Possible or Impossible Job?

[Uranium678]

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New attending looking at jobs. I am currently at a small rural ,single coverage, high volume (3-4) pph shop and am looking to see if the grass is greener and if I can see less patients per hour. I've done research online but not sure if what I'm looking for is possible.

Looking for

In mid sized or major city
1.5 patients per hour
Low liability state or environment (am even open to VA hospital or academics)
benefits a plus
200$/hr or more
Scribes
No single coverage

Is this situation possible or am I dreaming?

Any specific region or city center? Would love suggestions.

 

[miacomet]

Possible if you are OK with 2 PPH. In fact, probable!

 

[namethatsmell]

When I think of high-reimbursing states with a good med-mal environment I think of:


Texas
Indiana
Kansas
Inland and Northern California
Wisconsin

I bet if you look in those places you'll find some options that'll meet most of your wants. Good luck, your current job sounds like the pits.

 

[Uranium678]

thanks for the advice, its been paying my loans but definitely burning me out.

 

[miacomet]

Might I suggest that in the interim you simply slow down at your current job? Unless they are paying you over $300 an hour, they will certainly not lose money on you seeing fewer patients....

 

[Groove]

3-4pph? Consistently? Get out of there now before you burn out or hurt someone and find yourself in a lawsuit. At that pace it’s not a matter of if..but when. That gig sounds miserable. Too easy to cut corners at that speed.

 

[Hercules]

What is your ED volume? I can’t think of a small rural ED where you would see that many. Even if you were completely single covered with no midlevels that would mean the ED is seeing 72-96 patients/day. That would put you up around 30k/yr which will/should not be single covered. As far as your wish list, the only problem I could see with it is that you quite simply won’t need (or want to pay for) scribes if you’re that slow.


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[Tenk]

That job is rare as hell because you basically described a job that has enough volume to warrant scribes and double or more coverage yet you only want to see 1.5 pph and live in a major city while still being paid well.

Probably won’t find that.

 

[bravotwozero]

My gig has the average doc seeing 1.8 pph, in the suburb of a major city, and with scribes, and pays more than what you’re looking for.

It’s NOT double coverage though, single plus MLP.


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[thegenius]

3-4pph? Consistently? Get out of there now before you burn out or hurt someone and find yourself in a lawsuit. At that pace it’s not a matter of if..but when. That gig sounds miserable. Too easy to cut corners at that speed.

I don't believe 3-4 pph....not a real ER where people come in sick every now and then. I can't even imagine 3-4 pph at an Urgent care. For a standard 10 hr shift seeing 30-40 people?

 

[Hercules]

Everything needs context. I have worked terribly inefficient places where seeing 2 pph was a struggle. I have worked and continue to work somewhere where seeing 3 pph is the average and feels easy. Imagine a setting that is completely optimized and revolves around making your job easier and offloading all non-EM doc tasks. These places exist.

Same of urgent cares. 3pph at an urgent care is so slow that you would barely be covering overhead. An efficient urgent care setting with scribes can see >10pph for the duration of a 10 hour shift. It’s not exactly relaxing and fun but it’s doable for a couple of days.


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[Psai]

10 pph!?!?

 

[thegenius]

10 pph!?!?

That's mathematically 6 mins / patient, which in reality is more like 2-3 mins / patient. It's not believable. You have to piss every now and then. You have to examine people...LOL...washing your hands takes 10 seconds. Talking in English takes time. LOL. Walking from one room to the next room is like 6 seconds. Doing a double take at the hot woman in the waiting room is at least 5 seconds. All this time adds up!

 

[BoardingDoc]

An efficient urgent care setting with scribes can see >10pph for the duration of a 10 hour shift. It’s not exactly relaxing and fun but it’s doable for a couple of days.

What? You're saying that you see over 100 patients in a 10 hour urgent care shift? That is either
A: the most unsafe, sadistic working environments I've ever heard of, or
B: not true.

I'm assuming (and hoping) the latter.

 

[emergentmd]

In mid sized or major city - Yes
1.5 patients per hour - 1.5-2pp/hr
Low liability state or environment (am even open to VA hospital or academics) - Yes
benefits a plus - Yes
200$/hr or more - Yes
Scribes - Why do you need a scribe for less than 2pph?
No single coverage - For most of the shift but possibly not overnight

 

[namethatsmell]

Scribes - Why do you need a scribe for less than 2pph?

