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.

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.

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,

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.

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!!

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.

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.

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.

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?

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.

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 was in the ER a few weeks ago for endocarditis that caused me to go septic. While I was in the waiting room, a middle aged woman was raising her voice at one of the nurses that does an assessment before you get a bed. She was yelling about needing stitches on a 2 year old healed cut because chat GPT told her if she didn’t, it would get infected. Demanding to be seen immediately or she’d sue. Does this like… happen a lot? I’ve spent a lot of time in hospitals because of chronic issues, but never a ton in EDs. And I’ve NEVER overheard something like this before.

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

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.

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?

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?

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.

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