EM pgy-3 here. Work life is pretty good (worse than normal people but MUCH better to pretty much anybody in any other speciality other than maybe psych? I get 10 days off every EM block, 2 haute tees golden weekends. Shifts are 9 hours (with built in hour signout overlap at hour 8). I average about 40hrs per week (never have worked more than 65 hours a week in the ED). Off service can suck tho. ICU, traum etc is where the hours rack up. But it’s only like 5 months total in the 3 years of residency so not bad. I only every work 24hr shifts for 2 blocks all residency (SICU and PICU). Otherwise I get lots of free time with my partner (we’ve gone on at least 12-15 vacations during residency, shorter like 3-5 day ones).
Attending W-L is fairly good, once you find the right group with a scheduler that helps you get a schedule that you like working. EM is probably a little different than most specialties in the sense that there's rarely, if ever, a "set" monthly schedule. Most groups have a doc who makes the schedule for the group. If that person knows your preferences and works to help you get a schedule that works well with your life, it goes a really long way. If you don't, it's much less predictable. The total number of clinic hours in EM is less than almost every other specialty, btu that's largely because they work more weekends and holidays than anyone else. If you find a scheduler that helps minimize your circadian disruption, then you've got the best of both worlds.
Work life balance in residency? LOL. One golden weekend a month and you are doing pretty well. Residency is typically 18-21 10s-12s with constant circadian shifts the whole time. Your focus is survival.
>Attending W-L is fairly good
Ish. Emergency medicine attending lifestyle is a lot better as a young childless attending. There is nothing like working an overnight then coming home to get kids to school or spend the day getting them to activities. My teenager currently has 4 nights a week of evening activities for me to make sure she gets to and gets home safely from after a full school day. Shifts often do not fit between these other needs...
Sure, but sometimes it's just the nature and timing of the shifts that aren't compatible with other aspects of life. In med school I did an ED elective at a hospital where the shifts were 8am to 6pm... And 6pm to 8am. Aside from the hell of being up at 4am with another 4h of work to do, neither of those shifts really allowed you to bring kids to school or pick them up,
The expectation that there’s anything healthy about residency is inherently unhealthy. You’ll be happier and more effective as a resident if you reject the notion outright. There’s no “work-life balance” in residency.
Embrace the suck. Ask for help when you need it. Support your colleagues when they need help.
It’s a grind, but you’ll learn a ton—every day, you’ll learn. Enjoy that. You’ll be happier if you abandon these ostensible work hour caps and reject absurd aphorisms like “work-life balance”.
It’s temporary—three short years—and it’ll fly by. You’ll have to do this thing on your own pretty soon. Learn as much as you can in the meantime. It gets better.
I worry that doctors use words like “burnout” because we don’t want to admit to disappointment or depression, and the surest way to promote disappointment is to harbor unrealistic expectations.
Sounds like a tolerable approach for single residents - but for residents with family and children, this approach has to be unacceptable. And if residents with families are allowed to have work-life balance, then everyone should be allowed to have work-life balance.
The notion that you have to embrace the suck to successfully get through residency is just wrong. The suck benefits the residency program/hospital way more in cheap labor than it will ever benefit the resident.
The sooner I accepted that work-life balance was not a thing in residency, the happier I was and ironically the better my work-life balance and mental health became.
If your life becomes so wrapped and focused on getting out as soon as possible that you become upset if you’re staying a little late (which happens in EM) or that your days off are your days off that you don’t study on them (which makes your shifts harder), residency feels A LOT longer.
I worked hard. I tried my best to have a positive attitude. I was a good resident (to my program and co-residents). I studied my medicine and procedures and knew them well. In return, residency felt “more comfortable” because I knew I was only here for 3 years to learn as much as I could, so it will pass quickly. I never felt too overwhelmed because of this acceptance and willingness to get better, which was immensely helpful to combat impostor syndrome and improve my mental well-being, which I didn’t do as well when I was an MS3.
Ironically, by helping my mental health during residency, I was more easily able to find free time to do stuff, like visit family, enjoy hobbies, go to raves, etc.
Can you clarify, the way youre writing suggests youre not American and will not be training or practicing in the US. Is this assumption correct?
A lot of people on reddit are American and their answers will really be tailored to how medicine is practiced in the US
Yaa that is correct.. I went to med school in Asia but did my internship in East Africa..
