New Subforum?

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Arcan57 said:
But for the first time in the years I've been on here, there is a core group of attending posters that started their SDN careers in residency or even med school. We've always had lone voices crying out in the wilderness (Apollyon, etc.) but now there are enough of us to have productive dialog about attending life.
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Some of us attendings are ancient enough to have started on here as premeds circa 2000. I'm feeling pretty old right now.
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Apollyon said:
Not the same. The anesthesiology private forum is not visible to those who are not authorized (which is not what is being discussed here). The same applies to the "Pain Rounds" physician only subforum in the pain medicine forum.
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Yup, I pointed that out in the last line of my post you quoted. Do you think that a bad idea? To allow a forum to be read by all but only posts by some? Just curious as I'm confused why you quoted me then repeated (expanded some) what I said.
 
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atkinsje said:
Yup, I pointed that out in the last line of my post you quoted. Do you think that a bad idea? To allow a forum to be read by all but only posts by some? Just curious as I'm confused why you quoted me then repeated (expanded some) what I said.
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I read the first half of your post. I didn't notice the last sentence, having been up all night.

Again, on re-reading your post, you can't claim that the private forum has not diluted the gas forum (because you don't know what's in it, but only what's in the main forum, and they ain't talking). However, I would easily grant you that the forum in itself is quite robust, irrespective of what is or is not being posted in the private forum.

For reasons already enumerated, a "read only" private forum is a dud, which I feel would be due to the dearth of attending only input (as I noted earlier, just look at the "practicing physicians" forum - and that one, I believe, is accessible to all to read).

And, on a separate tack, the "Kappa Psi" and "NCPA" groups for pharmacists are two too many. Why can't I have an "ABEM" designator, then? Or what about "ACEP"? Then throw in ACP, ACOG, ACS, IDSA, and every other one under the sun.
 
We are discussing the logistics involved with admin. As has been pointed out there is a similar subforum on the anesthesia forum which has worked well. Gas is however a different animal.

We need to get an idea of how many attendings are for such a forum. A poll really wouldn't work because all the attendings could vote for and all med students against and that really wouldn't tell us what we want to know. The questions of how we will verify the users and if it will be visible by non-members will have to be worked out later.

For now the question for the attendings who post on the EM board is:

Do you want an attending only EM subforum?
 
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yes.

and it wouldn't be sermo-lite, because the posters are different. i read sermo as well, and i get something from that site as well, but i don't KNOW those posters.
 
fiznat said:
I donno man. While I am obviously not yet a physician, I was a paramedic for 10 years and I do know a little bit about burnout, the loss of excitement, and what it means to not have a "win" in a while. [...] Is physician training really all that different?
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Was a medic for 12 before med school, and being an attending is way different.
 
Yes, I think there is benefit from both ends!
 
Yes. I would read it and post to it.
M
 
Arcan57 said:
It leads to some thread hijacking, especially when we're talking plainly about the challenges of EM outside of academia. I don't know if an attending forum is strictly needed, but I do think this forum acts as a support forum for some of the longer time posters. And there can be some pretty significant interruptions in conversations about real-world issues because of med students and (mostly junior) residents talking out of their rectums about how we should think and feel. The level of cynicism and bitterness I feel on a daily basis would be horribly inappropriate for a med student, yet my world view is Pollyanna-ish compared to Birdstrike or GV.

Doing this job changes you, and I don't think anyone that's not an attending has a feeling for how lonely and stressful the job is out in the community. The last day of residency is a the end of an era, and most of you will be going out to jobs where the change in level of support is unfathomable. Even in shops with double (or more) coverage, you're not sitting around and chatting with the other docs. I can go HOURS without seeing one of my partners, and usually it's to hand the phone over because we both needed the same consultant.

It's knowing that as a new doc you can get fired at any time, even for doing the right thing, if someone who brings enough money into the hospital gets pissed off. It's the stress of circadian changes when you have more in your life to worry about then when the surf is up or what the weather outside is like.

