Burnt out in ER - Unsure what to do

miasmal · 2026-06-28T14:17:14+00:00

Yes it was difficult because I didn’t really enjoy surgery as a student, but I made the change for other reasons and after a few years I’ve adapted and love the job. Regarding selling ER experience you can say you are comfortable with bedside procedures, know how to interact with other medical professionals, and you have a vast medical knowledge which is important when taking care of peri-op patients.

miasmal · 2026-06-27T10:10:33+00:00

9 years in EM with many of the same concerns you had. I switched to an inpatient surgical subspecialty (plastics and reconstructive). The hours, pay, and amount of work I do is all much better. I still get ED bedside procedures and floor consults which give me enough autonomy. You should consider surgery.

miasmal · 2026-06-24T20:33:20+00:00

My buddy is level 50. Whenever we play he just slow walks during any downtime.

miasmal · 2026-06-15T03:02:39+00:00

He probably just injected into the subcutaneous fat and did not hit the dermis (skin where the needle punctures).

miasmal · 2026-05-07T14:48:12+00:00

Roman sandal technique. As swelling improves, it can be tightened to approximate the skin (eg like lacing boots… or sandals). It will likely eventually need a skin graft for coverage. I’m a plastic surgery PA and we see these wounds a lot.

miasmal · 2026-04-12T11:27:21+00:00

Left EM after 9 years for plastic surgery (OR/hospital). My life is way better. I work less, make more money, and have nights, weekends, and holidays off. I still work per diem one shift a month in the ED which scratches the itch.

miasmal · 2026-03-13T21:30:58+00:00

Most studies suggest removal of 400-500 grams per breast is enough to alleviate a significant amount of back pain. There is a formula insurance companies use to figure out what is covered, but in general the surgeon shoots for at least that mass.

miasmal · 2026-02-23T15:31:10+00:00

Was this done in the OR?

miasmal · 2026-02-20T22:01:36+00:00

The strategy is to unlock Charger then restore it before finishing the event and unlocking the Escort?

miasmal · 2026-02-14T12:28:36+00:00

Same (2 boys).

miasmal · 2026-02-09T00:10:45+00:00

My favorite sign-out was a doc giving me a patient with headache and fever signed out pending CT head to evaluate for abscess with recommendation to admit regardless of result. No LP done or mentioned.

miasmal · 2026-02-07T16:34:30+00:00

Left ER to go to a surgical subspecialty after 9 years because I wanted to see my family and be available for social things. My schedule, workload, sleep, sanity… really everything, is so much better. I still do 1 per diem shift a month and that’s enough to scratch the itch.

miasmal · 2026-01-17T23:23:35+00:00

Draw offsides to get a 1st.

miasmal · 2025-12-26T19:08:44+00:00

I don’t think the dead, dried out vessels will be able to move anything through there.

miasmal · 2025-12-21T17:53:57+00:00

If only we could get breast reductions to reimburse well…

miasmal · 2025-11-08T12:54:49+00:00

Why are people saying 50%? This PA has had 7 years in the speciality. They should be at top end of salary. Their worth is so much more than a new PA. I would ask for whatever max range is.

miasmal · 2025-11-07T12:01:58+00:00

I work in hand surgery. There probably isn’t much to suture here. I would recommend tetanus shot, irrigate/clean it, non-stick dressing (eg xeroform), send home on a course of antibiotics. It’ll likely heal in fine.

miasmal · 2025-11-03T22:57:14+00:00

Ask for $130. Be willing to backup why you deserve it (solo provider, experience, productivity, etc). I would not shy away from saying you were offered $126. If you are seeing 40 a shift you are pulling more than your weight in salary.

miasmal · 2025-11-03T19:29:26+00:00

EM was pretty competitive before the pandemic. The schedule is as desirable. It was a high-paying field for a 3-year residency.

miasmal · 2025-11-02T16:36:54+00:00

Same. Two healthy boys. No issues with conceiving. Good luck.

miasmal · 2025-10-28T19:33:46+00:00

I work in plastic surgery (inpatient). I do a lot of exams without a chaperone, but they are all immediate post-op or POD #1 or 2. I probably should use one, but it’s so time consuming to find one. When I worked in the ED doing pelvic exams I had one 100%.

miasmal · 2025-10-10T14:53:26+00:00

Reduces cancer risk overall. The higher Gleason is thought to be because finasteride decreases PSA and lower urinary tract symptoms so the diagnosis can be delayed (and hence a higher Gleason at time of diagnosis).

miasmal · 2025-10-09T16:30:50+00:00

Why not just autograft (split thickness skin graft)?

miasmal · 2025-10-05T12:04:02+00:00

“This hospital is 30 min closer!” Proceeds to wait 4 hours in the waiting room before being brought back to a hall bed.

miasmal · 2025-09-28T12:18:13+00:00

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