Not a good representation of EM physicians.

[jw3600]

http://www.kevinmd.com/blog/2014/12/dont-pay-specialists-call-heres.html

This guy makes some pretty ridiculous claims.

"When I’m sitting in a mostly empty ER at 4 a.m., I’m not getting paid either." Um. Yes you are.

"...hospitals are in rough shape." Yes the LLC/LLP/INC may be, but the guys who own it and are employed at the executive level are killing it.

"Structure your practices to make call suck a little less." Easy to say when you go home and sleep after your 8p-8a for 9 hours with 0 chance of being called back to hospital. Try seeing patients in clinic from 8 to 5 and then in the ED for several hours at night. When 4:30 rolls around you decide "F it", might as well stay up until clinic duties start at 7. Call is tough.

I like EM. I like most EM physicians. This guy is either delusional or really flinging **** at other specialties for his own interest.

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[Birdstrike]

Having been on both sides, first as an EM physician and also as a primarily outpatient subspecialist with little to no hospital-call or after-hours duties, I get it. I get both sides. I get how soul-sucking call and chronic sleep deprivation from it can be. I also get how soul sucking it can be to be the the guy left holding the hot potato at 3 am on a holiday, head-drunk from night-duty and circadian rhythm sleep disorder transferring a patient who shouldn't need to be transferred because of systems flaws.

But there's just only so much a person can take. I don't hold it against anyone that says, "I just can't take this **** anymore." That applies to the consultant who doesn't want his life ruined for a week because a drunk guys decided to saw his hand off at 3 am.....again. That also applies to the ER doctor who says, "I'm done with this ----. I can't do nights anymore," or "I'm cutting my shifts from 18 a month to 10," and therefore taking care of that many less sick people, because he/she feels the crush of burnout.

I get it.


And I get where Shadowfax is coming from. Shadowfax pretty much sounds like a guy about to say, "I'm can't take this ---- anymore either." Shadowfax sounds burned out. It's alright. Shadowfax is human.


This ---- is hard. Being a doc is hard. Being an EE doctor is hard. We're all human. A person can only take so much, and the unforgiving nature of the system leaves us no recourse but to find out own sanity-sustaining solutions otherwise physician burnout is the rule.

God bless all those who've found work-life balance, while playing this game called, "Doctoring in 2015." Even more so, God bless those that haven't, so that they can find it in this New Year as no one is going to hand it to them on a silver platter.

 

[jw3600]

I get it too Bird. I AGREE with him. No freaking human needs to demand $1000 for 1 overnight call just to be available. Maybe have a system where if you get X calls or X consults you get X dollars and never less than some amount. Reasonable men can bicker about what the number is but getting 1/2 of what the ED doc makes seeing 20+ patients, many of who are sick, even when you sleep the whole night is a little far fetched. That said, when people distort facts and purposefully misrepresent is when I lose respect for them, even if they want what I want.

 

[Hercules]

http://www.kevinmd.com/blog/2014/12/dont-pay-specialists-call-heres.html

This guy makes some pretty ridiculous claims.

"When I’m sitting in a mostly empty ER at 4 a.m., I’m not getting paid either." Um. Yes you are.

Actually that claim isn't ridiculous at all. I don't know how his pay is structured but if he is in a group like mine that has highly productivity based pay, then no he's not getting paid much if anything. I'm not crying about it, but many consultants have the misguided perception that every EM physician is a hospital employee and gets paid no matter what. They also tend to have the incorrect assumption that when they see a self-pay they are doing some great charitable act providing free services. One of our orthopods was shocked to realize I didn't get paid for the self-pay trauma we were taking care of together and that we see a much higher percentage of self-pay (charity) patients than practically any other specialty.

