24 shifts/rural EM

[witzelsucht]

I know you guys hate when med students whine about nights....but here's another one.

So I'm in the beginning of fourth year, deciding between EM, IM, maybe family. The nights are the biggest turn-off for me in EM. When I was an EMT before school, and when I did surgery call as a student it wasn't so bad, because you could get at least 2-3 hours non-contiguously throughout the night. It made a huge difference to me. anyway, I know you can't avoid nights, but I've been hearing about these rural nowhere jobs where you do 24s, with the expectation you get some sleep. Are these realistic jobs for someone to make a career out of, where they are able to maintain and build on their skills? I hate the idea of being a dilettante, especially at something important like people's healthcare. I'd rather do hospitalist or rheum/allergy and settle for a less interesting job than have to do at least 4 true overnights/mo as an attending, which seems like the minimum it is reasonable to expect.

I guess the other question is, how far away do you have to go for the rural gigs? I mean, I'd like to have some kids who can go to a school that doesn't teach creationism...:/

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[TooMuchResearch]

We have grads that work within 90 miles of our institution that work 24 hour rural shifts, 4-8 bed ED with minimal support staff.

 

[EMDoc0411]

Go with IM. We don't want you.

 

[Tenk]

Getting 3 hours of sleep on a regular basis is actually not guaranteed even at 5000 or less volume EDs. Sure you get lucky sometimes, but I stopped moonlighting 24s at small places because it seemed every time I went to bed that damn phone would ring. Some people love them though. To each their own.

 

[goodoldalky]

If you're truly not willing to work nights, don't pick emergency medicine.

 

[DO3]

I know you guys hate when med students whine about nights....but here's another one.

So I'm in the beginning of fourth year, deciding between EM, IM, maybe family. The nights are the biggest turn-off for me in EM. When I was an EMT before school, and when I did surgery call as a student it wasn't so bad, because you could get at least 2-3 hours non-contiguously throughout the night. It made a huge difference to me. anyway, I know you can't avoid nights, but I've been hearing about these rural nowhere jobs where you do 24s, with the expectation you get some sleep. Are these realistic jobs for someone to make a career out of, where they are able to maintain and build on their skills? I hate the idea of being a dilettante, especially at something important like people's healthcare. I'd rather do hospitalist or rheum/allergy and settle for a less interesting job than have to do at least 4 true overnights/mo as an attending, which seems like the minimum it is reasonable to expect.

I guess the other question is, how far away do you have to go for the rural gigs? I mean, I'd like to have some kids who can go to a school that doesn't teach creationism...:/

Emergency medicine is not for you. Please choose another specialty. Residency is gonna be a huge wake up call for you no matter what specialty you choose, except for maybe derm.

 

[DO3]

I mean, I'd like to have some kids who can go to a school that doesn't teach creationism...:/

And this comment is offensive and completely out of line.

 

[da8s0859q]

I see you're quickly winning hearts and minds here in the EM forum, OP.

 

[RustedFox]

And this comment is offensive and completely out of line.

We do offensive and out-of-line stuff all the time on here.

 

[Doctor Bob]

And this comment is offensive and completely out of line.

I thought it was pretty funny...

 

[bashwell]

The line (intentionally or unintentionally) implies most or all rural areas are backwards hick type places (if creationism is meant to be associated with backwards type thinking). That could be offensive to people who live in rural areas which aren't like this at all.

 

[Boatswain2PA]

And this comment is offensive and completely out of line.

Not anymore. Any conservative thought has now been deemed verboten and will be met with extreme measures.

 

[WilcoWorld]

I thought it was pretty funny...

Me too, and I live in a fly-over state.

 

[WilcoWorld]

Not anymore. Any conservative thought has now been deemed verboten and will be met with extreme measures.

Are you defending creationism?

 

[CajunMedic]

I guess the other question is, how far away do you have to go for the rural gigs?

From where I live, north of Baton Rouge, there are at least 3 ED's within a 15 minute drive on that schedule, there are another 4 with a less than 2 hour drive. The biggest one sees roughly 13,000 pts/year. It's technically in a city, but there are little to no specialists, no trauma service, surgery maybe 3 weeks out of the month. The most rural: maybe 3 patients in 24 hours- those docs work a 7 on/7 off schedule and live in the hospital. (one drove 8hrs from Little Rock). Pretty much anything with a higher acuity than a stubbed toe takes a 2 hr ambulance transfer to a major academic medical center, or we put it on a chopper from the scene.

The BC/BE EM physicians at these facilities I know moonlight there, and work full-time "in the city", the rest of the time, it's the local IM or FM doc. We've got one that's semi-retired and flies in from Roatan, works his 24 and flies back.

