Is the grass greener, or just a different shade of brown?

[Zebra Hunter]

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Not anymore. Sepsis 3 guidelines have been out for a couple of months now.
New definition is 2 or more of the following 3 items
-hypotension (SBP < 100)
-AMS (GCS <15)
-Tachypnea (R >= 22)

Severe sepsis no longer exists

Septic shock is now Sepsis +
-persistent hypotension despite fluids requiring pressors
AND
-lactate >= 2

Until CMS changes their sepsis definition, it's like this definition does not even exist.

 

[Arcan57]

Until CMS changes their sepsis definition, it's like this definition does not even exist.

Plus you don't need expensive and time
consuming lab tests so it's never going to make it into the guidelines.

 

[Siggy]

Not anymore. Sepsis 3 guidelines have been out for a couple of months now.
New definition is 2 or more of the following 3 items
-hypotension (SBP < 100)
-AMS (GCS <15)
-Tachypnea (R >= 22)

That's not entirely true. That's the Quick Sequential Organ Failure Assessment (qSOFA). What's actually supposed to be used is the full Sequential Organ Failure Assessment for the diagnosis of sepsis with the qSOFA being a screening tool. Regardless, the most recent guidelines (the Third International Consensus Definition for Sepsis and Septic Shock) have had some debate, including multiple professional societies in the US not accepting them.

 

[gman33]

For the people who have been at the same job for a long time, or have worked enough places for comparison, what are your top 3 things that make for a good job?

I'm in my first job now. Overall, I think it's a good place to work.
I work in a state/area that doesn't pay as well as some other parts of the country.
It's unlikely that I'll ever move to a different location.

It seems like the schedule is one of the biggest factors in long term happiness.
Another thing seems to be minimal meetings about complaints, metrics, etc.
Getting a call or an email on your day off about this kind of stuff really sucks.
I'm still new and neurotic enough to let this stuff bother me.
I still need to learn how to play the game to minimize this stuff.

 

[RustedFox]

In direct response to the above question:

1.) Manageable workload/flow. Specifically, sanity with respect to metrics and their impact upon your reimbursement.
2.) A patient population that you want to serve.
3.) A charting system that is reasonable.

 

[The White Coat Investor]

For the people who have been at the same job for a long time, or have worked enough places for comparison, what are your top 3 things that make for a good job?

I'm in my first job now. Overall, I think it's a good place to work.
I work in a state/area that doesn't pay as well as some other parts of the country.
It's unlikely that I'll ever move to a different location.

It seems like the schedule is one of the biggest factors in long term happiness.
Another thing seems to be minimal meetings about complaints, metrics, etc.
Getting a call or an email on your day off about this kind of stuff really sucks.
I'm still new and neurotic enough to let this stuff bother me.
I still need to learn how to play the game to minimize this stuff.

1. Control over how I work and who I work with
2. Reasonable patient flow. I could see more than the 1.4 I do now and still be happy, but I have zero desire to see 2.5+ an hour.
3. Great partners and fair treatment

Metrics? No. Metrics don't bother me a bit.

 

[Arcan57]

1. Control over how I work and who I work with
2. Reasonable patient flow. I could see more than the 1.4 I do now and still be happy, but I have zero desire to see 2.5+ an hour.
3. Great partners and fair treatment

Metrics? No. Metrics don't bother me a bit.

You do realize that seeing 1.4/hr kinda takes the pressure off of meeting the metrics, right?

 

[bravotwozero]

Thats right. EM is one of the few fields where you can make as much/work as you want or as little as you want without any start up cost, wait time.

I can see some docs working more to compensate if pay goes down, but most would just be happy making 300K/yr.

I am lucky to be in the middle of my career and nothing that happens will bother me but i don't think pay will change much for atleast 10 years.

Check your PM

 

[RustedFox]

For the people who have been at the same job for a long time, or have worked enough places for comparison, what are your top 3 things that make for a good job?

I'm in my first job now. Overall, I think it's a good place to work.
I work in a state/area that doesn't pay as well as some other parts of the country.
It's unlikely that I'll ever move to a different location.

It seems like the schedule is one of the biggest factors in long term happiness.
Another thing seems to be minimal meetings about complaints, metrics, etc.
Getting a call or an email on your day off about this kind of stuff really sucks.
I'm still new and neurotic enough to let this stuff bother me.
I still need to learn how to play the game to minimize this stuff.

