volume and job opportunity

[startupquick]

How much influence does taking a job at a small community hospital post residency vs working at large regional center affect your job opportunities down the road?

Do employers view one or the other more favorably?

Would there be any pushback from working at small, single doc 20k volume shop and then applying to work at 125k level trauma center? Or vice versa?

Appreciate any input

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[emergentmd]

For 95% of the jobs out there, it makes no difference.
For the 5% competitive Job, I would take a guy coming from a High volume place vs a low volume place. Trauma means very little. It all comes down to moving the meat. Most EM docs can see 2 pts an hr. But when the crap hits the fan, and you have to see 4-5 pts an hr, I think a guy coming from a High vol place would be better b/c they have experienced this.

 

[Angry Birds]

For 95% of the jobs out there, it makes no difference.
For the 5% competitive Job, I would take a guy coming from a High volume place vs a low volume place. Trauma means very little. It all comes down to moving the meat. Most EM docs can see 2 pts an hr. But when the crap hits the fan, and you have to see 4-5 pts an hr, I think a guy coming from a High vol place would be better b/c they have experienced this.

Yeah, but F going to a place where you have to see 4-5 PPH.

 

[emergentmd]

Yeah, but F going to a place where you have to see 4-5 PPH.

My point is that even avg places have surges where you have to see 4-5 pts an hr or when you walk in and there are 5-10 charts waiting for you to bee seen. Or your partner is stuck putting in a chest tube/central line and is out of commission for 1-2 hrs.

It happens. If I was the doctor stuck in the room for an hr, I would appreciate that my partner can manage the ED so I don't have to walk out with 10 charts to be seen.

I have been places where some docs have ONE speed. They see their 2 pts/hr (avg) but when surges comes, you are on your own. Those are the worse docs to work with when you are putting out fires all over the place while your partner methodically goes about seeing their 2pts/hr.

 

[Janders]

Yes there are many different "speeds" for practicing ED docs.

Some are marathon runners than can do 2.5-3pph all day but can't ramp up.
Some are cheetahs that see 12 patients in their first 90 minutes, then see 1.5pph for eternity.
Some can do repeated bursts of 6pph every -other-hour but hold dispos for 2-3hr at a time...

The ability to handle surges is, to me, VERY important especially in smaller shops

 

[Angry Birds]

My point is that even avg places have surges where you have to see 4-5 pts an hr or when you walk in and there are 5-10 charts waiting for you to bee seen. Or your partner is stuck putting in a chest tube/central line and is out of commission for 1-2 hrs.

It happens. If I was the doctor stuck in the room for an hr, I would appreciate that my partner can manage the ED so I don't have to walk out with 10 charts to be seen.

I have been places where some docs have ONE speed. They see their 2 pts/hr (avg) but when surges comes, you are on your own. Those are the worse docs to work with when you are putting out fires all over the place while your partner methodically goes about seeing their 2pts/hr.

Good point. Gotta know how to turn it up.

 

[fahimaz7]

Yes there are many different "speeds" for practicing ED docs.

Some are marathon runners than can do 2.5-3pph all day but can't ramp up.
Some are cheetahs that see 12 patients in their first 90 minutes, then see 1.5pph for eternity.
Some can do repeated bursts of 6pph every -other-hour but hold dispos for 2-3hr at a time...

The ability to handle surges is, to me, VERY important especially in smaller shops

That was me moonlighting at a single coverage place this past weekend. Came into a disaster. Saw 8 in the first hour and 19 in the first 5 hours (6 bed ED, 1 hall bed, 1 triage room). It slowed down after that (thank god it was an overnight). Whew. Not a safe speed to sustain for much longer than that. Had 2 hours of charting between 1am and 3am.

 

[emergentmd]

That was me moonlighting at a single coverage place this past weekend. Came into a disaster. Saw 8 in the first hour and 19 in the first 5 hours (6 bed ED, 1 hall bed, 1 triage room). It slowed down after that (thank god it was an overnight). Whew. Not a safe speed to sustain for much longer than that. Had 2 hours of charting between 1am and 3am.

You may be working in a place that I work. See this all the time. That is the reason they are paying me $500+/hr to cover.

 

[MSmentor018]

How much influence does taking a job at a small community hospital post residency vs working at large regional center affect your job opportunities down the road?

Do employers view one or the other more favorably?

Would there be any pushback from working at small, single doc 20k volume shop and then applying to work at 125k level trauma center? Or vice versa?

Appreciate any input

depends on how you look at it. at 2 am being the lone ranger at my 33k "entitled" shop can be WAY more hectic compared to 2 docs/1 PA at my inner city 110k place. everyone's comment on here is right. no one wants to walk into a shift or out of a room with tons of charts waiting but it is what it is. you'll find whatever techniques work for you like Janders described. handing the surge is a big component of keeping the place afloat but regardless of where you came from the biggest influence will be your track record. not to say you won't get a job but it could be more difficult

have you ever been sued? your directors thoughts, team player? colleagues complaints/recommendations

no one really cares about pph if you've got personal problems or a laundry list of documented complaints/legal action. every city has so many ED's, everyone has heard of someone else. it's like 6 degrees of kevin bacon. even if the group likes you, you may not get credentialed if you're tagged a "level 2" applicant. at least that's what FL board of medicine calls docs with any minor issues
I know you hear docs describe about how fast they're moving the meat like it's a badge of honor but the bottom line is work hard but work safe. hopefully you were pushed in residency and know when you're over your head, need to speed up/slow down....etc. most jobs won't care, just be a good doctor, stay with the pack, keep your nose clean

 

[Arcan57]

Your value as an EP is a base with two side by side towers. The base is quality. It's impossible to be fast or friendly enough to make up for your patients consistently having poor outcomes. The towers are speed and customer sat. Strength in one can help balance weakness in the other but there are certain minimum standards that must be maintained to keep the structure stable. If you see 5 pts/hr but piss off 2.5 pts/hr or 2.5 consultants/shift then eventually your director is going get sick of cleaning up your messes. If you have a 99% PG and golf with every member of the med exec committee but see 0.7 pph eventually the nurses will revolt and you'll start having quality issues or the CEO will punch your card.

 

[e30ftw]

Most places won't care how busy your prior jobs were as long as it's reasonable, ie > 15k/yr and you're ABEM. More competitive jobs would probably prefer someone who works in a larger hospital system opposed to a single shop in the middle of nowhere that transfers everything.

As stated, a single coverage shift at a 20-30k ED can be busier than a shift at a tertiary care facility. This week everyone's on spring break at my 34k shop so we dropped to single coverage; the last 4 nights I've seen between 30-45 patients from 7p - 1a before the volume drops off.. not ideal but gotta make it work. At the tertiary hospital at least there's another doc and a bunch of residents..

 

[Mighty Mouse]

volume of shop alone doesn't dictate anything. it's all relative to staffing. 35,000 annual volume in single coverage shop can be much harder than 100,000 shop staffed with multiple docs, PAs attendings.