Cutting down shifts and staying competent

[miacomet]

How many EM shifts per month are necessary to maintain competence? Do your groups have minimums? Anyone do UC and then return to the ED?

Thinking of cutting WAY back and wondering what others' experiences are.

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[southerndoc]

How far out of residency are you? It's easier to maintain your skills with 4 shifts/month if you've been doing it for 10-20 years. It becomes ingrained. If you're fresh out of residency, you haven't obtained the "hardwired" settings where procedures become second nature to you.

The bigger issue most groups face is reliable coverage, malpractice coverage, administrative overhead, etc. It becomes cost prohibitive to spend all the money on malpractice ($30-60k/year) if the doc doesn't work that much. The malpractice cost is per doc regardless whether you work 17 shifts/month or 2 shifts/month.

 

[miacomet]

How far out of residency are you? It's easier to maintain your skills with 4 shifts/month if you've been doing it for 10-20 years. It becomes ingrained. If you're fresh out of residency, you haven't obtained the "hardwired" settings where procedures become second nature to you.

The bigger issue most groups face is reliable coverage, malpractice coverage, administrative overhead, etc. It becomes cost prohibitive to spend all the money on malpractice ($30-60k/year) if the doc doesn't work that much. The malpractice cost is per doc regardless whether you work 17 shifts/month or 2 shifts/month.

Decade out.
Medmal issues aren't a concern if I decide to do locums, at least not in the ways you allude to.
Just concerned about competence. Most people seem to say six.

 

[Groove]

If you're 10 years out I wouldn't worry too much about it. You should be hardwired. I'd say 5-6 shifts/mo. If I were considering what you're describing, I'd work 6 shifts in a single block and take the rest of the month off. Rinse, repeat. 4 is a little anemic but I wouldn't worry about you nearly as much as the doc 1-2 years out.

 

[Groove]

As for our CMG group, one of our veterans works 10 shifts a month. He recently tried to work 8 and the CMG told him they wouldn't give him his bonus if he didn't work at least 10. Most of our guys have 14 included in their contracts. I negotiated 12 so that I could cut back in the future if I wanted, or work at other hospitals, but I typically work 15 and since AFMD don't moonlight anymore. No group is going to hire you part time long term for all the reasons southerndoc mentioned but it should be easily accomplished working locums through say...Weatherby, etc..

If it makes you feel better, I once knew a doc who was about 1 year out and took 6-8 months off to travel the world. He said that he really struggled for about a week when he came back and it was taking several minutes to process things that would have only taken him seconds before... However, he said he was back in his groove after about 7 days of work.

 

[miacomet]

Thanks
As stated before, I'm not concerned about contractual issues- I have that worked out. I'm concerned about competence and being able to jump back in if I want to.

 

[swamprat]

I might be in the minority here but I work 2-4 a month in a high acuity setting and feel fine!

 

[miacomet]

I might be in the minority here but I work 2-4 a month in a high acuity setting and feel fine!

I thought you just did Pain?

 

[swamprat]

I thought you just did Pain?

I do FT pain but I keep my foot in the door working a couple shifts a month/it’s nice to have some 1099 income right now I’m relatively “young” and no kids so I can do it

 

[Arcan57]

I think there’s a difference between competence and tolerance. Tolerating the grind of a busy ED extinguishes long before messing up on individual cases becomes a major issue, from
what I’ve seen.

 

[emergentmd]

I think 4 is a good number esp if they are spread around.

4 blocks each month could mean you go without work for 6wks sometimes which is a long time. Not that your skills is not sharp, its just hard jumping into the fast grind.

 

[EctopicFetus]

How far out of residency are you? It's easier to maintain your skills with 4 shifts/month if you've been doing it for 10-20 years. It becomes ingrained. If you're fresh out of residency, you haven't obtained the "hardwired" settings where procedures become second nature to you.

The bigger issue most groups face is reliable coverage, malpractice coverage, administrative overhead, etc. It becomes cost prohibitive to spend all the money on malpractice ($30-60k/year) if the doc doesn't work that much. The malpractice cost is per doc regardless whether you work 17 shifts/month or 2 shifts/month.

Med mal depends on policy type.

 

[namethatsmell]

I've worked PT at multiple places and none have ever complained about their med-mal costs due to me.

 

[Dr Mantis Toboggan]

Med mal depends on policy type.

Yeah we have what’s called a “slot policy” the premium is based on total visits.

 

[dchristismi]

I think there’s a difference between competence and tolerance. Tolerating the grind of a busy ED extinguishes long before messing up on individual cases becomes a major issue, from
what I’ve seen.

This. I cut back drastically (now only about 3 a month in a low-acuity freestanding) several months ago. I worked a couple of high volume days in Jan at my last hospital-based ED and this was exactly what I felt. About 6 hours in I was already starting to think that it was a long day...

I much prefer my new life... sitting, talking, letting families cry on my shoulder... putting in tiny IVs in very dehydrated, emaciated patients.

Can I still hack it? Yeah. Although now, I don't really want to.

 

[miacomet]

This. I cut back drastically (now only about 3 a month in a low-acuity freestanding) several months ago. I worked a couple of high volume days in Jan at my last hospital-based ED and this was exactly what I felt. About 6 hours in I was already starting to think that it was a long day...

I much prefer my new life... sitting, talking, letting families cry on my shoulder... putting in tiny IVs in very dehydrated, emaciated patients.

Can I still hack it? Yeah. Although now, I don't really want to.

Thanks dchristismi; you always have awesome comments. That's honestly something I had never considered- that my skills (and I don't just mean procedures, which I think are less of an issue) would outlast both my tolerance of and interest in EM. We've had some scary moonlighters recently, and I don't want to be the person using outmoded sedation protocols and not knowing how to handle traumas.

Maybe that's where I'm at right now. I can still do it, I'm addicted to, or scared of losing, the money (even if we are woefully underpaid for what we do), but I'm not really that interested, yet I still want or need to maintain my skills.

Thank you for the insight.

 

[RoyBasch]

This is pure speculation on my part as I have only ever been full time; but I would assume if you are at least 5 years out of residency and your training and skills are pretty well crystalized then maybe 4 shifts a month would be enough to maintain.

 

[dchristismi]

I don't know that I honestly considered it either until I looked back... and Arcan's comment crystallized it better than I could have described it. We all focus so much on our skills (and worrying about loosing them) that we forget about the other stuff. But now that I've been out of my insane-high-acuity-disaster shop for nearly a year, I look back and wonder how the hell I did it for so long. Definitely food for thought.

 

[The White Coat Investor]

Our group requires six. I'm currently working eight. I think eight is enough, but I'm scared to go lower. It's probably different for different people but I'm not sure working 6 for years is a good idea. It certainly is not a good idea in the first 5 years out of residency.

 

[erdoc111]

I think if you are a decade out then 5 shifts a month will keep you totally competent. Doing urgent care full time will not keep your critical care skills up. I practiced. EM for 8 years and now do UC. I took a hiatus in between. That (the hiatus) definitely is not good for your critical care skills!