Its this precise category of "stuff" that burns us out and makes us "jaded" so early in our career.
It happened to me, turbo-early. Thanks, HCA.

"Hi, I'm a new doc. I really care, a lot. About everything. I'll do my best at ALL times."

"Hi, I'm an administrative pointdexter. I "get woozy" at the sight of a needle, and haven't learned to breathe with my mouth closed yet. They don't teach that in "B-School". Here's a list of how you're not doing your job up to our standards, even though you've never worked harder, been better, or cared so much in your life."

KTHXBYE.

 

[The White Coat Investor]

You do realize that seeing 1.4/hr kinda takes the pressure off of meeting the metrics, right?

If you own your job you get to decide if you want to see 1.5, 2.0, 2.5 etc. Too many patients coming in? Hire some more partners, drop your hourly pay, and have a nice pleasant job. Last month we made $333 an hour. That's higher than usual, but still how much money do you need to fund your lifestyle? If I can make that much seeing 1.4, what's the point of trying to kill myself to see 3.5?

Guess how awesome your door to doctor times and patient satisfaction scores are when you see 1.4 an hour? That's exactly how to have awesome "metrics." It's also the same way you avoid burnout, decrease malpractice risk, maximize charting, and promote longevity. But it all starts with owning your job and having control of your finances.

 

[gman33]

Some of the happiness factors relate to the actual time at work.
Others have to do with the schedule, money, etc.

As you get further along, which matter more?
A lot of that likely depends on your home/family situation.

 

[Arcan57]

Some of the happiness factors relate to the actual time at work.
Others have to do with the schedule, money, etc.

As you get further along, which matter more?
A lot of that likely depends on your home/family situation.

Consistently prioritizing schedule, pay, etc over the actual clinical experience is a fantastic way to worsen burnout. We've all done it for a variety of different reasons, but your life and your relationships are just better when the moment to moment of your clinical work doesn't suck. To paraphrase "Those who would give up a reasonable practice environment for the perfect schedule deserve neither."

 

[Janders]

Have to balance all the factors; location, compensation/hour, schedule, unpleasantness of work environment. Not all have to be perfect, and some make up for others, but if completely un-balenced it won't be a good long-term fit.

 

[VA Hopeful Dr]

Consistently prioritizing schedule, pay, etc over the actual clinical experience is a fantastic way to worsen burnout. We've all done it for a variety of different reasons, but your life and your relationships are just better when the moment to moment of your clinical work doesn't suck. To paraphrase "Those who would give up a reasonable practice environment for the perfect schedule deserve neither."

This x 10000.

I'm not EM, but I don't think this is all that different across most fields. My previous job sounded awesome on paper. 12, 12-hour urgent care shifts/month. Pay half again higher than anything else I'd been offered before. EMR was decent, good nurses. I left after 1 year utterly miserable. Turns out, even a good schedule and good money doesn't make up for seeing 60 patients in that 12 hour shift.

 

[BJJVP]

Consistently prioritizing schedule, pay, etc over the actual clinical experience is a fantastic way to worsen burnout. We've all done it for a variety of different reasons, but your life and your relationships are just better when the moment to moment of your clinical work doesn't suck. To paraphrase "Those who would give up a reasonable practice environment for the perfect schedule deserve neither."

I have almost completely given up on a "reasonable practice environment" in the ED. I will, however, admit that some ED's are definitely less unreasonable.

It is also certainly possible that I am being too much of a control freak or unreasonable in my expectations. However, the rate of burnout for EP's and the recurring themes of SDNs message boards would imply that I am far from alone in my sentiments.

 

[WilcoWorld]

I have almost completely given up on a "reasonable practice environment" in the ED. I will, however, admit that some ED's are definitely less unreasonable.

It is also certainly possible that I am being too much of a control freak or unreasonable in my expectations. However, the rate of burnout for EP's and the recurring themes of SDNs message boards would imply that I am far from alone in my sentiments.

Yep. Every ED I've worked in seems to go through phases. The ones with better administration will make changes to improve the environment, but, invariably, things catch up to the changes and new changes become needed. I've decided that the right place to be (for me) is in an ED where the admins are at least trying to address whatever the current problems are. Nowhere's perfect, but you don't want to be somewhere that's not even trying to improve.

Now, WCI's ED sounds pretty idyllic, but I couldn't get my wife to move to Utah.

