I actually enjoy what I do... but I have a question.

[pinipig523]

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So for some years now, I've liked what I do - but tonight I actually realized that I enjoy what I do.

I'm rotating at an outside community rotation and I actually enjoy it more than even my home program. It's been great - I've been tubing people, placing central lines, running medical and trauma resuscitations. I've even had to ride with EMS to help with an unstable transfer.

I guess when you find a gig you like, you end up enjoying it.

That said - I have a question:

Does something "fun" as a resident equal "fun" as an attending? Do I really want the proverbial poop to hit the fan when I'm an attending?

 

[deleted109597]

I will say that as a whole, I get more of a "good job" feeling fixing the really sick person. However, my boss would prefer that I clear out the lobby than spend an hour working on someone that should go to the ICU.
Most places are similar I would bet.

 

[dchristismi]

Does something "fun" as a resident equal "fun" as an attending? Do I really want the proverbial poop to hit the fan when I'm an attending?

Sometimes.
Sometimes definitely. 🙂
Sometimes not. But you did pick this field for a reason. 😉

There is definitely more pressure to move the meat, but I still get a huge rush from certain things. I happen to practice in a pretty fun group with good coverage and high acuity (=old people), so it is not unfrequent that someone is running a big rescus and the others pick up the slack. Having good partners helps. For example, one of the other guys (who is also young) and I will compete for good cases, generally STEMIs and codes. This is generally involves an elaborate game of rock-paper-scissors in front of the ambulance bay, best 2 out of 3. Keeps it fun.


They call me the *#%t magnet. I love the sickies.
But then again, I am the pediatric ENT foreign-body queen. I LOVE a perfect colles reduction. I love a Champagne Tap. I love STEMIs. I don't work at a trauma center, but a little bit of homeboy ambulance trauma keeps us on our toes.

As an attending, you also get to bill critical care time for sickies if you spend the time. Helps out in the end. Picking the right place to practice is key, I think.

If this place seems to fit, find out if they're hiring. You never know.

 

[pinipig523]

If this place seems to fit, find out if they're hiring. You never know.

The place is hiring.... but I'm looking to move out of state. From Chicago to Dallas.

 

[EctopicFetus]

I think burnout in EM comes from the dental pain coming by ambulance, the 2 am bilateral knee pain for 3 years.

The Septic person needing a line, tube and pressors are what keep our job fun.

Personally, even though I loved residency I am infinitely happier with my community job.

 

[Jack is Back]

What is the big difference between community and larger city practices (is that the distinction or is it academic)?

Anyway, do you get more trauma vs. the frivolous stuff?

 

[Arcan57]

Community EDs can still be in a large city, just not the main inner city/indigent care hospitals. Typical signs of working in a community ED include concern over: patient satisfaction, turn-around time, insurance networks, and referral patterns. The upsides tend to include better payor mix, shorter turn-around times, fewer non-compliant trolls, and improved ancillary staff.

 

[docB]

Does something "fun" as a resident equal "fun" as an attending? Do I really want the proverbial poop to hit the fan when I'm an attending?

I say no. To me a procedure means 4 charts in the rack by the time I'm done and no lunch. The volume just kills.

I think burnout in EM comes from the dental pain coming by ambulance, the 2 am bilateral knee pain for 3 years.

I agree that those folks eat your soul but for me it's the volume. The omnipresent fact that if you slow down for even a second you'll get so far behind that you will have to stay hours late.

For me the volume is what makes the inappropriate patients so hard to deal with. If I wasn't so busy I could just smile and give the flu symptoms BIBA a motrin and pat them on the head as I show them the door. It wouldn't be so frustrating to see the Sunday morning "Grandpa's Alzheimer's has been getting worse for 2 years and today's the day we decided we decided it's too much for us to handle." These cases aren't hard, they're just futile. And because seeing them means no bathroom for half the shift I've lost my sense of humor about them.

 

[Jack is Back]

Community EDs can still be in a large city, just not the main inner city/indigent care hospitals. Typical signs of working in a community ED include concern over: patient satisfaction, turn-around time, insurance networks, and referral patterns. The upsides tend to include better payor mix, shorter turn-around times, fewer non-compliant trolls, and improved ancillary staff.

thanks. 🙂

 

[KYTNOH]

Where I train the urban community hospitals have very little case mix. In an urban setting the trauma all goes to the trauma center and peds all goes to the peds center. Of course, there's always drop offs and POV patients at those places, but in general parents take their kids to the peds hospital and EMS takes trauma to the trauma center. For a good case mix rural community hospitals are actually superior to urban community hospitals in many cases.