 

[Boatswain2PA]

Are you defending creationism?

No.

Nowhere is creationism being taught to children as "this is what happened". Every school curriculum teaches the theory of evolution. Instead many schools still discuss creationism as an idea that many people have, and this is accurate.

In one (I think it was only one) rural state the legislature passed a law that said the idea of creationism must be taught along with the theory of evolution because the often atheist liberals in academia were, as I suggested in my original post, so against offering any sort of conservative thought (in this case, any suggestion of God), that they were removing any mention of creationism from the curriculum. Of course this legislation played into the liberal media's stereotype that rural America is a bunch of backward hicks who are anti-science (because, you know, they stick to their guns and their bibles).

Want to see real science in action? Go to a modern farm, probably more science based than most of family practice medicine, and certainly more than chiropractology

 

[Doctor Bob]

As long as they teach about the flying spaghetti monster also, then I won't complain.

 

[Boatswain2PA]

As long as they teach about the flying spaghetti monster also, then I won't complain.

Its all about diversity, right?

 

[Janders]

His noodly appendage touches us all...

 

[Angry Birds]

The jobs with 24 hour shifts exist in no short supply. However, I will let you know they are more painful than overnights. Of course the plus side is that you have more days off. Keep in mind that it takes a couple days to recover from a 24 hour shift.

 

[Makati2008]

The jobs with 24 hour shifts exist in no short supply. However, I will let you know they are more painful than overnights. Of course the plus side is that you have more days off. Keep in mind that it takes a couple days to recover from a 24 hour shift.

You know I would say it's dependent on volume at the facility. I used to do 63hr shifts( odd number I know) and sometimes I was rested and other times I was praying would it end. The worst part was covering the ED that following Monday as well if someone had something come up. I was also a lot younger back then and don't think I could do it again at this age.

 

[CajunMedic]

In one (I think it was only one) rural state the legislature passed a law that said the idea of creationism must be taught along with the theory of evolution

Sounds like our now infamous Lousiana Science Education Act, where public school teachers can add creationism and use materials critical of global warming in science class. High school kid from a well connected political family rallied vehemently against it and got his career in politics started over it.

 

[Arcan57]

No.

Nowhere is creationism being taught to children as "this is what happened". Every school curriculum teaches the theory of evolution. Instead many schools still discuss creationism as an idea that many people have, and this is accurate.

There are of course many ideas that many people have that aren't taught in school. Your assertion doesn't make a particularly strong argument regarding this particular idea being taught. Ignoring fact in favor of story is comforting but comes at a cost.
From a societal standpoint, it seems like the culture with the least amount of magical thinking tends to outcompete the more superstitious tribes/nations.

 

[Brigade4Radiant]

Creationism is stupid though

 

[Polonium-210]

Well I suppose the alternative is to embrace what Bertrand Russell so poignantly opined: "That Man is the product of causes which had no prevision of the end they were achieving; that his origin, his growth, his hopes and fears, his loves and his beliefs, are but the outcome of accidental collocations of atoms; that no fire, no heroism, no intensity of thought and feeling, can preserve an individual life beyond the grave; that all the labours of the ages, all the devotion, all the inspiration, all the noonday brightness of human genius, are destined to extinction in the vast death of the solar system, and that the whole temple of Man’s achievement must inevitably be buried beneath the debris of a universe in ruins—all these things, if not quite beyond dispute, are yet so nearly certain, that no philosophy which rejects them can hope to stand. Only within the scaffolding of these truths, only on the firm foundation of unyielding despair can the soul’s habitation be safely built."

 

[deleted547339]

Creationism is stupid though

Thanks....

 

[Hawkman84]

Why can't creationism and evolution both be true? You can look at bacteria and prove that evolution occurs but you can't scientifically explain the beginning of everything. And with all of the training in medical school to be sensitive to people with alternate lifestyles or gender confusion or lack of faith, you should also remember that over half of the country believes that God, of whatever faith they belong to, exists and created everything. Suddenly believing in nothing higher than yourself and trying to demean those that believe there is something more important than themselves does not make you intellectually superior, it makes you look like a jerk. If it is in jest, that is one thing. But I would encourage you to be more accomadating when your theory that everything came into existence from a cloud of dust that was created by nothing, or a spaghetti monster, makes no more sense.

 

[Dares Dareson]

No.

Nowhere is creationism being taught to children as "this is what happened". Every school curriculum teaches the theory of evolution. Instead many schools still discuss creationism as an idea that many people have, and this is accurate.

