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

By Kevin Pezzi, MD


Pros and cons of being an ER doctor: Part 2

Continued from Pros and cons of being an ER doctor: Part 1

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Low pay? Some readers are probably wondering what on Earth you're talking about. To them, underpaid doctors probably seems as oxymoronic as ugly beauty contestants. However, your uncle hit the nail on the head in identifying one of the thorniest issues in medicine today: income or, more precisely, the lack of it.

As a doctor, you will probably always make more money than an average person, and many people will opine that you are well-paid. You could make $200,000 or more per year as an ER doctor, so what's all the bellyaching about income about?

• You may not make that much if you work in an ER with low patient volume, or an ER in a poor area.

• You will probably work more than 40 hours per week to achieve that income. You may work only 40 hours per week while on duty in the ER, but you will have many other work obligations to fulfill for which you aren't paid a penny, including proofreading and signing dictated charts (my charts for a few shifts were often as long as a book!), attending multiple staff and committee meetings, fulfilling your continuing medical education requirements (and the many hours of studying that you should do in addition to that legislated minimum), filling out insurance forms, and dealing with the legal system. You may be compelled to appear in court to testify as an expert witness about medical care rendered to one of your patients, or you may be sued even if you give flawless care and cover your butt in every way possible (it happened to me; here is a true example of how giving perfect care cannot shield you from a lawsuit when greedy and unprincipled lawyers and patients join forces).

• Then there's the matter of working overtime. As an ER doctor, I often worked up to three hours after my shifts were scheduled to end just to dictate charts and complete the care for my pending patients instead of transferring them to the doctor coming on for the next shift. Thus, what is supposed to be a 12-hour shift could easily turn into a 15-hour marathon during which I, as generally the only ER doc on duty, receive NO guaranteed breaks to eat, recuperate, or even empty my bladder. I'd occasionally have time to sit down for 15 minutes and enjoy a leisurely lunch, but more often than that I would drink a can of Ensure in 7 seconds or less and resume working. The foregoing factors could turn a 40-hour workweek into a 60-hour one. Notably, you are not paid for those hours of overtime, with rare exceptions. Most people make time and a half for overtime in the United States, but corporations who pay doctors are exempt from this requirement; they can (and do) pay them nothing.

• Unless you have rich and generous parents or a boyfriend with a trust fund, you are going to have a mountain of student loans to repay. I graduated from medical school with $35,000 of debt, which is far less than the average student loan debt currently incurred by graduating doctors. $35,000 may seem insignificant, but pay was less 20 years ago, so I lived in an apartment for a few years to economize. The money that I could have spent on a nice home and car was instead diverted into student loan repayments. (Note: When you consider student loan repayments, think of the principal—$35,000 in my case—AND the interest, which can substantially inflate that figure.)

• To become a licensed doctor, you will generally work for many years before you see your first true dollar of profit. Incidentally, your first paycheck as an intern isn't usually real profit because you're still in the hole because of student loans. I was in my early thirties when I finally made my first dollar of profit. In other words, someone who began working the day after high school could have been making money for 15 years while a prospective doctor was incurring debt and then working to repay it before finally earning a dollar of genuine profit. Some docs do not reach the break-even point until they are 40 or older. Anyone who goes into medicine should carefully consider the implications of this. I analyzed this in another topic and demonstrated how you might do better by becoming a UPS driver, for example. Read that topic!

Doctors often don't get enough sleep
If you become a doctor, here's something
that you will be shortchanged on: sleep!

• Instead of the typical 40 hours per week, let's say that you average 55 or 60 as an attending and much more than that as an intern and resident. That won't leave you with much free time, but what little time you have is often rendered useless because of lingering fatigue resulting from inadequate sleep and a chronically out of whack body clock. As an intern/resident and later as an ER doctor, you will work day shifts, afternoon shifts, and night shifts. Like many doctors, I NEVER acclimated to working schedules that were either constantly flip-flopping or just out of synch with the rest of the world by working the night shift as I did for many years. Research has shown that people who work at night receive less sleep and often less restful sleep for various reasons (I discuss them in Fascinating Health Secrets, True Emergency Room Stories, The Science of Sex, and my site). This chronic sleep deprivation robs you of a few years of life (on average) and increases your risk of cancer, which might cut your lifespan in half. For example, one of my classmates in medical school developed cancer and died a few years ago in her early 40s. Might she be alive today if she chose a different line of work? It is impossible to say with certainty in her case, but people who work rotating shifts or night shifts are statistically more likely to have health problems and a shorter life. The stress of being a doctor and the added stress of chronic jet lag will also accelerate your rate of aging. If you've seen me, you may think that I look young for my age, which I do in spite of the stress I endured and the years I spent in the sun mowing countless lawns and doing odd jobs in junior high, high school, college, and medical school to help pay for my education. However, you cannot look at one person and draw a valid conclusion. I probably have good genes, and I know a lot about health (not just disease, as so many doctors do), so I know how to slow the rate of aging (I share that information in Fascinating Health Secrets and The Science of Sex: Enhancing Sexual Pleasure, Performance, Attraction, and Desire). If you don't know and follow those tips, your rate of aging will increase. Women who'd spend $100 on a bottle of some purported beauty cream won't spend much less to buy my information that could make them look and feel decades younger. Go figure.

