Leave the USA??

[GonnaBeADoc2222]

For a lot of reasons - the state of EM and American medicine as a whole, sociologic changes, economic/tax burdens - the US is losing its appeal to me as a place to live long term. I don't see huge benefit to continued exposure to the environment of EM, while paying huge marginal dollars into a tax system that largely does not benefit me. I don't think the US holds the same position in the world as it did ~50 yrs ago, and I foresee continued erosion of western society.

Now, realistically, there are financial and familial barriers to my leaving. I am mid-30s, with mid 500K net worth, no student loans, no properties tying me down currently. I think I could increase this net worth to around 1.5-2 mil over the next ten years? Then there's the question of how to fund my life while I am wherever I am (thinking maybe south america or SE Asia). Some mix of working in my new country and returning to the US for 1-2 months / yr and pounding out shifts might be feasible, but who knows with the projected evolution of the EM landscape.

The major barrier currently is that I have a baby daughter in the US. I am divorced from her mother. Would probably need to wait until she is off to college before making this move (another 15 years ish). Complete collapse of the EM landscape may accelerate the move, but right now it's better to sit tight, continue to make hay while I can, and be with my daughter.

Has anyone thought about this, done this, know someone who has? Would be interested in hearing some experiences/thoughts.

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[bravotwozero]

There are great opportunities to make low tax money in EM, particularly in the Middle East/emirates. I say low tax, because although those countries don’t levy income taxes, the US government, unlike Canada, will still tax the income of its citizens abroad, which I do think is unfair as they are not utilizing any US tax payer funded services while living there. The first $103k of your income is tax free (married filing jointly). They will pay for housing, give you a car, pay for travel, even pay for your kids to go to private schools. The US/UK expats have established their own schools in the region.

I have thought about it and even discussed the idea with my wife, but due to our kids and family ties in North America, we don’t see that as feasible.

 

[GeneralVeers]

To the OP

I've travelled extensively around the world, and typically go to Dubai several times a year. Your exit from the U.S. would depend on if you still want to practice clinically or not. Right now there are only two regions in the world where it's financially worth it to practice EM:

Middle East - Salary of 300-400K USD. As has been stated no taxes on the first 103K of income. Companies usually pay a housing stipend, medical/dental, as well as schooling for the children in private schools. Can negotiate other perks like a car as well. Right now only Abu Dhabi/Dubai and Oman are realistic as they offer most Western amenities without draconian laws against Westerners. You can still go to a nightclub, drink and party in the places. Would avoid Saudi given it's 11th century attitudes and general intolerance of modernity. The downside to Dubai is that it's unbearably hot between June and September to the point you can't go outside. Think Las Vegas/Phoenix temperatures but with 80% humidity. Religious Holidays like Ramadan also impose extra restrictions and you need to understand when these are. Mosts expat leave the country if they can during Ramadan. Being the hub for Emirates means you are an 8-hour flight to 2/3 of the world's destinations on the best airline in the world.

Australia - Salary of 300-450 AUD. I'd definitely move here long term if things in the U.S. continue to decay. Downside is much higher taxes (currently about 10% higher than U.S. at our salary level) and high cost of living in the big cities. Jobs are definitely available near Sydney, Brisbane, and Melbourne. There's a better overall quality of life than pretty much anywhere in the world, especially for outdoor activities. Unfortunately most jobs require 6 years or more of experience to come in as "Consultant" level or higher to earn the top salaries. Doctors are still respected here, and patients are generally more intelligent and respectful.

You mentioned South America. Brazil/Argentina/Chile are all great if you have decent nest egg. If you work clinically you are essentially volunteering your time. Great if you want to semi-retire and just do outdoors stuff or live near the beach.