For some of the new attendings, it's taking jobs (for a variety of reasons) that pay way less then they thought they would be paid. It's understanding the impulse to just want to pay off your debt ASAP and be out of clinical medicine. It's figuring out why that's not what you're doing, or how other attendings rationalize their approach to a specialty that is toxic. The losses outnumber the wins on most days, and if you string enough shifts together you're not the same person at the end. We recover and bounce back and learn to value the rare wins out of proportion to their frequency. For most EM docs, there's a point where the recovery stops being complete and we start staying in the red. This requires some sort of change, either in our own coping mechanisms or our external environment. If you've never stared at a stranger's name and a chief complaint on a tracking board and HATED them without having even seen them, you're a better and different person then I am. And while I'd like to think you have some secret figured out, I can't help feel that you haven't seen what I've seen.
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I was a little shocked that some EM docs feel this way. I know that sleep deprivation can take its toll and the some of the big EM staffing groups can be a little unmerciless at times, but is this feeling isolated to a few or is it shared by many EM physicians?
 
TPBC said:
I was a little shocked that some EM docs feel this way. I know that sleep deprivation can take its toll and the some of the big EM staffing groups can be a little unmerciless at times, but is this feeling isolated to a few or is it shared by many EM physicians?
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Yep. its everywhere.
 
it's shared by many. Most people don't feel it so bad that they feel they need to quit or sink into the deepest depression or have it affect their performance or anything like that, but the feeling is still pretty prevalent. Both in Academics and Community. I'd say many people in general "don't mind" their jobs and still think it was the correct specialty for them, and it is still cool many times, but I don't know how many EM physicians absolutely love it. There's so many reasons for this both internally (hospital practices/policies etc.) or external (patient population, non-emergent presentations > acute, etc.). At some places some sleep deprivation might have a play, but I don't think this is really a big issue because we don't do >24 hrs on call kind of thing.
 
TPBC said:
I was a little shocked that some EM docs feel this way. I know that sleep deprivation can take its toll and the some of the big EM staffing groups can be a little unmerciless at times, but is this feeling isolated to a few or is it shared by many EM physicians?
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I'd say that Arcan's view is moderate and that his/her means of coping (admission of negative feelings and a discussion of their causes with an eye to solutions/mitigation) are healthy.

So, yeah - the sentiment's shared, but not often spoken about in public.
 
WilcoWorld said:
I'd say that Arcan's view is moderate and that his/her means of coping (admission of negative feelings and a discussion of their causes with an eye to solutions/mitigation) are healthy.
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That actually felt good to read. Last night was a tough shift, first 5 patients ended up being ICU players and 2 were persistently hypotensive requiring lines. One of them had chest pain and inf. lateral ST-elevation w/ sinus brady into the 40s (and a wickedly prolonged QT) in the setting of not having been dialyzed in a week (said he couldn't get the caps for his PD catheter, but had been switched to PD secondary to non-compliance with HD). I'm about 80% certain this is hyper K, but he's got STEMI changes and pain. The interventionalist on call refused to discuss the case with me, which lead to me hanging up on him. Which led to him calling administration, causing me to field a call from the hospital CFO (the administrator on call) right as my other patient in septic shock w/ hypotensive in the 70's after 4L went into new-onset a.fib. So I had to hang up on the CFO so I could cardiovert the patient.

Interesting the ugly EKG/no-dialysis patient ended up only having a K of 6.2, but had a HCO3 of 1 and a BUN of 196/Cr 29.5. After getting the hyperkalemia cocktail empirically (his first set of labs came back hemolyzed after having been up in the lab for an hour and his repeat draw was still on the machine), his EKG didn't change until he got a couple of amps of bicarb. And then it normalized with a rate in the high 60s, which makes me wonder if it was mostly the acidosis that was causing myocardial depression.
 
