Post residency options working less clinical?

[jillzhou]

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PGY1 EM Resident here. I’m more than 6 months in but still have a little over 2 years to go. As much as I loved EM as a medical student, I’ve learned there’s so much I don’t like about it either. Perhaps I’m burnt out but the switch to days/nights has definitely taken a toll on my mental/physical health. I’ve had thoughts about switching specialties or quitting but having nearly 400k in a student loans is preventing me from doing so and at the end of the day there was a reason I chose EM in the first place. But now, there are some days I absolutely dread going into work. Everyone tells me it gets better but it’s really hard to see the light at the end of the tunnel right now. For those of you done with residency, how many hours do you typically work? I’ve thought about working at an urgent care after residency but only for a change in environment- I know I’d take a significant pay cut. What are my other options if I want to work a little less clinically? I’ve heard of going into admin but what does that exactly entail?

 

[gamerEMdoc]

Perhaps I’m burnt out but the switch to days/nights has definitely taken a toll on my mental/physical health.

It gets much easier to deal with as an attending because your number of rest days goes way up. So while its harder to adjust as you get older, the fact that you aren't working 40-60 hours/week in the ED allows you to adapt easier. I can't even fathom working 6 nights in a row, having one day off, then 5 day shifts now. But I did that as an intern.

For those of you done with residency, how many hours do you typically work?

I do 99/month clinically. 11 nines a month. The rest of my pay is education/admin stuff for the residency. Our core faculty work 12 nines (108/month) and get paid four academic days a month. Our clinical faculty work 16 nines (144/month) but have no conference/research/admin responsibilities.

What are my other options if I want to work a little less clinically? I’ve heard of going into admin but what does that exactly entail?

You won't get an administrative job fresh out of residency. No one will make you chair or vice chair of a dept straight away. That will take years to see a significant shift reduction working your way into leadership. Academics is a good route in the sense that shift counts get reduced for faculty and program leadership to pursue their academic endeavors. Alternatively, you could pursue a fellowship in something that would take you out of the ED entirely, or even part of the time.

And while UC isn't usually lucrative, I had a grad who somehow got a job as a UC director in the same system her husband got an academic job right out of residency, and it paid just as well as his did.

 

[deleted497653]

Oh boy! It’s that time of year again.

I have a friend who did a clinic informatics fellowships and has a nice sit down job not seeing patients. But it’s a 2 year fellowship.

But no patients!

 

[docB]

I agree with GamerEMDoc about administration not being a possibility right out of residency. You need some experience to be a valuable administrator (the oxymoronic nature of that did not escape me). You'll also find that the lower level admin positions don't pay enough to let you significantly lower your clinical hours.
You can look at academics and other extracurriculars but, again, these can be hard to find and require you know people or have special expertise.
I have found that working urgent cares or low volume EDs is not good for me. They pay less and are sometimes more headache than the big EDs. Decisions you take for granted in the big EDs turn into nightmares in the UC, like get a CT or don't get a CT.
I suggest finding the situation you like working best and then try to live frugally enough to reduce your hours. I know you have loans and it sucks but the good thing about being an attending is you have power over your hours. Many groups will let you adjust month to month. In my group you could bust out 180 for a month or 2 to chip away at your loans then back off to 90 a month to take a break if you want. The best way to increase your ability to pay off debt is to avoid taking on more debt with houses and cars.

 

[ShockIndex]

First, try to isolate why you are dreading work. You don’t need to announce it to the world over the internet, but be very honest with yourself because a successful solution depends on you correctly identifying your problem. You’ve mentioned your mental and physical health, so I’d start there and make sure that you 1) see your own doctor, 2) avoid excess alcohol or any other substances, and 3) do you best to sleep, and 4) get at least 30 minutes of exercise 3-4 times per week (minimum).

Once you’ve taken care of the basics, it’s time to discuss this with people in your program. Grab a cup of coffee with a chief, APD, or even schedule some time with your PD. These people care about you and can give you an honest assessment of how they see you doing and where they see you going - in EM or elsewhere. If you really dread work and try to hide this, you will most likely slip up and run into performance issues. It is better for you to set up a meeting with your program leadership early rather than the other way around later when they see problems affecting your work.

Finally, it is extremely rare for someone to leave a 3-year program and immediately land a good job with a significant clinical buy-down. You will just have to trust me on this. I’m not saying this to discourage you; I just don’t think that “waiting it out” is a realistic or smart strategy. You need to change the doctor or your environment, and by change I don’t necessarily mean leaving residency.

 

[RustedFox]

Big post from me coming tomorrow on this topic.
For now, hot wings.

 

[Angry Birds]

PGY1 EM Resident here. I’m more than 6 months in but still have a little over 2 years to go. As much as I loved EM as a medical student, I’ve learned there’s so much I don’t like about it either. Perhaps I’m burnt out but the switch to days/nights has definitely taken a toll on my mental/physical health. I’ve had thoughts about switching specialties or quitting but having nearly 400k in a student loans is preventing me from doing so and at the end of the day there was a reason I chose EM in the first place. But now, there are some days I absolutely dread going into work. Everyone tells me it gets better but it’s really hard to see the light at the end of the tunnel right now. For those of you done with residency, how many hours do you typically work? I’ve thought about working at an urgent care after residency but only for a change in environment- I know I’d take a significant pay cut. What are my other options if I want to work a little less clinically? I’ve heard of going into admin but what does that exactly entail?