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• Even if you aren't disappointed by your income as an ER doctor, you might one day resent how others make more money even though their occupations demand less education, responsibility, dedication, risk, and time. For example, I know people who made much more than me by working HALF the year mowing lawns or putting in basements while I worked long hours every week of the year. One can do those jobs without going to college, so while you are training to become a doctor, they can be raking in money. If you become a builder, you could become wealthy. For example, a local contractor spent $8,000,000 of his spare cash to indulge his desire to own a minor league baseball team. He was quoted in the paper as saying that he doesn't care if he ever earns a profit from it, because it's really just a hobby for him. When I was young, I didn't care if others made more money than I did. Now that I am older, I admit to resenting the unfair way in which income is distributed in our society. A corporate CEO could make major blunders and still be paid more in one year than an ER doctor could make in a dozen lifetimes. A professional athlete could make more money by throwing a ball once than I could by saving many lives. A hot singer could make enough money by singing one song to be financially set for life. Or, more commonly, a person in Michigan could take the required 5-day course to become a licensed real estate agent and earn more than what doctors make . . . which explains why many doctors stop practicing medicine to begin careers that are more lucrative and less demanding. Time magazine had an article discussing this entitled "Doctors without Dollars" (I wrote about that in my blog; here's a link to that entry). Anyone who thinks of going into medicine should consider why more than a few doctors prematurely leave that profession. For every doctor who leaves, there are many more who wish they could, were it not for their mortgages and other financial obligations.

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• Another factor contributing to income resentment is this: As an ER doctor, the federal government obligates you to see every patient who walks in the door, whether or not they can pay for their care, even if what they have is clearly not an emergency (for example, in True Emergency Room Stories I presented a case in which a woman came to the ER via ambulance after calling 911 because she wanted me to check her vagina to see if it was "tight enough"). I would not object to this if the government fairly compensated me for that care, but they don't. In fact, I could be fined $50,000 per occurrence by refusing to see a patient. There is a name for forcing people to work without compensation: it's called slavery. Essentially, the government created an unfunded mandate, and put the burden for funding that mandate onto the backs of ER doctors. My income as an ER doctor was cut in half because so much of the work I did was without compensation. Not only did I treat thousands of patients for free, but I actually lost money from them because I still had to pay for malpractice coverage and other expenses. This unfunded mandate is a moral abomination. If the federal government thinks it is so important that emergency departments treat everyone, then it should provide the dollars to pay for that care. Instead, it uses (abuses) its power to do whatever it pleases, even if it is antithetical to our Constitution and something that would infuriate anyone subjected to these "work for free or else" laws. Who else in our society must endure such subjugation? Even if you are hungry and in danger of dying from starvation, you cannot go into a restaurant or grocery store and demand free food (try that and you'll go to jail). Even if you are freezing to death in wintertime, you cannot force a builder, landlord, motel, or hotel to give you free shelter. No matter how badly you need clothing, you cannot force a store to clothe you without paying. No matter how much you need transportation, you cannot force a car dealer to give you a free automobile. No matter how badly you need glasses or contacts, you cannot force an eye doctor to give them to you free. The need for food, clothing, and shelter can be far more important than healthcare, so why is it that only ER doctors must work for free? Is it fair? Obviously not. (I expand on this topic in my blog; here's a link to that posting.)

I discuss more drawbacks of emergency medicine on my site in its question and answer pages. I also discuss several plusses to that profession, too. I mentioned a few of them in my earlier response to you, and I will mention others in this site and upcoming books in the future.

Before you make any major decision, it is advisable to carefully consider all of the pros and cons. One of the best ways to do this is to create a list on a sheet of paper with the pros on one side and the cons on the other. List everything you can think of, and then judge the relative importance of each factor to you. I was outraged at being forced to work for free, but you may be tickled pink by earning $200,000 per year. Hence, everyone must personally assess the importance of each factor and the net result of weighing all of the pros versus all of the cons.

UPDATE 2008: Medicine just became a much more desirable profession, thanks to the economic crash that devastated our economy in 2008. The profession of medicine offers one thing—job security—that is nice in good times but as precious as gold in bad times. I needn't remind you that things are bad now, and almost certain to get much worse (if you doubt that, read this). When times change, it is important to change with the times. I've used a lot of ink warning students in the past about the drawbacks of a medical career, and all of those reasons were quite valid. The cons are still there, but the list of pros just mushroomed in importance thanks to the inherent job security in most medical careers. Good luck trying to find another career that offers comparable job security.

UPDATE 2020 is markedly different thanks to the coronavirus that made work-at-home jobs much more enticing.

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