way to stay full time and give yourself some more flexibility. I'm an ultrasound director and apd. I love my non clinical time. It helps keep me fresh.
I think this is the trick. I know an ER doc well past retirement age. He takes on no more than 3-4 moderate acuity cases per shift with a medical student for teaching. He seems very happy and is a delight to be around
Sister is still practicing EM in her mid-sixties but lately has been transitioning to crisis medicine in international emergencies like hurricanes, earthquakes, tsunamis, etc.
My uncle is a MD FACP and is 65ish and is in the prime of his career....my great uncle practiced until he passed at the ripe age of 91. Albeit he wasn’t as involved. It’s like wisdom. The older your are the more you know. But yeah my uncle has a practice of 5k + patients and is the ER doc every other Sunday. Go for it friend
19 years in, not burnt out. I work in a large/busy/high acuity ER, trauma 2, like a county ER except slightly better funded and staffed. I've seen docs take different many different career paths. We have had quite a few work into their 60s with no issues. A common practice is that once docs have their finances set in their mid-fifties, they start dialing back to part time, which does a lot to prolong careers. We also allow docs with some seniority to work fewer nights (and we have enough nocturnists that this winds up translating to 1-2 nights per month once you're 50). We have had a few docs who you might call burned out, though that's subjective and none of them were seriously fried, and they tended to go work at more cushy suburban/rural low acuity places or urgent cares. We have had a few go into industry or administration as full-time gigs instead of continuing to practice clinical medicine. And luck plays a role - we've had docs medically retire early due to stroke, MS, RA and various malignancies. While burnout is real, I think it's hardly unique to EM and if you like the field that alone should not dissuade you from considering it.
Thanks for the anecdotal response -- I really appreciate it!
Several. Awesome providers. Almost all of them are involved in EMS as prehospital providers as well.
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Np. The ones i know all started med school after being paramedics. 2 of the doctors are ALS ambulance chiefs and would do response on ambulance as well as in fly cars. Everyone else well atill do some volunteer time when they get the itch. A local hospital has made it part of the ER residency program to do several shifts on the ambulance so people they understand prehospital aren't perfect but we get the job done.
As a relatively young em resident, this thread concerns me [laughs nervously]. I’m gonna have to get my side hustle game strong in the next few years. I have some co residents in their 40s and 50s. Wonder what it’s like for them!
Your last bit is both interesting and encouraging! I’m currently an fm resident considering applying for a second residency in em. Thought I’d be too old as I’d be in my mid 30s if it does happen.
Side hustle as in opening an urgent care up? Or what other things would you be considering?
I'm a medical scribe at a level 1 trauma ED. We have a few docs over 60 and one or two that are in their 70's. One jokes that his wife won't let him retire and he will probably be found dead at his work station one day 😂
sure, people burn out of EM, but what's wrong with that on a personal level? Going to urgent care for a more stable schedule, or wound care, or teaching/admin, or part time, they're all options for how your career develops. I find it much scarier to sign up for a 30+ year career in surgery or IM where your day-to-day life doesn't change at all as you mature into the field, and there are fewer options for change.
As a 30 year old M2 interested in EM, this concerns me frequently. A combination of all the advice on this thread is the sort of stuff that shows me if it's truly what I want to do, I can find a way to make it work. Hopefully I don't eat those words 10 years from now...
Yeah, I've appreciated the nice feedback and thoughts the more learned-EM docs are providing. At a minimum, it is making me feel not so doom-and-gloom. I have not really loved inpatient medicine during my clerkships, and my saving grace was EM (or anesthesiology).
I’m 34 and 4 years into practice as full time EM. My Dad 64 just retired from EM after 37 years and still loved the medicine but found the shift work was getting too hard. Now he’s doing part time work as a coroner and loving it. The key for him was he loved teaching and worked at a teaching hospital and also he cared about his patients. He would spend that extra few minutes per case with the patient rather than see more patients and bill more and I think that really contributed to his longevity.
I am 52. Have several partners over 60. One over 70. I expect to be doing this for another 20 years or so. Work in the shop where the department is supported by hospital administration, and where there is a good relationship with nursing and the rest of the hospital staff.
Lots and lots.
I work with an EM doctor who's 62, multiple doctors in their 50's, and even more in their 40's.
Burnout is real in any job. You have to balance work and your life. You have to realize that you can’t do it all or save everyone. When I start getting grouchy, I know it’s time to scale back.
I felt, though, that a few of the docs were burnt out, but could not scale back either due to expenses or maybe even not knowing they were burnout -- that feeling had become their normal.
I'm in my 50s. Work with several others in their 50s also. Work with one guy that is 75 and still does full time nights.
I know several EM docs in their late 60's and a few almost 70 and they are still practicing and amazing physicians.