 

[Apollyon]

Now, WCI's ED sounds pretty idyllic, but I couldn't get my wife to move to Utah.

My wife would move to Utah (in a second), but I'm an FMG, so I don't think they'd even look at me, much less hire me!

 

[sum dude]

Not anymore. Sepsis 3 guidelines have been out for a couple of months now.
New definition is 2 or more of the following 3 items
-hypotension (SBP < 100)
-AMS (GCS <15)
-Tachypnea (R >= 22)

Severe sepsis no longer exists

Septic shock is now Sepsis +
-persistent hypotension despite fluids requiring pressors
AND
-lactate >= 2

According to CMS, it still is. Which means severe sepsis still exists. SOFA not much better than SIRS, w/ essentially non-stat. difference in sensitivity. With that said, all measures suck.

 

[emergentmd]

If you own your job you get to decide if you want to see 1.5, 2.0, 2.5 etc. Too many patients coming in? Hire some more partners, drop your hourly pay, and have a nice pleasant job. Last month we made $333 an hour. That's higher than usual, but still how much money do you need to fund your lifestyle? If I can make that much seeing 1.4, what's the point of trying to kill myself to see 3.5?

Guess how awesome your door to doctor times and patient satisfaction scores are when you see 1.4 an hour? That's exactly how to have awesome "metrics." It's also the same way you avoid burnout, decrease malpractice risk, maximize charting, and promote longevity. But it all starts with owning your job and having control of your finances.

Oh come one. Your job is the unicorn and not what 99.5% of EM docs have to deal with. I am sure all EM docs would love to work at a job where we see 1.4/hr, make 333/hr, own your own group, etc.... I am sure you work in a small city or where CMGs is not present b/c they would snatch you up in an instant. If you don't think the hospital CEO would not sell your contract if they get some kickback, then your head is in the sand.

But 1.4/hr for 333/hr is many standard of deviation from the norm. My main job runs about 1.9-2.1/hr and get about 220/hr which I find decent but in no way great.

 

[emergentmd]

DP

 

[The White Coat Investor]

We don't average $333, but it sure is fun to have a month like that every now and then. You probably earn $333 in a month every now and then too....they just don't give it to you.

Whether the CEO would or wouldn't sell the contract is irrelevant. The CEO has not yet done it. So I will continue to enjoy the benefits.

People call my job idyllic. They should be aware that I ONLY looked at jobs just as idyllic and found at least 5 of them. Yes, the trend is not good, but it's not nearly as fast as some would make it sound. Treat people well and you can be very picky about the people you take, especially if you have decent pay in a decent location.

A lot of you would balk at joining my practice because the pre-partner pay is lower than average. That's your right, but don't complain later when you're making less and have less control over your job.

 

[Neoplastic]

Sorry to be a noob but I found this thread really interesting and hoped someone could clarify the 2 abbreviations SDG and CMG for non-EM folks

Thank you in advance!

 

[The White Coat Investor]

Small Democratic Group - You own your job
Contract Management Group - "Kitchen schedulers" - i.e. someone makes a killing off other docs while sitting in his kitchen scheduling who will work the shifts.

 

[RustedFox]

Small Democratic Group - You own your job
Contract Management Group - "Kitchen schedulers" - i.e. someone makes a killing off other docs while sitting in his kitchen scheduling who will work the shifts.

He's got it right. Problem is that there are very very few SDGs left in any reasonable place. Don't be one of these MS4's that post on here saying something like; "I'm looking for an indie-demo group in so.cal or Miami - anyone know of any who are hiring?"

 

[goodoldalky]

SDGs are not a panacea. Few exist and of those that do many are some sort of take on glorified profit sharing where the buy in is quite high (may not be worth it in some cases, in others may only be worth it if you are able to stick around and not lose the contract for 10+ yrs) and the decisions are made by only a small group of people.

CMGs a different set of issues.

 

[GeneralVeers]

SDGs are not a panacea. Few exist and of those that do many are some sort of take on glorified profit sharing where the buy in is quite high (may not be worth it in some cases, in others may only be worth it if you are able to stick around and not lose the contract for 10+ yrs) and the decisions are made by only a small group of people.

CMGs a different set of issues.

CMGs aren't all bad. I make more working for a CMG than most SDG docs make. I do work in a s***ty location though that would definitely not be for most people.