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After the Match

After the Match

Is Academic EM the Secret of Career Longevity?

Cook, Thomas MD

doi: 10.1097/01.EEM.0000657692.45821.03
    academic emergency medicine, career longevity

    A common concern among my residents is career longevity. Can they do this work for the next 35 years? Most of them, after all, have not done one type of work for even a year, much less for decades.

    A resident's 100th shift still captures the imagination of what will come through the ambulance bay doors. But after 15 years of 15 shifts a month (or 180 shifts a year), the drive to work is now for shift number 2700. You have seen a lot of mayhem, and you have an appropriate fear of the few patients each shift who will hurl their emotional violence at everyone in the ED.

    I benefit from working with faculty members of a wide range of ages. This year, five of our 25 attendings are 60 or older—20 percent approaching retirement after long, successful careers. All of them still work a large number of clinical shifts, and all seem to be enjoying their jobs and personal lives. That's not to say there have not been a few bumps in the road. Physicians experience personal and professional failures like everyone else, and each of my older partners has had his challenges. Nonetheless, they have all managed to persevere through more than 5000 shifts and still find meaning and happiness in what they do. By and large, they are an impressive group, and my residents genuinely seem to enjoy their company and what they bring to their training.

    Would this be something residents might be interested in? Does the idea of enjoying work and the company of professional colleagues in their 60s sound appealing to them?

    Every physician wants career longevity. All of us have spent many, many years acquiring the education to practice medicine, and the idea of leaving prematurely is pretty depressing. We all know someone who went through medical school and even residency and then dropped out because he ended up hating the work. Likewise, we all have colleagues who are looking for ways to make a living outside of clinical medicine but cannot afford to make a move.

    That's why I spend a lot of time forcing residents to tell me how they see their lives 30 years from now. What types of experiences and relationships do they envision? What do they want for themselves when they are closer to the end of their careers than the beginning?

    Pros and Cons

    About half of our residents initially express some interest in going into academics when I meet with them for the first time as interns. They have been in an academic cocoon their entire lives, and there is the perception of security from moving up the academic ladder. Most residents also envy the lives of their faculty—their shifts seem not as stressful, they do not have to engage in as much verbal combat with difficult patients and consultants, and they are calm and self-assured. Becoming an attending can seem appealing. When their residency training ends, however, only about 20 percent of our graduates go into fellowship training, and roughly half of them will move on to academic careers.

    There is a lot of truth to increasing career longevity by going into academics. Having a buffer to the initial engagement with a lot of patients makes it easier physically and emotionally. The pace of the work is not as rigorous, there is time to eat a meal without wolfing it down between dictating charts, and you usually get out on time and don't have to worry about finishing long dictations on difficult patients. There is still is a lot of anxiety from working in a high-volume, high-acuity environment, but this is mitigated by working with a lot of dedicated, smart attendings.

    Of course, I would be remiss not to mention some of the components of academic life that many consider negative. You usually do not make as much money, you are expected to publish, you must trust the care of your patients to relative novices, submit an endless number of performance evaluations, prepare and give lectures, attend many local, regional, and national meetings, and receive blunt criticism from the residents you are working to help. It's a lot of work, and this can be an overwhelming counterbalance of the benefits of easier clinical shifts. It's not for everyone.

    Still, if you find this work meaningful, the impact you have on the lives of your residents will be apparent as you grow in your career. Years after they leave, many will reach out to express something scarce in emergency medicine—gratitude. This is often the most precious ingredient of the secret sauce that keeps you in the game for all of those years.

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    Dr. Cookis the program director of the emergency medicine residency at Palmetto Health Richland in Columbia, SC. He is also the founder of 3rd Rock Ultrasound ( Friend him, follow him on Twitter@3rdRockUS, and read his past columns at

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