 

[GonnaBeADoc2222]

To the OP

I've travelled extensively around the world, and typically go to Dubai several times a year. Your exit from the U.S. would depend on if you still want to practice clinically or not. Right now there are only two regions in the world where it's financially worth it to practice EM:

Middle East - Salary of 300-400K USD. As has been stated no taxes on the first 103K of income. Companies usually pay a housing stipend, medical/dental, as well as schooling for the children in private schools. Can negotiate other perks like a car as well. Right now only Abu Dhabi/Dubai and Oman are realistic as they offer most Western amenities without draconian laws against Westerners. You can still go to a nightclub, drink and party in the places. Would avoid Saudi given it's 11th century attitudes and general intolerance of modernity. The downside to Dubai is that it's unbearably hot between June and September to the point you can't go outside. Think Las Vegas/Phoenix temperatures but with 80% humidity. Religious Holidays like Ramadan also impose extra restrictions and you need to understand when these are. Mosts expat leave the country if they can during Ramadan. Being the hub for Emirates means you are an 8-hour flight to 2/3 of the world's destinations on the best airline in the world.

Australia - Salary of 300-450 AUD. I'd definitely move here long term if things in the U.S. continue to decay. Downside is much higher taxes (currently about 10% higher than U.S. at our salary level) and high cost of living in the big cities. Jobs are definitely available near Sydney, Brisbane, and Melbourne. There's a better overall quality of life than pretty much anywhere in the world, especially for outdoor activities. Unfortunately most jobs require 6 years or more of experience to come in as "Consultant" level or higher to earn the top salaries. Doctors are still respected here, and patients are generally more intelligent and respectful.

You mentioned South America. Brazil/Argentina/Chile are all great if you have decent nest egg. If you work clinically you are essentially volunteering your time. Great if you want to semi-retire and just do outdoors stuff or live near the beach.

This is great info. Is there a reason you haven't jumped ship to Dubai, since you're there so much anyway?

 

[GeneralVeers]

This is great info. Is there a reason you haven't jumped ship to Dubai, since you're there so much anyway?

Mainly salary. Right now I'm in a job that pays fantastically at $300+ per hour. Should that decrease to national norms, which I expect to happen soon, then I either retire from medicine, or jump ship to another country. I may move anyway even if retired due to the unstable tax/political environment in the U.S.

 

[xaelia]

I think it's generally the family considerations being the barrier. It's not a short flight to Australasia or the Middle East.

It's also worth noting each overseas location will have its own set of downsides and challenges. The culture of care delivery in the Middle East will be unique in its own way, while the public and rural EM in Australasia is likewise a challenge.

If you're looking out at a 5 to 10 year time horizon before going remote, anything we say today about the U.S. or overseas healthcare systems will likely be moot.

 

[deleted941485]

Will the US courts hunt you down for alimony if you skip town?

 

[Fox800]

I'm also considering an overseas jump given how the EM clinical practice environment has been imploding (falling salaries, CMGs expanding like cancer, inappropriately low wages, increasing commoditization of Burger King like patient interactions, metrics, midlevels). My current location is considering repealing our strong medical malpractice laws - in which case I'm out of here. There's a lot to be said about not having to be worried about frivolous lawsuits at all.

At a certain point I'm not taking $175-220/hr (1099 with no benefits) to dread going to work, traveling for hours out of my desired area (no jobs available where I'd want to be), and dealing with typical entitled patients and lawyers, seeing 2+ PPH and supervising a bunch of Jenny McJennyson, FNP-BC, JK, KFC, ACLS, ROFLMAO type midlevels.

I'll go to another country where doctors are still respected and you can make an appropriate salary, with paid leave, benefits, retirement, etc.

 

[Kryptocoin]

I would advice you FIRE first: Get a 1M networth and leave it in an S&P mutual fund to compound till you retire.
Once you hit 1M, then decide if you still wanna continue working clinically in the US or abroad . I personally would continue in the US. Do 2 to 3 24hrs shifts somewhere rural. That's enough to travel abroad and live. You're done saving at the point so all the money is just for living expenses.

 

[xaelia]

Even falling U.S. salaries will still exceed compensation in most places of the world.

I'd expect moving to be a choice between lifestyle + practice environment and salary; challenging to find both.

