Nope. That's why you cover the sign. If the emergency sign is covered, and there's a notice on the door, you're scot free. I know you don't want them to be, and would instead make this the EPs problem, but that's how we shut EDs down.
Have you ever shut down an ED? Yes or no? The company I work for has. I know exactly how to do it legally.
Except where state law requires a physician to be a licensed Emergency Department. If your being there is a requirement for licensure (and it is), then yes, you leaving shuts it down. You're not the one doing it, the lack of staffing is. Also, the IRS doesn't care about our IC status, because we simply aren't by law, we just get loopholed into it by companies who don't want to pay overtime, benefits, or both sides of SS.
You'll note that I'm not alone, and honestly, you're the one on an island here.
Is there a state that requires this?
Texas has a law that any hospital has to have an emergency room, and that emergency room has to be staffed 24/7 by a physician. They have allowances for rural counties that the doc can be on call. Other states do allow PA/NP single coverage, but not Texas.
I think you're pushing this towards hyperbole. We've all see hundreds of schedule holes. Those typically involve some degree of scrambling to cover. There is lots of communication. Even last minute problems like people missing their flight, or having a car wreck, or whatever. Nobody is walking off the job for those.
Yeah I think you just have to be persistent in your attempts to get coverage and document everything. I think you avoid legal trouble this way.
Meh, any decent person won't go back to that job.
This is nonsensical. YOu would be a slave. Take what you said the the extreme. No one shows up for a month. You think you are on the hook. GTF OOH. Fire off the emails and go from there. To think you are somehow on the hook in perpetuity because no one shows up is dumb.
Take my kid to the 4:30 star wars release, and then ice cream.
Right. Call the CMO/CEOCNO/ CMG and tell them. Patients wait for. 12 Hours or more to be seen by a doc. If not in extremis. Bye bye. Also regarding inpatients. they are most definitely not the ED docs fault. It is foolish to think that just cause you are there you are also responsible for them. We wait when colleagues oversleep or get stuck in traffic cause we would want that for ourselves and we are decent people. To think EDs havenot gone on diversion is silly. Happens all the time due to volume, inpatients, ED holds. This is equivalent to an internal disaster.
obvious answer. Someone’s business issue isnt my personal problem. If it is my ED contract or my hospital then it is my problem. As an ED doc this isnt your issue. I would also expend zero energy for the CMG to get the shift covered. If I’m not the ED director and I dont own this contract this isnt my problem.
You will generally wrap up your patients as best as possible and coordinate with your director and admin to meet both your patient and childcare responsibilities.
I’m not saying it’s not there but I’ve viewed 100s of contracts literally. Never seen it.
I've never seen that language, and I've worked for Schumacher, Team Health, EmCare, and 3 other private groups.
mayeb you worked at functional places. i believe someone gave an example of this in Mississippi. most BCEM docs dont work in the sticks so its not an issue.
The point we have tried to make is that it has never gotten to that point. Just making the threat is enough. Of course, if you're going to threaten it, you have to go through with it. But yeah, day of, no coverage, gonna start making phone calls.
I'm 99% sure that's not true. My state, and I expect most others, Have very specific rules about what is required to establish a doctor-patient relationship. Barring that relationship, there can be no abandonment.
Assigned in the EMR does not mean a doctor-patient relationship has been established.
I think you misunderstood my post.Assuming you practice EM, you may need to familiarize yourself with the legal definitions of abandonment as it pertains to EM and your own collage’s position statements on sign outs. This is from ACEP:
“EDs provide clinical care 24 hours a day and physicians work in shifts. There is a period around the time of shift change when providers transfer information, primary authority, and responsibility for patient care.22,23 Other aspects of the care environment, such as diversion status, boarding patients, pending transfers, equipment, and personnel issues, are also sometimes discussed. Handoffs can be a source of liability and error but also an opportunity for rescue when the re-evaluation of a case from a fresh perspective may result in preventing or recovering from an adverse event.11,24-29”
Moreover, all of the people claiming that you must “do something” to establish a physician-patient relationship are missing the important point that simply agreeing to assume care is the “doing something.” By accepting your partner’s sign outs you are agreeing to assume care of the patient and establishing a relationship. This from the AMA Journal of Ethics:
When Is a Patient-Physician Relationship Established?
The legal definition of a patient and the corresponding duties of the physician have been debated in state courts for over a century, and many aspects of the question are still unresolved.journalofethics.ama-assn.org
However, a patient-physician relationship is generally formed when a physician affirmatively acts in a patient’s case by examining, diagnosing, treating, or agreeing to do so [5]. Once the physician consensually enters into a relationship with a patient in any of these ways, a legal contract is formed in which the physician owes a duty to that patient to continue to treat or properly terminate the relationship.
Under your logic, EPs could absolve themselves from liability by simply not seeing their sign outs. While every state frames physician-patient relationships a little differently, a general trend in most state’s case law is that EPs have a heightened responsibility since patients in extremis cannot be reasonably expected to find an alternative provider. From an EMTALA perspective, refusing to stabilize to a patient in your department that was signed out to you can also be a problem. Fortunately, such issues generally become a problem for an EP when a patient deteriorates or suffers some damages which is generally pretty rare. However, you would be wise to follow ACEPs guidelines that I provided if you are interested in maximizing safety at sign out.
