interesting article

[lateness]

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good article about future of FPs

http://www.aafp.org/x42562.xml

 

[8744]

good article about future of FPs

http://www.aafp.org/x42562.xml

If the demand were really that high the salaries would be higher. You know, that little thing called "supply and demand."

There may be a shortage of FPs but this is not reflected in the market price.

 

[FamilyMD]

If the demand were really that high the salaries would be higher. You know, that little thing called "supply and demand."

There may be a shortage of FPs but this is not reflected in the market price.

Here comes Mr. Gloom and Doom again. Panda Bear, are you in practice yet, are you even an FP? It just seems on every FP post you are sure to insert your pessimism. If you are out in practice, thank you for your point of view. If you are just a resident or student, then how could you possibly know what you are talking about. If you don't like FP, you know where the door is.
I AM A practicing FP for 7 years now. True, 150k is the lower end for physicians but how many of your patients would kill for 1/2 of that. It just seems greedy to complain about 150k. Having said that, most FP's, myself included, make considerably more than this. I think 150k is true of employed physicians but if you are willing to take risks, (labs, midlevels, sell your own meds) you can be extremely well off-I know b/c I do this. So instead of students and residents just shooting out the mouth, I am someone in real world practice so I actually know what I am talking about.

 

[sophiejane]

If the demand were really that high the salaries would be higher. You know, that little thing called "supply and demand."

There may be a shortage of FPs but this is not reflected in the market price.

http://www.aafp.org/x42562.xml

"While physician compensation was relatively flat in 2004, primary care physicians saw larger gains than specialists for the first time in several years, according to the Medical Group Management Association (MGMA) Physician Compensation and Production Survey: 2005 Report Based on 2004 Data. Primary care physicians' compensation increased 3.13 percent in 2004, while other specialists' compensation increased just 0.18 percent.

Family physicians saw a 2.32 percent increase in median compensation to $156,011; pediatricians saw a 1.47 percent increase to $161,188; and internists saw a 5.36 percent increase to $168,551."

(http://www.allied-physicians.com/salary_surveys/physician-salaries.htm)
These numbers are after 1-2 years, after 3 years, and max

Emergency Medicine $192,000 $216,000 $295,000
FP (with OB) $182,000 $204,000 $241,000
FP (w/o OB) $161,000 $195,000 $239,000
FP - Sports Medicine $ 152,000 $208,000 $363,000
FP - Urgent Care $ 128,000 $198,000 $299,000

I think I can live on that. Check out the difference between FP urgent care and EM after a couple of years of practice. The max for urgent care is actually higher according to this source.

There are FPs making >$500K because the are smart and go learn new procedures, buy equipment for inhouse endoscopy, bone scans, laser hair removal, etc. These are services people pay for and they pay well. The lowest end of the salary curve in primary care are people who haven't bothered to pay attention to the bottom line and how they can improve it.

The people who choose family choose it because they love it and can't see themselves doing anything else. They know they will make less than some docs and that's really okay.

We have to make these decisions as 3rd and 4th year medical students. All you can do is go with your heart. There will always be people like you, Panda Bear, who are dissatisfied with their choice. Fine. Do something else. But honestly, you aren't saying anything new, or anything that all of us haven't already put a lot of thought into.

 

[deleted87716]

Panda Bear, are you in practice yet, are you even an FP? It just seems on every FP post you are sure to insert your pessimism.

If memory serves, Panda Bear is an FP intern at Duke who is switching to Emergency Medicine.

 

[deleted87716]

There may be a shortage of FPs but this is not reflected in the market price.

There really isn't a "market price" for FPs, because physicians do not operate in a free market economy. Prices for medical services are set by the government and insurance companies. The law of supply and demand does not factor into this. Some would like to see that change.

 

[FamilyMD]

If memory serves, Panda Bear is an FP intern at Duke who is switching to Emergency Medicine.

Well good riddance! Hope you enjoy the absolute #1 burn out specialty. Thought I read somewhere the average job span of an ER doc was 10 yrs. Enjoy all the lawsuits, drug seekers, absolute scum of the earth patients none of us would touch. Then come back and post about how wonderful your new specialty is.

 

[Sainttpk]

Well good riddance! Hope you enjoy the absolute #1 burn out specialty. Thought I read somewhere the average job span of an ER doc was 10 yrs. Enjoy all the lawsuits, drug seekers, absolute scum of the earth patients none of us would touch. Then come back and post about how wonderful your new specialty is.