 

[Franzd'Epinay]

Middle East - Salary of 300-400K USD. As has been stated no taxes on the first 103K of income. Companies usually pay a housing stipend, medical/dental, as well as schooling for the children in private schools. Can negotiate other perks like a car as well. Right now only Abu Dhabi/Dubai and Oman are realistic as they offer most Western amenities without draconian laws against Westerners. You can still go to a nightclub, drink and party in the places. Would avoid Saudi given it's 11th century attitudes and general intolerance of modernity.

Are the cultures and laws in the Emirates and Oman truly more modern, or do they just turn a blind eye to westerners?

 

[GeneralVeers]

Even falling U.S. salaries will still exceed compensation in most places of the world.

I'd expect moving to be a choice between lifestyle + practice environment and salary; challenging to find both.

You are correct about salary. We will still make good money, more than most of the world. The problem is that the practice environment has gotten so bad, combined with walking horrors that are entitled American patients.

 

[GeneralVeers]

Are the cultures and laws in the Emirates and Oman truly more modern, or do they just turn a blind eye to westerners?

It's almost a dual culture. 80% of Dubai is made up of expats. There are essentially 3 systems set up, and virtually no intermingling:

1. Indian and other Asians brought over for low-wage work to fill service and construction jobs.
2. Wealthy European and Australian ex-pats who fill the finance and management jobs. Local Dubai laws generally don't interfere with Westerners.
3. Emirati "Locals" who have their own system and laws based on Sharia law.

When I go there it's to visit my European and Australian friends who fill management jobs. We generally go out to hotels, restaurants and clubs that cater to westerners.

 

[GonnaBeADoc2222]

Will the US courts hunt you down for alimony if you skip town?

Luckily I don't pay any

 

[Franzd'Epinay]

1. Indian and other Asians brought over for low-wage work to fill service and construction jobs.
2. Wealthy European and Australian ex-pats who fill the finance and management jobs. Local Dubai laws generally don't interfere with Westerners.
3. Emirati "Locals" who have their own system and laws based on Sharia law.

I've heard this description before. My fear would be that I get on someone's bad side and they come after me under the rules described in 3. Does that ever happen?

 

[RustedFox]

You are correct about salary. We will still make good money, more than most of the world. The problem is that the practice environment has gotten so bad, combined with walking horrors that are entitled American patients.

I'll repeat this here, because its appropriate.

I've seen a therapist for some time now. Combat-tested Marine, IED survivor.
He has some great perspective.
I'm not the only ER doc he sees as a client, he tells me.

He has said to me: "Rusted, from what you and the other docs tell me, I have gathered that people in the war-torn middle east are better behaved than Americans are in the ER."

 

[GeneralVeers]

I'll repeat this here, because its appropriate.

I've seen a therapist for some time now. Combat-tested Marine, IED survivor.
He has some great perspective.
I'm not the only ER doc he sees as a client, he tells me.

He has said to me: "Rusted, from what you and the other docs tell me, I have gathered that people in the war-torn middle east are better behaved than Americans are in the ER."

I hate most of the patients. Even the normal-ish ones seem crazy to me. What is possibly going on in the lives of these average people that they have such anxiety that they have to come into the ED at 3AM for mild somatic complaints? This is not normal human behavior. When I tell my European and Aussie friends about this they are astonished. They would never think of going in for that, and would wait till morning to call their GP. Americans are crazy, and beyond hope.

 

[RustedFox]

I hate most of the patients. Even the normal-ish ones seem crazy to me. What is possibly going on in the lives of these average people that they have such anxiety that they have to come into the ED at 3AM for mild somatic complaints? This is not normal human behavior. When I tell my European and Aussie friends about this they are astonished. They would never think of going in for that, and would wait till morning to call their GP. Americans are crazy, and beyond hope.

I'm so glad you said this.

 

[bravotwozero]

Don’t want to hijack the thread but saw a lady in the ED who fell the other day and ended up with a small leg abrasion. She’s asking me with a straight face, ‘what’s going to happen to it’?

….You’re 40 plus years old. You’ve never had a cut or a scrape before? You’ve never seen a scab?

