martinri said:
Hey Jet:
I'm really interested in knowing a little more about "moonlighting". I hope you could share some more info on it. For instance, how you moonlighted in an ER as an anesthesia resident? I could definetly use the extra cash.
"Moonlighting" is an entity available to any resident with a medical license and a DEA number...which comes early in your PGY 2 year. Once you have those two things, you can moonlight.
Before college/med school, I was a firefighter/paramedic. So codes/trauma were familiar to me. I'd run countless codes/critical traumas in my previous-job-arena, so when it came time to step up a level, my previous experience became invaluable.
I started out at slow, rural ERs. The company I worked for had many ER contracts, and one could start at the slow ERs, and as confidence/experience came, you could request busier ERs (which paid more $).
Nearing the end of my PGY-2 year I was feeling pretty confident, so I requested (and received) a great gig at an outlying Charity-system hospital in Louisiana. It was a busy place with one doctor assigned to the ER, and one doctor assigned to the "clinic".
I worked in that ER enough to be considered "staff" during my residency. Because of my EMS background I bonded with the paramedics that brought patients there. One of the EMS supervisors, during one of my shifts, took my son with him in his Suburban, since my son (who I had brought with me that weekend) was looking bored, doing nothing but watching TV in my call room....Evan (my son) rode around with an EMS supervisor all day, stopped by the flight station and crawled around the helicopter, then went and ate lunch with the supervisor. What a great bunch of dudes.
The ER purists will defend their turf by saying no-one should be doing ER but ER dudes.
But let me ask you...the stuff that comes into the ER that is not critical in nature, if you can't figure out whats going on, theres always a consultant in said specialty to call. Got a dude after an accident with foot pain unexplainable by the x-ray? Call the orthopedist. Got a kid that doesnt look right, even though objective data is OK? Make sure the pediatrician sees the kid before they leave.
Unfortunately, in real life (anyways), specialists are overconsulted in the ER. Call it a result of our litiginous society, or whatever, but many ER docs consult too much. In my previous anesthesia gig there was an ER doc named Ricky...and whenever he was on, the specialists cringed...because they knew, for any problem, even minor, that concerned their specialty, they were gonna be consulted. Dude's nickname became Ricky Bin Laden.
Anyway, when a budding resident moonlighting in the ER, you can use this practice-style to your advantage. When in doubt, consult. Thats what the real-world ER dudes do anyway. (Yeah, I know. ER dudes, flame away. Its OK. Its the truth. So get over it.)
So now we've covered the non-critical stuff.
Now lets get to the critical stuff. And assuming you have experience in trauma (read: you did a surgery internship, etc), you know ATLS guidelines, you can place a chest tube, you can do a crich, you know how to do primary/secondary surveys and problem solve along the way,
you can moonlight in a busy ER.
When youre an anesthesia resident, your job, when needed, is critical care. You can intubate better than anyone else. You know codes better than the IM residents (ever noticed at a code that IM residents bark orders, while anesthesia residents know-said-barked-orders, but also know how to institute them?)...what you need is trauma experience...so during your intern year, if youve never seen trauma before, you need to spend some time in the trauma ER. Get comfortable with clearing C spines. Suturing.
Then spend some time in the medical ER. Chlamidia. PID. Ectopic pregnancy. Asthma. COPD exacerbation. DVT.
All the above stuff, if you do your intern year at a busy place, you'll see alot of.
And by the time you're midway through your PGY-2 year, you'll be pretty good at central lines.
So lets see. Mid-pgy-2 anesthesia resident. Airway-stud-extraordinairre. ACLS/ATLS deft. Knows how to manage a critically ill MI/CHF/septic shock/meningitis/ARDS etc.
And you can star an IV on an ant. And intubate the ant's infant son.
Bottom line is an anesthesia resident, assuming you've broadened your experience during your intern year/previous-healthcare-life, makes a pretty good ER doctor.