What about EM burns people out so quickly? Is it the fact that EM docs are put in stressful life and death situations that require quick decision making so often?

I personally do not think I could handle EM because I get really nervous in stressful situations where I am put on the spot. I am guessing that EM is not for me. Even though I am not a doc yet, I would think that FM is more easy going and relaxed.

 

[deleted87716]

What about EM burns people out so quickly?

Shift work, violence in the ER, infectious disease exposure risks, malpractice litigation, etc. The bottom line as far as burnout is concerned isn't necessarily the stressors themselves, but how the individual manages his/her stress. You can burn out in FM, too...but it's a lot less common.

 

[iatrosB]

Well good riddance! Hope you enjoy the absolute #1 burn out specialty. Thought I read somewhere the average job span of an ER doc was 10 yrs. Enjoy all the lawsuits, drug seekers, absolute scum of the earth patients none of us would touch. Then come back and post about how wonderful your new specialty is.

I hope these remarks are made in jest. Otherwise, I hate to see specialty bashing going on. Different specialties fit different personalities. I am sure your comments were made in jest and if so

 

[mmmmdonuts]

What about EM burns people out so quickly? Is it the fact that EM docs are put in stressful life and death situations that require quick decision making so often?

they arent put in stressful situations. they make lots of phone calls. i dunno why they burn out but probably half of it is because everyone rips on how little thought they put into thier work

 

[deleted6669]

they arent put in stressful situations. they make lots of phone calls. i dunno why they burn out but probably half of it is because everyone rips on how little thought they put into thier work

yeah, having 3-4 crashing pts at the same time while you are a solo provider is a piece of cake. in fact coffee breaks during codes are common and expected.....and figuring out which 85 yr old with vague neuro symptoms doesn't need to be admitted is a piece of cake too ( while running the aforementioned 3-4 crashing pts)
what an idiot......

 

[mmmmdonuts]

yeah, having 3-4 crashing pts at the same time while you are a solo provider is a piece of cake.

em ppl often talk liek that. they paint this picture where its like theyre ona deserted island and six guys just came in with gunshots to the head, someone is having an mi, and a train crashed nearby. the reality is they immediately call surgery, neurosurg, cardiology, im, and pretty much anyone else who will listen. televsion is nice but real life is a little different, dude.

if someone wanted to test out how great em ppl were just have one day where they werent allowed to make phone calls. i suppose nothing would change right?

 

[deleted6669]

"em ppl often talk liek that. they paint this picture where its like theyre ona deserted island and six guys just came in with gunshots to the head, someone is having an mi, and a train crashed nearby. the reality is they immediately call surgery, neurosurg, cardiology, im, and pretty much anyone else who will listen. televsion is nice but real life is a little different, dude."

THEN ALL THE CONSULTANTS WAIT 40 MIN TO CALL YOU BACK AND SAY THEY WILL BE IN 45 MIN FROM NOW AND GUESS WHAT? YOU STILL MANAGE THE CRASHING PTS BY YOURSELF UNTIL THEY SHOW...AND WHEN THEY DO YOU BETTER HAVE THEM FULLY WORKED UP(ALL OF THEM).......
dude, I have worked in em for 19 years...this doesn't happen every day but often enough to be stressful.......remind me again, are you an ms3 or an ms4......

 

[mmmmdonuts]

THEN ALL THE CONSULTANTS WAIT 40 MIN TO CALL YOU BACK AND SAY THEY WILL BE IN 45 MIN FROM NOW AND GUESS WHAT? YOU STILL MANAGE THE CRASHING PTS BY YOURSELF UNTIL THEY SHOW...AND WHEN THEY DO YOU BETTER HAVE THEM FULLY WORKED UP(ALL OF THEM).......
dude, I have worked in em for 19 years...this doesn't happen every day but often enough to be stressful.......remind me again, are you an ms3 or an ms4......

wow yu talk big. im glad all the er patients are all fully worked up and all everyone has to do is walk down there and smile. like i said, you need to stop watching reruns of 'er' lets ask everyone how many crashing patients are sitting around in their er?

