Moonlighting ER

[auguy13]

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Hey guys,

Do you know if internists are still allowed to pick up shifts at the ER, or should one considering doing some dabbling in EM but ultimately wanting to settle into a more routine lifestyle look into IM/EM combined residencies?

 

[namethatsmell]

Hey auguy,

This has been asked repeatedly, so search this forum. Short answer is IM folks can only work in undesirable/hard to fill places.

PS-- Unless you're cool with hurting people or getting sued I wouldn't "dabble" in EM.

 

[NERDY]

Many hospitalists do shift work like EM.

 

[fahimaz7]

Hey auguy,

This has been asked repeatedly, so search this forum. Short answer is IM folks can only work in undesirable/hard to fill places.

PS-- Unless you're cool with hurting people or getting sued I wouldn't "dabble" in EM.

Hurting people or getting sued? That's a bit harsh, no?

 

[namethatsmell]

Considering that a significant number of residency-trained EPs will get sued during their career, and many will also likely harm a few patients during their career (due to the math incurred when treating tens of thousands of patients, if nothing else)...I don't think it's at all unreasonable that an IM-boarded doc working in an ED would be at greater risk of both.

Maybe I was a bit blunt/dramatic. But no, I don't think I'm being too harsh. Especially since this guy is talking about "dabbling" in EM.

 

[Birdstrike]

Considering that a significant number of residency-trained EPs will get sued during their career, and many will also likely harm a few patients during their career (due to the math incurred when treating tens of thousands of patients, if nothing else)...I don't think it's at all unreasonable that an IM-boarded doc working in an ED would be at greater risk of both.

Maybe I was a bit blunt/dramatic. But no, I don't think I'm being too harsh.

It's not all black or white. It all depends on whose shoes the IM doc is filling in taking that shift. If he is covering a shift where they would otherwise have no physician, it's a positive. There are many undeserved EDs, with few or no BC/BE EPs. An internist should not feel bad about taking such a shift. If the internist is taking a shift where there's only an extender to work, no physician, again, there is value there. Though I've worked with some really good EM extenders, it's best to have a physician on duty, or if you prefer, physician and extender working together.

Now, if the IM physician is attempting to compete with, or is displacing a BC/BE EP, ideally you want to EP, who is residency trained and also has much more training in peds emergencies, and acuity.

That being said, I'm sure there are some internists that do a great job in the ED, especially with the adult stuff, and some BC/BE EPs that need improvement, but we have board certification for a reason. Get the piece of paper. It means something.

 

[namethatsmell]

It's not all black or white. It all depends on whose shoes the IM doc is filling in taking that shift. If he is covering a shift where they would otherwise have no physician, it's a positive. There are many undeserved EDs, with few or no BC/BE EPs. An internist should not feel bad about taking such a shift. If the internist is taking a shift where there's only an extender to work, no physician, again, there is value there. Though I've worked with some really good EM extenders, it's best to have a physician on duty, or if you prefer, physician and extender working together.

Now, if the IM physician is attempting to compete with, or is displacing a BC/BE EP, ideally you want to EP, who is residency trained and also has much more training in peds emergencies, and acuity.

That being said, I'm sure there are some internists that do a great job in the ED, especially with the adult stuff, and some BC/BE EPs that need improvement, but we have board certification for a reason. Get the piece of paper. It means something.

Agreed that things are rarely black or white. My point wasn't to take shots at IM docs in BFE filling a shift that would otherwise be unfilled. I have worked with IM-trained docs (2 of whom grandfathered into EM) and most were excellent. But they worked extremely hard learning about OB, peds, etc outside of their original training and working in the ED is all they do. All wish they'd trained in EM.

The OP is talking about "dabbling" in our field as an internist...and if he/she doesn't think that doing so likely incurs a higher chance of getting sued or hurting somebody than I'm not sure that idea has been fully thought out. If the OP knows they definitely want to work in an ED while also working in an IM role, than the safest option would be to train EM/IM (as they are considering).

 

[fahimaz7]

Agreed that things are rarely black or white. My point wasn't to take shots at IM docs in BFE filling a shift that would otherwise be unfilled. I have worked with IM-trained docs (2 of whom grandfathered into EM) and most were excellent. But they worked extremely hard learning about OB, peds, etc outside of their original training and working in the ED is all they do. All wish they'd trained in EM.

The OP is talking about "dabbling" in our field as an internist...and if he/she doesn't think that doing so likely incurs a higher chance of getting sued or hurting somebody than I'm not sure that idea has been fully thought out. If the OP knows they definitely want to work in an ED while also working in an IM role, than the safest option would be to train EM/IM (as they are considering).

He's not a psychiatrist dabbling in orthopedic surgery.. Most of what we do on a day-to-day basis is generalized medicine that a lot of different fields could do adequately. Most PGY 1's can get the level 2-4 patients diagnosed and treated right, so I think the board certified IM guy can probably do a fine job for the majority of patients.

Sure, if he has a 3 month old in status come in, he may be uncomfortable and under-prepared, but that can be said for most EM guys that don't spend enough time in their peds ED. Broselow tapes ftw.

 

[Brigade4Radiant]

Hey guys,

Do you know if internists are still allowed to pick up shifts at the ER, or should one considering doing some dabbling in EM but ultimately wanting to settle into a more routine lifestyle look into IM/EM combined residencies?

This is what i'm thinking of doing since burnout is such a big issue

 

[namethatsmell]

He's not a psychiatrist dabbling in orthopedic surgery.. Most of what we do on a day-to-day basis is generalized medicine that a lot of different fields could do adequately. Most PGY 1's can get the level 2-4 patients diagnosed and treated right, so I think the board certified IM guy can probably do a fine job for the majority of patients.

Pretty sure a med-mal lawyer would stroke out 2/2 to glee if the defense described their client like this.

Again, this is not about demeaning IM, FM, etc docs who pull shifts where there's no EP to do so. I'm suggesting to the OP that while they "can" get shifts in an ED somewhere as an internist, they should know what they'd be getting into in they just want to dabble and "do some EM" once in a while.