Job shortage ? When my ED avg wait time is 6hours …

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6 hour waits used to seem unheard of at most places, but now some are thankful to get to 6 hour waits. Saw a patient the other day who waited 17 hours. I cardioverted his new onset AF and discharged him.
 
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bravotwozero said:
Docs cost money. Money which the CMGs and hospitals are not willing to pay.
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Yeah they don’t even seem to want to pay enough for nurses right now… what part of that 6 hour WR time is the patient sitting around waiting for a doctor to see them, versus the ED/hospital just being jammed up with no throughput…
 
southerndoc said:
I'm trying to figure out what the angle is for this. Is he/she griping for doc shortages or nursing shortages?
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Yea I’m confused. I think the issue right now isn’t a doc shortage, it’s a nursing shortage. Both of the hospitals We cover have entire floors/ED areas currently sitting empty despite 12+ hr wait times. Plenty of docs but no nurses to actually carry out orders, no techs, no transporters, and no unit secretaries.
 
OP, ED wait times are dependent on the most severe bottleneck in the process. For most emergency departments, that's going to be having an available room to see the patient. For many hospitals, especially hospitals in the middle of a respiratory pandemic that are fresh off of feeling the financial bite of canceling surgeries, those ED rooms are going to be perma-occupied by patients waiting for beds upstairs. For those patients that are lucky enough to be going home, their length of stay is going to depend on nurses to administer medications and ancillary services to obtain and result tests/images. It's a rate situation where evaluation/disposition by the EM doc is going to be the rate limiting step, and most of those times are actually going to be an artificial scarcity due to batching. For example, EVS upstairs cleans 5 rooms, nurses all call report at same time, patients all go up at same time, and now you have 5 patients brought back to a room in the space of 8 minutes for the doc to see.

One of the tenets of queue theory is that adding capacity at places that aren't bottle necks actually slows down the process. So dropping in an extra doc has very minimal effect on overall length of stay because now you have two providers vying for the same overloaded x-ray tech and phlebotomist and they're losing some of their capacity explaining to the docs what is causing the delay. Additionally, dropping another doc in due to wait times doesn't generate extra revenue (unless you're using them in triage to bill patients that would have been Left Without Being Seen but instead become elopements). Not only are you sitting around watching the stagnant fetid swamp of boarders take up all your rooms, but now you're battling another doc for the few precious new RVUs that are trickling back.
 
Doesn't matter where the shortage is.
The shortage is the hospital's problem to address.
They could; but they won't - because that would mean less quarterly bonus money for zero-value-added people like administrators and corporate fatcats.
 
I guess it depends on how you're triaged. I remember going to the ER with a nasty stomach flu in college. I called my PCP and since I was in a different state and needed IV fluids, he told me to go to the nearest ER if I didn't feel better by night time. Took me about ~4-5 hours to be seen. Granted, I was probably the least sick in the waiting room. I honestly didn't mind. Eventually was kept over night for observation and was totally understanding that the attending treating me stopped by only twice that night/morning (was a super nice MD, quickly gave me a letter of excusal for an exam I missed that morning and gave me the number to reach him if I still felt ill later that day after being discharged).

Considering the lack of severity of my situation, I understood why I was seen later than most patients who came in after me.
 
Here is the problem that I see.

If we continue to have this pile up problem in the waiting room because of nursing shortage, why do we need so many EM physicians? Less meat is moving.
 
Nevergiveupok said:
I guess it depends on how you're triaged. I remember going to the ER with a nasty stomach flu in college. I called my PCP and since I was in a different state and needed IV fluids, he told me to go to the nearest ER if I didn't feel better by night time. Took me about ~4-5 hours to be seen. Granted, I was probably the least sick in the waiting room. I honestly didn't mind. Eventually was kept over night for observation and was totally understanding that the attending treating me stopped by only twice that night/morning (was a super nice MD, quickly gave me a letter of excusal for an exam I missed that morning and gave me the number to reach him if I still felt ill later that day after being discharged).