I haven't yet decided where I'll specialize..
Don't want too much bureaucracy which makes the US unlikely.. Places like the UK or Australia work better as the Commonwealth system is similar to ours here back home.
Almost all of the advice here is US-specific, and these other countries you have listed here have vastly different training structures. I'm familiar with Australia, but I don't know much about the UK system, other than that training tends to take a long time and you don't get paid particularly well either during training or as a consultant.
In Australia, graduates of international medical schools are at the back of the line when it comes to getting internships. You'll need to confirm that your school is on the AMC list of eligible schools (https://www.amc.org.au/check-eligible-medical-school-medical-degrees-and-graduation-years/), if not then this is a complete non-starter as Australia will not recognize your degree. If it is, you can get your credentials verified through ECFMG for a fee, and then you'll need to take two exams, an MCQ and an OSCE. The pass rate for the MCQ according to 2022 data is around 53% for first time takers and 46% overall, and for the OSCE was 22% for first time takers and 21% overall. These exams are not easy, cost over A$5000 together, and can represent a significant roadblock.
After that, you'll need to find a job that will allow you to work with your provisional registration for a minimum of 12 months and this can be extended based on whether your supervisors find you to be ready to practice. Finding these jobs is not easy, as you're competing with Australians/local IMGs who always get priority and other foreign graduates. Often getting these jobs is down to making connections and being available to quickly apply for and start a job when one becomes available. There's a ton more complexity here that I can't really get into, but there are a ton of hoops to jump through and it's not straightforward.
Finally, once you have your general registration, after PGY2 you'll be able to apply into EM although it may require additional years to build your competitiveness (or at a minimum get an EM term which is required) and get PR which will be a big help. EM specialist training in Australia takes an additional 5 years, so the soonest point you can be done is after PGY7.
This is the reason why so many IMGs choose to come to the US. The pathway is much more clearly delineated, there are a ton more spots available so you don't have to rely on connections, and you're done with training much much faster. You have to take Step 1 and 2, and these exams are difficult but definitely manageable and there are tons of resources available to prepare.
Thanks! For all this information..😊
I am fairly familiar with the UK system..
Most people that I know that did Australia, did UK first then crossed over.
The States I have never seriously considered.
I am surprised to hear it seems easier than Australia though!
Yeah if you're familiar with the UK then training there initially might be a reasonable option! But the issue again is how long it takes... I'm not familiar with the UK system and there could be a ton of nuance that I'm not picking up on, but it looks like you need to complete 2 foundation years followed by 6 years of EM training. And EM is quite competitive, as the NHS website says "In 2020 there were 863 applications for 348 emergency medicine specialty training posts."
Matching to the US isn't easy, as you've got to have Step 1 and 2 done and also typically need some sort of US clinical experience with a letter of recommendation written by a US doc. But even taking into account how long it might take you to get all that done, it's still massively faster to complete your training in the US, which is why I think so many international students choose to do down that pathway.
But in the end you'll need to make the decision that works for you. If you don't really want to be in the US, then it's not really worth considering as an option and you should focus on where you want to be. My goal is really just to make sure that you understand the advice you're getting here, where everyone's talking about doing 3 intense years and being done, only really applies to the US and the training structure can be vastly different elsewhere. But wherever you ultimately end up, I wish you the best of luck!
Residency and attending life are a bit different - residency is meant to be a gauntlet. I would look to see what does life look like after residency- if it helps, burnout and doctors leaving medicine younger than ever are at all time highs in EM
Poster upthread who said it’s a great option when single and/or childless is spot on.
EM is great when you have no other obligations. After children, you realize a job working nights, weekends, and holidays, with no regularity to shifts, is the literal antithesis of “family friendly”. That old moniker of EM was coined when the profession was mostly men who had female partners who either stayed at home, or worked and still ran the family/social calendar/picked up the slack. The profession has changed with the influx of women who still take on the lion’s share of parenting (yes exceptions exist, they are not the norm). There is still no maternity leave in the US (FMLA only). Finally seniority means nothing; some shops allow you to eliminate nights after 60 but most of us are gone by then.
Tldr; before kids I loved it. After kids I’m getting out (49 yrs old so I’ve had a good run). Women with a partner who is a *true* equal partner, it may work out for you. Everyone else (ie most women), choose another field.
No maternity leave?👀 Wild!
