Deciding on where to work

[han14tra]

Input appreciated.

Population 40,000 (college town) The population of the town easily triples depending on what's going on at the university.

Hospital A in that town: ED volume is 55,000 (approx 50 bed ER), has cath lab but no OB, thrombectomies, trauma. 8-9 hour shifts between about 17 physicians. Everytime I've called to transfer a patient there for the past 2 years, they've not been accepting patients from outside facilities due to capacity.

New Hospital B opening < 2 miles away from hospital A: 11 bed ER planned which will be single physician coverage, 12 hour shifts. No OB, trauma, cath lab. No APP coverage planned. There will be a < 20 bed inpatient unit. Complicated patients will be transferred to the "big house" associated with that hospital, which is about 1.5 hours away.

Would you take a job at hospital B? Or hospital A? Or neither? Pros and cons of working in a college town? Pros and cons of working in a brand new ER? Hospital A is RVU based with lower base pay, hospital B is straight hourly at competitive rate.

These aren't the only 2 places I'm considering, but they are the 2 that I don't really know what to think about them.

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[JacobMcCandles]

What do the compensation numbers actually look like? You left out one of the most important details.

 

[Groove]

Not enough info. W2 or 1099? Average PPH? Admission percentage? Compensation? Where are you in your career (recent grad or mid/late career?) Need more details to give you any real advice.

 

[Tenk]

No OB = no worky there.

 

[valianteffort]

Do they not do pregnancy at all in this town?

 

[JacobMcCandles]

Do they not do pregnancy at all in this town?

It’s a college town. Abstinence only.

 

[RustedFox]

No OB = no worky there.

I work at a shop with no OB.
Its really not at all bad.

 

[thegenius]

Input appreciated.

Population 40,000 (college town) The population of the town easily triples depending on what's going on at the university.

Hospital A in that town: ED volume is 55,000 (approx 50 bed ER), has cath lab but no OB, thrombectomies, trauma. 8-9 hour shifts between about 17 physicians. Everytime I've called to transfer a patient there for the past 2 years, they've not been accepting patients from outside facilities due to capacity.

New Hospital B opening < 2 miles away from hospital A: 11 bed ER planned which will be single physician coverage, 12 hour shifts. No OB, trauma, cath lab. No APP coverage planned. There will be a < 20 bed inpatient unit. Complicated patients will be transferred to the "big house" associated with that hospital, which is about 1.5 hours away.

Would you take a job at hospital B? Or hospital A? Or neither? Pros and cons of working in a college town? Pros and cons of working in a brand new ER? Hospital A is RVU based with lower base pay, hospital B is straight hourly at competitive rate.

These aren't the only 2 places I'm considering, but they are the 2 that I don't really know what to think about them.

How much $$$ do you make? RVU or hourly? And PPH?
BTW, Hospital A sounds rough. It might be considered interesting when you are out of residency or in your young career, but transferring patients is such a timesuck and bore.

I also advocate for an RVU system (or hybrid RVU) vs hourly. You get abnormal, unsavory behavior in both systems but there is 0 incentive to move the meat in an hourly system. Absolulely none. Nothing pisses you off the most then coming into work with 10 waiting to be seen, and the prior doc has seen 1 PPH and signs out several patients to you. The slowest docs wins in hourly systems.

 

[thegenius]

I work at a shop with no OB.
Its really not at all bad.

Do you do NSTs and other crap like that for the 20+ weekers that come in with cramping, spotting, or just "I don't feel good...please evaluate my baby."

 

[Tenk]

I work at a shop with no OB.
Its really not at all bad.

We have 24/7 OB but not in house. Sometimes stuff happens and we have to take care of it while waiting on OB. 99% of the time it’s not bad but it sure as hell is nerve wracking.

 

[EctopicFetus]

Do you do NSTs and other crap like that for the 20+ weekers that come in with cramping, spotting, or just "I don't feel good...please evaluate my baby."

I work at a myriad of places including those with no OB. 20 weeker comes in.. sort out their problem and then you either transfer to OB center or dc and tell them to see their OB and if things get worse or they have baby concerns to call their OB doctor and let them know and they will tell them where to go. Reiterate that there is no OB at your site. the patients and OBs already know so very very very few of these people actually come in.

 

[BoardingDoc]

Do you do NSTs and other crap like that for the 20+ weekers that come in with cramping, spotting, or just "I don't feel good...please evaluate my baby."

Nope. Transvaginal ultrasound, maybe basic labs and discharge with instructions to see their OB is pretty much the routine for all of these.