Considering the lack of severity of my situation, I understood why I was seen later than most patients who came in after me.
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Guys, guys.... LOOK ! - I FOUND ONE !

A reasonable patient !
 
Let's reclaim the language battle here.

There is no nursing "shortage." Nurses didn't just disappear. Techs didn't just disappear.

There is a shortage of admin will to pay these people a fair wage. You ever see an ED nurse run an assignment of 4 beds, one of which has a crashing intubated patient, the other with a out of control psych/substance abuser who just **** on the floor, the other who is a COVID+ vax denier who is coughing their lungs out and the fourth with family that won't stop asking questions? You think when they see the text for "help needed!" on a monday morning they wanna drive in traffic to be paid $45/hr for that nonsense?!

We literally pay our techs the same rate that McDonald's starts at. I am not joking.
 
Porfirio said:
Here is the problem that I see.

If we continue to have this pile up problem in the waiting room because of nursing shortage, why do we need so many EM physicians? Less meat is moving.
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We ran out of water, why do we need all this food!!??
 
GonnaBeADoc2222 said:
Let's reclaim the language battle here.

There is no nursing "shortage." Nurses didn't just disappear. Techs didn't just disappear.

There is a shortage of admin will to pay these people a fair wage. You ever see an ED nurse run an assignment of 4 beds, one of which has a crashing intubated patient, the other with a out of control psych/substance abuser who just **** on the floor, the other who is a COVID+ vax denier who is coughing their lungs out and the fourth with family that won't stop asking questions? You think when they see the text for "help needed!" on a monday morning they wanna drive in traffic to be paid $45/hr for that nonsense?!

We literally pay our techs the same rate that McDonald's starts at. I am not joking.
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There is a nursing shortage. All those NPs , CRNAs, nurse administrators are coming from somewhere.

The tech shortage is an f’ing self imposed tragedy. Given the disparity in pay, hospital’s should be running patient care teams with 1:1 tech/RN. Instead you have 2 techs for 8 RN’s and anything the tech does instantly becomes a tech only job. So now you’ve got nurses idling while waiting for the overwhelmed tech to do their blood draws, IV starts, transportation, etc. Good techs get sick of the abuse and take off for the first opening in a procedural area that’s not the ED.

FWIW, I can’t remember the last time I worked with a nurse that could stay on top of a 4 room assignment with moderately high acuity. They either leave prior to getting that good or the hospital dumps enough charting requirements that it becomes temporary impossible for them to perform all their documentation and pay attention to patient care.
 
Sure but all those people are still technically registered nurses.

We have more than enough nursing schools and nursing students but they all choose to leave the bedside within a couple years of graduation because of the horrible treatment by hospital administrators. If you think this forum is ridiculously negative sometimes head over to some of the nursing forums where literally every other post is about someone quitting their job or leaving for nurse practitioner school. I know plenty of nurses who left for non bedside jobs that would happily come back if they weren't treated like complete garbage. We often complain about how physicians keep getting screwed by corporate leadership who only care about their profit margins but in reality its everyone including doctors and nurses.
 
hector10 said:
Title says it all.
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You're being told you've got too many docs, when it feels like you're 100 docs short. I could see that feeling very confusing.

I feel like if I was still in the ED, that would be exactly my situation. Oversupply everywhere....just not for me. Because that's how it always felt in the ED. I was always being led to believe that everything should feel one way, when it felt the opposite.


"But you only work this much...."

"But you don't have to take call...."

"But you only triage..."

"But at least you don't have to deal with..."

"But when you're done, you're done..."


Then why does it always feel like I'm constantly getting destroyed?


So, I know how you feel (I think). Hopefully, it will get much better for you.
 
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GonnaBeADoc2222 said:
There is no nursing "shortage." Nurses didn't just disappear. Techs didn't just disappear.