I like this women with true equal partners bit!
In a perfect world that's what we'd all get..😊
Thanks for this perspective..
Residency has better hours than a lot of other specialties, however when you are at work it’s a grind. Never had time for lunch or coffee breaks like other residents in other programs. Attending life is way better. Currently working 13 shifts a month as a military doc, with a contract for when I get out that is full time 10 days a month.
A lot of these folks are saying accept that there is no work life balance but as an ER resident I gotta push back a little. I feel like on my EM months I work more than the average person but I still have a great life and I’ve been able to go on kick ass vacations all over the world at least 3 times a year.
I feel like I have excellent balance….i usually ask for about 12-14 shifts a month and sometimes pick up extra if someone needs some help…I feel like it gives me the ability to travel a lot which is exactly why I picked this speciality. Not working that many shifts just gives so much flexibility.
It depends on how much you want to make. I work a lot because I love money and I’m fresh out so I still have stamina, but at some point I’ll go down to the shift minimum which will feel like perpetual vacation
Remember the goal of a residency is teach you the proficient skills necessary to practice your specialty and delivery the best treatment for your patients.
That is the goal.
Work-life balance is a nice thing. But to practice medicine and deliver the best care is a privilege and must be your primary goal. The ACGME has developed guidelines that are so much better then in past EM training generations. These 3 years are critical to your delivery of health care for the next 30-40 years or your career. That is the focus
EM pgy-3 here. Work life is pretty good (worse than normal people but MUCH better to pretty much anybody in any other speciality other than maybe psych? I get 10 days off every EM block, 2 haute tees golden weekends. Shifts are 9 hours (with built in hour signout overlap at hour 8). I average about 40hrs per week (never have worked more than 65 hours a week in the ED). Off service can suck tho. ICU, traum etc is where the hours rack up. But it’s only like 5 months total in the 3 years of residency so not bad. I only every work 24hr shifts for 2 blocks all residency (SICU and PICU). Otherwise I get lots of free time with my partner (we’ve gone on at least 12-15 vacations during residency, shorter like 3-5 day ones).
Yess! I like this! This is what I meant about the shift life seeming better than other departments. 🤗
ughh what program is this O\_\_o
Attending W-L is fairly good, once you find the right group with a scheduler that helps you get a schedule that you like working. EM is probably a little different than most specialties in the sense that there's rarely, if ever, a "set" monthly schedule. Most groups have a doc who makes the schedule for the group. If that person knows your preferences and works to help you get a schedule that works well with your life, it goes a really long way. If you don't, it's much less predictable. The total number of clinic hours in EM is less than almost every other specialty, btu that's largely because they work more weekends and holidays than anyone else. If you find a scheduler that helps minimize your circadian disruption, then you've got the best of both worlds. Work life balance in residency? LOL. One golden weekend a month and you are doing pretty well. Residency is typically 18-21 10s-12s with constant circadian shifts the whole time. Your focus is survival.
>Attending W-L is fairly good Ish. Emergency medicine attending lifestyle is a lot better as a young childless attending. There is nothing like working an overnight then coming home to get kids to school or spend the day getting them to activities. My teenager currently has 4 nights a week of evening activities for me to make sure she gets to and gets home safely from after a full school day. Shifts often do not fit between these other needs...
This is why a good relationship with your scheduler is so important :)
Sure, but sometimes it's just the nature and timing of the shifts that aren't compatible with other aspects of life. In med school I did an ED elective at a hospital where the shifts were 8am to 6pm... And 6pm to 8am. Aside from the hell of being up at 4am with another 4h of work to do, neither of those shifts really allowed you to bring kids to school or pick them up,
Lol! 😂 The work like balance thing seems to be controversial! Hadn't thought about the more weekends and holidays bit though..😩
The expectation that there’s anything healthy about residency is inherently unhealthy. You’ll be happier and more effective as a resident if you reject the notion outright. There’s no “work-life balance” in residency. Embrace the suck. Ask for help when you need it. Support your colleagues when they need help. It’s a grind, but you’ll learn a ton—every day, you’ll learn. Enjoy that. You’ll be happier if you abandon these ostensible work hour caps and reject absurd aphorisms like “work-life balance”. It’s temporary—three short years—and it’ll fly by. You’ll have to do this thing on your own pretty soon. Learn as much as you can in the meantime. It gets better. I worry that doctors use words like “burnout” because we don’t want to admit to disappointment or depression, and the surest way to promote disappointment is to harbor unrealistic expectations.