RustedFox said:
The interventionalist didn't wanna discuss the case even ?

Maaan, what a d-bag.
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Yeah, but fortunately he lacked the self-awareness necessary to leave out that part when he called to the administrator to complain about me. So I don't think things are going to go well for him come tomorrow morning. In general, administrators don't like being called in the middle of the night on holiday weekends.
 
As long as the Sub-forum is visible to all this sounds like a definite "win-win" situation.

Attendings can have a platform for discussing important issues concerning emergency medicine without thread hijacking (lol, which is pretty overstated but oh-well).

The rest can sit back, read, digest, learn, grow, evolve.

That being said, it's kinda funny that an Attending only "clubhouse" needs to be designated for these discussions to occur. I mean, these discussions can happen anytime, so what if a pre-med, M3/4, resident, nurse, optometrist temporarily diverts a thread in a different direction. Simply don't reply to their comment and steer the conversation back to wherever the f*ck you'd like it.

Still a YES though, but only in the hopes that it would bring more EM attendings out of the woodwork and provide a greater breadth of EM topics, opinions, information....
 
RustedFox said:
You gotta indulge us here, what gives ?!
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The cardiologist is not so much good with the whole interacting with other people. The first time I met him was when he had ordered a diltiazem bolus on a patient I had already coded twice that day in the unit because of the pt's sinus tach. Nevermind that he was on levophed at 20mcg/min to keep his pressure up, or that his calcium was 6.5. So I get called to run up to the ED to code him again, which consisted of a round of chest compressions and an amp of calcium chloride. Pt stabilized, so I walk out of the room and see the cardiologist on the computer in nurses' station just outside of the patient's room.

I'm a little pissed that he just tried to kill someone I had spent an hour and a half keeping alive earlier in the morning, so I go over to talk to him. I introduce myself, and before I can say a word about the coding patient he starts screaming at me that I had admitted a patient he follows for HTN to their PCP for urosepsis without calling him.

He has also accused me of trying to kill a patient by starting a nitro gtt on a hypertensive heart failure pt without valvular dz, told me that the obese pt who had put on twenty lbs in the last 3 days couldn't be heart failure and that it was unacceptable that I hadn't worked her up for PE, and in general will refuse to listen to anything anyone says about the patient. Now if these discussions were happening after he had seen and examined the patient, then they would be inappropriate. But they're occurring after he's just looked up the patient's lab values, x-ray report, and the vitals (which are frequently several hours out of date) on our EMR.
 
Arcan57 said:
The cardiologist is not so much good with the whole interacting with other people. The first time I met him was when he had ordered a diltiazem bolus on a patient I had already coded twice that day in the unit because of the pt's sinus tach. Nevermind that he was on levophed at 20mcg/min to keep his pressure up, or that his calcium was 6.5. So I get called to run up to the ED to code him again, which consisted of a round of chest compressions and an amp of calcium chloride. Pt stabilized, so I walk out of the room and see the cardiologist on the computer in nurses' station just outside of the patient's room.

I'm a little pissed that he just tried to kill someone I had spent an hour and a half keeping alive earlier in the morning, so I go over to talk to him. I introduce myself, and before I can say a word about the coding patient he starts screaming at me that I had admitted a patient he follows for HTN to their PCP for urosepsis without calling him.

He has also accused me of trying to kill a patient by starting a nitro gtt on a hypertensive heart failure pt without valvular dz, told me that the obese pt who had put on twenty lbs in the last 3 days couldn't be heart failure and that it was unacceptable that I hadn't worked her up for PE, and in general will refuse to listen to anything anyone says about the patient. Now if these discussions were happening after he had seen and examined the patient, then they would be inappropriate. But they're occurring after he's just looked up the patient's lab values, x-ray report, and the vitals (which are frequently several hours out of date) on our EMR.
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Sounds like a winner. :rolleyes:

I would like to change my answer to yes as long as it's open and view-able to all.
 
