Starting to Get it Right

“The moment that you feel that, just possibly, you’re walking down the street naked, exposing too much of your heart and your mind and what exists on the inside, showing too much of yourself. That’s the moment you may be starting to get it right.”
- Neil Gaiman
“Neil Gaiman Addresses the University of the Arts Class of 2012” by The University of the Arts (Phl) on Vimeo.  http://vimeo.com/42372767

Living like a resident...Financially

Living like a resident means working 80 hours per week, snagging free food, and driving an old beater car.

When doctors graduate and become attending level status, we want to spend our hard-earned money.  For the most of us, this is a big mistake.  Why?

First, we have an ocean of student loans to pay off.

Second, we have little to no savings during our time as students and residents.

Third, we will get used to a "rich" lifestyle and may get stuck on the never-ending treadmill of having more.

So, what's the solution?  Continue to live like a resident until you have all loans payed off, maxed out on your savings, have a 6 month emergency cash reserve, and work as much as you can healthily handle.

6 Tips to Get Inspired for Burnt Out MDs

So, how can you get inspired if you're burnt and crispy?

1. Change your job. Go academic if you're a community doc or vice versa.  Work locums tenens in Australia or New Zealand.

2. Take some time off to recharge. Relax in your favorite country. Maybe someplace where you're currency will stretch much further.

3. Add to your expertise. EMS, U/S, Critical care, or whatever niche you choose

4. Be the change at work.  Try to associate with positive people and avoid negative people.

5. Remember your purpose in being a doctor.  Dig out the files and re-read your medical school application essay, residency program essay, and even college essay.

6. Consider a life coach. Three MD life coaches to check out are: Dr. Heather Fork, Dr. Philippa Kennealy, and Dr. Michelle Mudge-Riley.

10 Tips For Med Students Going Into EM

1.  Join AAEM, EMRA, and ACEP. Free or very inexpensive for medical students.

2.  Go to the annual meetings. AAEM is this Feb, 2013 and in Las Vegas. ACEP is this Oct. 2013 and in Seattle. Attend the medical student components of both conferences.

3.  Get honors in your emergency medicine clerkship.

4.  If you are committed to one program, do an away rotation there.

5.  Check out www.freeemergencytalks.net and listen to these 3 lectures to start:

http://freeemergencytalks.net/2012/10/joe-lex-an-old-fogey-speaks-45-years-on-the-front-lines/

http://freeemergencytalks.net/2010/03/amal-mattu-finding-your-niche-in-em/

http://freeemergencytalks.net/2010/04/peter-rosen-beginnings-of-emergency-medicine/

6.  Go to ACEP's leadership & advocacy conference in May 2013. http://www.acep.org/LACHome.aspx?MeetingId=LAC

7.  Score well on Step 1.

8.  Get a strong letter of reference from at least one emergency physician.

9.  Identify a niche in EM (Ultrasound, EMS, Pediatrics, Hyperbaric, EKGs, Social Media)

10. Seek balance in career, life, health, family, and fun.

What tips do you have?

Take Action

I came across this parable, while reading, "Action! Nothing Happens Until Something Moves," by Robert Ringer.

Every morning in Africa, a gazelle wakes up.  It knows that it must run faster than the fastest lion or it will be killed.

Every morning in Africa, a lion wakes up.  It knows that it must run faster than the slowest gazelle or it will starve.

It doesn't matter whether you're a lion or a gazelle; when the sun comes up, you'd better start running.




"Whatever you can do, or dream you can, begin it. Boldness has genius, power and magic in it." ~Goethe 

Non-Medical Advice for Young Emergency Physicians

I was browsing through AAEM's Commonsense Journal (Sept/Oct 2012 Issue PDF) last week and came across a brilliant article by Dr. Andy Walker.  He is a mentor for young EM physicians and offers these points of advice:

Live beneath your means.  Save 15-20% of income if you are employed. Save 25-30% if you are an independent contractor.  Stay out of debt and pay off debt as quickly as possible. EPs should have at least 6 months of income saved, as ER jobs are inherently unstable.  Money may not buy happiness, but it does buy freedom - and freedom is pretty damn good.  Save your money.