 

[jw3600]

Actually that claim isn't ridiculous at all. I don't know how his pay is structured but if he is in a group like mine that has highly productivity based pay, then no he's not getting paid much if anything. I'm not crying about it, but many consultants have the misguided perception that every EM physician is a hospital employee and gets paid no matter what. They also tend to have the incorrect assumption that when they see a self-pay they are doing some great charitable act providing free services. One of our orthopods was shocked to realize I didn't get paid for the self-pay trauma we were taking care of together and that we see a much higher percentage of self-pay (charity) patients than practically any other specialty.

Then you are probably making more per hour based off productivity during the busier times to make up for it. I doubt that your monthly wage/hours that month is below the average for EM. It is not like your are a contracted employee making $x/hour for the "busy parts" of your shift and then your boss decides not to pay you during the slow times because "you are not working." Shadowfax was making it sound like he is paid similar to a straight wage and only if he has patients. He is massaging the facts.

 

[Birdstrike]

I get it too Bird. I AGREE with him. No freaking human needs to demand $1000 for 1 overnight call just to be available. Maybe have a system where if you get X calls or X consults you get X dollars and never less than some amount. Reasonable men can bicker about what the number is but getting 1/2 of what the ED doc makes seeing 20+ patients, many of who are sick, even when you sleep the whole night is a little far fetched. That said, when people distort facts and purposefully misrepresent is when I lose respect for them, even if they want what I want.

The point is, that being in the hospital, or being at any job at 3am is life ruining. No one wants to do it. You can argue over the price, or whether or not someone took an oath to do so or not, but it still sucks bad. Really bad. After doing it into your 30's, 40's, 50's and beyond, it comes down to not wanting to do it AT ALL. Chronic sleep deprivation sucks that bad.

So what these docs are doing is essentially saying, "I don't want to do it AT ALL," and naming a price so silly, they just can't refuse it if offered. They primarily don't want the money. They want sleep, rest and piece of mind. Sleep and piece of mind are that precious. If you don't think so, go long enough without one or both, and pretty soon you'll gladly turn down $999 to consistently get a good nights rest. Some have called lesser things "enhanced interrogation techniques" and attempted to get them categorized as war crimes.

If I was offered even $1,000 per night to take 7-8 calls per month, year round right now, without hesitation answers is, "!@!$£#€! no, goodbye."

"How the CIA tortured its detainees...sleep deprivation...’"

http://www.theguardian.com/us-news/2014/dec/09/cia-torture-methods-waterboarding-sleep-deprivation

 

[Apollyon]

The point is, that being in the hospital, or being at any job at 3am is life ruining. No one wants to do it.

C'mon, man, I don't think that you can make such a blanket statement. I mean, people write about these jobs that have nocturnists in the ED. Hell, I did it for a year at age 41. I thought I had the world by the ass - nights in Hawai'i, single. Yes!

 

[Birdstrike]

C'mon, man, I don't think that you can make such a blanket statement. I mean, people write about these jobs that have nocturnists in the ED. Hell, I did it for a year at age 41. I thought I had the world by the ass - nights in Hawai'i, single. Yes!

Yeah, it was so awesome, that you....don't do it anymore. If it was that awesome or sustainable, you'd still be doing it. I can make such a blanket statement. Have your wife pop out a couple kids, and when you're 47 and you're kid(s) are in kindergarten, start pulling nights again. Nights suck. They're pharking miserable when you have anyone relying on you, other than you. Even people that do all nights, hate 'em. In fact, they hate them the most. Night rangers are those so utterly miserable by shift-work sleep-disorder, they make a deal with the devil that goes like this, "The only thing worse than working all nights, is the constant switching back and forth, from nights to days, and back. So I choose the lesser of two, evils: all nights."

Deal with the devil.

But whatever...it's all good. I'm glad someone somewhere is tough enough to do it. I'm not. Not anymore. It's like combat. It's a young man's game. You're older than me, but apparently tougher. Weak I am. Soft like baby's bottom Birdstrike be. But remember: Birdstrike = overly dramatic, negative, alarmist, double-agent, glass half-empty guy who should be ignored. So, it doesn't matter what I think. My opinion only has whatever relevance you give to it. And as far as I'm concerned, that doesn't have to be any.