Arcan57 said:
He has also accused me of trying to kill a patient by starting a nitro gtt on a hypertensive heart failure pt without valvular dz, told me that the obese pt who had put on twenty lbs in the last 3 days couldn't be heart failure and that it was unacceptable that I hadn't worked her up for PE, and in general will refuse to listen to anything anyone says about the patient. Now if these discussions were happening after he had seen and examined the patient, then they would be inappropriate. But they're occurring after he's just looked up the patient's lab values, x-ray report, and the vitals (which are frequently several hours out of date) on our EMR.
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I'm so glad that the PMD's and specialists get along at my shop. Seriously, this type of conversation rarely, if ever, happens where I work because this kind of behavior is simply not condoned.
 
docB said:
A poll really wouldn't work because all the attendings could vote for and all med students against and that really wouldn't tell us what we want to know.
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So a mixed vote of all users won't give the answer you're looking for, but a vote restricted to only those you've already (correctly, it seems) determined will vote "yes," will? I'm not understanding this. How is it that med students don't get a vote on the Student Doctor Network, and what's the point of taking a poll at all if you restrict the vote in this way?

There's no good reason for this move. At least none that has yet been put forward. I think the argument about med-student thread hijacking is way overstated (let the fact that I now know the K+ value on one of Arcan's last patients stand testament to that), and I think there is a real potential that contribution to the main EM forum will suffer as a result. This idea sends a message to the medical students of this forum that they have no value in the discussion, and are seen as a nuisance that needs to be quarantined off from the attendings. It would be a shame to see this get pushed through on such false pretenses, based on a sham vote in which only supporters of the idea are allowed to participate.
 
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Wow. This is a bit depressing. I've been on SDN since somewhere in the neighborhood of 2001 (I started a new profile in 2005 after I got into medical school). I always valued reading the posts by others even more than posting myself, so I have a relatively low post count. I'm really saddened to see this elitist mentality taking hold here. The forums used to be a great equalizer of sorts. Any person posting would be respected.

I'm pretty young, but I can tell you that working sucks. It doesn't matter what you do. Very few people out there are going to go to work everyday for 30 years and just love their job every day of it. I can also say that EM is a good job. True, parts of it suck. But, that can be said about any job. I've worked construction, factories, spent time in third world countries and I can tell you that this is a good job any day of the week.

I've have plenty of run-ins with consultants, administrators, and other staff (often tolerated being treated horribly when I was in the right). I deal with difficult patients every day. I'm pretty sure I get it. I've worked the 80 hour weeks here (I once worked ~145 hour/week before residency). I've gone entire shifts without seeing the other doc staffing a department with me. I could care less. I know that this job is difficult. I can also tell you from experience that there are worse things out there that pay a lot less. I can tell you that you can get burned out in any profession.

At what point in my career does my opinion matter as much as some of the other posters? In two weeks when I get my diploma from residency will it magically become more valuable? Two years and two weeks? Or will it be some other nebulous time frame? :rolleyes:

While I sit here and constantly read whining about how much the profession sucks, I'm reminded about the population that frequents the SDN network and it's forums. I remember that the board scores are consistently (way) above average. I would advise the students especially, but all posters on here to remember that these forums are not a true sampling of the profression.

I think we should value everyone's opinions and experiences. I would also like to reiterate that I think it may be beneficial to add a "thanks/like" button to the forum so that those in the community could find the more useful posts from all users.

I don't expect anyone here to really care because I don't know really any of you but, after over 10 years I'm seriously considering ending my time here. Either way, I'm ending my rant now.
 
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One of the reasons I read these residency sub-forums is to see relevant topics in that specialty. I think one of the points of SDN was to span the communication gap between the different levels of training. Taking most of the discussion to a private sub-forum limits med students and residents ability to understand what lays ahead of them...

There is an ignore button for a reason...although at the very least make it view-able by the public.
 
