Emergency room doctor dispells the glamor of television ERs

This emergency room doctor shares the real-life struggles of completing her residency in the emergency department at a major hospital.

What is your job title and what industry do you work in?
Emergency Department Resident Physician

Would you describe what you do on a typical day?
On a typical day I work an 8 to 12 hour shift. I either work in a pediatric emergency department (ED), adult/trauma ED, or a smaller community ED. I am still in residency, so I do off-service months, which means that I spend months in other specialties such as Cardiology, OB/GYN, ICU, etc. In the ED, I see as many patients as quickly as possible, either admitting or discharging and treating them. I also fly on a helicopter during some of my shifts, and have devoted helicopter shifts on my schedule.

On a scale of 1 to 10 how would you rate your job satisfaction? What might need to change about your job to unleash your full enthusiasm?
I rate it as anywhere from a 6 to a 9. A lot of this depends on the types of patients I see on any given day. Many patients are rude, disrespectful, entitled, and addicted to one drug or another. They tell me how to do my job, and curse at me when I disagree. On days that I see many of these people, it is hard. However, on days where I fly on the helicopter, perform multiple procedures, have interesting patients, and people are mostly polite, I am very satisfied.

What did you learn the hard way in this job and how did that happen?
I have learned that this job takes a much thicker skin than I ever expected. Nurses, patients, medical assistants, other physicians, etc, get frustrated or over-worked and these things are easy to take out on others.

What don’t they teach in school that would’ve been helpful to you?
The one thing I would have wanted to understand in medical school is how very difficult it is to know what the best thing for a patient actually is. I also did not understand clearly that there are many different ways to treat the same problem or symptoms.

The medical system I work in is very difficult to navigate for patients with mental disorders, patients who are homeless, and I try to not let me frustrations with these patients get the best of me, but it is hard. It can be hard to take care of people who will leave the hospital tomorrow without getting their antibiotic filled, or picking up their diabetic test strips – many of which are free or heavily discounted at a nearby pharmacy.

How did you get started in this line of work? If you could go back and do it differently, what would you change?
I got interested in Emergency Medicine (EM) in medical school, and went back and forth with this and a few other specialties. I chose EM for the wide range of problems that are encountered, as well as for the critical care aspects of it.

What’s the strangest thing that ever happened to you in this job?
I cannot begin to tell all the stories about the crazy things I see. I had a patient call the patient representative hotline and tell them that I was the worst doctor ever; after that, she (who was actually a male dressed as a woman) wrote the nicest letter to my boss and told them I was the best doctor ever. Very weird.

On a good day, when things are going well, what’s happening and what do you like about it?
On a good day, patients are moving through quickly, they are either sick or have minor complaints. I don’t like the vague “middle ground” where any decision I make feels like the wrong one.

What kind of challenges do you handle and what makes you really want to pull your hair out?
I think I handle parents well. A lot of ER physicians do not like dealing with parents of small children, and this is why they did not do pediatrics. I don’t mind them, however.

I cannot stand drug-seekers. I tell them straight out that I will not give them narcotics for their nosebleed/ankle sprain/whatever. I really started feeling this way when I had a sick patient with metastatic cancer come to the ED in severe pain, and he was out of his pain medications; when I wrote him a prescription, the pharmacy called me to tell me that they could only give him 10 of his pills on that day because they just did not have enough because of all the prescriptions they had filled for people who likely did not need them. That made me really sad.

How stressful is your job? Are you able to maintain a comfortable or healthy work-life balance?
It is an extremely stressful job. I cannot imagine one that is much more stressful, except for being in the armed forces. Right now I am in residency, so most of the time, I do not think my work-life balance is appropriate, but that will be different 2 years from now when I complete my residency.

What’s a rough salary range for the position you hold? Are you paid enough and/or happy living within your means?
I make 47,500 as a resident physician. I am very happy with my salary, and along with my husband, we do just fine with the amount we are making.

What’s the most rewarding moment you’ve experienced in this position? Of all the things you’ve done at work, what are you most proud of?
One night on call in the medical ICU, we got a patient that was as sick as one could be. I stayed up all night watching him, fiddling with fluids and pressors (drugs that increase blood pressure). When the attending physician came in the next morning, he walked to me, shook my hand, and told me that when he had heard about that patient – he had not expected them to be alive by morning.