 

[Fox800]

My patient last shift called 911, but then couldn’t explain to me why she called the ambulance or why she was in the ER to be seen. I just assumed it was her rapid atrial fibrillation and treated her for that (had her diltiazem in her purse but opting not to take it of course), told her that she looked better and sent her home.

Of course she is morbidly obese and has one zillion medical problems, laying on her side and refused to roll onto her back to allow us to get vitals or assess her even though she was perfectly capable of doing so, so we just had to move her into position ourselves to get anything done (of course).

She seemed to be happy enough at discharge, even though she couldn’t figure out why she was here to begin with.

Just another day in American emergency medicine.

 

[RustedFox]

My patient last shift called 911, but then couldn’t explain to me why she called the ambulance or why she was in the ER to be seen. I just assumed it was her rapid atrial fibrillation and treated her for that (had her diltiazem in her purse but opting not to take it of course), told her that she looked better and sent her home.

Of course she is morbidly obese and has one zillion medical problems, laying on her side and refused to roll onto her back to allow us to get vitals or assess her even though she was perfectly capable of doing so, so we just had to move her into position ourselves to get anything done (of course).

She seemed to be happy enough at discharge, even though she couldn’t figure out why she was here to begin with.

Just another day in American emergency medicine.

Yep.
America needs to learn some hard, hard lessons.

 

[GeneralVeers]

Don’t want to hijack the thread but saw a lady in the ED who fell the other day and ended up with a small leg abrasion. She’s asking me with a straight face, ‘what’s going to happen to it’?

….You’re 40 plus years old. You’ve never had a cut or a scrape before? You’ve never seen a scab?

I see a ton of these at the freestanding. It's not even easy money as I'm hourly. I simply don't understand why I have to explain to people how to use bandaids if they have an Owie, take pepto-bismol if their tummy is grumbly, or take OTC ibuprofen or Tylenol for a minor ache or pain. I literally just want to tell these people to GTFO and never come back.

 

[Fox800]

Patient Coming in for ____ pain for days.
Me: “did you take anything for pain? Tylenol? Motrin?”
Patient: ......no.

Or...
Chest pain, million dollar workup including negative troponin, non-ischemic EKG, normal labs, negative CT PE study. Discharging the patient home, “Can’t you give me anything stronger for pain?” (after a negative work up).
Me: “No, everything seems fine plus I’m not going to prescribe opioids because you drink 5 to 6 shots of alcohol every single day. That’s a great recipe for overdose.”

 

[RustedFox]

No joke.

Ten years in EM in America has made me a cold, callous, argumentative, hostile, person.

 

[Neopolymath]

It's appropriate that this thread is in the EM forum and talking about how Americans act so strangely compared to some other modern cultures.

All of the problems with EM as a specialty (especially the patients) is representative of what's wrong with American society in general. It's pretty amazing how well it trends. Corporate BS, admin problems causing make work, clientele that are bat**** crazy and rude etc etc.

My family unanimously agreed that I should not pursue EM before I even began med school because it would turn me into a terrible person. I tend to agree.

 

[CoolDoc1729]

Yep.
America needs to learn some hard, hard lessons.

I saw a lady a couple weeks ago that “didn’t feel well” after getting the covid vaccine, so she called 911. On the way to the ambulance sustained an orthopedic injury requiring sedation x 2 attempts by ortho. BMI 65/ home O2. Good times.

 

[RustedFox]

I saw a lady a couple weeks ago that “didn’t feel well” after getting the covid vaccine, so she called 911. On the way to the ambulance sustained an orthopedic injury requiring sedation x 2 attempts by ortho. BMI 65/ home O2. Good times.

 

[Fox800]

This thread has made me have an epiphany. I enjoy emergency medicine. I don’t enjoy taking care of most Americans with their “emergencies“.

I’m using that term lightly because 90% of what we see in the ER could have gone home without any kind of treatment and been fine, in exactly the same condition as when they started their day...

 

[Sushirolls]

Yep.
America needs to learn some hard, hard lessons.

There's still a big chunk of America - like your therapist - who still value personal responsibility, avoid healthcare unless true sicnkess is knocking, and treat others with respect. This America still lives, still exists, its out there.

