Practice Management: The Kids Are Not All Right : Emergency Medicine News

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Practice Management

Practice Management

The Kids Are Not All Right

Simons, Sandra Scott MD

Emergency Medicine News 45(3):p 20, March 2023. | DOI: 10.1097/

    Many residents and new attendings are burned out and already looking for the exit

    emergency medicine, burnout, COVID, attendings, EM residents

    On the third day of my honeymoon, the only medical talk I thought I'd hear was from my emergency physician-husband, so I was intrigued when I heard snippets of conversation that included “CT scan,” “abdominal pain,” and “CYA” coming from strangers in the pool.

    Matt and I couldn't resist the urge to wade over to strike up conversation. We learned they were a urology resident and an oncology fellow from New York City.

    We enjoyed some uncensored banter with these young docs in the relaxed setting of our resort pool. They seemed happy in that tropical oasis, but I heard frustration festering behind their smiles. The glimpse into the mindset of tomorrow's physicians was one I won't forget.

    “Our attendings who trained before work-hour restrictions think we have it easy. Yes, we have better call schedules, but the charting we have to do sucks,” one said. “They didn't have to write five pages of notes on every consult; they could scribble a quick illegible paragraph, and people gave them the benefit of the doubt. Instead of the benefit of the doubt, we get ‘Why didn't you chart that?’”

    I expressed surprise that they hadn't even finished training and already sounded as jaded as Matt and I feel, and they pointed out how demoralizing COVID was for residents.

    Frustrated Doctors

    “I was on an ICU rotation when COVID first hit New York City,” the urologist said. “Most intubated patients were splitting ventilators, two to a vent. We connected COVID patients on nasal cannula in a big circuit with as many as nine sharing one oxygen tank. Once, while I was moving a critical COVID patient, his high-flow nasal cannula somehow got tugged off his face and blew right into mine. I could feel it blow under my N95 because of my beard.”

    With frustration in his voice, he described how the institution that thrust him into the COVID line of fire wouldn't offer hazard pay or guarantee monetary support if he took a bullet.

    “Did you hear about the email from an NYU attending who said residents treating COVID patients should not get hazard pay?” asked the urologist. (MedPage Today. April 23, 2020; “That was my program director. I was scared about my parents having to pay for my funeral if anything happened me. But they were threatening retribution to any resident who signed the petition advocating for hazard pay and insurance.”

    No wonder these young docs were demoralized.

    Looking for the Exit

    “If you think we're disillusioned,” they added, pointing to a young man in a poolside lounge chair, “you should talk to our buddy. He was a second-year EM resident at the ground zero hospital for COVID in New York City. He's now a new EM attending, and he's already fed up.”

    It wasn't long before we were at the swim-up bar talking to him. The first thing he wanted to know was whether it gets better.

    Always too honest, I said, “Not really, but you do learn how to handle it better.”

    He was more fed up than his friends suggested. “Every shift is horrible,” he said. “It's one thing to have an awful shift once in a while, but they're all awful. I can never catch up. I was just finishing charts in my room before I came out to the pool.”

    I was incensed. No EP should be charting on vacation.

    The previous week, this young EP received sign-out from the overnight doc on 13 patients who had radiology studies pending—on top of all of the patients in the waiting room. “It wasn't the night doc's fault,” he explained when I told him I had never signed out that many patients in my 17 years as a nocturnist. “Radiology was backed up.”

    We've all had other services increase our clinical burdens at one time or another, but 13 patients waiting for imaging results plus a tracker full of red is too much even for veteran docs, let alone a fledgling attending. No wonder he was discouraged.

    Already Jaded

    I asked him about EM residency during COVID. “The interns did all the central lines, and we as second years did all the intubations,” he said, matter-of-factly describing being tasked with one of the most dangerous medical procedures during the pandemic. He endured the powerlessness of residency—which, in 2020, included life-threatening assignments—in the hope that attending life would be better. It had only taken him a few months after graduating to realize attendings are just as powerless and beholden to coders, metrics, and the almighty dollar.

    “What do you do outside of work to make your life better?” he asked. “I feel like I need something else to offset how horrible medicine is. I've thought about taking classes in something completely nonmedical, like history. Maybe one day I'll teach because I don't know how long I can do this.”

    What does it say about our specialty that our colleagues less than two years out are already jaded and thinking about exit strategies?

    I asked these three young physicians if I could write an article conveying what they told us because their outlook is a red flag worth talking about. They said yes. If this makes its way back to them, I want to say thank you for sharing an important perspective. I wish I could have told you it gets better.

    Having to tell a young colleague “you'll get used to it” made me sad for our specialty. The problem is not that that this young EP needs a history class or any other way to cope with the mental health insult of being in the trenches. (Though, admittedly, that's never a bad idea.) The problem is widespread systemic exploitation of EPs.

    Our profit-over-people health care system is burning out veteran docs and physicians fresh out of residency. Knowing our newest EPs already feel tortured by the career for which they worked so hard should be a wakeup call. Something has to give. The kids are not all right.

    Dr. Simonsis a full-time night emergency physician in Richmond, VA, and a mother of two. Follow her on Twitter@ERGoddessMD, and read her past columns at

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