There is a shortage of admin will to pay these people a fair wage. You ever see an ED nurse run an assignment of 4 beds, one of which has a crashing intubated patient, the other with a out of control psych/substance abuser who just **** on the floor, the other who is a COVID+ vax denier who is coughing their lungs out and the fourth with family that won't stop asking questions? You think when they see the text for "help needed!" on a monday morning they wanna drive in traffic to be paid $45/hr for that nonsense?!

We literally pay our techs the same rate that McDonald's starts at. I am not joking.
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One of our campuses is trying a test run of Paramedics at night to free up nurses from waiting room reassessment duties, etc. Problem is the same as why they're losing nurses-money. They make more on the truck on overtime that what the hospital is willing to pay. Plus, the Nursing admin and state EMS board handcuffs half their skills. We're also hiring NP's that left our ER for NP school to do both nursing and provider roles on fast-track patients to expedite discharges from the waiting room. (That's gonna be a interesting experiment)

Last local nursing class of 25 students, only 5 went to work for our system. The rest went to primarily offices. No one wants to work for us, between the wages and administration.
 
The St Luke’s hospital system in my area decided to cannibalize and close down their freestandings so that their nursing/tech staff can work at the mothership. The docs at the freestandings however got totally hosed and are now looking for jobs…
 
The lack of nurses and ancillary staff is the problem. If we were staffed appropriately, there'd be no shortage of doctors. The problem is that I have to pull patients from the waiting room, look for a place to see/examine them, remind the nurse to draw labs, chase down X-rays and CTS, bug the radiologist for reads, pull the patient out of the waiting room again to talk to them at discharge. If I had appropriate bed staffing with nurses/techs, it would eliminate 50% of the no-value-added tasks that I have to perform just to get paid.
 
Depends on what type of hospital you arrive at. If it’s a critical rural access, you’ll probably have two ER nurses and any number of techs and MAs immediately…and a doc within 30 minutes. That’s because they’re shipping all COVID patients to regional hubs.

Of course, they can give you a tetanus shot, stitches and set/cast a break…but going to a rural hospital comes at a great risk if you’re presenting with something like a heart attack or stroke.
 
GeneralVeers said:
The lack of nurses and ancillary staff is the problem. If we were staffed appropriately, there'd be no shortage of doctors. The problem is that I have to pull patients from the waiting room, look for a place to see/examine them, remind the nurse to draw labs, chase down X-rays and CTS, bug the radiologist for reads, pull the patient out of the waiting room again to talk to them at discharge. If I had appropriate bed staffing with nurses/techs, it would eliminate 50% of the no-value-added tasks that I have to perform just to get paid.
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This is exactly the situation in my ED (currently practicing in the PNW). I am effectively the tech, RN, unit secretary, and janit.. "environmental services" personnel. I literally would not be able to move a patient without spending 50% of my time doing non-physician tasks. No task is beneath me, I have no problem changing bedsheets if necessary, but when it's required for nearly every patient, my mind quickly wanders to fellowship and/or going back to residency. This is not sustainable!
 
I meant, there's a demand for patients to bee seen. My ED and 3 others ( in the same city) that I know of went on bypass. We are managing patients as if we are working in the wards. Our waiting rooms are packed overnight. I have an urge to open shop next door.. smh.


edit for grammar.
 
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hector10 said:
I meant, there's a demand for patients to bee seen. My ED and 3 others that I know of went on bypass. We are managing patients as if we are working in the wards. Are waiting rooms are packed overnight. I have an urge to open shop next door.. smh.
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If things continue this way I think the play is to start opening urgent cares across the street from EDs. I’m not joking one bit.
 
This system is soooo Fd.

I worked a low resource pod the other day, there was a PA next to me. I had to run every patient by my attending, and the PA obv didn't. I still managed to see the same number as her...


PGY2.
 
sylvanthus said:
We just closed one of our EDs due to staffing. ‘murica
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Admin: Wait times are increasing, PG scores are down, and %LOWT are high. Please try to be as efficient as possible, see patients asap in the WR and 'cross-pollinate'.

