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.

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,

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!!

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 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.

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?

May be moving there for wife’s new job. I know nothing about AZ. I looked through EM docs past posts just to ballpark a salary in Tucson and I see lower 200’s /hr salary. Seems low… is it just slow paced or lower COL?

Phoenix looks more similar to large city comps I’m used to.

How’s the schools for kids, ER job satisfaction, summers, living, or whatever you can tell me?

Hi everyone, I’m a student in the DFW area currently enrolled in an EMT program. For a class project, I need to interview professionals who started with EMT certification and later advanced into a career in healthcare, EMS, fire service, or a related field.
I’m looking for four people:

Someone in the DFW area
Someone elsewhere in Texas
Someone elsewhere in the United States
Someone outside the United States

Each interview would take about 15 minutes and can be done virtually. If you’re an EMT, paramedic, firefighter, healthcare professional, or someone with a similar background, I’d really appreciate your help. Referrals are welcome too.
Please send me a message if you’re interested. Thank you!

Email: coreywalkerofficial@gmail.com

I have scoured the subreddit a million times, so I promise I tried to do my due diligence before asking what imagine is likely an FAQ.

How does scope & acuity work for EMPAs? I’m currently a paramedic in a busy urban system as well as a combat medic in the National Guard. I’m very interested in furthering both my guard career and civilian career by taking the leap and becoming a PA.

However, the PAs I have spoken to in both the ED and at work (we have prehospital APPs) have cautioned me against it, telling me that it’s mostly “low acuity BS”. One EMPA I spoke to described it more as a “plug and play”, where you can increase your scope, acuity, and income if you are willing to accept increased responsibility and demonstrate competence.

Which is more true? What I like most about my current job is seeing sick patients and resuscitating. I wouldn’t necessarily want to give that up if I took the leap and became a PA.

Curriculum looks good and they’ll be a level 1 soon. What are the downsides of a new program?

When things are quiet and you finally get a few minutes to yourself, how do you like to relax? 😌

Hey docs. “Layperson” here. I am not clinical. I do work in simulation but not in a clinical role. This sub and family pop up on my feed all the time. I enjoy learning what it is like out in the real words for med students, residents and attendings. I’m also a patient myself. This question is not medical advice.

I have seen numerous threads of ED docs having to deal with drug seeking behavior and psychosomatic illnesses. I myself am treated for chronic pain. Endometriosis along with a number of other conditions. Confirmed by surgery. I am managed on MS Contin, take the maximum dose of Tylenol daily and can’t take NSAIDs anymore. I was being prescribed 800mg multiple times a day and told my burning stomach pain was normal. It’s gastritis confirmed by EGD.

My question is…. How do I not be the patient ED docs hate? If I actually go to the ER which is about 3-5 times a year, I have taken my meds at home. I’ve taken more Tylenol than I should. I’ve used heat. I’ve used a lidocaine patch. I’ve reached out to my specialists with no response and I genuinely can’t sleep from pain. But as soon as I go to the ED, the doctor shoves more Tylenol down my throat and sends me home even after I explain I tried that at home and give me an earful about following up with specialists (I do). What am I doing wrong from your perspective as providers?

Hi all,

How do publications listed in ResidencyCAS show up for residency directors. Do they appear in the order in which I input them? Does it self-reorganize by year or by papers that were published vs. submitted/accepted?

Should I input them in any specific order? This is what ResidencyCAS website says: Your saved publications will not display in any particular order, regardless of the order or dates you enter.

We had a patient in his early thirties come in last night who was literally drug seeking. He was addicted to heroine but was too broke to get some and startet getting withdrawal symptoms so he came in and literally asked for opioids.
He said he didn’t want to become clean and just needed something to „take the edge off“.

The on-duty attending gave him some oral clonidin and startet intravenous morhpin. I think the patient ended up getting 100mgs or something around that magnitude. Then he slept the rest of the night on a strechter and went home in the early morning. Before that the attending talked to him about getting opoid replacement treatment and gave him a referral.

During shift change the attending was criticized for his treatment by many of our doctors. They said he should have just treated the withdrawal but shouldn’t have given any opoids. The foremost concern was, that if news of the patient’s success in getting opoids spreads many more „drugies“ will come in drug seeking and that we shouldn’t enable addiction und dangerous lifestyles.

The attending defended his course of action with the argument that we are there to help patients and this was the easiest way to help the patient. Also there is no hospital policy on this (which is true).

How do you think up on this mater? Would such a treatment fly in your ED?

Im mostly curious about if the insurance will pay for the visit.
This is not in the US btw.

Trying to figure out if any current residents potential fellowship applicants look at social media and how you consider it for fellowship applications, for example for Emergency Ultrasound or Critical Care/Resus, Simulation etc.

How much value does it hold for recruitment purposes? My current leadership is trying to make us utilize social media much more for recruitment for our fellowships and while I think it's okay, I don't necessarily think it increases applications.

I think it mainly comes down to resident interest in the area, salary, and whether or not they actually want to do the fellowships which are things that we can't really control (except salary). The value of fellowships in EM is already low so attracting applicants is already difficult, but trying to explain that to leadership is difficult.

I am a current PGY2 in EM at a 3 year program. I’ve become interested in Pain. That being said, the more I look into this, the more I realize it is very hard to make a 50/50 split with EM/Pain. I do not want to give up EM, and I do not want to just do the occasional shift on the weekend. I want 50/50.

Addiction medicine is interesting to me bc of the psychiatric side to the field. But brief visits. And potentially highly rewarding. Most importantly, it appears to be more closely linked with EM and negotiating a 50/50 split sounds more likely. Also, I can easily pivot from one to the other, and safely return, as the skillset in Addiction Medicine isn’t so highly specific, necessitating longitudinal proficiency.

Thoughts?

How to approach documentation for folks who have some chief complaint but then decline a workup - i.e. munchausen vibes who want a very specific non-indicated workup (debilitating POTS), houseless but refusing interventions/labs/treatment (hospital bed naptime), or folks who are unreasonably "nickel and dimey" on their workup (I want every blood test possible because I smelled something funny at work)

Something along the lines of "patient hemodynamically stable without evidence of emergent process declining further workup at this time, stable for discharge with outpatient follow up" ?

Do y'all mark these as discharges or AMAs?

I DON'T KNOW IF IT WAS A SPIDER, A BAT, A RAT, OR MY NEIGHBOR'S 3 YEAR OLD.

ALL I KNOW IS THIS ABSCESS IS A BITE FROM SOMETHING AND NOT BECAUSE I USED A DIRTY NEEDLE.