General surgeon moonlighting in the ER

[deleted109597]

I may be a minority here, but I actually don't look down on non-EM residency trained docs. I just don't recommend it for people going forward. But as for IM or FP doctors who have worked in the ER for many long years, I can't reasonably look down on them. They are my colleagues, and some/many of them are damn good.

From a specialty and livelihood perspective, I think it's important to protect ourselves from non-EM boarded folks. But, this does not mean that non-EM boarded folks can't be just as good in reality.

And for a very long time to come there will be a need for these non-EM boarded folks to fill the need for EM doctors in understaffed and underserved facilities. I think in the end it works out for everyone. EM-boarded folks are blessed with having way more options, but even those non-EM folks (with ER experience) can find a place to work and fulfill a need.

I'll bite.
You're full of it. There's no way you don't look down on them. Just like you don't look down on docs in the community that send uncomplicated HTN in. It happens.
What's worse is that our specialty is the only one under assault. People who have been doing it? Sure, let them keep doing it. But there needs to be a "this stops now" clause in every ED. There aren't FM docs in the OR operating or gassing people. There aren't general pediatricians in the SICU. Pathologists aren't doing caths on people. Ophthalmologists aren't running codes. There aren't even general surgeons doing eye cases.
Letting people who didn't train our way do our job essentially makes our training meaningless. Yes, there's a shortage out there. There's also a shortage of GI, psych, general surgery, cardiology, neurology, etc, etc. I can't go into bum**** Idaho and start practicing that or anything other than EM. Why can others go somewhere and practice my job?
Letting them continue it is the problem. Ergo, people like you are a large part of the problem. You're on the same side as EmCare here, wanting to cut salaries and make it easier to fill positions. That's a bad place to be.

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[Psai]

So PAs and NPs with minimal medical training are qualified to work in the ED but FM docs who went through medicine and residency cannot? Oh okay.

 

[Mad Jack]

Lol, in light of the thread being about surgeons in EM, this is hilarious.

 

[Mad Jack]

So PAs and NPs with minimal medical training are qualified to work in the ED but FM docs who went through medicine and residency cannot? Oh okay.

That's what I don't get- we're really selling short our own in EM by either saying PAs/NPs straight up can't work in EM because they are unqualified or conversely saying that FM docs can work in EM if a PA/NP is qualified to.

 

[alpinism]

So PAs and NPs with minimal medical training are qualified to work in the ED but FM docs who went through medicine and residency cannot? Oh okay.

PAs and NPs are also qualified to work in the OR and perform all types of surgeries. Doesn't mean they should work independently without supervision.

 

[Fox800]

I'll bite.
You're full of it. There's no way you don't look down on them. Just like you don't look down on docs in the community that send uncomplicated HTN in. It happens.
What's worse is that our specialty is the only one under assault. People who have been doing it? Sure, let them keep doing it. But there needs to be a "this stops now" clause in every ED. There aren't FM docs in the OR operating or gassing people. There aren't general pediatricians in the SICU. Pathologists aren't doing caths on people. Ophthalmologists aren't running codes. There aren't even general surgeons doing eye cases.
Letting people who didn't train our way do our job essentially makes our training meaningless. Yes, there's a shortage out there. There's also a shortage of GI, psych, general surgery, cardiology, neurology, etc, etc. I can't go into bum**** Idaho and start practicing that or anything other than EM. Why can others go somewhere and practice my job?
Letting them continue it is the problem. Ergo, people like you are a large part of the problem. You're on the same side as EmCare here, wanting to cut salaries and make it easier to fill positions. That's a bad place to be.

Preach it!

 

[Angry Birds]

I'll bite.
You're full of it. There's no way you don't look down on them. Just like you don't look down on docs in the community that send uncomplicated HTN in. It happens.
What's worse is that our specialty is the only one under assault. People who have been doing it? Sure, let them keep doing it. But there needs to be a "this stops now" clause in every ED. There aren't FM docs in the OR operating or gassing people. There aren't general pediatricians in the SICU. Pathologists aren't doing caths on people. Ophthalmologists aren't running codes. There aren't even general surgeons doing eye cases.
Letting people who didn't train our way do our job essentially makes our training meaningless. Yes, there's a shortage out there. There's also a shortage of GI, psych, general surgery, cardiology, neurology, etc, etc. I can't go into bum**** Idaho and start practicing that or anything other than EM. Why can others go somewhere and practice my job?
Letting them continue it is the problem. Ergo, people like you are a large part of the problem. You're on the same side as EmCare here, wanting to cut salaries and make it easier to fill positions. That's a bad place to be.

I understand where you are coming from. As I said before, I don't disagree with ABEM-only in major cities, but I think rural places are going to have a tough time.

With regard to this:

There's also a shortage of GI, psych, general surgery, cardiology, neurology, etc, etc. I can't go into bum**** Idaho and start practicing that or anything other than EM. Why can others go somewhere and practice my job?​

I think there is a slight difference. These IM or FP folks have already been practicing rural EM for many long years.

Anyways, I know it's an unpopular opinion, and I respect your difference of opinion on this one. My opinion changed on this only when I started working at one of these hospitals and faced the issue of severe physician shortage.

 

[Makati2008]

I understand where you are coming from. As I said before, I don't disagree with ABEM-only in major cities, but I think rural places are going to have a tough time.

With regard to this:

There's also a shortage of GI, psych, general surgery, cardiology, neurology, etc, etc. I can't go into bum**** Idaho and start practicing that or anything other than EM. Why can others go somewhere and practice my job?​

I think there is a slight difference. These IM or FP folks have already been practicing rural EM for many long years.

