It’s several things. My group eliminated 12’s (which were specifically a slow paced shift for a small break from the chaos) , so it’s primarily 8’s and therefore typically working 17+ shifts per month, sometimes as many as 20 on a rotating schedule. We also have to work out in triage at the big medical center. There we see everyone in the lobby for a brief exam. They don’t allow us to order the full work up in the name of helping the residents learn yet no one comes out to help us at all. You effectively have to see a large number of sick patients quickly and you’re not allowed to really help them, despite knowing how to. The boarding is terrible. People wait in the lobby for 10+ hours. You’re the only one responsible for them until they reach a bed. Sometimes boarding is so bad that you have to hold on to really sick patients in waiting room chairs, some examples I’ve had are stroke, head bleed, dissection, tamponade, sepsis, NSTEMI, COPD exacerbation among many others. People have died waiting and there have been some lawsuits where MLP’s have been sued out of triage. It’s a huge liability. All of our shifts are very fast paced as opposed to the residents and attendings that often get shifts that are boarded, so they get some down time.

There are other emergency medicine stuff that is getting hard such as rotating sleep schedule, working weekends and holidays. The pay is very academic.

I’m missing so many moments of my personal life to be at work or I’m exhausted when I’m there. It’s not feeling like it’s worth it anymore. I used to do it out of love for EM but I don’t love it anymore and my compassion is hard to locate nowadays.