how "not good" are things in rural ER's?

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stoic

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What's up everyone -

I've noticed that generally rural ER's staffed by FP/IM people generally aren't highly thought of by you real EM types. Basically I've done most of my shadowing stuff (I'm still a premed) in a smaller, rural-ish hospital (level III, 150 beds)) that serves a very large, very rural surrounding area. I'm wondering just how much the standard of care suffers at places like this and what you guys think are the most important changes that need to be made.

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While I was in college, I was an orderly in the ED at a rural hospital (a coupel hundred bed but hte only hospital for 80 miles). I enjoyed it there, and can see myself working in that setting...

I also spent a summer in Alaska shadowing ED docs in a small hospital, whihc was the only hospital for several hundred miles (and a necessary plane trip at that).

I am not sure if standard of care issues are so different from rural to university settings. Obviously, in the rurla setting, you cannot call down a neurosurgeon (or resident) from the call rooms to take a look at a subdural that you have. In the rural setting, you stabilize, evaluate for possible transfer, and if need be, transfer the patient.

It is not a breach of standard of care to not have a neurosurgeon at your hospital. It is a standard of care to say "Gee this person has a epidural, but we dont' have a NS here... you're out of luck." You stabilize, then transfer. It is more of an EMTALA issue than anything else.

I wouldnt' mind working at a smaller hosiptal when I'm done... I plan on moving back to the Washington DC area when I'm done with my trianing, and if I'm unable to find a satisfactory job in the DC area, am willing to commute 1 hr in any direction (to relatively rural areas) for a full time position.

Q, DO
 
Yeah, I don't think it's per se "IM/FP bashing" - when people talk about rural ED's, it just 'cause EM-boarded people want to be in the cities and coasts. That's just what the numbers say. There is NOTHING stopping an EM-trained doc from going out to a rural area; some people may even prefer it, because there you're "the man", no matter what happens.

Believe me, there are enough metropolitan, cosmopolitan hospitals that aren't thought as highly of; the rural thing takes a certain kind of person. From my viewing, there's a respect for a guy who works 'without a net', as it were.
 
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It's definitely not IM/FP bashing. I'd say we all think they do a great job at what they do and most of them even do pretty well working in rural EDs. What we do think is that we are better at working in EDs than they are. I also know that I would not be as good as they are at working in an office setting, treating chronic conditions and seeing a patient every 6 minutes.
 
ONce you become a resident you will begin to notice a difference ;most are not able to recognize the subtle differences until an arrest arrives or an "unscheduled" trauma hits the doors...those that are EM trained usually stand out and are easily recognizable.
It certainly isn't IM bashing (though we may hold restraint , they have none when they bash US!), it is just the way it is!
 
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