 

[Apollyon]

Yeah, it was so awesome, that you....don't do it anymore.

My hospital closed down. That's why I don't work there anymore. I work 24s now. I love it. I am 44 now. I made more money in 2014 than I did in any year.

So, I stand by what I said. I just don't get why you are so stridently dogmatic (which is somewhat redundant).

 

[Birdstrike]

My hospital closed down. That's why I don't work there anymore. I work 24s now. I love it. I am 44 now. I made more money in 2014 than I did in any year.

So, I stand by what I said. I just don't get why you are so stridently dogmatic (which is somewhat redundant).

Back to the OP. Shadowfax wrote an article about why he was irritated that consultants were opting out of night call unless they could get paid extra, because they don't like being in the hospital between 12-8am. EPs typically want a night pay differential because most don't like being in the hospital between 12-8am if they can avoid it. If what you're saying is that doing so actually works for some people, and a certain percentage actually like or don't mind night shifts that much, then I agree.

But ultimately, most people want to be in bed at 3am, not at work and that's why most people want to either get out of it, or get paid extra if they have to do it. Trust me, if Shadowfax could find a way to get paid $1,000 to be home at night, instead of at work, he'd do it, too. I also get why he's irritated that his job is harder, because others have found a way to do so. Night work is a necessary evil of certain professions, obviously. I'm glad some like it, or don't mind it that much, otherwise we'd be in real trouble. I appreciate the people who do so.

 

[two guys]

To the OP: I don't have any problem with any physician or group of physicians working out whatever they want with their local hospital. As far as I'm concerned that's between the specialists and the hospitals. I'm not going to tell a urologist when and how to take call any more than I'd like that urologist to tell me how to run an ER.

I do understand where shadowfax is coming from but I think his anger is misdirected - it should be at the system (insurance, guvment, and hosp administrators) that set it up for call to not be a good option for the urologists. It does suck to end up in rustedfax's position. For example, there are 4 neurologist practices (total of 7-10 MDs) that are within a 2 minute drive from my shop but no neurologist on staff. It sucks for the patient to have to be transferred to another hospital simply because these guys won't take call. But, that's their fight with the hospital and not mine. I don't think they were getting anything out of being privileged there (they have enough referral base) so they dropped their privileges. That's their choice. Now for someone who is on staff and gets some benefits of the hospital (like a urologist), then it's a little different story.

OP, I only get paid for the patients I actually see. So, just like you I make nothing if I don't see a patient. Also just like you, I make plenty during the busy times to make up for it. I don't think it's any more reasonable for a urologist to say they don't get payed for call then for me to say I don't get paid when there is no one there in the middle of the night. We are both right, but we both get other benefits that the hospital provides (an OR staff) that allows us to make money during other times. Looking at call or an empty ER in isolation is a little disingenuous.

Lastly, my only fight is with docs who are on call being dicks about it to me or the patient. I can't stand hearing a grown adult whine. I didn't ask anybody to go in to cardiology or medicine or whatever. I didn't ask them to arrange their privileges with the hospital to require call. That's their fight and their decisions. If they don't like call, then set up an outpatient practice or find a hospital that lets the hospitalist admit everything at night and consult in the AM. But, if you're on call and there's a patient that needs your help it is indefensible to try to weasel out of it, ask for a transfer, or complain about it. It's like the specialists think I arranged their life's this way.

 

[danielmd06]

To the OP: I don't have any problem with any physician or group of physicians working out whatever they want with their local hospital. As far as I'm concerned that's between the specialists and the hospitals. I'm not going to tell a urologist when and how to take call any more than I'd like that urologist to tell me how to run an ER.

