Attending Life

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Yeah I'm wondering how feasible this is for someone who isn't boarded though, seems like it would get harder and harder to find gigs over time, like how it's become much harder for FM boarded docs to find full-time Em jobs to take them.

And I guess it's not the most stable life, but some people might not mind that.

Also i dont know how comfortable I'd be working in the ED as an anesthesiology trained doctor.. I'd be calling consults left and right... Im 100% not comfortable with setting back bones/dislocations in the ED, or reading vaginal ultrasounds, etc

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Also i dont know how comfortable I'd be working in the ED as an anesthesiology trained doctor.. I'd be calling consults left and right... Im 100% not comfortable with setting back bones/dislocations in the ED, or reading vaginal ultrasounds, etc

That’s no problem these days, ERs are now full of mid levels who operate this way on a daily basis.
 
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So, hypothetically speaking, what's stopping a young bachelor stud from doing a PGY1 year and just transitioning to doing this kind of work full-time for 10-15 years, buying a small house in the Caribbean, and saying goodbye to this whole Godforsaken profession?

Hypothetically speaking or course...

Its fleeting, and the jobs are few and far between.

At the ED I moonlight at the only opportunities are Friday PM - Sunday PM, I don’t know the details of their coverage system but just a few years ago extra docs covered the ED entirely. It’s a solid “extra” gig but definitely not a full time one. I get extra $ for holding the hospital’s airway pager, and they only let BE/BC docs do that.

That being said it’s a gigantic waste of money and I am sure at some point an administrator will plug that hole. And can’t say I’d blame them - it’s cheaper for the hospital just to get EM MD coverage and be done with it.

I cannot stand calling consults - no one wants to come in on the weekend (only MICU is required to be in house) and it’s a pain to drag people out of bed. Example: dog bite at 2 AM, had to call the plastics on call, it was pretty gnarly on a young person and I wasn’t comfortable suturing it up. I’ve spent 30+ minutes on the phone arguing why so and so needs to be admitted. I’d go mad if that was my job day in and day out.
 
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So, hypothetically speaking, what's stopping a young bachelor stud from doing a PGY1 year and just transitioning to doing this kind of work full-time for 10-15 years, buying a small house in the Caribbean, and saying goodbye to this whole Godforsaken profession?

Hypothetically speaking or course...

Over the three year span I did this, probably worked at 7-8 different facilities. The money runs out or you find a better gig. It was the same for most folks playing the game.

I will say this tho, some of the craziest shhh I ever saw came into these middle of nowhere places. In the end it definitely made me a better doc. Had a much different perspective than my coresodents. And while they were out getting drunk on weekends off I was studying and taking care of patients
 
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Over the three year span I did this, probably worked at 7-8 different facilities. The money runs out or you find a better gig. It was the same for most folks playing the game.

I will say this tho, some of the craziest shhh I ever saw came into these middle of nowhere places. In the end it definitely made me a better doc. Had a much different perspective than my coresodents. And while they were out getting drunk on weekends off I was studying and taking care of patients

For the guys doing this, how afraid are you of a bad outcome and associated liability? Obviously the answer is "not afraid enough to stop doing it", but...
 
I always saw it as if family medicine residents can do it why can’t I? We are much more equipped to deal with acute situations than them. The runny noses and URIs can be treated by mid levels so why can I? AMIs and CVAs have pretty clear cut treatment algorithms. Anything serious is always transferred out so you’re basically temporizing

Not to mention, with all the ICU we do in training, how can we not be better than FPs? I use to bring people back from the dead in SICU
 
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I'm gonna echo what @anbuitachi said. I went to undergrad on a scholarship, got accepted into 1 med school with 0 debt. My parents didn't go to college and are far from wealthy, but they set me up the best that they could. They couldn't pay for my cost of living let alone for my tuition. I'll be graduating med school with $380k in debt. I know it's my choice, but sometimes it's our only choice. A biomed degree wasn't going to land me a decent job, so it was either become a physician or face an uncertain, low-paying, future.

Sometimes we make the best with what we have. It's really brutal out there, especially if you don't come from a rich family and you're trying to build something from nothing.
State schools? Are they that expensive these days? Even in the East Coast?
 
Does anyone do surveys? I'm sure it's chump change for a lot of you all, but they're easy to do during down time and it probably doesn't count as moonlighting from a program perspective.
 
I cannot stand calling consults - no one wants to come in on the weekend (only MICU is required to be in house) and it’s a pain to drag people out of bed. Example: dog bite at 2 AM, had to call the plastics on call, it was pretty gnarly on a young person and I wasn’t comfortable suturing it up. I’ve spent 30+ minutes on the phone arguing why so and so needs to be admitted. I’d go mad if that was my job day in and day out.

I guess I'd tell them EMTALA requires them to come in and evaluate the patient if asked by the ED and if they don't they can be fined a massive amount of money that isn't covered by malpractice insurance so they will personally have to pay. I realize they may not want to hear that and might want to argue, but at that point you can safely hang up the phone and they either show up promptly or the fine will prevent them from ever arguing again.
 
If arguing with consultants, just say, “okay, I’m putting your name in my note saying you refused the consult and that I was uncomfortable discharging patient without your professional opinion.”
 
If arguing with consultants, just say, “okay, I’m putting your name in my note saying you refused the consult and that I was uncomfortable discharging patient without your professional opinion.”

EM as a specialty is one of the most “cover your a**” specialties - I was taught (and indeed, all of us do it) that when you call consults you document in the note who you spoke with and when (even if it’s Random Dude with the answering service for a given group) followed by when they saw the patient. Not my favorite part of the gig, I prefer to have collegial not punitive relationships with fellow physicians. But hospitals want people in and out of the ED, and this is part of how you account for that time. Pleading EMTALA or something like that over the phone will quickly lead to a toxic consultant relationship and I don’t want the gig to be closed off with them complaining to hospital admin - I totally understand the frustration from their end, I wouldn’t be thrilled about rural consults for complex hands lacs either at 3 AM.

I carry a small med mal supplement that covers me for the shifts. It’s inexpensive as most of us that do it sign up with the same group policy. My state has favorable malpractice laws and I’m reasonably protected with my policy - I am very conservative in management and let consultants go off-script with treatment if they feel warranted (while I push them to admit...) EM is more “cookbook” than I like - if X (stroke, MI, sepsis) happens then activate Y protocol with Z specialists responding. Anything dire (or high level Peds) gets shipped to the tertiary care center, and ideally you can handle this at the EMS level with real time diversion.

It sounds like @acidbase1 has a similar setup and approach to care, which is great while in training but definitely won’t be continuing out in practice.
 
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