Is being an ER doctor as cool as it seems?

(OR - Quit Medicine? Part II)

As a group, doctors are not very good advocates.

Not for themselves, not for their patients, and not for their profession.

Gradually (and not so subtly) everything non-medicine has played increasingly larger roles in interfering with the doctor-patient relationship. Everyone suffers (even those greedy bean-counting executives suffer when they finally succumb to their own illnesses, or as they deal with trying to navigate American healthcare for their families). And instead of demanding a seat at the table, exercising their responsibility to weigh in on all things medicine...they sit on the sidelines and complain.

But this is beside the point.

My point today is to talk about whether or not choosing emergency medicine (or even choosing a career in medicine) is what I thought it would be.

Let’s start with what I thought it would be like.


I knew, as a medical student, that my role was insignificant. I knew residency was hard with long hours and physical exhaustion. I understood that college and professional school would be expensive (and accrue a large debt for a girl from a non-wealthy family) and residency would mainly serve to delay my ability to pay off these debts.

I recognized that I was socially underdeveloped, and had no practical knowledge about anything not in the lecture notes. I expected to wait to have a family, and accepted being continually absent from my own life to undergo this training program.

However, I also expected more freedom once done. I hoped for enough money (which is subjective and constantly changing) to live comfortably. I hoped to reclaim some “lost” time (and hang out with friends, read some novels, get married, have kids). I hoped to mentally *graduate* from student status, and buy a big-girl house, and big-girl clothing.

Most of all, I thought there’d be more appreciation and respect for the sacrifice doctors make in order to do what we do. I hoped for a more powerful voice as a professional. I thought doctors and patients would advocate together for the best possible health-care situation. (Vocal in a 'I am woman, hear me roar' kind of way...sorta like the nurses. I guess medicine is still too male dominated to be very vocal....)

But what I quickly realized was…

…being a physician is not quite what I expected.

But I’m a roll-with-the-punches kinda girl (or at least I try to be), and realize that physicians are *still* quite cool. Saying you’re a doctor does offer a certain degree of legitimacy in conversation…and it is easier to get a ‘seat at the table’ if you bring a medical degree with you. I do acknowledge (and appreciate) that.

Instead of complaining (further) about all the things “wrong” with being an ER doc, let me make it clear…

…it really is a fabulous job.

Not a day goes by when I don’t get some fantastic job solicitation (usually in not-quite-so-desirable places to live) begging me to consider a move to Podunk, Wherever, for crazy sums of money. And even locally, having board certification in a specialty that everyone uses makes finding decent job a small issue. There’s never a shortage of ‘business’ as an ER doctor. As the recession progresses (and the economy slowly recovers) our ‘business’ just increases as people lose their health insurance along with their jobs - which is unfortunate. But single payer would allow everyone to have access to (at least minimal) medical care...and (get this) we'd actually get paid for said care. (I honestly don't know why doctors, especially primary care and first-responders, would be against getting *some* compensation from *everybody* you serve)....

...but I digress.

What I do in the ER, matters. It is meaningful work. And the pay is not bad either.

I often get asked: would you recommend this career for your children (or some variation thereof).

The answer is (still) absolutely yes!! But with caveats.

I think it’s important to go early, go hard, and get done. Doing it this way, you could be done with all your training by age 29. Still plenty of time to “catch up” on everything else in life. After all, what better way to spend your twenties than setting yourself up professionally (and possibly financially) for the rest of your life. All before you have children, get married, or acquire additional responsibilities (such as elderly parents) or in society.

I think it’s important to focus on the practical aspects of choosing any career, medicine included. It is not “a calling” or some sort of “special” state of being. It is a career. A way to make a living and contribute to society professionally. Just like a photographer (with better pay)….or a plumber (with equal pay).

Realize that having a fantastic career (any career) will not adequately replace loving relationships, family, and personal development. Temporary sacrifice is expected of many low-rung staff in any career…but constant/permanent sacrifice is not worth it.

If you put off having a family, miss your grandmother’s funeral, miss your cousin’s wedding…and then, at 35 realize that you cannot conceive…medicine would NOT have been worth it.

Everyone has their own ‘balancing act’ to achieve. Some of us put more emphasis on family…while others lean more towards career. That balancing act is highly personal. I will say, it’s very easy to weigh career more heavily (even when you don’t intend to) because of external pressures and the societal value placed on wage-earning and 'work' – especially for the “liberated woman.”

