Integrative Emergency Services

[RustedFox]

Anyone know anything about this outfit?

MODS: It's supposed to be "Emergency", not Emerald. Autocorrect hates me. Help a brother out.

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[bravotwozero]

Yeah, IES has a few sites in Dallas and Houston, w-2 gigs with benefits. Their pay sucks and is well below market rates, but benefits are good from what I hear.

I wouldn’t work for them unless I had no other options.

 

[southerndoc]

MODS: It's supposed to be "Emergency", not Emerald. Autocorrect hates me. Help a brother out.

Fixed it for you.

 

[EctopicFetus]

Started by former envision people trying to create a new cmg and cash out. They have contracts in Arizona Texas and others. Standard crappy cmg job.

 

[Franzd'Epinay]

I don't know anything about them, but apparently they offer a "Street Medicine" "Fellowship"...

 

[bravotwozero]

yes, they'e notorious for having stupid fellowships, so they can get cheap labour out of attendings.

 

[southerndoc]

Street medicine is different than EMS.

A prime example of street medicine is the administration of buprenorphine in the field. Usually it's done by community paramedics and NPs/PAs. We haven't started a program yet for buprenorphine administration due to lack of follow-up arrangements, but we currently send a team to any overdose call within 72 hours. So if somebody ODs and calls 911 (whether or not they received naloxone), then a team consisting of a police officer, community paramedic, and a mental health specialist (currently we're using social workers) will go to the scene and/or residence of the patient and talk with them about treatment options. We plan to implement buprenorphine soon when we can get outpatient follow-up arranged.

Street medicine would be doing the follow-up at the patient's residence, at a rehab facility, or in the streets for homeless people.

Quite frankly, I do not think there is enough reason to do a fellowship with it. I imagine that it's just to pad a resume or to give a hospital some cheap labor to have a street program. It can easily be done with community paramedics and NPs/PAs.

 

[Franzd'Epinay]

Quite frankly, I do not think there is enough reason to do a fellowship with it. I imagine that it's just to pad a resume or to give a hospital some cheap labor

You have just described every non-ACGME EM "fellowship".

 

[turkeyjerky]

Doesn't it seem like every single job out there has 'below market rates' these days? Someone should create a list of these shady smallish shady cmgs that try to obscure their practice/ownership structure.

I got my eye on that fleece vest

 

[EctopicFetus]

You have just described every non-ACGME EM "fellowship".

And many of the acgme ones too.

 

[emergentmd]

IES prides itself on having "physicians/partners" feel involved but rates did seem lower.

 

[bravotwozero]

They are all ‘involved’ in getting paid less than they should.

 

[Rekt]

Street medicine is different than EMS.

A prime example of street medicine is the administration of buprenorphine in the field. Usually it's done by community paramedics and NPs/PAs. We haven't started a program yet for buprenorphine administration due to lack of follow-up arrangements, but we currently send a team to any overdose call within 72 hours. So if somebody ODs and calls 911 (whether or not they received naloxone), then a team consisting of a police officer, community paramedic, and a mental health specialist (currently we're using social workers) will go to the scene and/or residence of the patient and talk with them about treatment options. We plan to implement buprenorphine soon when we can get outpatient follow-up arranged.

Street medicine would be doing the follow-up at the patient's residence, at a rehab facility, or in the streets for homeless people.

Quite frankly, I do not think there is enough reason to do a fellowship with it. I imagine that it's just to pad a resume or to give a hospital some cheap labor to have a street program. It can easily be done with community paramedics and NPs/PAs.

Seems like a giant waste of resources.

 

[RustedFox]

Seems like a giant waste of resources.

s/ I hope you get some therapy so you can heal because you clearly hate humans, you racist, classist, privileged oppressor.

Lololololol.

 

[JacobMcCandles]

"Don't let it take everything."

Okay, here it comes. No joke.

I've been seeing a counselor/therapist privately for over 2 years now. 9 years in EM has really left its mark on me to say the least.
My guy is a combat-tested marine. 2 tours in Iraq. Blown up by a roadside IED. Lost a lot of his buddies.
He has a great way of putting things into perspective for me.

I tell him the stories about how people misbehave in the ER. Same ones that I tell you guys.
I tell him some of your stories.
I can't begin to tell you the number of times he has said to me: "Rusted... you have taught me that people in war-torn villages don't behave as poorly as Americans do in the ER."

Arcan57 posted earlier in this thread about how he recognized that he was beginning to hate everyone.
I don't know how far along he is in his career, but I'm willing to bet that I crossed the "finish line" of the "hate race" before he did.
That's not a race that you want to win.

