EM hourly rate approaching that of the nursing staff at my hospital

[hoot504]

I hope that won't be case. He is a smart dude but has too much confidence in his ability. Hopefully his attitude has changed.

I wouldn't say I don't mean any ill will, because I definitely don't think this person deserved a residency spot, but it sounds like his medical career is destined to go down in flames.

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[Splenda88]

I wouldn't say I don't mean any ill will, because I definitely don't think this person deserved a residency spot, but it sounds like his medical career is destined to go down in flames.

I understand you don't mean any ill. He still has time to redeem himself. I actually told him last week that he should completely change his attitude if he wants to make it out of residency.

Worst care scenario, if only does a year, he will be eligible for licensure in some states. I am friend with someone who has been doing well as a GP working for IHS.

 

[WilcoWorld]

I think an EP should make a minimum of 4 times what an ER nurse makes just for the added responsibility of what we expose ourselves to (litigation, etc.).

Well there's a clear position! Hmm, is that something an actual BCEP has to do that others punt sometimes?

 

[MechEDoc]

I'm going to call BS on this. That's literally just not feasible.

It's feasible if you only take care of the sickest and you have strong nurses.

e..g 5 min assessment, verbalized plan of care -> next patient. Scribe writes the note, nurses execute labs, imaging, fluids, abx, vasopressors and then call you when the patient is fully ready for a central line (supplies at the bedside).

Also, no bathroom breaks for the entire shift.

 

[MechEDoc]

Assuming there were also several midlevels or residents in the ED for these shifts. 100k visit/yr hospital with 55 beds in the ER can not be run by a single doctor. To be clear, even with residents / PAs, this is still insanely unsafe as you'd probably see ~60 patients in an 8 hr overnight shift. And expected to respond to floor codes? I have to believe that there are key details missing here. I'm assuming we're missing something like: so there's another doc until 3a, then morning comes in at 7a so it's really 4 hrs solo, plus there are 3 residents and a PA...

Even in that scenario, I wouldn't do that job for anything but a prince's ransom. Actual solo coverage at that volume is physically impossible.

Solo time was a about 6 hours. It was stupidly dangerous. Multiple patients sleeping on the floor.

 

[BoardingDoc]

Solo time was a about 6 hours. It was stupidly dangerous. Multiple patients sleeping on the floor.

Again, to be clear, you're saying solo as in you and literally no one else. No pa/np/resident?

If so, any amount of time at a 100k annual visit ER being truly solo is grossly irresponsible on the scheduler end.

 

[emergentmd]

You are my idol. 100K+ is 300+ppd and given some 25% variation, some dys likely 400ppd.

I would seriously be walking the halls drinking coffee waiting on my next coffee break

 

[ScepticSkeksis]

These were last minute shifts. Essentially almost any hourly wage was better than not staffing the ER.

We are talking > 55 bed ER, ~100k visits a year, and floor codes SOLO COVERAGE overnight. Way to go Team Health!

Does anyone else find covering floor codes unacceptable in most cases? I've seen so many medium to large hospitals with more than 40 ICU beds who have no in-house critical care at night expecting the ED to come up and do their intubations and codes. ED physicians shouldn't tolerate this and should demand that either critical care or anesthesia cover these.

 

[Interpolfanclub]

Does anyone else find covering floor codes unacceptable in most cases? I've seen so many medium to large hospitals with more than 40 ICU beds who have no in-house critical care at night expecting the ED to come up and do their intubations and codes. ED physicians shouldn't tolerate this and should demand that either critical care or anesthesia cover these.

We did this for years and years until our ICU closed. We'd always go up at night and code or intubate because it generally only took a few minutes. The night APPs usually took over codes but procedures were all ours since no other docs were in hours. We'd get called all hours of the night for lines, chest tubes etc.

It got to the point we finally said enough and started calling in the gas docs from home to help. ICU RNs would write things like "Dr. Interpol refuses to place central line" in the chart when we were too busy in the ER to help. It was unreal. It's gotten better over my career. 15 years ago when I started I felt like it was the norm everywhere that if something happened on the floor they would "just have the ER doc do it."

 

[BoardingDoc]

Does anyone else find covering floor codes unacceptable in most cases? I've seen so many medium to large hospitals with more than 40 ICU beds who have no in-house critical care at night expecting the ED to come up and do their intubations and codes. ED physicians shouldn't tolerate this and should demand that either critical care or anesthesia cover these.

It is unacceptable. The only way it should ever be tolerated is if the hospital provides a written policy stating that they will absorb all liability resulting from you leaving the emergency department unattended while responding to said code.

Our hospital already has a code team, but it's hospitalists who can't intubate. They didn't want to accept the above liability to get us to go upstairs to intubate so we now have a policy that they can either call anesthesia (not in house after hrs) or can bring the patient to the ER and we'll intubate.

 

[ScepticSkeksis]

It is unacceptable. The only way it should ever be tolerated is if the hospital provides a written policy stating that they will absorb all liability resulting from you leaving the emergency department unattended while responding to said code.

