Careerealism: What They Don’t Tell You about Being an EP (Repost)

Work smarter, not harder. That’s the motto I attempt to live my life by and recently I broke that rule. I spent well over an hour over the past 2 weeks trying to locate an article my preceptor showed me about what the life of an emergency physician is like. What not to do: search every combination of phrases you vaguely remember, in every order, on any credible website you think might host the paper. What to do: ask your attending what the article was. He’s a super busy guy and I didn’t want to bother him with a seemingly stupid question. Au contraire, it stimulated a fun conversation, got me results immediately and most importantly he wasn’t bothered. Lesson learned. SMARTER, NOT HARDER GUYS!


There are some things they just don’t tell you about being an emergency physician. I’m not talking about the usual “find the right job for you” material. No, I’m talking about the lesser-known realities of being an emergency physician, from the full bladder you’ll constantly have and the meals you’ll skip to the blackout curtains you’ll have to buy to sleep in the middle of the day and the attention deficit disorder that you’ll develop.

I’m talking about the adrenaline rushes you’ll long for and the gallows humor you’ll develop to stay sane. They don’t really teach you these things in medical school, but you’ll understand soon enough. Here are some of the characteristics and skills you’ll need the longer you’re an attending.

A Lake Erie-Sized Bladder

You’re clearly an emergency physician if you’ve been telling your scribe you’ve got to go to the restroom for the past 90 minutes, but every time you try, you get interrupted. Maybe we would make it a priority if there were a billable code or if someone kept track of it as tightly as RVUs.

We as a specialty are presently out of luck. I’m not saying I’ve given up on my extra-large morning coffee or anything but still. Seeking one bright young attending to be the first to champion this important health issue at ACEP next year.

Talking Heads

There will be times when you will need to have at least four conversations at the same time: two in person, one over the phone, and one in your own head about the other three. You’ll be on the phone with a consultant and there will be two nurses who are simultaneously asking you for things (or at least staring at you). Not uncommonly, there will be a line of people waiting to speak with you.

In response, you may start pointing: “Yes, you, no, you, yes, yes, you, next?” Personally, I like it when they leave me sticky notes; they don’t need to stand in line to remind me that I forgot to order Tylenol. Another colleague used to have a piece of paper on his desk labeled “Doctor’s To-Do” list, on which he encouraged others to write. It saved everyone time.

Resist that Smirk

You’ve probably been practicing this one since starting residency. Keeping a straight face is for when a patient is crashing, you’re not sure how to fix it, and the nurses are all looking to you for direction, but it’s also for when a patient comes in with a root vegetable stuck up his anus. When there is a foreign body stuck in a place where it shouldn’t be and the patient is humiliated and in pain, one must try not to make the patient any more embarrassed than he already is while simultaneously cutting the tension by at least acknowledging that zucchini is better served as a side dish.

Sleep Masks Help, Too

You will have to sleep in the middle of the day. Perhaps you’re one of those lucky people who can fall asleep at any time in any place. (You lucky few can probably sleep like a baby in the middle seat on a long-haul flight, too.) Otherwise, you cultivate rituals to help develop this skill out of pure necessity. I choose my hotel based on the best blackout curtains, and I travel with a white noise machine. (Pro parenting tip: I sleep-trained my son with the same noise machine.)

The Pizza Food Group

I am well used to stuffing three Luna bars in my mouth and calling it a meal. Often it’s because that’s the only thing I have time to grab, but other times you just need a protective layer of plastic wrapper between you and your food.

Believe me, you will have touched things that, no matter how many times you wash your hands, you will not want to touch anything that is about to enter your mouth. I have decided that lemon and chocolate Luna bars constitute a well-balanced meal.

Other emergency physicians I know simply choose not to eat at all during a shift. Some feel that they’re too busy or they’re in the zone. Still others feel it decreases their productivity. I, for one, know what it means to be “hangry,” and would probably need some Haldol if I didn’t eat during my shift.

Look, a Shiny Object!

Most of us did not self-select for emergency medicine because we love nothing more than to be intently focused on one task for hours on end. We did it because we have the attention span of a squirrel. A squirrel literally focuses on an acorn longer than I focus on dispositioning a patient, especially a straightforward one.

If a patient starts talking to me for more than 10 seconds, my mind will wander. After 14 seconds, I’m already planning what I’m going to with the patient and directing them toward simple yes/no questions. Truth be told, you would be interrupting far more often if it weren’t for patient satisfaction scores. Learn this phrase: “I’m going to pause you there because I really want to hear more about [insert yes/no question here].” Say it with a smile, and the patient will still feel heard.

The ED Roller Coaster

You get a patch that someone is coming in to the emergency department who is going to require all your attention, all your skill as a physician, and all your focus as a leader. You get to marshal all your physical and mental resources to save lives, and it’s a huge adrenaline rush. I miss it because I don’t get it as much as I did in residency at a slamming trauma center. Most of us, after all, are not practicing in receiving centers in urban environments. But it’s very close to why we do this job in the first place despite all its difficulties, boredoms, and frustrations. When you get that hit of adrenaline, that means you’re doing something that is just a little heroic and a little noble. You’re practicing emergency medicine.

Author Information

Dr. Fowler is an emergency physician at MedStar St. Mary’s Hospital in Leonardtown, MD, the director of recruiting of the Mid-Atlantic Region for MEP Health, and a founder of U.S. Acute Care Solutions (USACS). Follow her on Twitter @MagpieMedicine and find frequent posts from her on USACS’s Facebook page, Read her past columns at

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