I do understand where shadowfax is coming from but I think his anger is misdirected - it should be at the system (insurance, guvment, and hosp administrators) that set it up for call to not be a good option for the urologists. It does suck to end up in rustedfax's position. For example, there are 4 neurologist practices (total of 7-10 MDs) that are within a 2 minute drive from my shop but no neurologist on staff. It sucks for the patient to have to be transferred to another hospital simply because these guys won't take call. But, that's their fight with the hospital and not mine. I don't think they were getting anything out of being privileged there (they have enough referral base) so they dropped their privileges. That's their choice. Now for someone who is on staff and gets some benefits of the hospital (like a urologist), then it's a little different story.

OP, I only get paid for the patients I actually see. So, just like you I make nothing if I don't see a patient. Also just like you, I make plenty during the busy times to make up for it. I don't think it's any more reasonable for a urologist to say they don't get payed for call then for me to say I don't get paid when there is no one there in the middle of the night. We are both right, but we both get other benefits that the hospital provides (an OR staff) that allows us to make money during other times. Looking at call or an empty ER in isolation is a little disingenuous.

Lastly, my only fight is with docs who are on call being dicks about it to me or the patient. I can't stand hearing a grown adult whine. I didn't ask anybody to go in to cardiology or medicine or whatever. I didn't ask them to arrange their privileges with the hospital to require call. That's their fight and their decisions. If they don't like call, then set up an outpatient practice or find a hospital that lets the hospitalist admit everything at night and consult in the AM. But, if you're on call and there's a patient that needs your help it is indefensible to try to weasel out of it, ask for a transfer, or complain about it. It's like the specialists think I arranged their life's this way.

Exactly.

 

[Old_Mil]

To the OP: I don't have any problem with any physician or group of physicians working out whatever they want with their local hospital. As far as I'm concerned that's between the specialists and the hospitals. I'm not going to tell a urologist when and how to take call any more than I'd like that urologist to tell me how to run an ER.)...

...Lastly, my only fight is with docs who are on call being dicks about it to me or the patient. I can't stand hearing a grown adult whine. I didn't ask anybody to go in to cardiology or medicine or whatever. I didn't ask them to arrange their privileges with the hospital to require call. That's their fight and their decisions. If they don't like call, then set up an outpatient practice or find a hospital that lets the hospitalist admit everything at night and consult in the AM. But, if you're on call and there's a patient that needs your help it is indefensible to try to weasel out of it, ask for a transfer, or complain about it. It's like the specialists think I arranged their life's this way.

This. Yeah it sucks, but if you agree to do it just shut up and show up.

 

[criticalelement]

I agree with the specialists in this case. Getting called in to do anything in the hospital after hours aint really worth it. And not because of the reasons birdstrike gave (which are true btw) but because the medicolegal risk is too high. The patients you see after hours are tougher than your daytime patients and you are more likely to get involved in a huge malpractice case at night. So if the risk is HIGH the reward has to be high. That is how the world works. Get a nurse to work in the icu from 7p,-7am. You are going to pay double. WHen you are on call (even if you dont get called in). Your behaviors are not the same. You typicaly dont sleep as sound. constantly checking the phone if it rang etc etc etc. This deserves PAY. and 1000 dollars aint gonna cut it. Should be 2000 dollars.

 

[Birdstrike]

I agree with the specialists in this case. Getting called in to do anything in the hospital after hours aint really worth it. And not because of the reasons birdstrike gave (which are true btw) but because the medicolegal risk is too high. The patients you see after hours are tougher than your daytime patients and you are more likely to get involved in a huge malpractice case at night. So if the risk is HIGH the reward has to be high. That is how the world works. Get a nurse to work in the icu from 7p,-7am. You are going to pay double. WHen you are on call (even if you dont get called in). Your behaviors are not the same. You typicaly dont sleep as sound. constantly checking the phone if it rang etc etc etc. This deserves PAY. and 1000 dollars aint gonna cut it. Should be 2000 dollars.

Very true. Good point.