Burnout In Emergency Medicine

[Euphenism1]

Hi,

 

Anyone know how serious burnout is for ER docs? I know it was a problem in the past, but I've heard anecdotally that it's gotten much better in recent years. Do ER docs have an earlier retirement age?  

[mononoke]

Based on people I've shadowed, some do confirm the 8year burnout time, but a lot have said that it gets harder to do shiftwork and recover as they get older. Also, they don't necessarily have a 'retirement' age, they usually go off into doing administrative or public health/health policy work

[amichel]

But... They don't work very many shifts a month. And the shifts aren't that long.

 

I have to admit that from the outside it seems like a seriously sweet gig.

[LittleDaisy]

Yeah it is hard to do 12-8 am shift once you hit 40-50s with three kids! But if you love emergency, there is always a way to work around it.

In academic centers, the staff with more clinical experience tend to have better schedules (i.e: more day shifts). 

Based on people I've shadowed, some do confirm the 8year burnout time, but a lot have said that it gets harder to do shiftwork and recover as they get older. Also, they don't necessarily have a 'retirement' age, they usually go off into doing administrative or public health/health policy work

[bloh]

It's not just the hours but the really silly things clueless people come for. I worked a shift yesterday and pretty much 90% of what I saw until about 1300 were colds, stubbed toes and back pain. It gets really mentally exhausting after a while. It's different if you see those in your family clinic and they're your regular patients but you never know what you might be missing in emerg. And when I see a 2-for-1 or god forbid 3-for-1 with the parent being the third, a part of my soul is lost forever. Those pretty much never get to have something cool like DKAx2.

[ploughboy]

But... They don't work very many shifts a month. And the shifts aren't that long.

 

I have to admit that from the outside it seems like a seriously sweet gig.

 

Ya, totally cupcake. We spend most of our time eating bon-bons.

[amichel]

Ya, totally cupcake. We spend most of our time eating bon-bons.

Lol of course that's not what I meant. Obviously it's stressful when you're at work but you have to admit that most staff have pretty chill schedules if you're looking at hours worked by specialty.

[ploughboy]

Ok, so a serious answer with no snide "bon bon" remarks.

 

When I was a clerk, I had a serious crisis of conscience regarding emergency physician burnout.  I was working a shift with a senior ER doc at a program that I wanted to match to (if you're at Western, you will likely recognize him if I refer to him as  'Dr Labia').  I saw an ovarian Ca patient who was in significant discomfort from abdominal ascites.  My management plan was a tap, then an admission to gyne onc to set up palliative home care. 

 

He yelled at me.  Then he yelled at the patient's sister.  Then he yelled at the patient ("wasting healthcare resources").  I have never been more embarrassed to be a physician than I was then.   I remember her looking at me, and I wanted to crawl into a hole somewhere and die.  I can feel myself getting tachycardic as I'm writing this seven years later with an fr-fcking-cpc in emergency medicine behind my name.  I was *so* angry, but was in a position where all I could do was nod in agreement with my preceptor's plan.   I guarantee you that I will never forget this. 

 

My medical colleagues, my nurses, my allied health and my juniors will all tell you that I'm a cynical nihilistic who thinks that we do far too many futile interventions.  But Dr. Labia's response to the situation was beyond the pale.

 

So what's the point of this story?  Looking back, he was probably burnt-out.   It happens to lots of ER docs.  Being asked to fix the unfixable, over and over again, can be soul-destroying.  Being asked to fix the unfixable at 4AM only makes it happen faster.

 

So yes, emergency physician burn-out is real.  It happens.   But there are also a lot of old ER docs who have learned to deal with the job and come to work with a smile on their face and a song in their heart.  While that's admittedly a self-selected group, it is possible.

[ploughboy]

Lol of course that's not what I meant. Obviously it's stressful when you're at work but you have to admit that most staff have pretty chill schedules if you're looking at hours worked by specialty.

 

The number one reason that people go into emergency medicine - shiftwork.

 

The number one reason that people leave emergency medicine - shiftwork.

[ploughboy]

But there are also a lot of old ER docs who have learned to deal with the job and come to work with a smile on their face and a song in their heart. 

 

Addendum:  I count myself lucky that most of my preceptors and exemplars have come from this group.

[mononoke]

In spite of all of this, what I don't get is why emerg is so competitive - it was even more competitive than plastics at U of T!

 

It seems like very tough work physically and mentally - are people selecting it because they like it in the moment and then realize later on the harsh realities and burnout?

[LittleDaisy]

I think that as a medical clerk, we often work in the minor ER, i.e: back pain, stubbbed toes, acute pharynigitis . 

There are major ER in academic hospitals, but we get less exposure as clerks.

I find ER fascinating, you diagnose quickly, treat the most acute condition and then ask for your internal medicine colleagues or surgery colleagues to stabilize the patients. You never know what your patients have when you open the door, and you do all the fun Ddx with a precise questionnaire! 