 

[deleted6669]

wow yu talk big. im glad all the er patients are all fully worked up and all everyone has to do is walk down there and smile. like i said, you need to stop watching reruns of 'er' lets ask everyone how many crashing patients are sitting around in their er?

SO THAT WOULD BE MS 3 THEN...
EVER HEARD OF "NO AVAILABLE INPT BEDS....."
WE BOARD ICU TYPE PTS IN THE ER ALL THE TIME AND THE INTERNIST WON'T SEE THEM UNTIL THEY GO TO THE FLOOR....GUESS WHO MANAGES THEIR DRIPS, ETC FOR 8 HRS UNTIL A BED IS AVAILABLE.....GUESS WHO STARTS THEIR CENTRAL LINE IN HALLWAY BED 6?
I WORK IN A 100K+ ER PTS/YR FACILITY....WHERE HAVE YOU DONE YOUR 1ST FEW MS 3 ROTATIONS.....

 

[mmmmdonuts]

SO THAT WOULD BE MS 3 THEN...
EVER HEARD OF "NO AVAILABLE INPT BEDS....."
WE BOARD ICU TYPE PTS IN THE ER ALL THE TIME AND THE INTERNIST WON'T SEE THEM UNTIL THEY GO TO THE FLOOR....GUESS WHO MANAGES THEIR DRIPS, ETC FOR 8 HRS UNTIL A BED IS AVAILABLE.....GUESS WHO STARTS THEIR CENTRAL LINE IN HALLWAY BED 6?
I WORK IN A 100K+ ER PTS/YR FACILITY....WHERE HAVE YOU DONE YOUR 1ST FEW MS 3 ROTATIONS.....

wow no available inpt beds. thats like the er version of a code, right? then they all look at thir algorithms and say oh this is where we go on divert. problem solved! by the way you dont really manage drips if you ask other ppl which drips to put patients on and how to titrate them. just so you know

 

[deleted6669]

wow no available inpt beds. thats like the er version of a code, right? then they all look at thir algorithms and say oh this is where we go on divert. problem solved! by the way you dont really manage drips if you ask other ppl which drips to put patients on and how to titrate them. just so you know

hello... divert only applies to ambulances...people still walk in and are brought in by their families......with aaa's, mi's, gsw's, screwdrivers stuck in the neck, ruptured ectopics, etc.....
and guess who teaches all the internists how to run codes...oh yeah, the er docs...ever seen an internist run a code...what a cluster...."call anesthesia, call a pharmacist, call the er doc to come and start a central line....where my pocket guide to acls?"
you still haven't answered my question about your level of training.....ms1...ms2....premed?

 

[iatrosB]

What the hell happened to this thread. EMEDPA, leave doughnut alone. We all respect you here, know EM works hard, and value your input. I say leave the troll alone and attempt to get this thread back on topic.

 

[mmmmdonuts]

hello... divert only applies to ambulances...people still walk in and are brought in by their families......with aaa's, mi's, gsw's, screwdrivers stuck in the neck, ruptured ectopics, etc.....
and guess who teaches all the internists how to run codes...oh yeah, the er docs...ever seen an internist run a code...what a cluster...."call anesthesia, call a pharmacist, call the er doc to come and start a central line....where my pocket guide to acls?"
you still haven't answered my question about your level of training.....ms1...ms2....premed?

see how its like ' yeah were on divert and yet there are still about sixteen people coming in with aaa's, mi's, gsw's, screwdrivers in the neck, zzz, and then the second minute of my shift occurs. by the way has anyone ever seen or heard anyone consult an er doc to start a central line? anyone? was that before or after the er doc did a stat endovascular repair and then broke up with that chick in season 2?

 

[mmmmdonuts]

leave the troll alone

out of curiosity did yu notice how nasty emedpa got towards internists? kinda shows you what he/she really thinks about them but thats not trolling right? 🙄

 

[iatrosB]

out of curiosity did yu notice how nasty emedpa got towards internists? kinda shows you what he/she really thinks about them but thats not trolling right? 🙄

I think you just fired him/her up. I'm sure he/she respects internists as much as I do.

 

[mmmmdonuts]

I think you just fired him/her up. I'm sure he/she respects internists as much as I do.

oh so when i make a remark about em docs thats trolling. but when he/she makes a remark about im docs thats just me firing him/her up. that souds very fair.