 

[RustedFox]

There's still a big chunk of America - like your therapist - who still value personal responsibility, avoid healthcare unless true sicnkess is knocking, and treat others with respect. This America still lives, still exists, its out there.

Clearly, you (psych, if I remember correctly) don't work in the ER.
No shade thrown. I'm glad you're here.

 

[Neopolymath]

This thread has made me had an epiphany. I enjoy emergency medicine. I don’t enjoy taking care of most Americans with their “emergencies“.

I’m using that term lightly because 90% of what we see in the ER could have gone home without any kind of treatment and been fine, in exactly the same condition as when they started their day...

Anesthesiology actually has a sort of similar problem according to my friends. Americans think they should have no pain for any moment surrounding surgery whereas in Europe people get that it's gonna hurt somewhat. Americans also absolutely lose their **** about being awake during a case. As a result, in Europe you can do regional and other light anesthetics instead of general and a ton of pain meds. It's better for the patient and throughput during the day.

All about the expectations.

 

[Sushirolls]

Clearly, you (psych, if I remember correctly) don't work in the ER.
No shade thrown. I'm glad you're here.

Psych depending on the setting has strong overlap with ED population. In addition to its own soul sucking. I did my own stint in a Psych ED and fled fast. Can only see meth/crack psychosis or the occasional PCP/wet/spice so many times. Or the police dropping people off at the end of their shift because they didn't want to do the booking paperwork. Or the "suicidal" patient who just really wants the bed and sandwich, etc, etc

In my outpatient office some weeks all I'm doing is rubber stamping, lay off the weed.

I've had consults where I spent 90 minutes of my time digging for any pathology and finally the patient states they just want an ESA letter so they can take take their pet into hotels while they vacation (no mental health diagnosis, and no letter provided).

The point is, try to get exposure to other social circles. Normalcy still exists in America, it is out there. Might even need to move to enhance the exposure.

 

[GeneralVeers]

Just saw a 29 yo female tonight with sore throat for 4 days. Her throat was "Inflammidated". She did at least try benadryl for her sore throat. C+ for effort, F for results.

I blame cell phones and modern schooling. With all of human knowledge at your easy disposal, no one wants to learn anything, or take responsibility for learning anything. It's just look something up, or ask someone else.

 

[Fox800]

Just saw a 29 yo female tonight with sore throat for 4 days. Her throat was "Inflammidated". She did at least try benadryl for her sore throat. C+ for effort, F for results.

I blame cell phones and modern schooling. With all of human knowledge at your easy disposal, no one wants to learn anything, or take responsibility for learning anything. It's just look something up, or ask someone else.

We are the easy button.

Push button, get opioids.
Push button, get sandwiches and unnecessary admission.
Push button, get tests ‘n scans.
Push button, get adult babysitter for your parent that you don’t want to take care of.
Push button, get work note.
Push button, get free stuff.

While you’re at it (taking care of 10 other people), can you give me a cell phone charger, another blanket, and something to drink?

 

[GeneralVeers]

We are the easy button.

Push button, get opioids.
Push button, get sandwiches and unnecessary admission.
Push button, get tests ‘n scans.
Push button, get adult babysitter for your parent that you don’t want to take care of.
Push button, get work note.
Push button, get free stuff.

While you’re at it (taking care of 10 other people), can you give me a cell phone charger, another blanket, and something to drink?

Someone came in for handcuffs they couldn't get off the other day. SEriously??? Why do we even check that in?? Go get a $#&*#($&* Locksmith.

 

[Fox800]

Someone came in for handcuffs they couldn't get off the other day. SEriously??? Why do we even check that in?? Go get a $#&*#($&* Locksmith.

Or, I don't know, the place where people have a lot of handcuffs???

(Not an adult toy store)

 

[Apollyon]

Someone came in for handcuffs they couldn't get off the other day. SEriously??? Why do we even check that in?? Go get a $#&*#($&* Locksmith.

From home, call the police (seriously). Tell them it's not an emergency, but, you're in cuffs, don't have a key, and you're not under arrest by another agency.