In one (I think it was only one) rural state the legislature passed a law that said the idea of creationism must be taught along with the theory of evolution because the often atheist liberals in academia were, as I suggested in my original post, so against offering any sort of conservative thought (in this case, any suggestion of God), that they were removing any mention of creationism from the curriculum. Of course this legislation played into the liberal media's stereotype that rural America is a bunch of backward hicks who are anti-science (because, you know, they stick to their guns and their bibles).

 

[Dares Dareson]

Why can't creationism and evolution both be true? You can look at bacteria and prove that evolution occurs but you can't scientifically explain the beginning of everything. And with all of the training in medical school to be sensitive to people with alternate lifestyles or gender confusion or lack of faith, you should also remember that over half of the country believes that God, of whatever faith they belong to, exists and created everything. Suddenly believing in nothing higher than yourself and trying to demean those that believe there is something more important than themselves does not make you intellectually superior, it makes you look like a jerk. If it is in jest, that is one thing. But I would encourage you to be more accomadating when your theory that everything came into existence from a cloud of dust that was created by nothing, or a spaghetti monster, makes no more sense.

 

[WilcoWorld]

Why can't creationism and evolution both be true? You can look at bacteria and prove that evolution occurs but you can't scientifically explain the beginning of everything. And with all of the training in medical school to be sensitive to people with alternate lifestyles or gender confusion or lack of faith, you should also remember that over half of the country believes that God, of whatever faith they belong to, exists and created everything. Suddenly believing in nothing higher than yourself and trying to demean those that believe there is something more important than themselves does not make you intellectually superior, it makes you look like a jerk. If it is in jest, that is one thing. But I would encourage you to be more accomadating when your theory that everything came into existence from a cloud of dust that was created by nothing, or a spaghetti monster, makes no more sense.

You are correct that evolution does not preclude a Creator/intelligent designer. However, positing an intelligent designer doesn't actually answer the question of how we got here. Saying "God did it" simply kicks the can down the road, and gets you caught in either an infinite regress (what created the creator?) OR appeals to extra-logical/supernatural explanations (i.e. God is not bound by reason or science).

 

[Hawkman84]

I go with the God is not bound by reason or science view. I think to have a beginning you have to default to unexplainable or it doesn't work. It's as good as any scientific answer. and I enjoy a life with God. And there are great doctors that don't believe in God. Great doctors working both 8 and 24 hour shifts if we want to discuss the original post! I just like to point out that saying everything was created by nothing makes no more sense then God. I hope everyone on SDN has a great, safe celebration of our country this weekend!!

 

[Cinclus]

Why can't creationism and evolution both be true? You can look at bacteria and prove that evolution occurs but you can't scientifically explain the beginning of everything. And with all of the training in medical school to be sensitive to people with alternate lifestyles or gender confusion or lack of faith, you should also remember that over half of the country believes that God, of whatever faith they belong to, exists and created everything. Suddenly believing in nothing higher than yourself and trying to demean those that believe there is something more important than themselves does not make you intellectually superior, it makes you look like a jerk. If it is in jest, that is one thing. But I would encourage you to be more accomadating when your theory that everything came into existence from a cloud of dust that was created by nothing, or a spaghetti monster, makes no more sense.

The Flying Spaghetti Monster makes no less sense, though. *applies eye patch and hook hand*

 

[Birdstrike]

How did we get from 24hr rural shifts to debating the meaning of all existence, again? Lol

 

[WilcoWorld]

How did we get from 24hr rural shifts to debating the meaning of all existence, again? Lol

Haven't you noticed? This forum is not about discussing medicine, it's about finding the least charitable interpretation of any statement, willfully misunderstanding each other and taking pot-shots.

Oh wait, I guess it is about medicine after all.

 

[ccfccp]

This is the best comment I've seen on here in a long time...

(WW's... for some reason I can't figure out how to use the quote function any more...)

 

[Arcan57]

How did we get from 24hr rural shifts to debating the meaning of all existence, again? Lol

You've never been working a 24 in BFE treating your third psychotic meth patient of the night and wondered what it all means?

 

[deleted109597]

You've never been working a 24 in BFE treating your third psychotic meth patient of the night and wondered what it all means?

Who uses meth these days? Are you in some weird location that nobody can get synthetic cannabanoids?

 

[deleted547339]

Who uses meth these days? Are you in some weird location that nobody can get synthetic cannabanoids?

Central Florida. Everyone in central Florida uses meth.....

 

[Arcan57]

Who uses meth these days? Are you in some weird location that nobody can get synthetic cannabanoids?

