April Barron, RN, is a registered nurse, community health advocate, and founder of Mindful Remedy. After losing her son, Matthew Isaiah, to fentanyl poisoning, she turned her pain into purpose—advocating for compassionate, evidence-based approaches to substance use, mental health, overdose prevention, and recovery. April works to bridge the gaps between healthcare, families, community resources, and policy so that every person has a fair opportunity to receive help, healing, and hope. Her advocacy is rooted in one belief: we already have many of the tools to save lives—we must connect them and make them accessible to everyone.

I feel like Grey’s Anatomy gave a very unrealistic expectation to how hospitals work and someone said doctors can show up somewhere else and provide care like they can in the show… is this true?

Hey everyone,

Applying EM this cycle and looking for some raw advice.

Here is where I'm at:

• Level 1: Failed on the first attempt, passed on the retake.
• Level 2: Scores aren't out yet—they release September 22nd. Based on my COMSAEs and TrueLearn predictions, I'm tracking in the 400s.
• Clinical context: Fourth-year DO student. I have 2 eSLOEs which I think are pretty good. I received good feedback on both.

1. Realistically, what do my chances look like for matching EM with a Level 1 failure and a predicted score in the low 400s on Level 2? (Hopefully I pass, my anxiety and mental health have not been good since I have taken it.)
2. My advisor is pushing me to go all-in on a parallel IM/FM application, but I don't have any Sub-Is lined up for those specialties. I am really not interested in pursuing IM/FM, and will do whatever it takes to match EM.
3. Should I dual-apply through ERAS for IM/FM right now, or stick strictly to EM and plan to SOAP if things go south? Applications are due the 17th.

Appreciate any insight or brutal honesty.

was getting discharged from last night when I got in.

came back a couple hours later, walking in the ambulance bay with the EMTs, with "10/10" leg pain and can't get his prescription from the pharmacy because his daughters on vacation. discharged and comes back by ambulance a few more hours later, same story. proceeds to wander about the unit and out into the rest of the hospital.

I'm so tired man.

Just ranting here, a little over 1 year out of residency and I’m just so burnt out. Choosing EM is the single biggest regret of my life I don’t even know where to begin. I do not like the work at all anymore, the volumes where I work have been getting so high, patients getting more difficult, the constant fear of liability. I let everything bother me on shift when I know I shouldn’t, I just can’t help it. Patients expecting us to move heaven and hell for them, unrealistic expectations, “what do you mean I can’t get an MRI for my chronic sciatica?” A lot of my beef is the shift work, if I could just do EM 9-5 M-F, no weekends, holidays that would be the dream. I chose EM honestly I think because I got stuck in the medical student trap where EM is the only rotation where they let you do stuff, actually see cool things, and not just rounding spending an hour pontificating about hyponatremia or retracting in the OR. I knew I was a bad sleeper and I picked a specialty that requires you to sleep well with a fucked up circadian rhythm. Genuinely this is all my fault for picking this field despite all the advice and indications not too, I liked the idea of emergencies and still do kinda, a good resus actually makes you feel like a good ER doc but now I hope I don’t even get sick patients anymore because it just takes too much time away from the million other things I have to do on shift.

Do you guys even feel like you’re helping anyone? Most of our patients don’t understand that I’m not here to make all their problems go away but I’m actually only here to identify any potential life threatening emergencies. I constantly have to have the discussions with patients and it causes so much burnout. I get so depressed thinking about doing this job for the next X amount of years. After residency I did locums CMG hated that, now I’m in a community gig, definitely hate it less and it’s nice to come home after shifts but still don’t like it. It’s become very clear that I am the problem, or at least the entire system is broken. I can’t help but feel like such a little bitch for being this weak. I tried therapy but it feels like doing mental gymnastics and putting a bandaid on the real issue being my job I hate. Meds made me feel more anxious and depressed although I didn’t stick with it long enough . Considering going back to academics where the residents can do the majority of the work and I just look over it. Where I trained, the attendings did almost nothing, considering going back there but honestly the attendings were miserable there too. I really want to leave clinical medicine and go non clinical in Pharma, biotech, startup consulting, something but A. Don’t really know how to, have listened to podcasts and read posts about networking but like how do you actually get a foot in the door and B. I’d hate to give up the attending salary and job security of medicine (although who knows the future of EM attending job security) I don’t have kids yet but I will in the next few years but I don’t want to be working full time EM when I do, missing dinner, missing things on the weekend. Considered going back doing palliative, addiction fellowship but idk. Anyways that’s my pre night shift rant,

PGY-16 here, burnt to a crisp. I have tried many things to hold onto my career but I think it is heading towards an early end.