I hated everyone that he listed. And more.

s/ I hope you get some therapy so you can heal because you clearly hate humans, you racist, classist, privileged oppressor.

Lololololol.

What happened to this RustedFox from the past?

 

[RustedFox]

What happened to this RustedFox from the past?

I don't think you understood my post.
Or I don't understand your reply.

the <s/> is used to indicate sarcasm on reddit and other various forums; then I followed it up with "lololololol" to further indicate parody.

Rekt and I see eye-to-eye on a lot of items. I'm not maligning him in the least.

EDIT: If you want me to expound upon this and other related topics, I will. I promise you that what I say won't be popular, as pearl-clutching is common for those who deal with the unpleasantries of human existence by ignoring them and pretending that "its not their problem".

 

[JacobMcCandles]

I don't think you understood my post.
Or I don't understand your reply.

the <s/> is used to indicate sarcasm on reddit and other various forums; then I followed it up with "lololololol" to further indicate parody.

Rekt and I see eye-to-eye on a lot of items. I'm not maligning him in the least.

EDIT: If you want me to expound upon this and other related topics, I will. I promise you that what I say won't be popular, as pearl-clutching is common for those who deal with the unpleasantries of human existence by ignoring them and pretending that "its not their problem".

It seemed like a jab at me from the other thread where I suggested counseling and struck a nerve with some docs suffering from burnout who acted appalled at the sheer suggestion of counseling. I guess sarcastically recommending counseling was coincidence.

 

[RustedFox]

It seemed like a jab at me from the other thread where I suggested counseling and struck a nerve with some docs suffering from burnout who acted appalled at the sheer suggestion of counseling. I guess sarcastically recommending counseling was coincidence.

Oh! That was you who said that?

You must have missed the other post in the other thread also mocking that statement, but adding in the reductio ad absurdum juice that habitual nosepickers were "having difficulty navigating the healthcare system" and labeled the post as "racist, homophobic, whatever". Great post, (I think it was GonnaBeADoc). I sincerely wish I'd have thought of that one. Five-star joke.

You see... it's not "us" that's the problem. It's the fact that we're overrun by the metaphorical habitual nosepickers and then we're told that is US that is the problem.

You must be missing the point (in the very post of mine that you quoted) that yeah, I sought therapy... and it only served to validate that it is humanity... not me... that has lost decency.

 

[JacobMcCandles]

Oh! That was you who said that?

You must have missed the other post in the other thread also mocking that statement, but adding in the reductio ad absurdum juice that nosepickers were "having difficulty navigating the healthcare system" and labeled the post as "racist, homophobic, whatever". Great post, (I think it was GonnaBeADoc). I sincerely wish I'd have thought of that one. Five-star joke.

You must be missing the point (in the very post of mine that you quoted) that yeah, I sought therapy... and it only served to validate that it is humanity... not me... that has lost decency.

But you still got value from the therapy. Got it. Carry on.

 

[RustedFox]

But you still got value from the therapy. Got it. Carry on.

Did I feel better? Yeah.
Did it solve any of the problems ? No.

You're solving the wrong problem.
We burned-out EPs don't "all need therapy".
Society needs to exercise a picocurie of self-sufficiency.

 

[JacobMcCandles]

Did I feel better? Yeah.
Did it solve any of the problems ? No.

You're solving the wrong problem.
We burned-out EPs don't "all need therapy".
Society needs to exercise a picocurie of self-sufficiency.

I never recommended therapy for every one that’s burned out. It’s not necessarily a problem solver but sometimes people just need to feel better, as you discovered.

 

[GonnaBeADoc2222]

Round 2......FIGHT

 

[VA Hopeful Dr]

Seems like a giant waste of resources.

Very possibly. But a trial run to see if it actually decreases calls to EMS/ED visits for overdoses has value. If it does, probably worth expanding and seems like a win for emergency physicians (well, except the ones who gave up a year of earning power for that fellowship)

 

[RustedFox]

I never recommended therapy for every one that’s burned out. It’s not necessarily a problem solver but sometimes people just need to feel better, as you discovered.

Somehow I feel that "not needing to attend therapy/counseling by maintaining a sense of control of your workplace, in which you are the expert" is the bigger win.

 

[emergentmd]

This has become an epic tangential thread

 

[JacobMcCandles]

This has become an epic tangential thread

Every thread is the basically the same these days. If it doesn’t start about burnout, CMGs, future job market, or finding another job then it ends there.