What’s the most challenging moment you’ve experienced? What would you prefer to forget?
I have had so so many challenging moments. I think one of them was my first day as an intern. I did not know ANYTHING, didn’t know where anything was, did not know who people were…it was so hard! I would like to forget my whole first 3 months of residency, in fact. I learned a lot during that time, but it was painful every step of the way!

What education and skills do you need to get hired and succeed in this field?
4 years of college (with classwork in biology/chemistry, likely with a degree in one of those)
high score on MCAT
4 years of medical school
3-4 years of residency

You have to enjoy learning to do this. More than anything, if you hate learning new things, and doing unfamiliar things, it will be impossible to succeed.

What would you tell a friend considering your line of work?
To consider it, reconsider it, reconsider it, and reconsider it. It’s hard, there are more sacrifices than people can imagine, and it’s stressful.

How much vacation do you take? Is it enough?
4 weeks per year, in 2 two week blocks. I would like more, but I think everyone feels that way. The thing to remember about my job is that I don’t have weekends off. A weekend off is a gift to me, not a norm.

Are there any common myths you want to correct about what you do?
It is not glamorous like it is on the show ER. It is dirty, smelly, stinky, putrid, and difficult a lot of the time.

Does this job move your heart? Feel like you found your calling or sweet spot in life? If not, what might do it for you?
Of course it does, and if it didn’t I would quit.

If you could write your own ticket, what would you like to be doing in five years?
Working a few shifts a month in a level 1 trauma center, a few shifts per month in a chill/community ED, one week per month in an ICU.

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  • Augusto Cigliano

    As an ER doc 3 yrs out of residency I must say it gets easier. Now what I focus on is sitting with my patients, listening, giving them time to say what is on their minds and the problems they have. I remember training that my teachers would limit patients to one chief complaint, I let Pts talk and what ever comes out of there mouths in 5 to 10 minutes is what they have. Then I sum it up, ask if they have allergies, give them a 3 to 5 minute speal on smoking cessation, tell them it will take 2 to 3 hours to get there tests back, give them an estimated time of when I will see them again, and always conclude with thanking them for letting me be there doctor. The skill of er is routine, I can sum up a sick person by the gut wrenching feeling I get when you know something is wrong and you know when someone is going home within a minute of talking to them. My last shift I had a lady with b/l pneumothorax, a man with pericardial tampanode and another with svt that all presented at the same time. I managed all of them, none were routine, and they all were feeling better the next day in the icu. Life is easier out of residency. You get paid more, people respect you more and you can work 13 shifts a month. Work strings of nights and every month can be a 2 week vacation. Have fun!

    • Anon.

      Are you at an academic center or a private hospital? I’m a med student interested in EM and it seems like there is no standard “this is what your life will be like” for EM, so I’m just trying to get an idea of what the different options are.

    • Ac

      If you don’t mind me asking (I am premed), do you feel you are well compensated enough as a physician? Well over six figures? I am getting conflicting numbers about what ER doctor compensation.

  • After taking an EMR class and becoming a certified Emergency Medical Responser in high school I learned very quickly that the pictures you see onscreen are nothing like reality. There is a lot of gore involved in the medical field and it is by no means for the faint-hearted. It is, however, a very fun profession and well worth the many years of schooling and the scenery of the job.

  • Lola

    This really inspires me to choose this career. I already know that this will be a very stressful and exciting work environment, but I am still very interested. This interview was very helpful! I am a 14 year old and looking forward to becoming and ER Physician after I finish schooling/residency/internship of course but I am still determined!

    • Ian

      Lola i am 14 too and interested also! Nice Follow your dreams

  • Maryan

    Thanks for writing this, before i wasn’t sure about whether i wanted to work in the ER, now i know. Also that comment you made about how it’s not like the tv shows made stop for a moment because that’s where i got
    this career idea from, but i would rather have a job that has me walking and rarely sitting down in an office with LOTS of action and generally helping people. I’m kind of an adrenaline junky!

  • mstein

    I have visited the College of Nursing at my school and have talked with upcoming graduate nurses about their job and what they do but I have never heard what a doctor thinks about their job and this was very eye opening to read. I have always been interested in a job in the Emergency Department whether it is a nurse or a doctor but I enjoyed learning about what the job is like because it gives me another point of view to make a decision off of.

  • Dchss80

    I have viewed many t.v shows and they do resemble the actual ER. I understand that it is omly acting, however the medical terminology used seems to be identical to those used in a real life hospital.

  • Fbgreat80

    This was very inspiring to me, and it showed me the more personal side of a doctors life and experiences in and out of the hospital.

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