If I got that pt, I would 1. tell the pt that I don't have a key 1a. Tell them I'm calling the police to come by and unlock them. If they elope, well, there's your answer!

 

[Apollyon]

There's still a big chunk of America - like your therapist - who still value personal responsibility, avoid healthcare unless true sicnkess is knocking, and treat others with respect. This America still lives, still exists, its out there.

And they don't come to the ED with rank bull**** problems. I've said for years that "We don't see normal people in the ED, unless it's either trauma, ranging from a laceration to rolling over their vehicle, or, they have crushing chest pain."

 

[GeneralVeers]

Just for giggles, I'm bored at the freestanding night shift tonight, so here's what I've seen so far:

1. 26 yo female on her 3rd visit for epigastric pain. Prior workups negative. Scheduled for EGD next week. Here for a "refill of Bentyl".
2. 34 yo male for "bug bite" on his left leg. He had some mild cellulitis
3. 42 yo male in A-fib RVR with a positive troponin
4. 29 yo female with the "inflammidation" in her throat
5. 68 yo lady with chronic shoulder pain for a month, MRI scheduled in 2 days. Here cuz "she can't sleep"
6. 50 yo female who stubbed her pinky her toe yesterday. She's sure it's not broken, just wants to know "if anything can be done".
7. 18 yo male who hit his head and sustained a concussion after cliff diving.
8. 45 yo male with a nosebleed, who came in by ambulance "Cuz I didn't wanna get blood in my car".
9. 7 yo male with no medical complaints. Here for "Rapid COVID Test" cuz his family is going to Hawaii tomorrow.

So out of 9 patients, only 2 really needed emergent or urgent care. I still have 6 hours to go.......

 

[Cinclus]

Just for giggles, I'm bored at the freestanding night shift tonight, so here's what I've seen so far:

1. 26 yo female on her 3rd visit for epigastric pain. Prior workups negative. Scheduled for EGD next week. Here for a "refill of Bentyl".
2. 34 yo male for "bug bite" on his left leg. He had some mild cellulitis
3. 42 yo male in A-fib RVR with a positive troponin
4. 29 yo female with the "inflammidation" in her throat
5. 68 yo lady with chronic shoulder pain for a month, MRI scheduled in 2 days. Here cuz "she can't sleep"
6. 50 yo female who stubbed her pinky her toe yesterday. She's sure it's not broken, just wants to know "if anything can be done".
7. 18 yo male who hit his head and sustained a concussion after cliff diving.
8. 45 yo male with a nosebleed, who came in by ambulance "Cuz I didn't wanna get blood in my car".
9. 7 yo male with no medical complaints. Here for "Rapid COVID Test" cuz his family is going to Hawaii tomorrow.

So out of 9 patients, only 2 really needed emergent or urgent care. I still have 6 hours to go.......

Did you do the COVID test?

 

[GeneralVeers]

Did you do the COVID test?

Yes the kid was a son of one of the daytime lab techs, so of course. Most expensive non-urgent COVID test ever!

 

[wamcp]

Just for giggles, I'm bored at the freestanding night shift tonight, so here's what I've seen so far:

1. 26 yo female on her 3rd visit for epigastric pain. Prior workups negative. Scheduled for EGD next week. Here for a "refill of Bentyl".
2. 34 yo male for "bug bite" on his left leg. He had some mild cellulitis
3. 42 yo male in A-fib RVR with a positive troponin
4. 29 yo female with the "inflammidation" in her throat
5. 68 yo lady with chronic shoulder pain for a month, MRI scheduled in 2 days. Here cuz "she can't sleep"
6. 50 yo female who stubbed her pinky her toe yesterday. She's sure it's not broken, just wants to know "if anything can be done".
7. 18 yo male who hit his head and sustained a concussion after cliff diving.
8. 45 yo male with a nosebleed, who came in by ambulance "Cuz I didn't wanna get blood in my car".
9. 7 yo male with no medical complaints. Here for "Rapid COVID Test" cuz his family is going to Hawaii tomorrow.