Our hospital already has a code team, but it's hospitalists who can't intubate. They didn't want to accept the above liability to get us to go upstairs to intubate so we now have a policy that they can either call anesthesia (not in house after hrs) or can bring the patient to the ER and we'll intubate.

I refuse to do central lines or chest tubes. It's intubations and codes only. They complain and whine about that, but it's important to stand your ground.

 

[oldtown]

Does anyone else find covering floor codes unacceptable in most cases? I've seen so many medium to large hospitals with more than 40 ICU beds who have no in-house critical care at night expecting the ED to come up and do their intubations and codes. ED physicians shouldn't tolerate this and should demand that either critical care or anesthesia cover these.

“Just have the ER do it” is a 100 level core curriculum required course when obtaining one’s MHA.

 

[Janders]

“Just have the ER do it” is a 100 level core curriculum required course when obtaining one’s MHA.

Happy to do it if you bring me the patient.
“But its not safe putting these patients in an elevator to bring them to you!”
Well, some 20yo kids in an ambulance bring them to me all day!
“But it still might not be safe to spend 2 minutes wheeling them to you!”
Then how is it safe for me to leave my 20 Er patients and unknown incoming arrivals to go to the floor?

In circles ad nauseum.

 

[RustedFox]

Happy to do it if you bring me the patient.
“But its not safe putting these patients in an elevator to bring them to you!”
Well, some 20yo kids in an ambulance bring them to me all day!
“But it still might not be safe to spend 2 minutes wheeling them to you!”
Then how is it safe for me to leave my 20 Er patients and unknown incoming arrivals to go to the floor?

In circles ad nauseum.

Quoted for truth.

 

[kidthor]

ED physicians shouldn't tolerate this and should demand that either critical care or anesthesia cover these.

As an anesthesiologist myself I nominate critical care for this opportunity.

 

[ScepticSkeksis]

Quoted for truth.

It's got el

Happy to do it if you bring me the patient.
“But its not safe putting these patients in an elevator to bring them to you!”
Well, some 20yo kids in an ambulance bring them to me all day!
“But it still might not be safe to spend 2 minutes wheeling them to you!”
Then how is it safe for me to leave my 20 Er patients and unknown incoming arrivals to go to the floor?

In circles ad nauseum.

It's got electrolytes, that's what plants crave!

 

[TooMuchResearch]

Does anyone else find covering floor codes unacceptable in most cases? I've seen so many medium to large hospitals with more than 40 ICU beds who have no in-house critical care at night expecting the ED to come up and do their intubations and codes. ED physicians shouldn't tolerate this and should demand that either critical care or anesthesia cover these.

We cover in our small hospitals (i.e. no ICU and only physical overnight doctor), but the understanding is we show up to stabilize, hospitalist is responsible for transfers, and critical patients in ED are still priority.

I'll show up, get the patient on a ventilator if needed, start peripheral pressors, etc but can't stay and play for an hour.

 

[MechEDoc]

Again, to be clear, you're saying solo as in you and literally no one else. No pa/np/resident?

If so, any amount of time at a 100k annual visit ER being truly solo is grossly irresponsible on the scheduler end.

Yes. I did several nights like that. Never again. Maybe the volumes were slightly lower at the time (I looked up their 2023 volume for this post, my time there was 2016, maybe 70k+?). Solo was solo. No PA or NP for at least 6 hours. It was stupid. Everything bad you can see, I saw there. 19 y/o STEMI (SCAD), emphysematous pyelonephritis, CRAO, blast crisis w/ DIC (survived), etc, etc. They would usually have ~20 people in hallway chairs (not beds!) that would never get seen at night due to their low level of acuity. Nurses would give them a thin fleece blanket and they would sleep on the floor. One of them flagged me down around 6 AM and told me she had a sore throat - it was a retropharyngeal abscess🙁 Yikes!

 

[ToliBro]

I appreciate this and I think some of the emergency medicine physician frustration is equivalent to nurses cherry picking the few highly compensated shifts that I have had. I have earned comfortably over $500 per hour, I would not do it again and it wasn't worth it. Additionally, those shifts are exceedingly rare and stupidly dangerous.

Understandable.

As a bit of an update, travel pay has topped out at 70-80 an hour here, so about double to 2.5x staff nursing here. Which is still good money, but it ain't EM, and the conditions are ones I doubt anyone in here would tolerate in terms of job stability.

I do very much doubt that any of yall would have wanted to be a nurse despite the pay.

 

[Splenda88]

Understandable.

As a bit of an update, travel pay has topped out at 70-80 an hour here, so about double to 2.5x staff nursing here. Which is still good money, but it ain't EM, and the conditions are ones I doubt anyone in here would tolerate in terms of job stability
I do very much doubt that any of yall would have wanted to be a nurse despite the pay.

I was one for ~8 yrs and the job ain't pretty. I enjoy being a hospitalist a lot more.