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You guys are just going to end up repeating yourselves... I can imagine it now, you're all happily brooding in your private forum. It's lovely for a while, the hellish naive posts of the non-attendings silenced. Then, one of these noobs will post a question in the Public Forum about a topic you've been discussing:

"I was wondering about EMrgencE_TopiCxxx, blah blah blah really true, how so, what about blee blah bluu?"

"As we said in the private forums MEdSTudent2025, blah blah blah gurgle gurgle gurgle this is the 20th time I've said this thing and because I don't really have a way to answer your question I'm regurgitate regurgitate regurgitate complex issue."

This will probably continue for some time until one of you comes up with an idea-- what if we let non-attendings ask questions in our forums?! That way, we wouldn't have to follow more than one thread about the same thing! What do you guys say???

______________

tl:hungover:r ---- This private forum idea creates more work for those attending physicians who are interested in addressing the questions and concerns of those with less experience than they have.
Also, I think the thread derailment complaint is overstated--- you attendings are just as bad (if not worse) at changing the subject on these forums.

This video comes to mind for some reason (at least the first 1:20 or so):
[youtube]iMUiwTubYu0[/youtube]
 
fiznat said:
So a mixed vote of all users won't give the answer you're looking for, but a vote restricted to only those you've already (correctly, it seems) determined will vote "yes," will? I'm not understanding this. How is it that med students don't get a vote on the Student Doctor Network, and what's the point of taking a poll at all if you restrict the vote in this way?

There's no good reason for this move. At least none that has yet been put forward. I think the argument about med-student thread hijacking is way overstated (let the fact that I now know the K+ value on one of Arcan's last patients stand testament to that), and I think there is a real potential that contribution to the main EM forum will suffer as a result. This idea sends a message to the medical students of this forum that they have no value in the discussion, and are seen as a nuisance that needs to be quarantined off from the attendings. It would be a shame to see this get pushed through on such false pretenses, based on a sham vote in which only supporters of the idea are allowed to participate.
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I hope you bring that passion to things that actually matter. The question was whether the attendings wanted an attending-only forum. This is not an issue that directly impacts you or your ability to someday became a (no doubt outstanding) emergency physician. And if you want to argue semantics, you are looking at the Emergency Medicine subforum of the Physician/Resident Forums [MD / DO].

Looking through the ten most recent threads, most were started by residents or students and the majority of posts in the threads are from the same (this thread being an exception for obvious reasons). Your beloved forum is not going to wither and die because of attendings starting threads in a separate sub-forum. And I'm pretty sure no one is talking about forbidding attendings from posting in the main forum. Which I'm certain everybody is going to continue to do regardless of what happens.

If you look at the attendings' join dates, most of us have been here a very long time and apparently SDN has served us well since we're still reading and (occasionally) posting. We are part of the community, and we are asking ourselves if we could make the experience better.

My personal feeling is that most of us are interested to see what kinds of discussions arise, but aren't terribly invested in the idea either way. I envision 3 scenarios:

1. It may end up being an attending only duplicate of the main forum, which would quickly flame out (the main forum has come dangerously close at times, and it has 10x the number of posters).

2. It may be a place where attending specific questions are occasionally raised, and answered and it putters along (the most likely scenario).

3. It may be a thriving community of attendings that increases our involvement in SDN and serves as a valuable resource for graduating residents and new attendings trying to learn how the game is played, and a source of support for those of us out there trying to appease all our masters while doing what we became doctors to do.

The last is what I'm hoping it becomes, but that's being overly optimistic. In only one of those scenarios is your world negatively effected, and in a temporary way. If an attending only EM forum offends your egalitarian nature too much, think of it like the Surgery or Gas forums. Entertaining (and occasionally infuriating) to read but not something you feel compelled to post on. Or launch a crusade about how bulls--t it is that the high school forum is in a separate place from the pre-med forum,which is separate from the med school forum,which is separate from the physician/resident forum. The only forum with an attending only subforum is Gas, which is one of the most vibrant forums on the board and features an even more restricted access to that forum.
 