So out of 9 patients, only 2 really needed emergent or urgent care. I still have 6 hours to go.......

So.... How do we expect America to win in a shooting war with China or Russia if this is what our society has become.

 

[GeneralVeers]

So.... How do we expect America to win in a shooting war with China or Russia if this is what our society has become.

Drones. And robots. Cuz our people are too stupid and anxious to fight a battle.

 

[Apollyon]

Drones. And robots. Cuz our people are too stupid and anxious to fight a battle.

Again, though - the dregs are who we see. I'll put up a US Maine against any fighter anywhere on this planet, and bet it all on the Marine.

 

[xaelia]

There are folks without the cognitive or financial wherewithal to put it together to go to their GP or the Urgent Cares for minor complaints here in NZ, but I would say there's not as much of a sense of "entitlement". I like most of my patients, they're frequently normal people.

 

[RustedFox]

Just for giggles, I'm bored at the freestanding night shift tonight, so here's what I've seen so far:

1. 26 yo female on her 3rd visit for epigastric pain. Prior workups negative. Scheduled for EGD next week. Here for a "refill of Bentyl".
2. 34 yo male for "bug bite" on his left leg. He had some mild cellulitis
3. 42 yo male in A-fib RVR with a positive troponin
4. 29 yo female with the "inflammidation" in her throat
5. 68 yo lady with chronic shoulder pain for a month, MRI scheduled in 2 days. Here cuz "she can't sleep"
6. 50 yo female who stubbed her pinky her toe yesterday. She's sure it's not broken, just wants to know "if anything can be done".
7. 18 yo male who hit his head and sustained a concussion after cliff diving.
8. 45 yo male with a nosebleed, who came in by ambulance "Cuz I didn't wanna get blood in my car".
9. 7 yo male with no medical complaints. Here for "Rapid COVID Test" cuz his family is going to Hawaii tomorrow.

So out of 9 patients, only 2 really needed emergent or urgent care. I still have 6 hours to go.......

I did this exercise before here on SDN; listing every patient in a shift and then elaborating as to why work in the ER is a soul-sucking endeavor.
It didn't help.

 

[RustedFox]

Psych depending on the setting has strong overlap with ED population. In addition to its own soul sucking. I did my own stint in a Psych ED and fled fast. Can only see meth/crack psychosis or the occasional PCP/wet/spice so many times. Or the police dropping people off at the end of their shift because they didn't want to do the booking paperwork. Or the "suicidal" patient who just really wants the bed and sandwich, etc, etc

In my outpatient office some weeks all I'm doing is rubber stamping, lay off the weed.

I've had consults where I spent 90 minutes of my time digging for any pathology and finally the patient states they just want an ESA letter so they can take take their pet into hotels while they vacation (no mental health diagnosis, and no letter provided).

The point is, try to get exposure to other social circles. Normalcy still exists in America, it is out there. Might even need to move to enhance the exposure.

Now.... imagine that this kind of behavior is encouraged by administration... and its your fault if they're not satisfied.

 

[Dr Mantis Toboggan]

And they don't come to the ED with rank bull**** problems. I've said for years that "We don't see normal people in the ED, unless it's either trauma, ranging from a laceration to rolling over their vehicle, or, they have crushing chest pain."

True. My non-medical neighbors are always stunned to hear that everyone doesn’t treat the ER with such respect.

 

[Franzd'Epinay]

A lot of folks are mentioning how things aren't this bad in Europe, for example.

1. Is there anyone here very familiar with both systems who can comment on whether this is actually the case?
2. If so, any ideas why there's a difference?

 

[GeneralVeers]

A lot of folks are mentioning how things aren't this bad in Europe, for example.

1. Is there anyone here very familiar with both systems who can comment on whether this is actually the case?
2. If so, any ideas why there's a difference?

Patients in Australia weren't like this, though granted I was a med student and that was ages ago.

It not even limited to socioeconomic status or race. I find all races behave equally poorly. People of all means abuse the ED, even ones who clearly have a good PCP and could afford an urgent care.