 

[iatrosB]

good article about future of FPs

http://www.aafp.org/x42562.xml

 

[mmmmdonuts]

 

[iatrosB]

 

[mmmmdonuts]

 

[deleted6669]

good article about future of FPs

http://www.aafp.org/x42562.xml

very interesting.....I see an ever expanding role for fp docs as hospitalists, solo docs and as part of multispecialty practices.the increasing #s of outpt procedures done by fp at this point(sigs, treadmills, vasectomies, derm procedures, etc ) can make this quite a rewarding career for someone willing to take full advantage of their training.
I have only the utmost respect for fp folks and would probably go that route at this point if I went back to school.

 

[mmmmdonuts]

see once he gets his composure back its back to how everyone respects everyone else. group hug, right

 

[Misterioso]

http://www.qfever.com/issues/20020206/erdocs.html

 

[mmmmdonuts]

get a load of that complex decision tree

dont worry once his shift is over hes out the door too. funny stuff. i like the one about his daughter.

 

[8744]

There really isn't a "market price" for FPs, because physicians do not operate in a free market economy. Prices for medical services are set by the government and insurance companies. The law of supply and demand does not factor into this. Some would like to see that change.

By change you mean a system where you can charge whatever you want with no restraint from the the market.

Sorry.

No profession including medicine is immune from market forces. Insurance companies and the government do not "set" the price, rather they "bid" for medical services. If they set the price then they would set it at at zero or next to nothing because this makes the most sense for them economically.

Of course, if they bid too low then they will have no takers. Consequently between you, me, and the invisible hand of the market we have all arrived at a price for medical services which is exactly what those services are worth.

By what they're worth I mean what someone (the government or the insurance company) is willing to pay and what you are willing to accept. You do not have to do business with either the government or the insurance companies if you don't want to. Some physicians operate on a strict "cash only" basis and I understand they do very well. Most physicans make the rational decision that what they lose in price per piece they will make up somewhat in volume and bite the proverbial bullet.

Biting the bullet is part of market economics. I think some of you are confused and think that the market doesn't work because it is constantly trying to minimize your salary. Actually, my friends, this how it's supposed to work.

By the same token nobody is going to operate for long at a loss so even though an insurance company or the government can screw you by bidding down the price of medical services, eventually a point will be reached where no one but the zealots will work (for the Glory of the Motherland, naturally).

In socialist or communist countries where the low price is fixed arbitrarily the market responds by creating scarcity as there is no longer an incentive (except at gunpoint) for anyone (except the zealots once again) to produce. This is why health care is more-or-less rationed in the UK and Canadians who can afford it flock across the border from their socialist utopia to purchase health care.

When you read that hospitals are hot for Family Practice physicians your natural question would be "how hot?" In other words, are they putting their money where their mouths are? Well, 150K is certainly a decent salary. And I don't believe that anybody said that Fmaily Physicians will be flocking to the unemployment office. On the other hand what hospitals want is to maximize their profit.

The assertion that primary care is a big money-maker for a hospital is laughable and typical Duke style Family Medicine propaganda. What the hospital wants is a primary care physician who can send them as many customers as possible. They are not interested in how well you are controlling Mr. Jone's cholesterol or that you have delivered every one of Mrs. Smith's children.

Although I would never accuse any hospital adminstrator of wishing for this, for his bottom line it would be better if there was no primary care as keeping someone out of the hospital also shuts down his revenue stream.

The hospital will get their gate-keeper for the lowest possible price that they can factoring in costs of doing business such as legal liability and competition from other hospitals with better customer service. Currently the FP is the cheapest option for the hospital which explains both the demand and the relative inelasticity of the bid price.

When NP and PAs start admitting patients then the bid price is going to go down to a new level, in this case to what a PA or an NP with a third of the human capital invested as you and none of the debt will take.

Economics is not rocket science.

 

[8744]

Well good riddance! Hope you enjoy the absolute #1 burn out specialty. Thought I read somewhere the average job span of an ER doc was 10 yrs. Enjoy all the lawsuits, drug seekers, absolute scum of the earth patients none of us would touch. Then come back and post about how wonderful your new specialty is.

The reports of "burnout" are greatly exaggerated. There is nothing particularly stressful about Emergency Medicine compared to other specialties. The hours are certainly better (both in residency and practice) and you can currently work in as busy or as buccolic an Emergency Department as you wish.