Also admin: We're closing one of our EDs and half the remaining rooms are only going to be open during lunch.
 
Honestly, when in the middle of a pandemic hospitals were cutting hours and reducing pay, too many ER docs were happily willing to accept these terms.

The hospitals and cmgs know exactly what type of people many ER docs are. They will continue to push even worse conditions because they know they will likely get away with it.

The fact that every doc didn't walk off the job when they pulled this crap is very unfortunate.
 
erdoc00 said:
Honestly, when in the middle of a pandemic hospitals were cutting hours and reducing pay, too many ER docs were happily willing to accept these terms.

The hospitals and cmgs know exactly what type of people many ER docs are. They will continue to push even worse conditions because they know they will likely get away with it.

The fact that every doc didn't walk off the job when they pulled this crap is very unfortunate.
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Many docs willing took pay cuts during COVID.

How many healthcare CEOs did?
 
I was thankful working in our FSER before COVID and the crap I have heard makes me 1000x more thankful working in our FSER during covid. I hope the gov notices how important FSERs in Tx are when crap hits the fan.

Came off a 24 hr shift last week, saw 95 pts, multiple positive pts, holding Covid hypoxic pneumonia pts for 40+ hrs with all hospitals in the state closed for Covid transfers. Where would these people go if not for FSERs - yeah stuck in the ER clogging up the systems more. Doing IV Regen like water and likely greatly reducing the hospital admission rates further reducing hospital's burden.

That was a tough 24 hr shift but still got 4 hrs of sleep. Tired as anything on my feet all day. Went home worn out more than any other 12 hr hospital based shift. Brought 2 hrs of charting home which I never do working in the hospital. But when you own something, make your own decisions, reap the fruits of your labor, it is all worth it making 3-4X what I made working in the hospital.

If I worked that hard making $$$ for the hospital systems, I would wonder where my exit will be.
 
emergentmd said:
I was thankful working in our FSER before COVID and the crap I have heard makes me 1000x more thankful working in our FSER during covid. I hope the gov notices how important FSERs in Tx are when crap hits the fan.

Came off a 24 hr shift last week, saw 95 pts, multiple positive pts, holding Covid hypoxic pneumonia pts for 40+ hrs with all hospitals in the state closed for Covid transfers. Where would these people go if not for FSERs - yeah stuck in the ER clogging up the systems more. Doing IV Regen like water and likely greatly reducing the hospital admission rates further reducing hospital's burden.

That was a tough 24 hr shift but still got 4 hrs of sleep. Tired as anything on my feet all day. Went home worn out more than any other 12 hr hospital based shift. Brought 2 hrs of charting home which I never do working in the hospital. But when you own something, make your own decisions, reap the fruits of your labor, it is all worth it making 3-4X what I made working in the hospital.

If I worked that hard making $$$ for the hospital systems, I would wonder where my exit will be.
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You re very fortunate! The rest of us are stuck being virtual slaves. Doctor owned freestanding are illegal in many states.

Glad I have only 70 days left and I'm out.
 
GeneralVeers said:
You re very fortunate! The rest of us are stuck being virtual slaves. Doctor owned freestanding are illegal in many states.

Glad I have only 70 days left and I'm out.
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What what is your exit plan?
 
What states are physician owned free standing ERs legal in?
 
emergentmd said:
What what is your exit plan?
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I see that COVID has broken our system, and it's accelerated a lot of the evil plans that Envision, Teamhealth, and USACS were brewing. I think we are stuck in a COVID morass for years to come. Combined with worse work environment (lobby medicine is here to stay), and decreasing pay it simply isn't worth it.

I have my FIRE, and could live frugally off of investments if I really needed. My plan as has been discussed is to work Telemedicine, and then part time at my Critical Access hospital for 3-4 days a month. I'll do that until they cut the pay, then I'm completely done. At the moment it's $350/hr non-RVU and I get to sleep 1-2 hours every night, so not a bad deal.
 
erdoc00 said:
Honestly, when in the middle of a pandemic hospitals were cutting hours and reducing pay, too many ER docs were happily willing to accept these terms.

