Rapid response/code team doc? Does this exist anywhere?

[CTtiger]

Anyone ever heard of a rapid response/code team physician job? My suspicion is no as it's much cheaper to make the hospitalists respond, but if I could see maybe in a large tertiary/quaternary hospital?

Brainstorming ideas for ways to see more/exclusively high acuity...yes, ED crit care comes to mind but those jobs are also few and far between, and not sure that I'm interested in fellowship.

Thanks

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[RustedFox]

My God, this would be awful.

 

[emergentmd]

You will be happy finding career jobs with 1 inch puts and not 30 feet chip shots. Trust me. Walk in, drink your coffee, chat with staff, do a bunch of 1 inch putts, go home to your family.

 

[WildEMDoc]

Don't know why you would want that.

But the only place I have ever seen a role like this was where I did medical school. Even then it wasn't really a dedicated "rapid/code" role. They had a rotating EM/CC attending (all ICUs were all or partially EM/CC) assigned to respond to all inpatient codes/rapids based on the day of the week. Even then they had their typical duties in between.

Every place I have been since then have not. Bigger teaching hospitals have typically had assigned residents/fellows depending on location of code/rapid in the hospital. Community places have been hospitalists +/- ER for procedures based on time of day

 

[CajunMedic]

There's a kinda sketchy, small CMG that advertises one for a surgery center. Guess they have overnight/short stay beds and need someone in house that knows resuscitation.

 

[JacobMcCandles]

Do you just go around and pronounce everyone dead?

 

[ScepticSkeksis]

Do you just go around and pronounce everyone dead?

That would be doing the bare minimum. Way to go!

 

[CTtiger]

Slightly surprised by the idea that my dream job (ok that's definitely a stretch) is several other's nightmare but it's fun to hear the input so thanks for everyone's response.

For me, burnout seems to come from multitasking, as well as dealing with the low to moderate acuity stuff and pt's and families who are appalled/angry that you can't fix or explain slight every derangement with the human body with 100% certainty.

So to be clear, my dream job is not responding to the floor from the ED while on shift. Been there done that, and it is a nightmare. Very stressful wondering about what dumpster fire is waiting for you back in the ED when you return.

I find I enjoy my job the most when I have multiple high acuity (medical) patients per shift, so I'm trying to figure out how to do more of what I like and less of what I consider BS.

 

[GonnaBeADoc2222]

Slightly surprised by the idea that my dream job (ok that's definitely a stretch) is several other's nightmare but it's fun to hear the input so thanks for everyone's response.

For me, burnout seems to come from multitasking, as well as dealing with the low to moderate acuity stuff and pt's and families who are appalled/angry that you can't fix or explain slight every derangement with the human body with 100% certainty.

So to be clear, my dream job is not responding to the floor from the ED while on shift. Been there done that, and it is a nightmare. Very stressful wondering about what dumpster fire is waiting for you back in the ED when you return.

I find I enjoy my job the most when I have multiple high acuity (medical) patients per shift, so I'm trying to figure out how to do more of what I like and less of what I consider BS.

I'm a perfect world, all rapid responses, just like all emergency room visits, would be for emergencies.

Too often, rapid response is used because someone syncopes in the lobby or a floor nurse gets nervous because the patient farts the wrong way and cant be bothered to page the primary team.

 

[prolene60]

It seems that would get old very quickly. In my experience, the types of hospitals that need this type of coverage mainly need it at night so I mean essentially you would just be sitting in the physicians lounge or call room watching Netflix and then the seldom random occasion you get a call to intubate someone you say bye as the hospitalist takes over the rest of their care or stand overseeing chest compressions until you pronounce someone. I mean it’s not like you’re going to be called up every hour to manage sick GI bleeds, septic shock etc. Most of the time the kind of setting where the ED trained person responds to rapids are smaller rural hospitals and not big tertiary care centers as they generally have an intensivist 24/7. I would imagine you would be bored out of your mind.

 

[WorkNoteEmergency]

During peak Covid there were some places that had airway docs but I think those are gone now.

 

[Siggy]

So... the ICU doc at every hospital I've ever been in?

...but sure... you want to respond to the patient with the known seizure history having a seizure where he's back to base line before you arrive or the patient who can't poop and the family is complaining that no one can get a hold of the hospitalist? Be my guest.

However if you're coding the floor patient, I'm expecting the patient to be lined and fully worked up before handoff... not a "we just got ROSC after 5 minutes, the blood pressure is 60/30, no central line, no arterial line, have fun while I go back to watching Youtube."

 

[JacobMcCandles]

That would be doing the bare minimum. Way to go!

It’s mainly realizing somebody who is in the hospital and codes is likely very sick at baseline and quickly calling time of death (obviously situation dependent) would prevent them from receiving cruel and inhumane intervention with close to zero chance of meaningful recovery.

 

[Mount Asclepius]

Even high acuity tertiary/quaternary centers don't have the volume to employ an EP to just respond to codes. This is in the purview of the inpatient critical care teams given not overly common and these patients are coming to them anyways.

If you really only want to do critical care, then you need to do critical care.

