I went out to the back porch one evening to feed our two lovable cats. As I poured the food on the rail where they eat, I jumped back involuntarily. Between the felines was a big opossum.
The cats were nonplussed. It was as if they said, “Hey, can our friend sleep over?” I dutifully poured out cat food for both species; we do not discriminate against marsupials in our house. Soon the opossum scooted back into the bushes.
You have to admire the opossum. The species is versatile. From cat food to ticks to trash and everything in between, opossums are masters at finding food. They live in all sorts of environments, and their lineage traces back to the dinosaurs.
What does this have to do with emergency medicine? Those of us in this challenging specialty have made it our business to adapt and survive. The parallels are not insignificant. We are all at some point largely nocturnal. We subsist on virtually anything that we can find in a cabinet at work. We can be found in every kind of medical environment. And we may hiss when cornered. I haven't played dead, but I have learned not to make eye contact sometimes.
This matters because our specialty is in a tight spot. Our patient volumes plummeted during the pandemic shortly before we learned what we had long suspected: There are too many physicians for the jobs available.
I'm not writing this to play pin the blame on the donkey but to offer encouragement and a bit of advice for all of the young opossums who have so recently emerged from the warm pouch of residency.
Try Something New
I have practiced emergency medicine for 28 years. I worked in a privately owned fee-for-service group for 20 years starting right after graduation. (Those groups are going the way of the dinosaur too, it appears.) Along the way I have done consulting work, professional writing, a fair amount of telemedicine, a little bit of urgent care, and a lot of locums.
I have worked in busy urban departments, small suburban departments, and tiny critical access hospitals with so few resources that I was happy just to have a laryngoscope and an x-ray machine.
Sometimes I made more money, sometimes I made less. But my bills were paid, my family clothed and fed, and debts were gradually paid down. (Not off but down.) I drive a 10-year-old Tundra that my wife bought for me that I love dearly. (Both of them, if you're wondering.)
My children are graduating from state universities a bit at a time. We have health insurance, some retirement money, time together, and great memories, and we're remarkably happy. I know physicians who grew fantastically wealthy in the specialty, but I can't imagine they are any more fulfilled than I am.
I made some good career decisions and some very bad ones. Sometimes, however, my bad decisions came from forgetting the old maxim that perfect is the enemy of good. I didn't always think things through. I had jobs where I could have powered through minor inconveniences, but instead, thinking there was always something better, I changed situations. Mostly it worked out. Occasionally not so much.
I was always willing, however, to try something new. As my sagacious friend Howard has said, “You just never know where these things may lead!” That aphorism has held true over and over again. All of my career chaos has given me necessary income, versatility, valuable experience, and wonderful stories.
Best of all, I have never been a high-powered administrator or educator or been much involved in the politics of medicine, but I have taken care of very sick people and comforted worried people in all kinds of situations. I have also made friends with an army of my colleagues who are my readers. What a delight it has been!
Be the Opossum
I urge you to be the opossum. Embrace your work as much as you can even if your dream job in emergency medicine doesn't materialize. If there isn't a full-time position nearby, offer to be credentialed to cover vacations or illnesses. Practice locums, domestic or international. If there isn't an ED job, work in an urgent care. If there isn't one of those, learn to do telemedicine. Consider direct primary care. Become a media personality. Read and keep your skills up as best as you can along the way.
Be reassured that rewarding jobs exist outside of teaching centers. Open your mind to places you wouldn't have considered before. Find a small town or a rural county hospital, maybe in a state you never would have considered. Go there and offer to work for less in exchange for loan repayment. America is an amazing place, and you might find yourself in an unexpected location in love with the people and the geography.
So many wonderful, rewarding options are available! Volunteer to serve in the Armed Forces, whether active, reserve, or the National Guard. Work for the Indian Health Service or the Public Health Service Commissioned Corps. Check out options with your state public health department. Work with disaster response teams. Find a college that needs someone to do student health and maybe be a pre-med advisor. Sometimes a lower salary with a decent benefit package will get you through. Hopefully something better will open up. (For all the doom and gloom, we really don't know what the future holds.)
I know, it's easy for me to say. My loans are paid off, and I'm well along in my career. The truth is that I'm concerned for my younger brothers and sisters who are facing a difficult job market. Anyone who can navigate the challenges of an emergency medicine residency and also the unforeseeable, deadly ambush of COVID-19 can also find a meaningful way through a tough job market. If anybody can survive career challenges with opossum-like tenacity, it's you people.
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Dr. Leappractices emergency medicine in rural South Carolina, and is an op-ed columnist for the Greenville News. He is also the author of four books, Life in Emergistan, available athttps://amzn.to/2T60WET, and Working Knights, Cats Don't Hike, and The Practice Test, all available atwww.booklocker.com, and of a blog, http://edwinleap.com/. Read his past columns athttp://bit.ly/EMN-Emergistan.