Anyways, I know it's an unpopular opinion, and I respect your difference of opinion on this one. My opinion changed on this only when I started working at one of these hospitals and faced the issue of severe physician shortage.

The problem with this is there is still programs pumping them out yearly( the fm "em fellowship" and alternative boards) which dilutes our specialty. Also doesn't it make you worry that these same people advertise as Emergency Medicine Physicians?


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[Angry Birds]

The problem with this is there is still programs pumping them out yearly( the fm "em fellowship" and alternative boards) which dilutes our specialty. Also doesn't it make you worry that these same people advertise as Emergency Medicine Physicians?


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I feel ya. It's against our personal and specialty'a interest. For sure. But I don't personally begrudge those people. I have friends who couldn't get into EM. I tell them to consider this other route if they couldn't imagine doing anything else. But with the understanding that they'd have to work in underserved areas.

You're right though. This could become problematic. They could threaten our livelihood in the future.

But my main issue is a hospital turning down people with twenty years experience in EM when they can't find an ABEM person to replace them. That seems silly to me.

 

[deleted109597]

I understand where you are coming from. As I said before, I don't disagree with ABEM-only in major cities, but I think rural places are going to have a tough time.

Yep. They've got a tough time with everything.

With regard to this:

There's also a shortage of GI, psych, general surgery, cardiology, neurology, etc, etc. I can't go into bum**** Idaho and start practicing that or anything other than EM. Why can others go somewhere and practice my job?​

I think there is a slight difference. These IM or FP folks have already been practicing rural EM for many long years.

There's no difference. GPs were doing all of those things for decades. Then specialties formed to disallow them to do that. And they've been effective. We haven't.

Anyways, I know it's an unpopular opinion, and I respect your difference of opinion on this one. My opinion changed on this only when I started working at one of these hospitals and faced the issue of severe physician shortage.

As have I. I daresay I've worked in more rural areas than you. And the reason those hospitals have crappy doctors is because they won't pay real EM rates. Ones that do will at least have EM docs, even if they aren't the best. The answer isn't to allow lesser quality docs to do your job.
I've received signout from plenty of assassins. I even got to see a 29 day old on their 2 day bounceback because they were still febrile. Their workup on the prior visit? A CBC. Nothing else. I still cannot fathom this.
I could practice cardiology as well as some of these assclowns practice EM.

 

[Angry Birds]

Yep. They've got a tough time with everything.


There's no difference. GPs were doing all of those things for decades. Then specialties formed to disallow them to do that. And they've been effective. We haven't.


As have I. I daresay I've worked in more rural areas than you. And the reason those hospitals have crappy doctors is because they won't pay real EM rates. Ones that do will at least have EM docs, even if they aren't the best. The answer isn't to allow lesser quality docs to do your job.
I've received signout from plenty of assassins. I even got to see a 29 day old on their 2 day bounceback because they were still febrile. Their workup on the prior visit? A CBC. Nothing else. I still cannot fathom this.
I could practice cardiology as well as some of these assclowns practice EM.

I feel ya.

 

[AdmiralChz]

So PAs and NPs with minimal medical training are qualified to work in the ED but FM docs who went through medicine and residency cannot? Oh okay.

Oh come on, they do fellowships in EM and half of their education is online so duh of course they can

In all seriousness, I continue to moonlight in an ED as a non-EM attending in fellowship about once every month or so. It's nice for extra $$ on the weekend, but there's (usually) an EM MD there to help if I have questions. I don't know how I feel about whether it should be allowed or not, but I'll take it.

 

[Birdstrike]

We had a general surgeon come talk to us today, and he told us that he often moonlights in the ER. This confused me, so I asked him why an EM residency even exists if general surgeons can do everything an EP can do. He told me that general surgeons have all of the "basic medical knowledge" an EP does, but "finished their training" in the GS residency. What are your thoughts?

Could an Emergency Physician "get through" a family practice or Peds shift if the other choice was "no doctor" to work the shift?
Probably so.
That wouldn't make them a Family Practitioner or a Pediatrician, would it?
It sounds like you're in training, and I would advise you to be respectful to this guy. But my guess is that he either was grandfathered in before you had to do an EM residency and in that case, there won't be any more of this guys around after a few more years. Or, he may actually think he's as good as a board-certified, residency-trained Emergency Physician, but really has absolutely no idea how utterly far he is from that.

Bottom line: What he's saying is not correct, so I wouldn't let it shake your confidence in the slightest.

 

[NinerNiner999]

There is hypocrisy everywhere today. I bet if you consulted that same ER/Surgeon with a pregnant appendicitis he'd balk because the patient is pregnant and he's not comfortable operating. I wonder how he makes the call from our side of the building...

 

[frosted2]

Here is one for you... I did my medic clincials at an ER that was staffed by family medicine/OBGYN physicians during the day and a family practice NP at night... yikes.

 

[Angry Birds]

I just want it on the record that I have flipped my position on this 180 degrees. I have now realized how big of a difference an EM residency makes, and even 20 years working in an ER cannot replace that experience. I stand corrected.

 

[Old_Mil]

We had a general surgeon come talk to us today, and he told us that he often moonlights in the ER. This confused me, so I asked him why an EM residency even exists if general surgeons can do everything an EP can do. He told me that general surgeons have all of the "basic medical knowledge" an EP does, but "finished their training" in the GS residency. What are your thoughts?

When all you have is a hammer, everything looks like a nail.

General surgeons do not have the breadth or depth of knowledge of pediatric or adult medicine to be effective EPs. Family medicine physicians are far more suited for that role if you have to put a non ABEM guy in an ED.

In fact the worst EDs I have ever seen have been under the administrative direction of general surgeons.