Rent, don't own. There will be surprises and you will be in a stronger position if you can pick up and leave.  Especially, rent for the first year.

Insure wisely.  You absolutely need disability insurance, as you are far more likely to become disabled than to die early. Get "own occupation" disability insurance.  If you do get life insurance, get term insurance.  

Be a faithful and disciplined investor.  Start investing early and time will be on your side. Diversify widely. Educate yourself.  He recommends books by John Bogle, the founder of Vanguard. 

Participate in organized medicine. The biggest enemy of physicians is their own sense of hopelessness. But a difficult fight is not an impossible fight. Join your state medical society. Join AAEM today. 

I'd also like to add a couple of things:

Be happy now. You have arrived.  Stop getting trapped in thinking, "I'll be happier, once I get the BMW, house, etc."

Seek balance. Residency can be extreme and now is the time to focus on your health, family, friends, fun, leisure.

Finding Happiness in the Emergency Department

Finding Happiness in the Emergency Department

by Sam Ko, MD, MBA
CAL/EMRA President, 2010-11

“It’s too busy in the ED these days.” “Another faker.” “Why can’t they go to their primary medical doctor?” Have you ever said these words or overheard them during a shift? It can be disheartening to work a shift and see the patient chart rack mount higher and higher, as you place a central line in the patient with septic shock, then evaluate a patient with chronic low back pain, and then examine the ears of a two-year old whose fever “came right back four hours after Tylenol was given.”

Recently, I’ve discovered the secret of being happy while working in the ED. It’s a simple idea, but has profound implications. The idea stems from Srikumar Rao’s talk, “Plug into your hard-wired happiness.” He states that our mental model of happiness is flawed. Our model is based upon the logic, “I’d be happy if...”

For example, do you remember when you were pre-med college student? You said, “I’ll be happy once I get into medical school.” Then when you were in medical school, you told yourself, “I’ll be happy once I get a high score on the boards.” Then when you were in residency, you said, “Life will be great when I’m an attending.” This mental model is flawed, because it never allows us to be happy in the current moment. Instead, we continually seek the next step to elusive happiness.

Now, can you recall a time when you were truly happy? It may have been while watching a sunset over the ocean, seeing a beautiful rainbow, or welcoming your child into the world. Why were you happy? It was because you accepted everything at that very moment. You didn’t say, “Oh, it’d be more perfect if there were less seagulls flying across the sky.”

The emergency physician’s role is to evaluate everyone who comes into the ED - regardless of how sick or not sick they appear to be - and rule out emergencies. Our realm of practice includes the most bogus visits to the most critical illnesses. The key idea is acceptance of this fact. To accept everything that is happening and every patient who comes in to the ED, no matter what. When I accept the patient with an ingrown toenail, the asymptomatic patient who meticulously measures their blood pressure at home, or the patient in DKA who doesn’t take their diabetic medications, I feel calmer and relaxed. If I don’t want to develop stress-induced hypertension, burst an aneurysm, or start loading up on benzodiazepines prior to work, I choose to accept all aspects of my field.

Every shift, we have the opportunity to relieve pain, alleviate fears, and save lives. It’s a privilege to be an emergency doctor and everything that comes along with it. So here’s the challenge: during your next shift, calmly accept everyone you see in the emergency department.

Reference: Rao, Srikumar. http://www.ted.com/talks/srikumar_rao_plug_into_your_hard_wired_happiness.html Accessed 8.31.10

Originally posted in CAL/ACEP Lifeline October 2010.

Top Ten Financial Tips for Graduating EM Residents

1. Save more than 20% of your income.

2. Have cash reserves for six months of expenses.

3. Automatically have savings deducted from check.

4. Take full advantage of employer's financial benefits, i.e. retirement, child care, advanced education, etc.

5. Max out your 401K, Roth IRA, or other retirement plan.

6. Review insurance policies (malpractice, disability and life insurance.)

7. Create an investment strategy based upon income, age, and risk tolerance.

8. Start an education plan for your children (529 or education IRA.)

9. Review estate planning and update your will or trust.

10. Start planning now to avoid income tax suprises next year.

Source: Lane Financial & Dew Wealth Management