The shift work could get tiring after you have a family, but when you have quite a few experience, you often pick the best ''daily'' shifts..It's not fair to the young ER doctors, but that's how it works for now. 

It's not just the hours but the really silly things clueless people come for. I worked a shift yesterday and pretty much 90% of what I saw until about 1300 were colds, stubbed toes and back pain. It gets really mentally exhausting after a while. It's different if you see those in your family clinic and they're your regular patients but you never know what you might be missing in emerg. And when I see a 2-for-1 or god forbid 3-for-1 with the parent being the third, a part of my soul is lost forever. Those pretty much never get to have something cool like DKAx2.

[amichel]

The number one reason that people go into emergency medicine - shiftwork.

 

The number one reason that people leave emergency medicine - shiftwork.

Fair enough! I just think lots of people early on in medicine and premeds seem to think that emerg people work 18 hour shifts every other day because that's what they saw on ER.

[LittleDaisy]

8 hours shift and you rarely stay more than 30 minutes past shift, but the 8 hour shift is quite demanding mentally and physically and high volume!

Fair enough! I just think lots of people early on in medicine and premeds seem to think that emerg people work 18 hour shifts every other day because that's what they saw on ER.

[samy]

I think that as a medical clerk, we often work in the minor ER, i.e: back pain, stubbbed toes, acute pharynigitis . 

There are major ER in academic hospitals, but we get less exposure as clerks.

I find ER fascinating, you diagnose quickly, treat the most acute condition and then ask for your internal medicine colleagues or surgery colleagues to stabilize the patients. You never know what your patients have when you open the door, and you do all the fun Ddx with a precise questionnaire! 

The shift work could get tiring after you have a family, but when you have quite a few experience, you often pick the best ''daily'' shifts..It's not fair to the young ER doctors, but that's how it works for now. 

 

Got a good experience doing ER as a senior clerk. Got a lot of exposure to acutely sick patients (anything from STEMI to a simple laceration requiring sutures). I could only say that some ER physicians consult way to much (e.g. getting 5 consults for afib by the same ER doc in 1 night as the CCU resident can be quite exausting).

[rogerroger]

I would say burnout is rare. As one gets more senior in their career they tend to do fewer night shifts and adopt more regularity in their schedules. There are usually "youngins" eager to pick up nights from the more senior docs. There are many reasons why night shifts are attractive to those starting out after residency.

 

This said, many do transition into other side gigs alongside emerg. Very few leave completely, and emerg usually remains one's primary job regardless of other activities. I don't think any of this is reflective of burnout. I believe this is reflective of a desire to keep things fresh and interesting and speaks to the personality types which enter into this speciality.

[rogerroger]

Fair enough! I just think lots of people early on in medicine and premeds seem to think that emerg people work 18 hour shifts every other day because that's what they saw on ER.

 

There is variability in how much people work, a lot of this has to do with preference. I estimate the rough average would be between 100-150hrs/month.

[ploughboy]

I would say burnout is rare.

 

Really?  I think it's incredibly common, and I'm pretty sure there are surveys using validated tools that show we're a burnt-out, cynical group.

[rogerroger]

Fair enough, the literature suggests feelings of "burnout" occur. Perhaps in my previous post I was looking through the lens of "career changing burnout". Take that for what you will.

 

Perceptions of burnout exist within many other high stakes fields. Based on what's written I'm skeptical of emergency med being a special case when compared to many other demanding specialities. Burnout is a complex thing with many factors and means of measurment. I think we need to be careful when generalizing quantified burnout perceptions to causative effects such as job dissatisfaction and wellbeing.

 

A more important question for this this thread is does burnout translate into feelings of decreased job satisfaction? Does it change one's desire to do emergency med? Do people want to escape the scene because of feeling burntout and other related stressors? If this was shown I would say this notion of being burnt out suggests a critical concern when planning a career.

 

Luckily, the same studies demonstrating feelings of burnout often also suggest simultaneous high levels of job satisfaction. So whatever one perceives as burnout isn't tipping the balance over to job dissatisfaction. Should burnout be a concern? Yes in all areas of medicine. Should concerns of burnout turn one away from a career in emergency med? I would say this notion is not supported.

 

Workload perceptions are an area of interest of mine. If those on this thread would like to see some studies around the above let me know. I'm happy to provide the papers.

 

Really? I think it's incredibly common, and I'm pretty sure there are surveys using validated tools that show we're a burnt-out, cynical group.

[ralk]

Fair enough, the literature suggests feelings of "burnout" occur. Perhaps in my previous post I was looking through the lens of "career changing burnout". Take that for what you will.

 

Perceptions of burnout exist within many other high stakes fields. Based on what's written I'm skeptical of emergency med being a special case when compared to many other demanding specialities. Burnout is a complex thing with many factors and means of measurment. I think we need to be careful when generalizing quantified burnout perceptions to causative effects such as job dissatisfaction and wellbeing.

