VA Emergency Medicine as an Internist

[cloosh10]

Hey guys,

I recently heard about a guy working at a VA ED and he was an internist. I was wondering how much truth there was to this and if so, how common is it in your experiences? I'm doing IM but I like EM in general and wouldn't mind working at a VA ED (assuming I'll be assigned to all the male patients...) for some shift work.

Thanks.

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[Apollyon]

Hey guys,

I recently heard about a guy working at a VA ED and he was an internist. I was wondering how much truth there was to this and if so, how common is it in your experiences? I'm doing IM but I like EM in general and wouldn't mind working at a VA ED (assuming I'll be assigned to all the male patients...) for some shift work.

Thanks.

Why would you not see the female patients?

VA's often have IM docs in the ED because of the low acuity or low patient volume (due to many being attached or proximate to large medical centers, so the upstairs people just cross the street - the Durham VA comes to mind, which is literally across the street from Duke); even if the surgery volume is good, the patients don't come through the ED. The busier ones, though, will have EM, but also IM with ED experience (like the Spark M. Matsunaga VA Medical Center in Honolulu, which is attached to the Tripler Army Medical Center), because they need the warm bodies.

 

[DreamingTheLive]

I know of VA EDs with Infectious Disease docs and Nephrologists (NOT fellows) pulling shifts. There was a LOT of shot-gunning 30+ labs and seeing what landed.

 

[diphenyl]

Some VA's do have large volume/ high acuity. These are usually the ones without surrounding tertiary care centers. There are many of these in the south eastern part of the country. On the other hand there are quite a few VA's (usually in metropolitan areas) where they are a glorified urgent care clinic and could easily be run by an internist/ family practitioner.

 

[Birdstrike]

Why would you not see the female patients?

My question exactly. You don't see females in IM clinic? You're going to act competent to practice another specialty, then exclude half the patients right off the bat? That's not going to fly well.

Triage nurse: "Dr H, we need you to see this chest pain."

You: "Does the patient have a vagina?"

Nurse: "Are you serious? Yes."

You: "My seeing them is contraindicated, then. Call in back up, stat!"

WTF?

 

[DreamingTheLive]

My question exactly. You don't see females in IM clinic? You're going to act competent to practice another specialty, then exclude half the patients right off the bat? That's not going to fly well.

Triage nurse: "Dr H, we need you to see this chest pain."

You: "Does the patient have a vagina?"

Nurse: "Are you serious? Yes."

You: "My seeing them is contraindicated, then. Call in back up, stat!"

WTF?

Only a matter of time before some CMG catches on to this and begins marketing this to EM docs:

<Ad in back of Annals>

Tired of having to know both male and female anatomy and physiologic nuances? Tired of setting up for a pelvic in room 13 only to walk in and find the patient is a 46 year old male trucker with absent vagina syndrome upon speculum examination? Believe that untreated hospital-acquired cooties is a major source of morbidity and mortality amongst Emergency Medicine physicians? Convinced that the door-to-chai tea latte time is more important than silly things such as clinical outcomes? Then come join us at 'SchemeHealth' and see why we're the leader in unisex Emergency Medicine. Competitive compensation when compared against other SchemeHealth physicians. Better benefits than illegal immigrants.

Never have to deal with another gender landmine of wondering if a patient is a He or a She. Come see why 36% of physicians stay with SchemeHealth after 3 years.

 

[Birdstrike]

Only a matter of time before some CMG catches on to this and begins marketing this to EM docs:

<Ad in back of Annals>

Tired of having to know both male and female anatomy and physiologic nuances? Tired of setting up for a pelvic in room 13 only to walk in and find the patient is a 46 year old male trucker with absent vagina syndrome upon speculum examination? Believe that untreated hospital-acquired cooties is a major source of morbidity and mortality amongst Emergency Medicine physicians? Convinced that the door-to-chai tea latte time is more important than silly things such as clinical outcomes? Then come join us at 'SchemeHealth' and see why we're the leader in unisex Emergency Medicine. Competitive compensation when compared against other SchemeHealth physicians. Better benefits than illegal immigrants.

Never have to deal with another gender landline of wondering if a patient is a He or a She. Come see why 36% of physicians stay with SchemeHealth after 3 years.

 

[cloosh10]

Woah that got out of control. I phrased that entirely incorrectly. I meant OB patients. Sorry about the confusion. I can do (and currently do, and don't mind at all doing) Gyn medicine. I really just meant that I'm not trained to do Peds or OB in a legal sense. Happy to see female patients. Calm down everybody.

Thanks for the help guys!

 

[deleted206819]

Woah that got out of control. I phrased that entirely incorrectly. I meant OB patients. Sorry about the confusion. I can do (and currently do, and don't mind at all doing) Gyn medicine. I really just meant that I'm not trained to do Peds or OB in a legal sense. Happy to see female patients. Calm down everybody.

Thanks for the help guys!

Peds and OB / pelvic pain account for a large minority of the complaints we see in the ED. If one does (and it will) show up in the ED, what would you do if you were single coverage?

 

[diphenyl]

^ Don't know which VA's you've worked in, but OB is a very microscopically small component of what comes into their ED's. Ped's is non existent practically as well. We are talking about VA's. The VAST MAJORITY of your patient population is MI's/ CHF/ GI problems/ liver disease in people who are old enough to remember Hamburger and pork-chop hill.

 

[cloosh10]

Peds and OB / pelvic pain account for a large minority of the complaints we see in the ED. If one does (and it will) show up in the ED, what would you do if you were single coverage?

Again, I meant I'm not entirely trained to do OB or Peds. I'm not saying I don't want to do any Peds/Ob stuff, I'm saying that I have low training in such fields, which led me to my inquiry and clearly poorly phrased original thread. Like the above post says, I'm talking specifically the VA. And pelvic pain is part of but not the same as OB. I'm sure the VA EDs work through this lack of training somehow? Just not sure how.