I also love critical care patients and burn out on bread and butter EM, but that's unfortunately not the reality of EM. Financially it's all about the level 4 and 5 charts. The volume of these patients is significantly higher than CC in EM. I've accepted the bed that I lay in even if I'm not entirely content with my choice.

I would love to only do ED resuscitation if I had the opportunity. Although occasionally when you get a ton of high acuity like I did on one shift recently it can be draining. Had multiple sick patients all in one shift including a super difficult airway disaster, trauma arrest, unresponsive CVA, and legit NSTEMI amidst all of the other druggies and psychotic patients, as well as multiple procedures including two intubations, two chest tubes, procedural sedation, fracture reduction and abscess I&D. Luckily intensivist helped out with lines instead of having me do in the ED or I would have had even more procedures. On top of a large volume of patients, the acuity and number of procedures was draining. I love acuity, but sometimes it is exhausting. I definitely don't want "short puts" all day either, but this job is definitely a young person's game.

 

[alpinism]

There are no dedicated code team emergency physicians as far as I'm aware since the only places to have enough volume of patients are normally university centers where they always have a team of residents to run all of their codes.

At the moment if you only want to see all the high acuity cases the only real option is to work shifts at the 100k volume EDs with their own separate designated EM-CCM section that sees the resus cases. Its very difficult to find a full time position and then work all EM-CCM shifts however its certainly possible to do PRN then work all EM-CCM shifts. You don't need a fellowship to work those shifts since you're technically still caring for emergency patients in the emergency department however it definitely helps to have strong CCM experience since these places regularly board CCM patients for over 24 hrs. If you're interested I know of multiple NYC hospitals where its possible however like anything good there's a price to be paid and these are highly dysfunctional understaffed EDs that all have sub 200/hr salaries.

 

[gro2001]

Anyone ever heard of a rapid response/code team physician job? My suspicion is no as it's much cheaper to make the hospitalists respond, but if I could see maybe in a large tertiary/quaternary hospital?

Brainstorming ideas for ways to see more/exclusively high acuity...yes, ED crit care comes to mind but those jobs are also few and far between, and not sure that I'm interested in fellowship.

Thanks

Not aware of any jobs that are exclusively code/RRT. Typically these are rotated among the intensivists (either ones on service that week or, if volume requires, as an additional assignment). An emergency physician who is not also an intensivist at that institution wouldn't be a great fit for that role though. While ER docs would be fine at the code/resus part of the job, a large chunk of it is the disposition after and care for this critically ill patient until an ICU bed is available. This requires both institutional knowledge of how ICUs work at your hospital (which patients go where if the target ICU is full, which ICUs can make beds and how, which nurses can do which tasks, etc) and the longer bit of stabilization after initial resuscitation that many ER docs typically want to hand over to the ICU docs as soon as possible. In some ways this is a similar role to what happens in the ER, but in many ways it's not. A non intensivist ER doc would both hate it and muck it up too often.

 

[emergentmd]

This is like a Marine wanting to lead an assault into Iraq every day. After a few mission, I bet most dream of a quiet day until retirement. I have had some really high acuity, critically ill days going room to room throwing water on every fire. Ever time I left those shifts reinforced my wishes for all shifts to be 1 inch putts.

 

[Mount Asclepius]

This is like a Marine wanting to lead an assault into Iraq every day. After a few mission, I bet most dream of a quiet day until retirement. I have had some really high acuity, critically ill days going room to room throwing water on every fire. Ever time I left those shifts reinforced my wishes for all shifts to be 1 inch putts.

Some of us just like higher acuity. Others don’t. As EPs most of us were sold a bill of goods that isn’t true. EM isn’t critical care and emergencies 24/7/365. Not even more than 10% of the time. It’s acute care medicine. Some of us knowing that better in advance maybe should have picked critical care or another specialty. Others would have been better served in primary care. It’s important to know yourself, but it’s not a universal truth that high acuity in EM is undesirable with time. It’s the ED itself that’s draining, not inherently the sick patients. Those ones have always brought me excitement and kept me going. That hasn’t diminished with time. For others that isn’t true. That’s okay - at least in the sense that you need to find the right job for you and your path even if EM isn’t all ‘rainbows and butterflies.’

 

[alpinism]

Some of us just like higher acuity. Others don’t. As EPs most of us were sold a bill of goods that isn’t true. EM isn’t critical care and emergencies 24/7/365. Not even more than 10% of the time. It’s acute care medicine. Some of us knowing that better in advance maybe should have picked critical care or another specialty. Others would have been better served in primary care. It’s important to know yourself, but it’s not a universal truth that high acuity in EM is undesirable with time. It’s the ED itself that’s draining, not inherently the sick patients. Those ones have always brought me excitement and kept me going. That hasn’t diminished with time. For others that isn’t true. That’s okay - at least in the sense that you need to find the right job for you and your path even if EM isn’t all ‘rainbows and butterflies.’

So to use another military analogy its similar to the difference between normal medics and special operations medics.

There are some of us that really like to push the limits and enjoy the challenge of caring for the sickest patients.