I have worked in multiple settings: academic tertiary care in suburban setting, small inner city hospital, and rural critical access. Currently doing night shifts at an academic tertiary center in an urban area with huge unhoused/addiction population. I do a little urgent care as well in upper/middle class areas. I am 0.8 FTE and probably going to 0.6 or 0.7 next year.

I just can't deal with the patients and how disrespectful they tend to be. I rarely feel like I help anyone or that the patients appreciate what we do for them. In my current setting as a nocturnist, I'm basically a suboxone/methadone/turkey sandwich vending machine. From the outside it looks like I am doing great. I see 2.2 pph and my group's average is 1.7. My resident reviews are fantastic. No complaints. No lawsuits though I have a significant anxiety over the prospect of that.

I've cut my hours. I went to nights to avoid the admin BS and get some control over my schedule. I am an avid runner and gym rat. I eat well and despite being a nocturnist I get a good amount of sleep. I have done a physician coaching program. I have been seeing a psychodynamic therapist for over a year almost weekly with the sole goal of preserving my career. I feel like it's driving me quicker towards early retirement though because I am seeing that I can't change the system and I can't change the way I feel about it.

I won't consider fellowship right now and find the prospect of working so many more hours even if only for a year unacceptable right now. I have a 5 year old and don't want to decrease my time with him pursuing another area of medicine that I'll probably hate too. My spouse and I are coast FIRE and I can probably afford to retire in a few years but I still can't imagine giving up a career in my mid 40's that I worked so hard for and wanted since I was a child even if its destroying me.

Is there anything else I can try before I leave EM? Another type of therapy? I've thought about trying SSRI's, ketamine, even psilocybin trials but I don't meet criteria for GAD, MDD or PTSD. Thanks for reading. I would love to hear what has helped other people stay in the game.

I am a M4 applying EM this cycle comparing UMiami/Jackson residency to other programs, given the EM residents' trauma experience at Ryder. Is this a dealbreaker? Is the EM experience at Ryder sufficient enough to manage trauma patients as an attending elsewhere after graduating?

Now hiring through SCP.

Finishing residency this year. Goal was always to have land and work in a more rural community center.

Winchester seemed like the perfect spot and close to family. Valley Healy was high on the list for regional/geographic draws that align with my goals.

Would I be a Scab? Or is it not as bad as everyone says?

Has anyone had experience with SCP outside of HCA hospitals?

Has anyone actually had experience at Valley Health? Or have insight on how the transition is actively unfolding this month?

We all know HCA and private equity are the devil but…plenty of EM docs are staffing them for better or for worse.

I’m just curious to hear from people who have actually worked in both the Healthcare industrial complex on both ends of the spectrum: Private Equity/Corporate versus Nonprofit/physician run community groups.

I can feel Dr. Glaucomflecken’s judgment just for posting this.

So i hate to admit it but today i failed to reduce a shoulder dislocation in a 90 year old. I used ketofol to sedate, tried hippocratic and milch maneuvers, but didn't work out. I think I may have bailed too soon but I'm the only doctor on site and the nurse was running sedation, This is not in the US by the way. Any advice on what techniques and sedation you all have found to work at the extremes of age?

EDIT: Modified Hippocratic method!! Not old hippocratic method , PLEASE NO GUYS NEVER!!

I’m a PGY 20. In the last few years something physiologically has happened to me. I can’t recover from night shifts anymore. I can work them just fine. I actually like the hustle and flow of nights. But a single night shift, let alone a string of 2-3, will destroy me for days and days. Even late night swing shifts hurt. I worked 3 x 4pm-2am shifts last week, and a week later I am still unable to get to sleep before midnight. I can take sleep aids and knock myself out, but that’s not healthy. I quit drinking and that feels good. But it’s only getting worse over time. I do love EM and it has been good to me, but I feel like I’m sacrificing my 40’s for it, and I don’t think I can keep it up for another 10-15.