politics and malpractice in ER?

[Bucky Katt]

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Hi, everyone! I am not a medstudent yet, but starting this summer. I know my direction will probably change many times, but right now i am very interested in ER for a lot of reasons.

An upper classman who is currently interviewing for residencies recommended Med Student's Survival Guide by Polk. The author claims that ER specialty is palgued by malpractice suits and the in-house politics. Granted the last edition of the book was published 9 years ago, but would any current ER residents/physicians comment on whether they encountered these issues? In my humble ER volunteering experience and emerg. tech training, I did not pick up ony anything of that sort. But then again, I was not a medical trainee. Thanks a lot for your input.

BK

 

[Surgery2Do]

Malpractice insurance is hurting everyone. Pres. Bush has been stating that he wants to abolish these crazy lawsuits and I think he is the only hope we have.

The Clintons destroyed healthcare and really hurt physicians. The second time Clinton was re-elected I actually saw doctors with tears in their eyes.

It will take time to get malpractice under control and under Republican power.........I am sure it will get done.

I have to laugh the other day when I saw Kerry on TV.......he wants to increase taxes......so all you doctors paying 30% taxes.........we could be facing 50% taxes with a Democrat.

Kerry has 500 million dollars and I am sure it is in a trust fund .......so that he does not have to pay taxes.......Give me a break.

 

[DrQuinn]

I'll comment less on the nationwide politics... but more on your specific question...

EM has its malpractice issues just like all the other specialties. Althogh it is not quite as high as say neurosurgery, OB, or trauma, I would consider EM to be above-average in "riskiness." But keep in mind I am not an attending physician, just an EM intern.

That being said, if you are residency trained in EM, you'll be prepared to DEFEND yourself against lawsuits. You will NEVER EVER be able to stop all lawsuits against you, but you CAN defend yourself successfully in court... and that's what the Emergency Medicine Residency trains you for. "Anyone" can work in the ED... look at all the PAs/ARNPs/FPs/IMs that still work in the ED. But they may not practice to the extent of an ABEM MD/DO, and are less likely (IMHO) to defend their actions in regards to EM standard-of-care once they get ot the witness stand or the deliberation chair.

Bottom line: No matter what specialty you practice, you will have no effect on the # of lawsuits brought against you. What you CAN do is defend them either SUCCESSFULLY or unsuccessfully.

Q, DO

 

[Hayduke]

"I actually saw doctors with tears in their eyes. "

Yeah it's heartbreaking to witness that sort of emotion in a fellow human. I saw several of my Medicare patients tear up when W was installed.

H

 

[Bucky Katt]

thanks for your replies, Surgery2Do and Quinn! you both have a good point that lawsuits have now permeated all specialties. i did not really define what i meant by "politics". i was referring not to the healthcare reforms but to politics/hierarchy within the ER department. something to the extent of having to "please those higher up in the pyramid" and "playing the right game" (again, all from the book). True? I guess politics are found in every field as well (i come from the science PhD background and there is plenty of ego stroking in academia), but ER physicians, older or younger, have always struck me as really cool, down-to-earth folks, not back-stabbers...

 

[DrQuinn]

Most EM'ers are pretty laid back, as you can hopefully tell from this thread. We have pre-meds, medical students, interns, residents, fellows, and attendings here. Check out the "What i learned from my patient" thread. Indeed, we all have a different sense of humor and are pretty cynical.

That being said, in regards to intradepartmental politics, it *might* be true that the younger attendings have to work some of the less attractive shifts, but as one becomes more and more senior, they can probably do less and less nights/weekends/holidays if that's what they want. I know that hwen I'm young, I won't mind working nights, I prefer nights now actually.

Our department chairman is in his late 50s, and I saw him doing a night shift once. I said "Dr. O, I didn't know you still did night shifts." He said that he does them every once in a while becuase its "fair and everyone should do their share."

Q, DO

 

[Surgery2Do]

Recently I know of an excellent Urologist who left Tampa, Fl........because of malpractice insurance expense.

Also another Orthopedic Surgeon quit his practice in Atlanta, Ga.......because of malpractice insurance expense.


Nobody wants to hear it.........but there are professional patients out there looking to sue a doctor for anything. People need to decide who they want to be there for them when they have an MI........a doctor or a lawyer?

Caps need to be set and restrictions need to be set.

 

[NinerNiner999]

Perhaps your question about departmental politics can go further than the ED. In many instances, the Emergency "Department" can actually be a division of another Department within the hospital (i.e. Medicine, Surgery, etc). With the advent of EM as its own specialty, more and more Emergency Centers in hospitals are becoming their own Department of Emergency medicine within the hospital hierachy. What does this mean? Often times when budgetary considerations within a hospital must be considered, the ED might fall into a division of another department.

For example, if the ED was a division of the department of Surgery, and the annual budgets were being discussed, the Department of Surgery would submit their budget and the Emergency Room (for lack of confusion) would recieve whatever the department of surgery would fund for its operation. This is common in county hospital settings, where the hospitals receive their budgets from state and county governments (trickle down economics) and must be frugal with what they get. Often times, leaving the Emergency budget by the wayside (many county EM programs are constantly in a battle of uncertainty about their fiscal year operating budget).

From that perspective, politics play a HUGE role in the viability of the ED, and Emergency faculty must constantly jocky their position to recieve funding. The flipside to this are the free-standing Departments of Emergency Medicine, which have more-or-less equal political footing with the departments of surgery or medicine and can consistently get their budgets approved.

The advent of EM as a specialty has opened many hospital administrator's eyes to the potential that skilled and efficient emergency care can bring to the hospital. While historically recognized as a financial liability in operating costs and reimbursement, Emergency Rooms across the country are being recognized for their overall financial boon for the hospitals they are situated in - based on referrals and admission rates. It is for reasons like this that funding for brand new trauma centers can be justified, and the creation of departments from EM divisions can be made.

The data you read may have been the status quo 9 years or so ago, but with the changes in healthcare today and the pattern of reimbursement dictating our current economy, EM has, if anything, gained political "clout" among other hospital departments because of its economic contributions.

P.S. Quinn - Dr. O is the shizzle.