The hospitals and cmgs know exactly what type of people many ER docs are. They will continue to push even worse conditions because they know they will likely get away with it.

The fact that every doc didn't walk off the job when they pulled this crap is very unfortunate.
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What can you do when you have a family to take care of and 400k in student loan debt? They know they have us and theres zero chance, as a group, wed do anything.
 
sylvanthus said:
What can you do when you have a family to take care of and 400k in student loan debt? They know they have us and theres zero chance, as a group, wed do anything.
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Find the easiest, full-time employed job at a non-profit and pursue PSLF for loans.
 
nexus73 said:
Find the easiest, full-time employed job at a non-profit and pursue PSLF for loans.
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Then the C suite changes and he hands your contract to Envision, because no one cares about EM docs, when you're on your 7th year of PSLF. Now you have a family and 700k in loans.

rip
 
Rekt said:
Then the C suite changes and he hands your contract to Envision, because no one cares about EM docs, when you're on your 7th year of PSLF. Now you have a family and 700k in loans.

rip
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Your unbridled optimism is insufferable.
 
nexus73 said:
Find the easiest, full-time employed job at a non-profit and pursue PSLF for loans.
Click to expand...
Rekt said:
Then the C suite changes and he hands your contract to Envision, because no one cares about EM docs, when you're on your 7th year of PSLF. Now you have a family and 700k in loans.

rip
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Good calls here. I'd be vary wary of any broad loan repayment program that technically includes doctors. Too vulnerable to the change of political whims / budgetary changes during the many years you need to participate. We are the last group (well, maybe just in front of lawyers) who the public wants to see their tax dollars benefit.
 
namethatsmell said:
Good calls here. I'd be vary wary of any broad loan repayment program that technically includes doctors. Too vulnerable to the change of political whims / budgetary changes during the many years you need to participate. We are the last group (well, maybe just in front of lawyers) who the public wants to see their tax dollars benefit.
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Forget the loan program, you’re just transferring ownership of your soul from a bank to the public.
 
Yeah, when I rotated in the ED a couple of months ago, wait times were like 12 hours but we each saw like 3 patients in an 8 hour shift, many of them in the hallway. Hospital capacity and boarded up rooms were 100% the issue, not lack of MDs.

We actually didn’t have an issue with nursing shortage, but for those places that do why don’t MDs just draw their own blood and vitals at this point? I saw some residents literally clean rooms to get patients seen faster
 
ace_inhibitor111 said:
Yeah, when I rotated in the ED a couple of months ago, wait times were like 12 hours but we each saw like 3 patients in an 8 hour shift, many of them in the hallway. Hospital capacity and boarded up rooms were 100% the issue, not lack of MDs.

We actually didn’t have an issue with nursing shortage, but for those places that do why don’t MDs just draw their own blood and vitals at this point? I saw some residents literally clean rooms to get patients seen faster
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1. I don't get paid to draw blood and vitals. I'll do it if **** is truly hitting the fan but that isn't my job.

2. If I start doing other people's jobs for them (without extra compensation, mind you) then admin won't see the need to hire people to actually do that job.

3. If I end up doing two jobs, I will inevitably be worse at both than if I had only one job.

Unless you're gonna give me the extra $50/hr it costs to hire a nurse, I'm not doing a nurses' job in addition to my already stressful, difficult job.



As an aside, f*ck any institution that tries to force it's residents to clean rooms. We didn't go through 8 years of postsecondary education to be bloody janitors.
 
ace_inhibitor111 said:
We actually didn’t have an issue with nursing shortage, but for those places that do why don’t MDs just draw their own blood and vitals at this point? I saw some residents literally clean rooms to get patients seen faster
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Go rotate at the ED of any public hospital in NYC to get an idea of how well this works.
 
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