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fiznat said:
So a mixed vote of all users won't give the answer you're looking for, but a vote restricted to only those you've already (correctly, it seems) determined will vote "yes," will? I'm not understanding this. How is it that med students don't get a vote on the Student Doctor Network, and what's the point of taking a poll at all if you restrict the vote in this way?

There's no good reason for this move. At least none that has yet been put forward. I think the argument about med-student thread hijacking is way overstated (let the fact that I now know the K+ value on one of Arcan's last patients stand testament to that), and I think there is a real potential that contribution to the main EM forum will suffer as a result. This idea sends a message to the medical students of this forum that they have no value in the discussion, and are seen as a nuisance that needs to be quarantined off from the attendings. It would be a shame to see this get pushed through on such false pretenses, based on a sham vote in which only supporters of the idea are allowed to participate.
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Whoa there, Patrick Henry... lets keep it simple.

Many attendings don't post as often because they "don't want to bother" with the inevitable responses of "...but... but.. but..." from the students. Its that simple.

Many attendings will continue to post in both forums. Hell, I will for sure. I used to be one of those aggravating students that loved to stir the pot. Now, sometimes I don't want the pot to be stirred because its a pain in the arse. Give the forum the option, and you'll see the attendings come out of the woodwork... to post on BOTH forums.
 
Arcan57 said:
I hope you bring that passion to things that actually matter..
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Clearly, I think this does matter. I've been using SDN for a long time too (as long as or longer than many of the attendings here), and it has saved my ass or pointed me in the right direction more times than I can count. What can I say, I like the place and this idea really struck the wrong cord with me.


Rusted Fox said:
Many attendings don't post as often because they "don't want to bother" with the inevitable responses of "...but... but.. but..." from the students. Its that simple.
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But but but, maybe they should just write a blog, or participate in some other forum. Hearing people complain about students participating in threads on the Student Doctor Network seems a little silly to me.



In any case, it seems the vote is done and the decision mostly made. I guess there's no point continuing to fight this with the same arguments over and over. I've said my peace. If the decision isn't yet firmed up, please do make the new place at least visible to the residents and students.
 
fiznat said:
In any case, it seems the vote is done and the decision mostly made. I guess there's no point continuing to fight this with the same arguments over and over. I've said my peace. If the decision isn't yet firmed up, please do make the new place at least visible to the residents and students.
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This keeps coming up. No one has suggested that it not be viewable by all, simply limited in who can post replies.
 
atkinsje said:
This keeps coming up. No one has suggested that it not be viewable by all, simply limited in who can post replies.
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Well, there was this from the moderator who started the poll:

docB said:
The questions of how we will verify the users and if it will be visible by non-members will have to be worked out later.
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You're right though, it seems most (if not all) are in favor of making it visible.
 
In response to docB's "poll" of attendings:

No -- but, of course, I would post there.

HH
 
I'm glad to see this idea is getting some traction, and I'm sad to see the negative views shared by a few in this thread. Since I brought up the idea, let me explain a little further...

As has been mentioned, there are many topics that are simply not in the same realm, planet, or universe of medical students or residents. This is not meant as an "elitist" statement, but just a true fact. As examples, nowhere in medical school is malpractice litigation discussed. Nowhere in residency is the deposition process discussed. These are sensitive topics that may or not be discussed in depth in an attending forum (generally, such as "what should I wear to my deposition", "how much should I charge for an expert witness testimony," "how do you write off time spent in court," etc) that need not be clouded with indirect or off topic postings. This is an example of how innocent questions or "opinions" of those less sensitive the the challenges of attending life can actually "kill" a thread, or prohibit others from posting who have the knowledge and experience to add to the conversation.