Trauma and critcial care are only stressful to the extent that you don't know how to handle them. As an intern my stress level was pretty high on the few codes that I have had to run (before the code team arrived, naturally) but with experience these things become routine and I have rarely seen one of my EM attendings being anything but unflappable in the direst of medical emergencies.

 

[8744]

...drug seekers, absolute scum of the earth patients none of us would touch...

I know you don't mean this. At Duke Family Medicine if you even breathed this sentiment you would be sent to sensitivity training.

I happen to like the scum of the earth and have a pretty good rapport with most of 'em. I certainly prefer a drunk crack-head who cut his hand slapping one of his biaches to some sixty-year-old professor's wife with "fibromyalgia," a thirty year addiction to percocet, and the expectation that I want to spend thirty minutes listening to her non-medical problems.

I also want to point out that matching into EM is by no means a sure thing. I think my odds are better than fifty-fifty but I'd hesitate to say how much better. The match is not kind to retreads.

 

[8744]

em ppl often talk liek that. they paint this picture where its like theyre ona deserted island and six guys just came in with gunshots to the head, someone is having an mi, and a train crashed nearby. the reality is they immediately call surgery, neurosurg, cardiology, im, and pretty much anyone else who will listen. televsion is nice but real life is a little different, dude.

Well no, not really. Only one percent of all hospital visits take place at an academic medical center. At a typical community ED the nearest specialist is at home in bed and nowhere near being readily available.

And it is not even true that every EM residency program is at a big academic hospital. Several where I interviewed had a definite "cowboy" feel to them.

 

[deleted87716]

Economics is not rocket science.

It's a lot more complicated than you're making it out to be, though.

 

[deleted87716]

By change you mean a system where you can charge whatever you want with no restraint from the the market.

No, I didn't say that. If you just want to argue against a straw man, there's little point in my continuing to participate in the discussion.

 

[mmmmdonuts]

Only one percent of all hospital visits take place at an academic medical center.

ok lets assume thats true. then you can also say that 0% of traumas are going to most hospitals since many are not accredited trauma centers. people with aaas will either go to places where they can have vascular intervention or basically die when they rupture and em docs arent saving them. people with mis are getting treatments with thrombolytics if theres no cardiologist and ct surgeon on site. and so on. so you tell me how many crashing patients you can truthfully say that em docs are juggling as portrayed by empadoc.

 

[8744]

ok lets assume thats true. then you can also say that 0% of traumas are going to most hospitals since many are not accredited trauma centers. people with aaas will either go to places where they can have vascular intervention or basically die when they rupture and em docs arent saving them. people with mis are getting treatments with thrombolytics if theres no cardiologist and ct surgeon on site. and so on. so you tell me how many crashing patients you can truthfully say that em docs are juggling as portrayed by empadoc.

Not at all. There is no such thing as an "accredited Trauma center." Any ED which is staffed by a physician who is presumably qualified for the job can expect to recieve trauma (and critically ill) patients.

My hometown in Louisiana of about 25,000 has a fairly large Parish (what you call County) hospital which is essentially deserted of physicians at night except for the ED staff. Since the nearest level one trauma center is about ninety miles away they get plenty of trauma through their doors, albiet MVA blunt trauma and farm accidents rather than the usual urban knife and gun club stuff.

It is also true that they life-flight many patients to the regional trauma center but they stabilize the patient first which is kind of the job description of Emergency Medicine.

As to how many trauma patients the on-duty EM physician in Ruston, Louisana juggles I can't say. He may go a few nights with no serious trauma or he may have four or five from the same motor vehicle accident. The ambulance service in our parish does not routinely make the ninety mile drive to Shreveport.

An EM physician is perfectly qualified to administer thrombolytics if they are indicated and there are no absolute contraindications. Certainly this is a judgement call but I would note that even the cardiologists here at Duke, one of the World's cardiology powerhouses, are extremely cautious with thrombolytics and in a month of cardiology I never had a patient on whom they had been used even if there use would have been indicated.

 

[sophiejane]

...another decent discussion turned into an SDN boys club pi$%ing contest...

Maybe I should go hang out with the cool chicks on OBGYN again....

 

[mmmmdonuts]

Not at all. There is no such thing as an "accredited Trauma center."

really? the american college of surgeons and the hospitals designated as level 1-4 in america disagree.

