EM FIRST ATTENDING JOB

[EMgig]

So just wondering what your thoughts are on low volume singe coverage critical access hospital EM jobs versus an inner city double coverage moderate volume RVU based job as a first attending job? Anyone have advice or experience with critical access hospital jobs or any advice in general? Any helpful advice would be very much appreciated

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[Tenk]

I work at a critical access hospital, and occasionally academic and once a month at a big community shop. Love my critical access job to death. You have to do a lot of stuff on your own, i.e. When you go into the bathroom and look in the mirror you're looking at the trauma team, the OB team, the NICU, the PICU, and the ICU. You're it. It's my favorite place I work though and I started there right out of residency. Scope it out and see. If you have specific questions feel free to ask or PM me.

 

[winkleweizen]

I love my RVU gig. When Im busy busting my ass, I don't feel so bad because I know I'm getting compensated for it. If a doc I'm working with is lazy, I don't mind so much now as opposed to residency or my past moonlighting gig. Ive also gotten much more familiar with the inner workings of billing/documentation

 

[bravotwozero]

I wouldn't do single coverage if I were you. Too many possibilities for complete disaster.


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[exsanguination]

I work at a critical access hospital, and occasionally academic and once a month at a big community shop. Love my critical access job to death. You have to do a lot of stuff on your own, i.e. When you go into the bathroom and look in the mirror you're looking at the trauma team, the OB team, the NICU, the PICU, and the ICU. You're it. It's my favorite place I work though and I started there right out of residency. Scope it out and see. If you have specific questions feel free to ask or PM me.

As mentioned already, how do you deal with that huge amount of added risk? All those care settings (NICU/PICU/L&D/etc) are so high risk and the potential for "complete disaster" seems higher than your average community hospital

 

[GonnaBeADoc2222]

I asked my PD about this. I was expecting a more measured answer, but he basically said he wouldn't worry about any of our graduating class going to a single coverage situation. He said even if you have 5 other attendings there, at the end of the day you have to make the decision and you can't ask another attending for help all the time.

I guess it'd be nice in a peri-code situation to have one person doing procedures and one person running the show. However, I think it's a good skill to have to be able to intubate, slide down and pop in the fem line, all the while being the leader.

 

[Daiphon]

I asked my PD about this. I was expecting a more measured answer, but he basically said he wouldn't worry about any of our graduating class going to a single coverage situation. He said even if you have 5 other attendings there, at the end of the day you have to make the decision and you can't ask another attending for help all the time.

I guess it'd be nice in a peri-code situation to have one person doing procedures and one person running the show. However, I think it's a good skill to have to be able to intubate, slide down and pop in the fem line, all the while being the leader.

True. And EM residency is only partially about the procedures; as we could train monkeys to do them, it's more about knowing *when* to do them & anticipating (rather than reacting to) complications.

Your question about single coverage goes back to the adage that EM is really a 3.5 year residency - you learn so much your first 6 months out - and so single coverage can be a steep but rewarding learning curve.

The more important question as to your site in question is: what protocols are in place for getting people out? SC critical access is all about the "stabilize & ship" model, so while residency ought prepare you well for the former, the latter can be a real pain. Never fun calling a gazillion shops to try & transfer a train wreck on the fly; much better to have those relationships already agreed upon & in place... especially ICU, STEMI, CVA, OB, & Trauma.

Just my 0.02,
-d

Semper Brunneis Pallium

 

[namethatsmell]

The more important question as to your site in question is: what protocols are in place for getting people out? SC critical access is all about the "stabilize & ship" model, so while residency ought prepare you well for the former, the latter can be a real pain. Never fun calling a gazillion shops to try & transfer a train wreck on the fly; much better to have those relationships already agreed upon & in place... especially ICU, STEMI, CVA, OB, & Trauma.

This is SO true. I'm a new attending in a place that's functionally a quasi-critical access hospital. It's pretty challanging at times but has been really rewarding. Having pathways in place to ship out STEMIs, trauma, CVAs, etc is incredibly helpful and frankly a big reason I felt comfortable taking the job. That, and having a pediatrician in house 24/7 (we have a small peds floor) are two huge luxuries.

 

[fahimaz7]

I'm single coverage fresh out of residency. It gets exciting for sure! With that said, I wouldn't change a thing so far.

 

[The White Coat Investor]

I had a nice thing my first couple of years out- single coverage at one site, and a big academic center at the other. Then I added a third site- the local trauma center. After 4 years I had a pretty good idea what mattered to me in a job and site.

 

[Tenk]

As mentioned already, how do you deal with that huge amount of added risk? All those care settings (NICU/PICU/L&D/etc) are so high risk and the potential for "complete disaster" seems higher than your average community hospital

No more risk than having that person show up at your doorstep with a blue baby. Another way to look at this: if that were your newborn baby who needed resuscitation, would you want a FP doc doing it or would you want an EM trained doc doing it?

Ultimately pretty much everyone goes into EM to make a difference and save lives. There are other reasons, but most of us enjoy the action, the thrill, the close save. These are the jobs where you will actually feel that difference because if you aren't there, they will probably die. I get lots of thank yous at my small job. I rarely if ever hear those words at the bigger shops.