Agree with the above. I feel like this job trains you to hate people
It’s almost impossible to work as an EP over a long period of time without developing a dislike for people. These are the changes that I think are key to restoring physician satisfaction as an EP:
1) In an EMTALA bound environment, autonomy has to be increased to dictate patients’ ED course, care and disposition. We can’t select or fire our patients. They just show up 24/7/365. Therefore, we need to have more control over those that we do see. If it isn’t an emergency, then we shouldn’t be obligated to continue to provide care for them unless we want to and there is a clear financial benefit to doing so that both the patient and physician mutually agree upon. Patient satisfaction for ED patients doesn’t correlate with improved care. Our work shouldn’t be tied to patient satisfaction metrics. Even if you wanted to use patient satisfaction, the metric should be applied to patients with emergencies that you stabilized and not the worried well without emergencies that you discharged home.
2) Improved medicolegal protection. A high percentage of testing we do in the ED is for medicolegal protection, and also a large percentage for patient satisfaction. We often don’t feel testing is indicated or want to order, but pretty much have to a lot of the time for the above reasons. We can’t practice medicine if the lawyers and patients are doing it for us.
3) Decrease the level of charting required. Most charting is medicolegal protection. The second biggest reason is billing. Very little is actually done for future patient care.
4) Payment for services provided needs to primarily go to those providing the services. I’m lucky to work in an environment where this is the case, but many aren’t who are employed by CMGs. Also, billing shouldn’t be so tedious. A certain number of ROS elements shouldn’t dictate how much we are paid. No one honestly goes through and documents an entire ROS for every level 5 encounter.
5) Decrease circadian rhythm disruption. Most presentations to the ED aren’t emergencies. If it’s not an emergency, it can wait until the morning. No one pays a plumber or an electrician to come to their house in the middle of the night because a toilet won’t flush or their TV stops working. Many things can wait until the morning. If EDs can significantly decrease overnight staffing, then it will dramatically improve the quality of life of EPs. We can be on call with a quick response time like other physicians. It’s not perfect, but seems like a satisfactory compromise.
None of these are easy to address, hence why the odds of EPs continuing to dislike people and burnout is high. The solution is potentially there though.