An EM physician is perfectly qualified to administer thrombolytics if they are indicated and there are no absolute contraindications.

its not hard to administer (give) thrombolytics. its the 'if they are indicated and no contraindications' part that throws the ed. or are you saying that at duke they dont consult cardiology?

 

[8744]

really? the american college of surgeons and the hospitals designated as level 1-4 in america disagree.



its not hard to administer (give) thrombolytics. its the 'if they are indicated and no contraindications' part that throws the ed. or are you saying that at duke they dont consult cardiology?

Designation as a particular level is not the same as being "accredited." The level indicates the availibilty of sub-specialty support and things like an ICU. Even a Level IV trauma center, presumably the base level ED, has the facilities to evaluate, stabilize, and transport all sorts of trauma. You don't have to be at the Mayo Clinic to do the "ABCDs," cardiovert, start a central line, push fluids, do a tracheostomy, intubate, put in a chest tube, or any number of invasive and dangerous procedures.

"Accredited" is a meaningless term.

As to thrombolytics, I'm talking about spending a month on the Duke cardiology service and just pointing out that it's not just ED physicians who are reluctant to administer thrombolytics.

 

[mmmmdonuts]

Designation as a particular level is not the same as being "accredited."

actually it is since you have to demonstrate/prove that you have the facilities and services to qualify for a designation as a level x trauma center. you dont just say 'i am one', which means you are being accredited either by the acs or the state.

just how many major traumas do you know of that are being handled by ed docs?

As to thrombolytics, I'm talking about spending a month on the Duke cardiology service and just pointing out that it's not just ED physicians who are reluctant to administer thrombolytics.

i didnt say people administered them without caution and for good reason. but how many people requiring thrombolytics are being treated by ed docs without consultation to cardiology? at duke or anywhere else?

 

[8744]

actually it is since you have to demonstrate/prove that you have the facilities and services to qualify for a designation as a level x trauma center. you dont just say 'i am one', which means you are being accredited either by the acs or the state.

just how many major traumas do you know of that are being handled by ed docs?



i didnt say people administered them without caution and for good reason. but how many people requiring thrombolytics are being treated by ed docs without consultation to cardiology? at duke or anywhere else?

But that's the point. Risk aversion is not unique to any specialty. At the same time I do know personally one of the physicians who worked at our parish hospital's ED (a moonlighting internist) and he has administered thrombolytics. And your point is well taken about consultations because he told me that he did call LSU Shreveport to talk to a cardiologist before he pushed them on several occasions.

If you want to talk about the most risk averse specialty it would have to be FP, at least at my program, because we punt everything that is remotely complicated.

At Baton Rouge, the program where I hope to match, he EM residents manage all the traumas as there is no in-house anything except for medicine and OB-Gyn. At some of the other programs where I interviewed the EM residents alternate days with the surgery residents. I was told that since the EM residents rotate on the trauma service, the trauma resident is often-times an EM resident.

If you are working in the ED at a small community hospital then you are going to run the trauma by default as there is no one else.

I think we can agree that the majority of cases seen in most EDs are not trauma but acute medical problems which range from the serious to the silly. Still, to say that EM physicians don't manage traumas would be a stretch.

I don't know what you mean by a major trauma. A gunshot wound is pretty major to some people but jsut another day at the office to others.

 

[mmmmdonuts]

Risk aversion is not unique to any specialty.

thats true but theres a difference. with other specialties you weigh the risk and then you do something or not. with the ed its more like you call someone else to have them take the risk for you. true or false ed docs call other specialities to clear patients to leave? if an ed doc did what they say they do then id have respect but its silly to say they 'handle crashing patients' when theyre more like third-party players in the entire situation. if the ed wants more respect then they need to take more responsibility for their patients but its more like they want it both ways on everything. they excuse their superficial 'work-up' by saying their job is not to diagnose on one hand then they brag about how they 'did everything' for the admitting team. which is it? they say that one of the pluses of the field is that it allows you a great lifestyle but then they get offended when you comment on their shiftwork. which is it?