Yeah this is true. No need for scribes if seeing less than 2pph. Unless you're using Mckesson.

 

[Hercules]

That's mathematically 6 mins / patient, which in reality is more like 2-3 mins / patient. It's not believable. You have to piss every now and then. You have to examine people...LOL...washing your hands takes 10 seconds. Talking in English takes time. LOL. Walking from one room to the next room is like 6 seconds. Doing a double take at the hot woman in the waiting room is at least 5 seconds. All this time adds up!

What? You're saying that you see over 100 patients in a 10 hour urgent care shift? That is either
A: the most unsafe, sadistic working environments I've ever heard of, or
B: not true.

I'm assuming (and hoping) the latter.

I've been on here for a long time and have always been open about my experience starting and owning an urgent care as a side hustle. I'm not one who is prone to exaggeration but I assumed these numbers would raise some eyebrows. I assure you this is not only believable but factual. I pulled the reports and in January of this year's flu season we were averaging ~75 ppd (open 8a-6p on weekdays and 8a-3p on weekends) with multiple days breaking the century mark. Our urgent care is 7 years old now and the systems we developed over that time are what make it run so efficiently. We could not have processed that kind of volume in the beginning because we were inefficient. Urgent care (especially during the flu season) is both repetitive and not that complicated for the most part. When I work a shift there I don't touch the computer until I'm signing charts. I verbalize my exam, orders (there's no rules against this in office based practices as opposed to ED scribes), diagnosis, and prescription while talking to the patient and the scribe/MA inputs all of that in before we leave the room the majority of the time. Then I walk out of the room and the scribe/MA directs me to the next room with a quick one-liner on what they are here for ("Room 6 has a 24 YO with fever, cough, bodyaches for 1 day; flu test positive"). Rinse. Repeat.

What’s to be gained by inflating numbers on how many patients are seen in an hour ? It’s frustrating as a resident to see. Unless one is making $500 an hour all of the chest thumping and misrepresentation only plays into the hands of CMGs that profit off of docs thinking that horrible working conditions are normal or acceptable.

There's no number inflation and I'm firmly against CMGs for most EPs. I don't want to discourage a resident; I would hope to encourage by showing the difference an efficient environment makes. I'm also the Medical Director for a 60k community ED run by an 8 doc SDG with 6 MLPs and scribes. Everything I said above about urgent care inefficiencies and streamlining processes applies to EDs as well. The great thing about being an SDG is that we have chosen to staff and run our ED this way. As a result we do quite well financially. We also made the lifestyle choice to decrease MD staffing on weekends and holidays to get more of these off. If we felt the volume was unmanageable we could simply extend our shifts and add coverage as needed. I would not work this hard for a CMG, but as an SDG all of the profits come right back to us and we can control our practice environment. To me that is the way EM should be practiced.

 

[Angry Birds]

New attending looking at jobs. I am currently at a small rural ,single coverage, high volume (3-4) pph shop and am looking to see if the grass is greener and if I can see less patients per hour. I've done research online but not sure if what I'm looking for is possible.
.

This sounds like the worst possible job.

The rural shop has its appeal, but only because of a low PPH. You've just found the worst possible combination. Keep in mind--if it hasn't been mentioned already--that you (usually) have no consultants working in a rural hospital and have to ship sick patients. These difficulties are only offset if your volumes are lower, so you can focus on the few patients you do have.

 

[Old_Mil]

New attending looking at jobs. I am currently at a small rural ,single coverage, high volume (3-4) pph shop and am looking to see if the grass is greener and if I can see less patients per hour. I've done research online but not sure if what I'm looking for is possible.

Looking for

In mid sized or major city
1.5 patients per hour
Low liability state or environment (am even open to VA hospital or academics)
benefits a plus
200$/hr or more
Scribes
No single coverage

Is this situation possible or am I dreaming?

Any specific region or city center? Would love suggestions.

If you drop "major city" and "scribes" it will be a lot easier for you to find what you seek.

The job you are at sounds like it sucks. Get out of there before you get sued for something. Even if it means doing some locums till you can find a full time gig.

A CMG shop, right?

 

[Old_Mil]

Yeah this is true. No need for scribes if seeing less than 2pph. Unless you're using Mckesson.

No reason to take the job if they are still using McKesson. That indicates a serious failure on the part of hospital leadership.

 

[Uranium678]

Thanks for all the advice, the job has felt bad but I thought I might have been overreacting, now I know its bad. Will be leaving soon.