Another Colleague Leaves the Profession

I recently had the honor of writing a letter of recommendation for a friend of mine who is leaving Emergency Medicine to go back and do an anesthesia residency. This is no small decision. He is going back to four years of low pay, long hours, and the humbling title of 'residenct physician'. I asked him why he was doing this and he wrote me an email that, as I read it, I found myself nodding my head again and again to. So, without further ado, and with his permission, here is his letter to me about why he is leaving Emergency Medicine.


As you remember, this is something I've been thinking about for a while. Basically, over the past couple of years I've become very disillusioned with Emergency Medicine and the direction it is heading. EM has become permeated with too many pseudo-business men who are more concerned with spreadsheets and bottom lines and "customer satisfaction" than they are with promoting the specialty and helping it to evolve. They especially don't seem to care at all about physician satisfaction and well-being.

It is my impression that most ED and hospital directors view their docs as a commodity to be used-up and tossed aside when they get burned out. They also don't seem to care that the ED is being used more and more as a walk-in primary care clinic than as an actual emergency room. I didn't go into this field to take care of a bunch of primary care bullshit that FPs and internists should be taking care of in their clinics.

I'm also disgusted with the growing sense of entitlement and grandiose expectations of the average ER patient. I had hoped this would change when I moved to a different area of the country. And, while it is better here, it's just not enough for me to see this as a long-term career choice. Also, frankly, I'm getting tired of listening to the same bullshit complaints from the vast majority of whiny, emotionally needy patients that stream into the ER at an ever-increasing rate.

Honestly, I'm getting to the point where I hate people in general. I think being in the ER all the time constantly reinforces my impression that people are worthless, and I'm tired of feeling that way. It's just like when my uncle became a cop. He turned into the most miserable misanthrope because he was immersed in the worst side of humanity every day. Therefore, I guess what appeals to me about anesthesia in part is the fact that I don't have to delve too deeply into the social aspects of medicine. My job is to put people to sleep and make sure they don't die during surgery. A lot of the ambiguity and uncertainty that is inherent in EM just isn't there in anesthesia. There's a definite endpoint for each patient encounter. Plus if the patient starts getting on my nerves, relief is just the push of a syringe away.

In the meantime I get to do all the things I like about EM, airway and vent management, vascular access procedures, epidurals and spinals, and critical care among others. Also, they're doing some cool cutting-edge stuff in anesthesia like intra-operative TEEs and EEGs among others, plus I can do a critical care fellowship out of anesthesia and actually get boarded in it so that I can find a job with a critical care group. Plus, a friend from EM residency is already out doing her anesthesia residency, and she's loving it. She and I are very similar, and she thinks it's the best decision she's ever made. Every time I talk to her she tells me how happy she is, while I tell her my latest aggravating stories about the ER.


Good luck old friend.