F&$? cush abusers. While I find them less ridiculous than the meth heads, the sheer volume of them and their uncanny ability to name drop potentially life threatening symptoms is troubling. Also, way too many of them believe it's "all natural herbs" and so it legitimately doesn't cross their minds that the high potency, completely unregulated and unstandardized and untested drug they just smoked could be the cause of their ripping CP, intractable vomiting, new onset delirium, or unverifiable neuro deficits.

 

[Birdstrike]

You've never been working a 24 in BFE treating your third psychotic meth patient of the night and wondered what it all means?

I haven't worked a 24 hr shift of any type since residency.

 

[Hercules]

Who uses meth these days? Are you in some weird location that nobody can get synthetic cannabanoids?

Your patients just pick one? That sounds nice. Mine prefer a little alcohol, little meth, can't leave out the opiates, then spice to taste. Oila! The recipe for an ungrateful resource wasting patient encounter is complete.

 

[deleted547339]

Your patients just pick one? That sounds nice. Mine prefer a little alcohol, little meth, can't leave out the opiates, then spice to taste. Oila! The recipe for an ungrateful resource wasting patient encounter is complete.

Everyone here does heroin. Everyone.

 

[deleted6669]

I love high acuity/low volume solo coverage 24 hr rural shifts. one of my favorite per diem gigs ever. typical shift is 12-14 pts in 24 hrs and I generally sleep through the night. gotta love it.
oh, and they pay me 15 dollars more/hr than my night shifts at an urban trauma ctr where I see 30 pts in 12 hrs...

 

[mega_colon]

I have some related questions as I'm interested in working in a rural ED in the mountain west.

1) How small an ED can a recent grad realistically work without losing their skills? I don't want to go somewhere and be incompetent 5 years later because I don't see enough complex cases.

2) A lot of the places I'm looking at have mostly FP's staffing the EDs. Is this a sign that working in these locations would mean a significant pay cut?

 

[Vandalia]

I have some related questions as I'm interested in working in a rural ED in the mountain west.

1) How small an ED can a recent grad realistically work without losing their skills? I don't want to go somewhere and be incompetent 5 years later because I don't see enough complex cases.

2) A lot of the places I'm looking at have mostly FP's staffing the EDs. Is this a sign that working in these locations would mean a significant pay cut?

It is difficult to directly compare the experience of different practice environments. A medschool, urban, level 1 trauma center may see many cases of X, but they also have the advantage of having rapid access to sub-specialty services that can quickly take over management. On the other hand, in smaller places you may see many fewer cases of X, but it is going to be completely up to you for a significant time. How do those compare? I am not sure, but there is certainly some trade-off.

Also, there is a difference between competence and comfort. If you are board certified in EM, still have your mental and physical abilities, and stay reasonably current (the real thing, not just MOC), then you should be able to handle whatever comes through the door until those conditions no longer apply. Now that doesn't mean you will set any speed records. That is the difference, and that is where comfort comes in. They guy who has been doing urban trauma for decades will be seeing a lot more patients than you initially. However, there is a difference between showing up for work wondering if you will kill someone, versus worrying if you are moving patients fast enough. Also, competent people with good training usually get up to speed pretty quickly. If you are at a small rural place, you may have to put some more effort into CME - time and travel, but is not necessarily a career ending move.

As for FP staffing the ED, that is not a real positive sign, but it does not necessarily mean a pay cut. It depends on what they are actually paying the FPs - I know some who are making EM salaries - and what the hospital is willing to pay for in the future. A lot of warning bells should be going off, but it is still possible they will make a decent offer.

 

[RustedFox]

I too, have a bizarre fascination with the mountain west and rural EM. I have a frequent daydream where I can "walk the earth... like Kane" and just go 'yonder from ED to ED.

Its a great dream. No idea how well it would work out in practice.

Still. What a great dream. Pack everything you truly need into a car or van. If it doesn't fit.... you probably don't truly "need" it.

 

[Birdstrike]

I have a frequent daydream where I can "walk the earth... like Kane" and just go 'yonder from ED to ED.

.

You had me at "walk the earth... like Kane" and then.....it all came crashing dawn with the "go yonder from ED to ED." Smh

 

[RustedFox]

You had me at "walk the earth... like Kane" and then.....it all came crashing dawn with the "go yonder from ED to ED." Smh

Of course, you wouldn't have a necessity to bend the clock and kowtow to admin. It'd just be a means of income when needed, so you could get back to walking the earth, like Kane.

 

[Birdstrike]

Of course, you wouldn't have a necessity to bend the clock and kowtow to admin. It'd just be a means of income when needed, so you could get back to walking the earth, like Kane.

You are learning....Grasshopper.

 

[RustedFox]

You are learning....Grasshopper.

Christ, I loved kung fu.