As our specialty evolves, as government regulation and core measures become increasingly relevant in our daily practice, documentation, flow, and basic specialty management, there will be increasingly challenging topics we need to address swiftly, with like-minded people, who - as has already been mentioned here - we "grew up with" so to say, and are at the same periods in our lives and careers. We are all student doctors (and will always be learning), but as our individual knowledge increases, we must begin to focus on those issues that are more relevant to our needs.

In that spirit, an attending only forum will only add to this board in many ways. For the medical student, it is a way to look into the window and see what being an attending is all about. For the resident, it is a way to learn more about the relevant topics that will be impacting their future practice. For the attending, it is a way to ask poignant and appropriate questions and receive like answers directly, from reliable sources, and even get information to share with your colleagues, partners, or hospital administrators.

By allowing viewing access to everyone, this is an excellent way to educate, and also inspire thought that can spin off similar threads in the main ED forum - which I would plan to also regularly follow and contribute to. I continue to learn clinically from this board, and I often do so without asking or posting, because I can read and learn. This will continue I imagine for all of us. This is why this board has remained so successful through the years.

A group of cardiologists meets monthly to discuss what OR sets they are going to order, what scheduling is most cost-effective to their group's bottom line, which surgeon has a substance abuse issue and how they are going to address it internally, which etc, etc, etc. This is not a secret meeting with a sinister plan - this is a real world example. The more you practice medicine, the more you realize that the clinical aspect of medicine is a very small (and sometimes relatively non-existant) part of your job, and that the real meat and potatoes of how you do what you do is learned "on the job" and can't be taught.

The practice of Emergency Medicine (and in many respects Anesthesiology, Radiology, Pathology, and other commonly "contracted" hospital-based specialties) has many challenges that take years out of residency to realize, and at times even realizing them is no comparison to waking up on a daily basis and having them alter your practice. Please don't consider the idea of sub forum as a negative, but look at it as a necessity as we all continue to cope with the challenges that lie ahead. For those of you still in training, having even a basic understanding of how real-world practice will impact your future can only help prepare you, educate you, and - God willing - empower you to realize how screwed up medicine is in our Nation, and how emblematic Emergency Medicine is of all of our problems.

*** Disclaimer - I am actually a very happy medical director who deals with these issues and others on a daily basis and can attest to how much I thought I knew as a medical student and resident, and how little I actually did. I can also testify to how little I know now, and how much I have to learn.
 
NinerNiner999 said:
I'm glad to see this idea is getting some traction, and I'm sad to see the negative views shared by a few in this thread. Since I brought up the idea, let me explain a little further...

As has been mentioned, there are many topics that are simply not in the same realm, planet, or universe of medical students or residents. This is not meant as an "elitist" statement, but just a true fact. As examples, nowhere in medical school is malpractice litigation discussed. Nowhere in residency is the deposition process discussed. These are sensitive topics that may or not be discussed in depth in an attending forum (generally, such as "what should I wear to my deposition", "how much should I charge for an expert witness testimony," "how do you write off time spent in court," etc) that need not be clouded with indirect or off topic postings. This is an example of how innocent questions or "opinions" of those less sensitive the the challenges of attending life can actually "kill" a thread, or prohibit others from posting who have the knowledge and experience to add to the conversation.

As our specialty evolves, as government regulation and core measures become increasingly relevant in our daily practice, documentation, flow, and basic specialty management, there will be increasingly challenging topics we need to address swiftly, with like-minded people, who - as has already been mentioned here - we "grew up with" so to say, and are at the same periods in our lives and careers. We are all student doctors (and will always be learning), but as our individual knowledge increases, we must begin to focus on those issues that are more relevant to our needs.

In that spirit, an attending only forum will only add to this board in many ways. For the medical student, it is a way to look into the window and see what being an attending is all about. For the resident, it is a way to learn more about the relevant topics that will be impacting their future practice. For the attending, it is a way to ask poignant and appropriate questions and receive like answers directly, from reliable sources, and even get information to share with your colleagues, partners, or hospital administrators.

