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Information for people contemplating
a career in emergency medicine and
other medical specialties

By Kevin Pezzi, MD


The family life of ER doctors: better than good

Q: Hi, my name is Nia. I am going to be a junior in high school and I am starting to decide what I want to be, but I am not sure. I wanted to do medicine forever and recently considered becoming an ER doctor, but I wanted to research more about it before I make my final decision.

I read from you and others about the fatigue and burn out and dangers of this practice, but my biggest concern is for my future family. I know there is no guarantee and that it is different for everyone, but do you personally believe that being able to be involved with your family while being an ER doctor is possible?

I want this ER career because I believe it is important; even with the cons I have heard, it is still very rewarding. However, I want to make sure I also can have a personal life. I care about my career but I also do not want to feel like I am abandoning my family and the people I love for my career.

Answer by , MD: On the old Sears Good, Better, Best scale, the family life for ER doctors is Better.

In terms of medical careers, Best would go to specialties such as dermatology or allergy/immunology. Here's a true story to illustrate that:

In the middle of the night (my usual shift), I called the on-call plastic/hand surgeon, who floored me by saying, “You only called me because I'm black.”

I was so stunned I don't recall responding to it, but no, I called him because he was on call for plastic/hand surgery and I had a patient who needed hand surgery.

ER doctors repair some hand injuries, including cut extensor tendons, but not flexor tendons or a few other problems that necessitate plastic/hand surgeons and the sterility of a bona fide operating room, not an ER with germs from who-knows-where wafting about.

Parenthetically, beyond that Basic Fact 101, I happened to like that plastic surgeon, who I knew well after spending months with him when I trained in plastic surgery as part of my ER residency and he was a more senior resident. I loved his down-to-earth personality. Some residents, especially those in surgery, are brimming with ego or too much caffeine, but this fellow was just focused on getting the job done. Hence when he suggested I only called him because he is black, I assume he must have thought ER docs don't call white or other physicians.

Oh, if he only knew how many of them I'd called in the middle of the night! And not one ever complained I had no reason to call. The closest I ever came to a complaint was when a cardiothoracic surgeon insisted I must be wrong in thinking a surgical site was infected because it was very red, warm, swollen, and painful: all cardinal signs of infection.

In retrospect, what on-call specialists who value uninterrupted sleep should do is coordinate in advance with ER docs, giving them permission to refer urgent cases to their offices, with assurances the patient would be seen within the time frame deemed necessary by the ER doc, not six weeks or whenever later.

Responsible ER doctors do not discharge patients into a vacuum, expecting them to persuade office staff they must be seen pronto, especially when they're a new patient.

Now for the relevance of this anecdote: Of the countless doctors I woke up repeatedly, not one was a dermatologist or allergist/immunologist. Almost all skin/allergy/immunology emergencies require an ER doctor, not specialists in dermatology or allergy/immunology. Not only do they sleep well, but they rarely if ever work holidays or weekends, and they typically make oodles of money. Hence the Best rating, at least in terms of family life.

ER docs work plenty of night shifts, holidays, and weekends BUT they can work one or two days per week and live just fine off that unless they've just gotta have a big house and big car. Hence the Better rating.

All doctors help people, but as an ER doc, you will save lives on a regular basis in the ER and possess skills enabling you to save lives anywhere. On those rare days when I feel down, I can cheer up by recalling the life I saved outside the ER when I figuratively risked my life to save the life of a young man who, coincidentally, was black — proving I think of them the same as others; if I didn't, I certainly wouldn't have risked my neck to save his life — hence why I was so stunned by the “You only called me because I'm black” comment.

As an ER doctor, I learned to value patients not based on their skin color or insurance or money, but for what I could do for them, especially if it was something that other docs likely couldn't do. Early in my career, I feared patients with true emergencies, and they had good reason to fear me, because I didn't always know what the hell I was doing. Then everything fell into place and I became exceptionally able to save lives based on how much better my batting average, so to speak, was compared with other ER doctors.

Statistically, at that time (and it's barely better now), 85% of people who code in hospitals go to their graves, while 95% with cardiac arrest outside a hospital die from it. In contrast, working in a busy ER in the top 5% of acuity in the state, and sometimes handling up to three codes at the same time, I saved everyone in cardiac arrest for over 18 months straight — likely a world record, or at least worth an honorable mention. I feel good about all those saves, but the one I relish the most was the aforementioned one I wasn't paid to save when I left the ER and broke rules to do the right thing.

As an ER doc, sooner or later you will have a similar opportunity that's frankly priceless. I won't disparage dermatologists or allergists/immunologists because they do important work, too, but not as crucial as what ER docs do, IMHO.

Speaking of family lives: After I saved the life of the young man, I saw his Mom approaching and was thrilled that I was able to help keep their family intact. I am also cheered by knowing that because of what I did, he was able to live and potentially go on to have a family of his own, with his children possibly now old enough to have kids, too. A thousand years from now, there will likely be many people alive who never would have lived, were it not for what I did that one night — all because I became an ER doc instead of becoming a dermatologist: my initial aspiration that I abandoned when I realized patients would question the skills of a dermatologist with acne as bad as mine. Decades later, though, I invented a solution to a common dermatology problem (not acne) that's much better than current treatments, as almost everyone will discover after that invention is marketed.

Miscellaneous Memory: Answering Nia's question caused me to think of one of my grandfathers who had strong opinions. He hated doctors so much I never told him I became one, and he hated blacks so much he would have blown a fuse if he knew I went out of my way (not in the ER) to save the life of a black man. The crazy barriers of intolerance.

PS to Nia: I apologize for taking two weeks to respond, but I've been very busy. Also, your question led me to think of another topic, listed below:

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