If you’re not careful, you’ll become imbalanced, convincing yourself that you’re where you want to be…even when it’s not. And…discontent sets in.

But, if you are able to put “everything in its proper place” in the ranking of your life priorities, medicine can be an excellent career. And EM...allows a doctor to do this. To work a lot...or work a little.

There are days, nonetheless, when you think to yourself...

....what *else* might I be good at? Is there anything else I might want to do?


Quit medicine? (part one)

When I was a medical student there was a girl who, after 2 years of medical school, decided…she didn’t want to be a doctor after all! I remember hearing a rumor that she decided she would rather spend her days swimming with dolphins. Then…she was gone.

That got me thinking, for the first time in my life actually, what do I WANT to do? Prior to this, my standard reply of “I want to be a doctor” achieved sufficient accolades from everyone, and the satisfied look on their faces served as confirmation that I was on the “right path.” I never really gave it a second thought. But this girl…had the audacity to decide on her own that she was going to “throw away” everything she’d worked for (and all the sacrifices her family had made to allow her to opportunity to attend medical school) and make the “irresponsible” choice to swim with dolphins in lieu of becoming a doctor. I mean, who does that?

At that time, I thought to myself: good for her for knowing what she wants to do, but why not finish medical school first, *then* go swim with dolphins? That way, if her perception of a dolphin-swimmer’s life was misaligned with the reality, she would have “being a doctor” as a back-up career option.

So I spent no further time pondering any other choice at this time. Instead of thinking about what I *wanted* to do, I focused on completing the path I was on, because that’s what made sense to me. I reminded myself that the most difficult (academic) work was complete after taking the USMLE Step I (after 2nd year). The third and fourth years were the clinical (interesting, “field-trip”) years, where you *finally* get to legitimately “play doctor” for real! Why quit now?

But *when* IS a good time to quit? Once you get on the ‘medical-training-in-America’ highway, there is no “easy” time to deviate. It makes sense to complete medical school because once you achieve your advanced degree, you can *still* go fold jeans at The Gap if you want. Nothing (but a few years) is lost by finishing the degree program. So you finish…

Then, you can’t quit before internship. You can’t even get a medical license without completion of an internship! It only makes sense to obtain licensure. Why go through all of that training (and torture) in medical school to become a doctor, and then take away your ability to actually get a medical license because you’re too “lazy” to do just one more year?

Unless you know something that I don’t (which is quite possible), there’s nothing you can practically do as a new doctor (with no other training) without residency completion. You can’t really make any money (and with the huge burden of student loans, *choosing* to NOT make money is a crazy option), aren’t respected as a doctor, and are ostracized completely from “real” specialists (and everybody’s a specialist these days). Who wants to sign up for that? When in just 2 more “short” years, you too can be a board eligible specialist! So…I made up my mind that I would complete the entire training program, and *then* I could reevaluate my decision from a position of “safety” – as a board certified physician specialist.

As a 4th year student contemplating specialty choices, I decided *then* that (despite everything I thought I knew about myself) I had no desire to spend significant time taking care of sick people – gasp! And this realization just kind of snuck up on me as a senior medical student.

Before medical school I thought I wanted to be the quintessential doctor who took care of the entire family their entire lives, family medicine. Then I realized that people are “difficult” and I do not want to be ‘responsible’ for people, sick people…and certainly not their entire lives! Whose crazy idea was that in my head all those years, thinking I could pull that off?

So I eliminated the kids and pregnant women which is essentially internal medicine. That felt better. But still, too big. Too much. Too long. But, nothing else was particularly appealing, and this late in the game many options are essentially removed from the table. So IM it was. But then, I signed up to do an anesthesiology rotation because I’d heard it was super easy…and after 3.75 years of medical school, I was so ready for easy!

True to its reputation, the rotation was a cake walk! Show up at 6am (which was the most difficult part) and intubate a patient or two, then go “read” (i.e. do whatever) until the next morning. There was the opportunity to see trauma anesthesia, which allowed the student to do a-lines, venous lines, and more! Very cool stuff! Still not completely sold on my IM choice, I switched to anesthesia, just like that. I was desperate to “find” my “place.” I was a gypsy, and even as 2nd semester 4th year (senior) student, I was uncommitted!

