It's a funny state of affairs.
You want the hospital to do well, really well, so that it's financially better-off, it develops a great reputation, or maintains it if it already has one, and perhaps even ups your pay a little. At the same time, you don't want too many patients. You don't want to work too bloody hard, or else it won't seem worth it.
Some departments have come up with methods to reward productivity amongst emergency physicians: bonuses based on number of patients seen, RVUs, and other methods which are largely based on one's CV rather than on how hard one actually works. I guess you're getting paid for having studied a few years earlier!
Tic, tic, tic, the clock advances rather slowly when one is waiting for something to do. So we sit and wait for patients, and write blogs like this one, or we work our asses off and go home and complain how hard we're working! If we sit and wait too long for a patient, like my buddy Jeff who works in a 3,000 census ED in the middle of Nowheresville, TX, then one runs the risk of atrophying those procedure lobes in the brain. But then, isn't riding a bike, essentially a procedure?
Oops, the CEO just walked through the ED and saw me typing. I didn't minimize my screen, and wow, he smiled and just walked out, probably under the impression that I'm hard at work or something. Oh well, I can just say this blog was pure fantasy and bears no reflection in reality whatsoever. Or maybe someone else was using my name and blogging away..
I love some busy shifts. The ones where you don't even have a chance to check your email or call your wife. When all the patients have something genuinely wrong with them. When no drug-seeker seems to be awake or they managed to lose their way to your particular ED. When all the specialists are extremely responsive and appropriate. When all the nurses are so hard-working, you find yourself realizing how lucky you are to be a doc, while not doing all the really hard work that nurses have to do. When the team works smoothly, and every patient seems to have a good outcome, and all the ED staff are all smiles. When your cohort is pulling his weight and seeing as many, if not more, patients as you are.
Yes, those shifts are great. Those are the shifts that make you think your work is easy and that you you might even be overpaid.
Although it is nice to have that occasional shift when you can read a good book, chat with coworkers and catch up with what's going on in their lives, or just surf the net. It doesn't last very long though.
So, even though there are those shifts, like this one, where nothing could be described as actual 'work', it does seem that I'm working all the time. I should rephrase. It does seem like I'm away from my wife and kids all the time.
Perhaps that's the modern definition of work: when you're not with family. I don't subscribe to the 'when you're not having fun' definition, because I believe that work can be fun.
So you're an emergency physician, knocking around 40 or 45 years old, and you're wondering what's happening for the next 15 years. Is this it? Should I write a book? Should I start a business? Should I invest in the stockmarket or real estate? Should I become an internist? Hmm. Why do we have these questions?
Well quite simply, because we know, deep down, that we're not going to be Speedy Gonzalez the ED doc forever. We're gonna get older and slower and possibly even crabbier and more cynical. Or maybe we'll always have a pleasant disposition, while the new kids on the block are running rings around us, and mumbling behind our backs how slow we are, just like we're saying about the old chaps these days. What goes around comes around.
Perhaps, because we all believe in the karma of such back-biting, we don't want to stick around long enough to have such talk commence about us... That's probably it.
So what should we do instead of this job? What? Really? You're just sitting around waiting for a new patient? Well that sounds a lot like retirement to me already. What a life!