 

[emergentmd]

Every thread is the basically the same these days. If it doesn’t start about burnout, CMGs, future job market, or finding another job then it ends there.

I actually think EM is a great field, job prospects not that bad, work balance great, etc but it just gets beaten down by the "I hate life" crowd.

Go to any get working man together, start complaining to the typical worker how hard you have it making $350K/yr working 14 dys a month. See that goes.

 

[Franzd'Epinay]

Very possibly. But a trial run to see if it actually decreases calls to EMS/ED visits for overdoses has value. If it does, probably worth expanding and seems like a win for emergency physicians (well, except the ones who gave up a year of earning power for that fellowship)

Hearing about it from @southerndoc, it certainly sounds like it could be a good public health outreach program. That being said, I'm skeptical that you need a physician to be the one going out, and I'm 1000% sure you don't need a fellowship for it.

I don't know what's wrong with the academic folks and why they think every one of their passions (no matter how important) needs to be a fellowship.

There's probably some room for a couple of umbrella non-ACGME EM fellowships:

• A public health-type thing where you get experience with public/private grants as well as coordinating with other public health institutions
• A research-type thing where you get experience getting research grants and carrying out research

 

[Franzd'Epinay]

I actually think EM is a great field, job prospects not that bad, work balance great, etc but it just gets beaten down by the "I hate life" crowd.

Go to any get working man together, start complaining to the typical worker how hard you have it making $350K/yr working 14 dys a month. See that goes.

I don't think this is a good standard, though. While you're likely right that the average person believes wealth makes one immune to all problems, you must surely know that's not the case. I'm certain every one of those working men would curse you out for saying they don't have it as bad as someone living in the slums of a third world country.

 

[Rekt]

I actually think EM is a great field, job prospects not that bad, work balance great, etc but it just gets beaten down by the "I hate life" crowd.

Go to any get working man together, start complaining to the typical worker how hard you have it making $350K/yr working 14 dys a month. See that goes.

You're not even EM. You're a business owner. Essentially admin.

 

[RustedFox]

You're not even EM. You're a business owner. Essentially admin.

It's like he forgets that it takes 11 years of training to do this job, only to have everyone else tell you how to do the job.

 

[emergentmd]

It's like he forgets that it takes 11 years of training to do this job, only to have everyone else tell you how to do the job.

Well, its not 11 years. Its an extra 7 yrs, hard to count college when everyone with a decent IQ goes to college.

You're not even EM. You're a business owner. Essentially admin.

I still do EM, see pts. Yes I am a business owner but I don't sit back flogging docs, were all partners. I did EM pit for 15 yrs, if you look at my posts, most are positive on EM.

 

[TexasSurgeon]

bump

 

[The Knife & Gun Club]

Street medicine is different than EMS.

A prime example of street medicine is the administration of buprenorphine in the field. Usually it's done by community paramedics and NPs/PAs. We haven't started a program yet for buprenorphine administration due to lack of follow-up arrangements, but we currently send a team to any overdose call within 72 hours. So if somebody ODs and calls 911 (whether or not they received naloxone), then a team consisting of a police officer, community paramedic, and a mental health specialist (currently we're using social workers) will go to the scene and/or residence of the patient and talk with them about treatment options. We plan to implement buprenorphine soon when we can get outpatient follow-up arranged.

Street medicine would be doing the follow-up at the patient's residence, at a rehab facility, or in the streets for homeless people.

Quite frankly, I do not think there is enough reason to do a fellowship with it. I imagine that it's just to pad a resume or to give a hospital some cheap labor to have a street program. It can easily be done with community paramedics and NPs/PAs.

We’ve got a pretty robust street medicine program at my hospital. We have seen some pretty solid benefit from it actually.

Since the hospital/system is a county system and serves a large indigent population they’re able to have a meaningful decrease in ED utilization and system cost because they’re able to do things like wound checks, dressing changes, med refills, and prescribe/refill chronic meds on patients who would either get their care from the ED or delay care until they’re in extremis. Our street med doesn’t do bupe but can get people into a free clinic for it within a day or two.

None of our docs are fellowship trained and I’d imagine there’d be no utility for doing a fellowship in the field unless you wanted to maybe get a crash course in how one of these systems operates so you could start your own or jumpstart an academic faculty position at a new institution.

The pay is virtually nothing as a physician aside from maybe some small amount of buy down.

There’s very few hospital systems that I believe would find benefit in having a street program - really only large county systems in major cities where a single safety-net soaks up all the indigent care for the city.