EM Mindset: Longevity

Author: Loice A. Swisher, MD (EM Attending Physician, Mercy Philadelphia Hospital, Drexel University, College of Medicine) // Edited by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UT Southwestern Medical Center / Parkland Memorial Hospital) and Brit Long, MD (@long_brit)

It was the waning few hours of my 3^rd year resident’s sixth twelve hour shift.  There were a handful of drunken men sleeping on stretchers, likely to metabolize to freedom by the time the sun rose.  A couple asthmatics were sitting on chairs getting a breathing treatment, as they had run out of their inhalers.  A patient with knee pain for two years was just registering.  Then the ambulance doors opened letting forth sounds that would put screaming banshees to shame.  The accompanying officers in blue yelled, “running in and out of traffic naked; probably PCP.”  The resident, who had been doing admirably, sputtered “How have you been doing this for a quarter of a century?  How does this not get to you? “Her eyes silently pleaded, “What is the secret?”

Sure, the question regarding burnout was frequently bantered about thirty years ago when I was a 3^rd year medical student considering this new specialty as my career.  The ‘party line’ so to speak was that few in emergency medicine at that time actually chose and trained for this field.  It was likely many, if not most, came to EM after ‘burning out’ in their chosen specialty.  Thus, they were already essentially behind the 8-ball when they moved their job to the emergency department.  We wouldn’t be at such risk.  We were going into this with eyes wide open.  We were trained for exactly the situations we would encounter.  We would know all the pitfalls, plateaus, and rewards.  We would be able to deftly negotiate the punishment of shiftwork, chaos, and lack of control to be able to leave the hospital enjoying life without being on call.  We got this.

Burnout has increasingly entered conversation, ever since the landmark 2012 article by Shanafelt showing nearly half of physicians at that time suffered from at least one symptom of burnout [1].  Since that time emergency medicine has consistently taken either the first or second spot within the house of medicine [2,3,4,5].  I was wrong.  We don’t ‘got this’.

The resident’s question was a fair one.  How does one have longevity and sustain passion in this line of work?  How do we avoid burnout from the systemic pressures piled on us?  How do we combat compassion fatigue or PTSD from constant flow of people being seen on the worst days of their lives?

If you are interested in reading the rest of this and other EM Mindset pieces, please see “An Emergency Medicine Mindset,” a collection evaluating the thought process of emergency physicians. This book is available as ebook and print on Amazon.