The EM Paradox

I’ve been posting some recently about a paradox that exists in EMS which is basically a need vs. resources problem and it got me thinking about a similar paradox in EM. I currently see 2.5 to 3 patients per hour. That’s just the volume/staffing of the places I work. I would really be happier seeing ~1.5 patients per hour. That’s just me. I know this because when I have a slower shift I’m much happier.

Here’s the paradox:
When you work at a slower ED your resources a fewer and you have to work harder. I could go work in a nearby rural ED and see my 1.5 per hour BUT that place has no ICU and few consultants so many patients must be transferred. The nurses are less comfortable with the critical stuff. Because the inpatient census is low and there are few consultants the IM and FM docs are reluctant to admit anything. The transfers require a lot of extra work, phone calling and so on.

You are on your own for a lot of things in a small ED/Hospital. There’s no L&D so a precipitous 28 weeker rolls in you’re on your own. Bad multi-casualty trauma, all you. If you’ve never been the only doc in a rural ED with several critical patients and you have to start choosing who gets the helicopter versus the ground ambulance it sucks.

So, even though EM provides more flexibility than any other specialty we will always be trapped at the intersection of a few factors; volume, consultants/resources and what ever rolls in the doors. You can change jobs all you want to find the best fit for you but you’ll always be at the mercy of those three elements.

Wackie said:

Is it really a paradox? Or is it simply an issue resulting from the coveted bottom line?

Click to expand...

Excellent question! For the students and residents this question points out a different solution for my paradox. The initial paradox is "You can work in a busy ED with lots of support and see lots of patients or work in a slower ED with less support but the work load will be about the same." You could have an easier workload in either setting if you increase staffing. That would cause a decrese in pay. It is a solution but you would have to find an entire group of docs who value ease of workload over money. Tough to do. It is possible though, again speaking to the flexability of EM.