Crappy Sign Outs

[BoardingDoc]

A shop I used to work at had variable signouts. However, there was one universal truth. The lazy docs would stop picking up charts overnight after the 2am rush of "admitted patients go upstairs now we pull til full and all these new patients show up". So you would get there at 6a with 15 charts in the rack of people waiting 4 hours after getting to a room.
So yeah, I wouldn't take signout from those guys. I would just start making a dent in the chart rack.

WTF? lazy docs? Docs, plural? This idea is so utterly foreign to me that I barely know how to respond to this. If anyone in my group stopped seeing patients at 2am and left 15 people waiting to be seen until 6am, they'd be fired.

---

Members don't see this ad.

 

[NYEMMED]

Agreed, and that's my plan when I return to the Big Apple.

California can actually pay well, even nearish the big cities. And the nurses occasionally do their jobs, unlike NYC. The NYC market is insane, yet EM is extremely popular there and most people stay. I don't get it, either.

Perhaps NYCEMMED can enlighten us...

The city is a hard place to work.

Pay is lower but most facilities are academic, so you are supervising and teaching more than grinding in the pit.

Because you have an academic position you also make a stipend each month for that (and reduced clinical hours if you want), and then your clinical hours on top of that, this helps raise your hourly rate. Also at NYC HHC hospitals docs have immunity from malpractice negotiated into the contract, the hospital/corporation takes all liability(you can still be named in the databank), but we are not personally sued.
In all I have a spouse that’s needs to be in the city for work right now, I can assure you once she gets a transfer elsewhere or new job we are moving.

 

[miacomet]

The city is a hard place to work.

Pay is lower but most facilities are academic, so you are supervising and teaching more than grinding in the pit.

Because you have an academic position you also make a stipend each month for that (and reduced clinical hours if you want), and then your clinical hours on top of that, this helps raise your hourly rate. Also at NYC HHC hospitals docs have immunity from malpractice negotiated into the contract, the hospital/corporation takes all liability(you can still be named in the databank), but we are not personally sued.
In all I have a spouse that’s needs to be in the city for work right now, I can assure you once she gets a transfer elsewhere or new job we are moving.

Thank you for your explanation. I love NYC and would move back but the hatred of ER docs in NYC is legendary. Curious as to how much they are paying you guys these days.
Still named in the databank? Then they don't drop you? I don't understand how this works.
I do hear you on the academics, but still. Best of luck moving on.

 

[GonnaBeADoc2222]

The city is a hard place to work.

Pay is lower but most facilities are academic, so you are supervising and teaching more than grinding in the pit.

Because you have an academic position you also make a stipend each month for that (and reduced clinical hours if you want), and then your clinical hours on top of that, this helps raise your hourly rate. Also at NYC HHC hospitals docs have immunity from malpractice negotiated into the contract, the hospital/corporation takes all liability(you can still be named in the databank), but we are not personally sued.
In all I have a spouse that’s needs to be in the city for work right now, I can assure you once she gets a transfer elsewhere or new job we are moving.

It's exceedingly exceedingly rare for a physician to pay out of pocket for a medmal judgement. If you can still be named in the NPDB, then what is the point of this?

 

[miacomet]

It's exceedingly exceedingly rare for a physician to pay out of pocket for a medmal judgement. If you can still be named in the NPDB, then what is the point of this?

Exactly. The point of immunity from malpractice is that you don't end up on any list or in any database and you can answer "no" on any licensing application as to whether you've ever been sued. What exactly, if anything, are they offering above regular medmal @NYEMMED?

 

[Brigade4Radiant]

Even if you say yes

WTF? lazy docs? Docs, plural? This idea is so utterly foreign to me that I barely know how to respond to this. If anyone in my group stopped seeing patients at 2am and left 15 people waiting to be seen until 6am, they'd be fired.

Yeah but then again it depends on how many they see. If you are seeing 2.3 an hour in one of my shops we slow it down after 3. Also if the rooms are filled or if you have a nursing shortage. In one of my shops its a high acuity area that is pretty understaffed. seeing 15 in 4 hours is 3 patients per hour.

 

[Groove]

The city is a hard place to work.

Pay is lower but most facilities are academic, so you are supervising and teaching more than grinding in the pit.

Because you have an academic position you also make a stipend each month for that (and reduced clinical hours if you want), and then your clinical hours on top of that, this helps raise your hourly rate. Also at NYC HHC hospitals docs have immunity from malpractice negotiated into the contract, the hospital/corporation takes all liability(you can still be named in the databank), but we are not personally sued.
In all I have a spouse that’s needs to be in the city for work right now, I can assure you once she gets a transfer elsewhere or new job we are moving.

Are you referring to sovereign immunity? Do you work for the VA or a state owned hospital?

 

[deleted109597]

That's a huge liability for them to leave patients unseen for that long.