So I clung to anesthesiology. Sure, I was cognitively aware that I would not be able to intubate and leave. I realized that the days began very early, and were long. Call was busy, and the training stressful. But, I *also* didn’t have to take care of a bunch of people…forever. One patient at a time. Done with surgery/procedure, done with patient. Sounds perfect.

Let me say, it is about this time I began to awaken from the unconsciousness of whirlwind academic overachievement and hierarchal indentured servitude, and realize that “maybe this whole doctor bit is overrated by those *stuck* IN it.” As a coping mechanism, I think many doctors just don’t *think* about their lives, and are unable to consider alternative life paths because they subsist on the delusion that this way is the only way to “be somebody.” And it doesn’t help that doctors typically see themselves as professional corporations and not the workers that they are, so their work conditions are super shitty, but no one cares. Especially not the doctors.

But I digress.

As an internal medicine intern (required prior to starting my anesthesia training) I actually had a great time. Becoming an intern is, in many ways, the prize for years of hard work and being invisible. Years of proclaiming “I’m going to be a doctor on day” to finally *being* a doctor is a huge step forward. Because, honestly, how many of us know someone who’s “going to be a doctor one day?” Not a big deal.

Just *finally* being the DOCTOR was enough positive momentum to sustain me through the internship year. And the amount of practical knowledge I acquired was worth the “abuse” and “sleep deprivation” at that time in my life. I felt legitimate (although incompetent). Also helpful was the knowledge that I was moving on to ‘bigger and better things’ with anesthesia. I was NOT going to be “doing this” (rounds, carrying a pager, writing long H&Ps, the whole deal) much longer. I was going to do short notes, cool procedures, and sit on my ass all day as an anesthesiologist listening to uplifting music, reading trash magazines, and getting paid well. Couldn’t wait!

So you can imagine my disillusionment when I actually began the anesthesiology residency. It was early mornings and long days. It was being on-call and lack up sleep. It was lonely. And in some respects, demeaning, boring, yet stressful all at the same time. And, the worst part was (for me) – there was no one to talk to, and minimal patient interaction. Who knew that taking care of sleep people would be lonely and impersonal?

Clearly, I hadn’t thought out my specialty choice well.

What now? I don’t want long term relationships taking care of sick patients. I don’t particularly like small children (even more so before I had my own). Being all up in vaginas all day was the *last* thing I found appealing. What else is there? Maybe I would go back and finish IM, and then subspecialize? But that would tack on like 5+ years to my training, and after this whole fiasco, I had no time for such nonsense. After all, I’d been trying to find an exit off this medical highway since 2nd year medical school, but stayed on for very logical and practical reasons. But at some point, I just had to draw the line.

It is important to keep in mind that doctors have done themselves a huge disservice by subscribing to the current status quo of medical training. Unlike nurses, or PAs, we cannot just “switch” specialties and “do a new thing” when we get bored with the current thing, or otherwise we can no longer do certain procedures or function in certain capacities. Nor can you move to another part of the country on a whim and expect be granted a medical license from another state (never mind the fact that you already HAVE a medical license after passing a *national* exam, which is asinine and a post for a different day). For multiple reasons it is not practical for a mid-career physician to “go back” and do another residency to obtain different credentials to do a new thing. Overall, medical education does not easily extrapolate into meaningful work outside of medicine. So, once you choose a specialty, you’re essentially stuck! A decision you make about your career at age 25 had better serve you well when you’re 50.

Oh, the pressure!

After all of this, I decided to pursue emergency medicine, primarily because it allows doctors to be doctors when they want to be doctors – and cool doctors at that. But, when you didn’t WANT to be a doctor, you could do something else. Anything else! And still be cool. With a solid “back-up” plan that is EM. And the cherry on top of that sundae was: I didn’t have to take care of sick patients for forever. I can step in when they really NEED help, I can TALK to them, I won’t be lonely, I get to do cool stuff….and then…I get to go home! To my life. All the while, making 100% more than a pediatrician, and 50% more than FM with less stress, less work, less ‘distraction’ from my REAL (non-doctor) life. (And judge if you must, but money *does* matter, especially when the cost of medical education is in the hundreds of thousands of dollars!)


Right? It’s all good now as an ER doctor….isn’t it?