 

[8744]

thats true but theres a difference. with other specialties you weigh the risk and then you do something or not. with the ed its more like you call someone else to have them take the risk for you. true or false ed docs call other specialities to clear patients to leave? if an ed doc did what they say they do then id have respect but its silly to say they 'handle crashing patients' when theyre more like third-party players in the entire situation. if the ed wants more respect then they need to take more responsibility for their patients but its more like they want it both ways on everything. they excuse their superficial 'work-up' by saying their job is not to diagnose on one hand then they brag about how they 'did everything' for the admitting team. which is it? they say that one of the pluses of the field is that it allows you a great lifestyle but then they get offended when you comment on their shiftwork. which is it?

Well, I love shift work and absolutely despise call, probably more than most people despise it which is saying a lot. It is my fondest hope to never have to take call again (well, after repeating intern year next year if all goes well).

I think overnight call is stupid. Yeah. Yeah. I know. You learn a lot by admitting patients but I think a night float system would be just as effective for this and lets everybody get a good night's (or day's) sleep.

I did serve for eight years in the Marines as an infantryman, doing the military equivalent of "hard time." I have paid some dues in life, enough to know that there is no reward for getting screwed out of sleep and time off.

I have worked on several codes in the ED with EM residents so I can say with authority that they were managing a crashing patient.

 

[8744]

It's a lot more complicated than you're making it out to be, though.

Sure it is. But SDN is a hobby, not a career and I don't have the time or the inclination to write a treatise on economics.

The fundamentals of economics aren't really that hard ot grasp. It's just that people can't get past their emotional reaction to what they view as the unfairness of the market.

 

[mmmmdonuts]

Well, I love shift work and absolutely despise call

who likes call? but other specialties do it. the er can decide not to have any because there is little to no commitment to patient care. at the end of their shift they just sign out. and thats because really there are other physicians who are taking care of the patient even if they are physically in the er in many cases. all you need to do as an er doc is to make sure you actually know who is taking care of that patient, in other words youre like a nurse.

I have worked on several codes in the ED with EM residents so I can say with authority that they were managing a crashing patient.

not really. they may have been initiating a code on a patient but i can guarantee 100% that another group of physicians managed the patient. they either took over after a mnute of the code or at the very least they took the patient at the end of the code, but actually ive never seen an ed doc complete an entire code in isolation. have you? and to say that coding a patient consists of 'managing' them is false. if you say that you 'manage' a gsw to the head, as ed docs and empadoc say, thats fairly different from starting a code as you call the trauma team and neurosurgery. dont get me wrong im not saying that the ed should be managing a gsw to the head, but neither should they be pretending they do. they dont. thats just plain and simple. do they manage mis? no cardiology does. do they manage broken bones? no ortho does. what does the er really manage? theyre triage nurses. tell the trueth, how quickly is another physician called by the er on any patient? and dont say there are patients who are down in the ed for 16 hours without a consult because then usually the consultant comes down and sees that nothing has been done for the patient and they have just been sitting around for 16 hours. i mean how much is actually done by er docs other than drawing up the same labs on every patient and maybe throw in an imaging study at random?

 

[deleted87716]

The fundamentals of economics aren't really that hard ot grasp. It's just that people can't get past their emotional reaction to what they view as the unfairness of the market.

My original post stated that healthcare does not operate in a free market economy. You said a lot of things in your reply, but nothing was really germain to what I originally wrote. The free market is defined as "business governed by the laws of supply and demand, not restrained by government interference, regulation or subsidy." With rare exceptions (e.g., a doctor who only accepts cash), medicine in the U.S. operates almost exclusively under the umbrella of regulation. The free market law of supply and demand is not a factor.

 

[deleted87716]

Insurance companies and the government do not "set" the price, rather they "bid" for medical services. If they set the price then they would set it at at zero or next to nothing because this makes the most sense for them economically.

Private insurers set their fee schedules according to Medicare. Medicare rates are determined using a formula based on the gross national product (GNP), not the actual costs of providing healthcare. Again, not a free market.

The insurance industry itself operates in something more akin to a free market, with insurers negotiating rates with employers based on market forces in their particular geographic area. However, these rates have little bearing on the fee schedules that are offered to physicians. Insurers typically use fee schedules to grow their network of providers as they see fit. With rare exceptions, physicians have little leverage when negotiating fee schedules. The "negotiations" usually amount to little more than "Here's what we pay, take it or leave it." In many locales, one or two carriers now insure the majority of covered lives. If you choose not to accept those plans, you lose access to a significant chunk of your patient population. Again, not a free market from the physicians' standpoint.