Yeah, but ultimately it ends up on me when I see them.
My all time favorite "Fast Track" patient that I saw at 0 dark thirty after 12 hours? "Facial swelling", triaged as dental. It wasn't so much facial swelling on the once side, as a facial droop on the other, from their stroke. But hey, can you expect the NP and RN in triage to pick that up?

 

[Vandalia]

Exactly. The point of immunity from malpractice is that you don't end up on any list or in any database and you can answer "no" on any licensing application as to whether you've ever been sued. What exactly, if anything, are they offering above regular medmal @NYEMMED?

Even with "sovereign immunity", these organizations may have a duty to report physicians who are named in the suit to the NPDB. You may also have to answer "yes" to the malpractice question depending on state rules. With the VA, there is a procedure that is supposed to be followed for reporting anyone involved with a malpractice suit to the NPDB. Of note, there is an internal review panel, but do not assume that since you are working for the government or have "sovereign immunity", you are immune from reporting.

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135

Also note, that unless there have been changes, the military is required to report physicians to the NPDB if there was a malpractice claim and the service Surgeon General (really the consultant) finds there was a deviation from "standard of care."

Note: Things may have changed since I left, from what appears to be the most current DoD policy, there is mandatory reporting:

"It is DoD policy that: (a) Professional review shall occur in every case of alleged malpractice. (b) When a malpractice claim results in a monetary payment for the benefit of a physician, dentist, or other healthcare practitioner required to be licensed by DoD Directive 6025.6, it shall be reported to the NPDB." https://www.govinfo.gov/content/pkg/CFR-2003-title32-vol2/pdf/CFR-2003-title32-vol2-part221.pdf

 

[NYEMMED]

Exactly. The point of immunity from malpractice is that you don't end up on any list or in any database and you can answer "no" on any licensing application as to whether you've ever been sued. What exactly, if anything, are they offering above regular medmal @NYEMMED?

Are you referring to sovereign immunity? Do you work for the VA or a state owned hospital?

.

In theory if you work for HHC (NYC government public hospitals) which are most hospitals in NYC , you are supposed to have sovereign immunity, I was trying to be honest to the fact that once in awhile physicians still find themselves in the databank, but it’s usually for really bad malpractice cases, not the usual medical lottery suit.

 

[scummie]

Ah wonderful. Just thinking of this thread as I wonder what trash my colleague will give me today.

 

[miacomet]

.

In theory if you work for HHC (NYC government public hospitals) which are most hospitals in NYC , you are supposed to have sovereign immunity, I was trying to be honest to the fact that once in awhile physicians still find themselves in the databank, but it’s usually for really bad malpractice cases, not the usual medical lottery suit.

Thanks for the explanation, but then...what's the point? What exactly are you getting?

 

[Vandalia]

Thanks for the explanation, but then...what's the point? What exactly are you getting?

In reality, not an awful lot.

The main advantage is that there are no "policy limits", with respect to indemnification by your employer.

It is technically possible that if you have such an agreement with your 20 bed hospital, they could go bankrupt and possibly leave you liable.
It is far less likely with a large employer like Kaiser. (Even though their arbitration provisions are a different animal.)
It might be theoretically possible with respect to the State of New York. (Who knows about Illinois.)
It is absolutely impossible with respect to the Untied States government.

To clarify matters, people speak of "sovereign immunity", but the important point is that it is not sovereign immunity. The federal government and the states all have sovereign immunity. That means they cannot be sued for damages without their consent. (Note, counties and cities do not have sovereign immunity. That can be an important point.) Now, these governments realized it was unfair to leave an individual citizen to bear the burden if they were the victim of negligence. So, all the states and the federal government passed laws waiving their sovereign immunity in certain cases. Very generally speaking, if you could sue a private individual or a corporation for negligence, you could sue the state or the federal government. With the federal government, it is called the Federal Tort Claims Act. There are some situations where the federal government did not waive immunity. As an example, if the DEA wrongly revokes your DEA number because they think you are illicitly prescribing, you are out of luck when it comes to suing for damages. The most important way that it impacts physicians is that the plaintiff must sue the federal government, and not the individual physician. But that doesn't change a whole lot practically. You would still have to give depositions, etc.

But - and this is a huge but - the federal government will (or can) still report you to the NPDB. Does it help you with respect to licensing/renewal? Not really, those list if there have been any malpractice claims against you, not whether you have been sued. A very important distinction. Not that - absent ridiculous circumstances - anyone really cares about that anyway.

 

[NYEMMED]

Thanks for the explanation, but then...what's the point? What exactly are you getting?

Not much, just proximity to family and residents.

 

[miacomet]

Not much, just proximity to family and residents.

Lol, no, I meant from the "sovereign immunity" medmal.

 

[NYEMMED]

Decreased chances of being named to the databank. No financial limits on medial policy. It’s a small benefit