 

[RustedFox]

Do you do NSTs and other crap like that for the 20+ weekers that come in with cramping, spotting, or just "I don't feel good...please evaluate my baby."

20 weeks? Bye. Go to the nearest OB shop.
Oh, you don't feel good? Yeah, its called being pregnant.

Seriously though; things must be different out there on the left coast. Nobody. NOBODY does this nonsense here.

 

[The Knife & Gun Club]

20 weeks? Bye. Go to the nearest OB shop.
Oh, you don't feel good? Yeah, its called being pregnant.

Seriously though; things must be different out there on the left coast. Nobody. NOBODY does this nonsense here.

Little satellite non-OB hospital we covered when I was a resident would basically do algorithm of baby not actively coming out on the the floor in front of us —> stat transfer by fire rescue to nearest OB capable center if sick or actively delivering. If not super sick maybe a POC US to get fetal heart rate and offer a bolus of fluids, Tylenol/zofran, and some labs followed by the discussion of “if you don’t feel better we can transfer you to XYZ OB capable hospital.”

I always wondered if they could sue if they had a late term complication after such a minimal workup.

But at the same time not sure what else to offer at a Non-OB place that doesnt have formal US in house at night. Even if we’d had the capacity to do tracing/fetal heart rate monitoring, BPP or NST testing (we didn’t) I’m not sure there’s many EPs out there they would be able to reliably interpret them.

 

[RustedFox]

Little satellite non-OB hospital we covered when I was a resident would basically do algorithm of baby not actively coming out on the the floor in front of us —> stat transfer by fire rescue to nearest OB capable center if sick or actively delivering. If not super sick maybe a POC US to get fetal heart rate and offer a bolus of fluids, Tylenol/zofran, and some labs followed by the discussion of “if you don’t feel better we can transfer you to XYZ OB capable hospital.”

I always wondered if they could sue if they had a late term complication after such a minimal workup.

But at the same time not sure what else to offer at a Non-OB place that doesnt have formal US in house at night. Even if we’d had the capacity to do tracing/fetal heart rate monitoring, BPP or NST testing (we didn’t) I’m not sure there’s many EPs out there they would be able to reliably interpret them.

This is the answer.
Same answer as cognitive behavioral therapy, physical therapy, whatever.
"We don't do this here."
Impolitely: "Sorry, you're in Home Depot and you're trying to order the lasagna."
Direct them to the appropriate place, and that's all you can do.

 

[BoardingDoc]

Impolitely: "Sorry, you're in Home Depot and you're trying to order the lasagna."

I literally told someone 2 shifts ago that they were "in home Depot and trying to order spaghetti. I can't help even if I wanted to. I've got hammers and belt sanders. I don't do spaghetti."

 

[RustedFox]

I literally told someone 2 shifts ago that they were "in home Depot and trying to order spaghetti. I can't help even if I wanted to. I've got hammers and belt sanders. I don't do spaghetti."

It wasn't me that came up with that saying, but I use it all the time. I just swapped lasagna for spaghetti this time because I just ate some.

 

[thegenius]

20 weeks? Bye. Go to the nearest OB shop.
Oh, you don't feel good? Yeah, its called being pregnant.

Seriously though; things must be different out there on the left coast. Nobody. NOBODY does this nonsense here.

I can't believe it

Unless your patient's average age is 139.

 

[thegenius]

I literally told someone 2 shifts ago that they were "in home Depot and trying to order spaghetti. I can't help even if I wanted to. I've got hammers and belt sanders. I don't do spaghetti."

I use this line regularly. I reiterate that you don't go into Home Depot looking for spaghetti. But Home Depot does sell a few random bits of food like Twix or Altoids.

 

[EctopicFetus]

ACEP’s push to be all things to all people to mitigate the workforce issues is contributing to this nonsense. Some Acep butt kissers reiterate it as well. I don’t want to run an obs unit, I don’t want to do ultrasounds on people for run of the mill complaints.

I don’t want to create and execute a bunch of stupid algos for every complaint under the sun. I don’t want to do virtual care for nursing homes.

 

[CoolDoc1729]

I work at a shop with no OB.
Its really not at all bad.

I guess I wouldn’t mind that either if all my patients were over 70 🤣

 

[RustedFox]

I can't believe it

Unless your patient's average age is 139.

Believe it.
I haven't done anything pregnancy related in years with no OB at my shop.

The local pregnant females know "there's no OBGYN at that place."

 

[trackrunner321]

At my non-OB hospital, if a pregnant patient over 20 weeks with any complaint remotely related to pregnancy walks in, they are transferred almost immediately if not actively delivering.