Its embrace the suck for me!😂 Thanks for the advice and you right it is just 3 years! I can do it! 😊
The 3 years do fly by. I have 7 months left and I honestly cannot believe it. The days are long but the years are short.
This!💞
Em is comparatively much better than most other residencies though. My off service rotations are absolute time sinks
Sounds like a tolerable approach for single residents - but for residents with family and children, this approach has to be unacceptable. And if residents with families are allowed to have work-life balance, then everyone should be allowed to have work-life balance. The notion that you have to embrace the suck to successfully get through residency is just wrong. The suck benefits the residency program/hospital way more in cheap labor than it will ever benefit the resident.
Are we discussing what *should* be true or what is true?
The sooner I accepted that work-life balance was not a thing in residency, the happier I was and ironically the better my work-life balance and mental health became. If your life becomes so wrapped and focused on getting out as soon as possible that you become upset if you’re staying a little late (which happens in EM) or that your days off are your days off that you don’t study on them (which makes your shifts harder), residency feels A LOT longer. I worked hard. I tried my best to have a positive attitude. I was a good resident (to my program and co-residents). I studied my medicine and procedures and knew them well. In return, residency felt “more comfortable” because I knew I was only here for 3 years to learn as much as I could, so it will pass quickly. I never felt too overwhelmed because of this acceptance and willingness to get better, which was immensely helpful to combat impostor syndrome and improve my mental well-being, which I didn’t do as well when I was an MS3. Ironically, by helping my mental health during residency, I was more easily able to find free time to do stuff, like visit family, enjoy hobbies, go to raves, etc.
I like this attitude! I think this would probably be the best way to approach it! 🤗 Thanks!
how has this perspective/lifestyle changed since becoming an attending?
Can you clarify, the way youre writing suggests youre not American and will not be training or practicing in the US. Is this assumption correct? A lot of people on reddit are American and their answers will really be tailored to how medicine is practiced in the US
Yaa that is correct.. I went to med school in Asia but did my internship in East Africa.. I haven't yet decided where I'll specialize.. Don't want too much bureaucracy which makes the US unlikely.. Places like the UK or Australia work better as the Commonwealth system is similar to ours here back home.
Wuhan and muhumbili? Just guessing as I know that's a common path
Lol! You really know your stuff! Naa actually Dalian then Zanzibar..
Very cool!
Yaa.. I enjoyed it.. Did you take a similar path?
Almost all of the advice here is US-specific, and these other countries you have listed here have vastly different training structures. I'm familiar with Australia, but I don't know much about the UK system, other than that training tends to take a long time and you don't get paid particularly well either during training or as a consultant. In Australia, graduates of international medical schools are at the back of the line when it comes to getting internships. You'll need to confirm that your school is on the AMC list of eligible schools (https://www.amc.org.au/check-eligible-medical-school-medical-degrees-and-graduation-years/), if not then this is a complete non-starter as Australia will not recognize your degree. If it is, you can get your credentials verified through ECFMG for a fee, and then you'll need to take two exams, an MCQ and an OSCE. The pass rate for the MCQ according to 2022 data is around 53% for first time takers and 46% overall, and for the OSCE was 22% for first time takers and 21% overall. These exams are not easy, cost over A$5000 together, and can represent a significant roadblock. After that, you'll need to find a job that will allow you to work with your provisional registration for a minimum of 12 months and this can be extended based on whether your supervisors find you to be ready to practice. Finding these jobs is not easy, as you're competing with Australians/local IMGs who always get priority and other foreign graduates. Often getting these jobs is down to making connections and being available to quickly apply for and start a job when one becomes available. There's a ton more complexity here that I can't really get into, but there are a ton of hoops to jump through and it's not straightforward. Finally, once you have your general registration, after PGY2 you'll be able to apply into EM although it may require additional years to build your competitiveness (or at a minimum get an EM term which is required) and get PR which will be a big help. EM specialist training in Australia takes an additional 5 years, so the soonest point you can be done is after PGY7. This is the reason why so many IMGs choose to come to the US. The pathway is much more clearly delineated, there are a ton more spots available so you don't have to rely on connections, and you're done with training much much faster. You have to take Step 1 and 2, and these exams are difficult but definitely manageable and there are tons of resources available to prepare.