 

A more important question for this this thread is does burnout translate into feelings of decreased job satisfaction? Does it change one's desire to do emergency med? Do people want to escape the scene because of feeling burntout and other related stressors? If this was shown I would say this notion of being burnt out suggests a critical concern when planning a career.

 

Luckily, the same studies demonstrating feelings of burnout often also suggest simultaneous high levels of job satisfaction. So whatever one perceives as burnout isn't tipping the balance over to job dissatisfaction. Should burnout be a concern? Yes in all areas of medicine. Should concerns of burnout turn one away from a career in emergency med? I would say this notion is not supported.

 

Workload perceptions are an area of interest of mine. If those on this thread would like to see some studies around the above let me know. I'm happy to provide the papers.

 

 

I'd love to take a look at them. Any of them Canadian? I've read a few American studies, but they're not too applicable to a Canadian context. For Canada, the National Physician Survey is about all I've seen of any real applicability and it shows only minor differences between specialties (with Emerg on the lower end for job satisfaction).

[rogerroger]

I'd love to take a look at them. Any of them Canadian? I've read a few American studies, but they're not too applicable to a Canadian context. For Canada, the National Physician Survey is about all I've seen of any real applicability and it shows only minor differences between specialties (with Emerg on the lower end for job satisfaction).

 

How is a systematic review that includes Canadian centers? This review pretty much concludes what I said above.

 

Bragard I, Dupuis G, Fleet R. Quality of work life, burnout, and stress in emergency department physicians. European Journal of Emergency Medicine. 2015;22(4):227–234. doi:10.1097/mej.0000000000000194.

 

Only about 2 months late in responding, better late than never

[ralk]

 

How is a systematic review that includes Canadian centers? This review pretty much concludes what I said above.

 

Bragard I, Dupuis G, Fleet R. Quality of work life, burnout, and stress in emergency department physicians. European Journal of Emergency Medicine. 2015;22(4):227–234. doi:10.1097/mej.0000000000000194.

 

Only about 2 months late in responding, better late than never

 

Haha, thanks for following up!

 

It's an interesting article, but I don't think it evidences your point very well. For one, only a single Canadian study was included, and it's contribution was to say that EM physicians have the highest rates of what they called "distress", by a decent margin. The conclusions on job satisfaction come from an American study, and it didn't exactly show high levels of satisfaction. On a 5-point scale, only 65% were rating their satisfaction as a 4 or 5 (meaning 35% were a 3 or lower), and no comparison was made to other specialties. It's hard to say that's a high level of satisfaction from an absolute perspective (1/3 chance you won't like your job very much) and provides no relative information.

 

The NPS seems to have a more applicable, comprehensive data set. It puts EM job satisfaction at 70.7%, higher than what was reported in the US, but below the average for physicians which sat around 72% with a pretty narrow range. That certainly supports the notion that EM docs aren't uniquely dissatisfied with their jobs, but it does put them on the lower end of the scale. EM physicians in Canada appear to experience high levels of burnout and, at best, average levels of job satisfaction.

 

Maybe I'm misreading or overstating your point, but I want to push back against the notion that job satisfaction negates burnout as a meaningful factor in choosing a career. People can love their jobs but still be burnt out because of their work, all while experiencing the negative effects of that burnout. While it shouldn't be the only consideration, high burnout rates (and the reasons behind those high rates) are worth taking into account when choosing a specialty, independent of job satisfaction.

[LittleDaisy]

IMO, I find that the ER doctors are way less stressed than my gen surgery residents . If you don't feel comfortable with a patient's clinical presentation, you could always refer them to IM or surgery. There is always back-up and you are often the first physician to assess the patient

8 hours of shifts sounds a pretty good deal to me. It sucks to do night shifts as a young ER staff. Nevertheless, when you accumulate years of experience, you will end of doing mostly daily shifts with residents and clerks 

 
How is a systematic review that includes Canadian centers? This review pretty much concludes what I said above.
 
Bragard I, Dupuis G, Fleet R. Quality of work life, burnout, and stress in emergency department physicians. European Journal of Emergency Medicine. 2015;22(4):227–234. doi:10.1097/mej.0000000000000194.

 

Only about 2 months late in responding, better late than never

[mononoke]

IMO, I find that the ER doctors are way less stressed than my gen surgery residents . If you don't feel comfortable with a patient's clinical presentation, you could always refer them to IM or surgery. There is always back-up and you are often the first physician to assess the patient

8 hours of shifts sounds a pretty good deal to me. It sucks to do night shifts as a young ER staff. Nevertheless, when you accumulate years of experience, you will end of doing mostly daily shifts with residents and clerks 

I think the accumulate years of experience part can be generalized to most specialties, even for Internal when the call can be pretty hard at first, when you're senior enough you'll have pretty good hours. It's true that the 8 hrs sounds quite nice but from what I've heard, the blending of your nights and days and certain patient populations you see in the ER are what tires you out more than working a regular 10-12 hr day.