Is it common for surgeons to rip EM docs where you are?

[dpmd]

Our hospital enacted a policy that choledocho gets admitted to surgery upfront (unless they have some other medical issue that takes precedence). Rationale being that (a) it's ultimately a surgical problem and needs operation prior to discharge and (b) if the surgeons are running the show there is usually less d**king around with unnecessary studies like HIDAs and MRs.

There is a study out there somewhere that they based this on - that study was able to show decreased LOS and decreased costs if the patients are admitted to surgery.

I don't doubt that, but here the only difference it would make is I would be arguing with GI more often or continue to let them demand the unnecessary studies because they are the drivers of it not the hospitalists.

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[dpmd]

Well yeah, that's how it works. We are more willing to say no to the GI docs than the hospitalist. And when they are on our service we are more apt to keep the ball moving

Eh, not interested in that headache. If the hospital doesn't like the length of stay they can argue with GI and I will see other consults that are ready for me. If I had minions to do all the work for me it would be different.

 

[ThoracicGuy]

Residents or attendings? Every time the ED calls a resident they get more work without any extra compensation...

It is generally much different in the community, as was mentioned already. Also the culture in many academic institutions is biased towards no miss, consult heavily which may lead to some weaker consults.

I think this pretty much nails it. I really loathed getting ER calls when I did general surgery residency. Half the time the calls were something that was only partially worked up or not even worked up. What's the CBC? Oh, you want that? What's the CT show? Oh, you want that? Then there were the consults to just "lay the hands" on some patient that in a community setting would have had GI evaluating the patient first for abdominal pain. They weren't in house like we were, so they didn't often get called about things.

Now as an attending in a community hospital, I generally love my ER guys. Sure I still get some marginal consults, but that's RVUs for me even if I don't need to operate. Rarely do I need to come in at night. Chest tubes? They'll put them in for us. It's a total different mentality now.