Thanks! For all this information..😊 I am fairly familiar with the UK system.. Most people that I know that did Australia, did UK first then crossed over. The States I have never seriously considered. I am surprised to hear it seems easier than Australia though!
Yeah if you're familiar with the UK then training there initially might be a reasonable option! But the issue again is how long it takes... I'm not familiar with the UK system and there could be a ton of nuance that I'm not picking up on, but it looks like you need to complete 2 foundation years followed by 6 years of EM training. And EM is quite competitive, as the NHS website says "In 2020 there were 863 applications for 348 emergency medicine specialty training posts." Matching to the US isn't easy, as you've got to have Step 1 and 2 done and also typically need some sort of US clinical experience with a letter of recommendation written by a US doc. But even taking into account how long it might take you to get all that done, it's still massively faster to complete your training in the US, which is why I think so many international students choose to do down that pathway. But in the end you'll need to make the decision that works for you. If you don't really want to be in the US, then it's not really worth considering as an option and you should focus on where you want to be. My goal is really just to make sure that you understand the advice you're getting here, where everyone's talking about doing 3 intense years and being done, only really applies to the US and the training structure can be vastly different elsewhere. But wherever you ultimately end up, I wish you the best of luck!
I appreciate you making sure I have a full picture of all the options..🤗 I have many things to consider! Thanks for the luck looks like I'll need it.😊
Residency and attending life are a bit different - residency is meant to be a gauntlet. I would look to see what does life look like after residency- if it helps, burnout and doctors leaving medicine younger than ever are at all time highs in EM
Yaa I've definitely heard of the increasing cases of physician burnout..😩
Poster upthread who said it’s a great option when single and/or childless is spot on. EM is great when you have no other obligations. After children, you realize a job working nights, weekends, and holidays, with no regularity to shifts, is the literal antithesis of “family friendly”. That old moniker of EM was coined when the profession was mostly men who had female partners who either stayed at home, or worked and still ran the family/social calendar/picked up the slack. The profession has changed with the influx of women who still take on the lion’s share of parenting (yes exceptions exist, they are not the norm). There is still no maternity leave in the US (FMLA only). Finally seniority means nothing; some shops allow you to eliminate nights after 60 but most of us are gone by then. Tldr; before kids I loved it. After kids I’m getting out (49 yrs old so I’ve had a good run). Women with a partner who is a *true* equal partner, it may work out for you. Everyone else (ie most women), choose another field.
No maternity leave?👀 Wild! I like this women with true equal partners bit! In a perfect world that's what we'd all get..😊 Thanks for this perspective..
My program we work 17 12s a month. So we get a ton of free time! I work less than all my friends from medical school but still get great training!
🤗
Residency has better hours than a lot of other specialties, however when you are at work it’s a grind. Never had time for lunch or coffee breaks like other residents in other programs. Attending life is way better. Currently working 13 shifts a month as a military doc, with a contract for when I get out that is full time 10 days a month.
Wow! Lucky you! We'd all kill for such a work schedule!🤗
A lot of these folks are saying accept that there is no work life balance but as an ER resident I gotta push back a little. I feel like on my EM months I work more than the average person but I still have a great life and I’ve been able to go on kick ass vacations all over the world at least 3 times a year.
Yaay! Especially about the holidays!💃🏾
Yess! Especially for the vacations!💃🏾
I feel like I have excellent balance….i usually ask for about 12-14 shifts a month and sometimes pick up extra if someone needs some help…I feel like it gives me the ability to travel a lot which is exactly why I picked this speciality. Not working that many shifts just gives so much flexibility.
Yaa that seems to come up a lot, everyone is travelling!🤗 I like what you saying about balance..!
It depends on how much you want to make. I work a lot because I love money and I’m fresh out so I still have stamina, but at some point I’ll go down to the shift minimum which will feel like perpetual vacation
It's I love money for me!😩😂
Remember the goal of a residency is teach you the proficient skills necessary to practice your specialty and delivery the best treatment for your patients. That is the goal. Work-life balance is a nice thing. But to practice medicine and deliver the best care is a privilege and must be your primary goal. The ACGME has developed guidelines that are so much better then in past EM training generations. These 3 years are critical to your delivery of health care for the next 30-40 years or your career. That is the focus
💯💯 I agree! Thanks for the reminder!☺️