By allowing viewing access to everyone, this is an excellent way to educate, and also inspire thought that can spin off similar threads in the main ED forum - which I would plan to also regularly follow and contribute to. I continue to learn clinically from this board, and I often do so without asking or posting, because I can read and learn. This will continue I imagine for all of us. This is why this board has remained so successful through the years.

A group of cardiologists meets monthly to discuss what OR sets they are going to order, what scheduling is most cost-effective to their group's bottom line, which surgeon has a substance abuse issue and how they are going to address it internally, which etc, etc, etc. This is not a secret meeting with a sinister plan - this is a real world example. The more you practice medicine, the more you realize that the clinical aspect of medicine is a very small (and sometimes relatively non-existant) part of your job, and that the real meat and potatoes of how you do what you do is learned "on the job" and can't be taught.

The practice of Emergency Medicine (and in many respects Anesthesiology, Radiology, Pathology, and other commonly "contracted" hospital-based specialties) has many challenges that take years out of residency to realize, and at times even realizing them is no comparison to waking up on a daily basis and having them alter your practice. Please don't consider the idea of sub forum as a negative, but look at it as a necessity as we all continue to cope with the challenges that lie ahead. For those of you still in training, having even a basic understanding of how real-world practice will impact your future can only help prepare you, educate you, and - God willing - empower you to realize how screwed up medicine is in our Nation, and how emblematic Emergency Medicine is of all of our problems.

*** Disclaimer - I am actually a very happy medical director who deals with these issues and others on a daily basis and can attest to how much I thought I knew as a medical student and resident, and how little I actually did. I can also testify to how little I know now, and how much I have to learn.
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This echoes my hope for the sub-forum. As mentioned by Neato, residents deal with a lot of the things that can have a major influence on our practice (difficult consultants, shift work, dealing with difficult patients) but there are a lot of things that either have different overtones or are completely different once you are in practice.

Things like:
1. the importance of having administration know your name in a good way (if I'm Joe Part-Timer, that conversation about the revenue producing cardiologist's behavior goes a completely different way),
2. whether it's worth it to pull a couple of extra shifts outside of your main job so that if things do go south you have somewhere you can pick up at a hospital that you are already credentialed. It's true the ED is portable but in most cases you're looking at a 1-3 month lag time to get started in a new place, longer if the state is an a-- about licensing.
3. how to tell if your groups contract is in trouble, and what kind of hospital support (nursing, techs, # of rms) should be expected for a certain patient volume (adding more doc hours to a shop chronically short on nursing resources or unable to get patients upstairs actually makes things worse).

etc.
 
Agree w/ Arcan. Right now, I have one foot in each pond (so to speak). The waters are waaay different temperatures.
 
NinerNiner999 said:
A group of cardiologists meets monthly to discuss what OR sets they are going to order, what scheduling is most cost-effective to their group's bottom line, which surgeon has a substance abuse issue and how they are going to address it internally, which etc, etc, etc. This is not a secret meeting with a sinister plan - this is a real world example.
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It may not have a sinister plan, but I doubt it's not a secret meeting, especially if they are discussing strategy or if someone has a substance abuse problem. In other words, if it IS a "public" meeting (meaning entrance is not restricted), any lawyers looking at this thread are salivating at coming to Naples and getting to that meeting, or the person about whom the problem is being discussed.
 
docB said:
We are discussing the logistics involved with admin. As has been pointed out there is a similar subforum on the anesthesia forum which has worked well. Gas is however a different animal.

We need to get an idea of how many attendings are for such a forum. A poll really wouldn't work because all the attendings could vote for and all med students against and that really wouldn't tell us what we want to know. The questions of how we will verify the users and if it will be visible by non-members will have to be worked out later.

For now the question for the attendings who post on the EM board is:

Do you want an attending only EM subforum?
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Yes (for many of the reasons mentioned above).
 
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