So you've hit on something important: EM looks amazing as a med student but it has huge drawbacks as a practicing physician. However, EM definitely *does* suck less after residency.
I was also thinking like you during the same time of my residency: I was thinking I would just work for an urgent care. However, this is not the most viable option in reality. Urgent care pay is a half or even a third of EM pay. Do you think working twice as much would make you happier? Obviously not. The good thing about EM is that you get many recovery days in the month.
The other thing is that urgent care can also be hectic based on sheer volume of patients and how fast you have to churn them out.
On the other hand, maybe running an urgent care center as a business would be a better option... But you would need to have a knack for business to do this.

As for admin, this is a possibility but would take at least a few years... Also, I used to have a boss who hated clinical work and this made him a miserable person. I think you should love clinical work if you want to go down this path.

The other option, my friend, is to think outside the box. You can look into the limited fellowships that are available ... or even consider careers outside of medicine. However, debt and standard of living are definitely handcuffs.

Of course, you may end up liking clinical practice after you become more competent and autonomous. Also, keep in mind that we make a lot of money per hour and that's quite nice.

Ultimately, you need to find something you find enjoyment in, have competency in, and can monetize in some way. It's not easy but what I remind myself is that the vast majority of people slog away in jobs they hate and only get paid a fraction of what we get. Even so, I don't think that's a reason not to pursue happiness.

 

[ShockIndex]

So you've hit on something important: EM looks amazing as a med student but it has huge drawbacks as a practicing physician.

I think we need to fundamentally change the structure of the 4th year EM AI so that our students have a better understanding of what awaits them. First, grades are going to be a little late going forward because we are going to start incorporating Press Ganey scores in the mix - 20% of their grade will come from PG.

Next, we are going to cut the number of those high-acuity “front side” shifts in half and reallocate them to backside and urgent care shifts where all of the patients with chronic abdominal pain, those needing nursing home placement, and back pain are bedded.

All admissions will be handled by the MS4. That includes calling report to the IM triager for patients needing admission for NH placement, COPDers with great vitals in bed but can’t walk more than 10 feet without gasping, and that 40 year old with an equivocal US that surgery wants a HIDA scan on before they put it on their service. The goal is that the student will spend at least half their shift with a phone to their ear (most of that on hold) trying to find the perfect intern to write the H&P.

To top it off, we are going forward all patient complaints and negative Press Ganey comments to the student for a response within 2 business days. We will also send those complaints and comments to the Dean of Students so that they can be incorporated into their Dean’s Letters. After all, who is better to comment on a student’s abilities than the patients that they treat.



EDIT: It has come to my attention that some might take the above post seriously. If that is the case, I suggest that you take two shots of your favorite whiskey and re-read.

 

[TheSingularity]

I hope this is a joke

Sent from my Pixel 3 using SDN mobile

 

[TheSingularity]

Honestly, don't do UC. It sucks. The people I know who do it are seeing up to 5pph on a 10 hr shift. Would also avoid big shops that ship their ED docs to do UC shifts.

Residency sucks, it gets better as an attending.

You have to be willing to change jobs if the first one doesn't work out. I was a CMG cog for a few years (made a lot money, laid off my loans, saved a lot, went on a lot of nice vacations) and then took a paycut once my family could afford it to work in a nice shop with good residents/nurses/leadership and no night shifts.

Nothing wrong with being a cog in the beginning to extract money if you need it then change jobs later

Sent from my Pixel 3 using SDN mobile

 

[ShockIndex]

I hope this is a joke

Sent from my Pixel 3 using SDN mobile

It was only a joke if it made you chuckle. Otherwise, it was poorly delivered sarcasm and hyperbole and I’ll try to do better at brightening your day next time.

 

[The Knife & Gun Club]

I think we need to fundamentally change the structure of the 4th year EM AI so that our students have a better understanding of what awaits them. First, grades are going to be a little late going forward because we are going to start incorporating Press Ganey scores in the mix - 20% of their grade will come from PG.

Next, we are going to cut the number of those high-acuity “front side” shifts in half and reallocate them to backside and urgent care shifts where all of the patients with chronic abdominal pain, those needing nursing home placement, and back pain are bedded.

All admissions will be handled by the MS4. That includes calling report to the IM triager for patients needing admission for NH placement, COPDers with great vitals in bed but can’t walk more than 10 feet without gasping, and that 40 year old with an equivocal US that surgery wants a HIDA scan on before they put it on their service. The goal is that the student will spend at least half their shift with a phone to their ear (most of that on hold) trying to find the perfect intern to write the H&P.

To top it off, we are going forward all patient complaints and negative Press Ganey comments to the student for a response within 2 business days. We will also send those complaints and comments to the Dean of Students so that they can be incorporated into their Dean’s Letters. After all, who is better to comment on a student’s abilities than the patients that they treat.



EDIT: It has come to my attention that some might take the above post seriously. If that is the case, I suggest that you take two shots of your favorite whiskey and re-read.

I realize this is a joke, but this is actually not that dissimilar from the AI I did. They said openly that the rotation was meant to mirror the life of an attending, not an intern.

We had a timer for all ESI level +3s, admit or d/c within 2 hrs. We did our own admissions and bed placements for everyone we saw, including having a full, billable/codable note done on every patient by 24hrs post-shift. We had a social worker to help, but if your Pt needed a SNF, follow up coordinated, or psych placement, etc that was our job. 2/3 was in the low acuity/medically complex pod, 1/3 in the high acuity pod.

We didn’t have press ganey scores as students, but the attendings were very clear that they did, and if they got a bad one it’d be considered when ranking your sloe.

No exams, no quizzes, no sims, or OSCEs. Just shifts where your efficiency, throughput, note writing, and ability to put together a competent work up were numerically measured against the other rotators.

It was quite an experience.

 

[miacomet]

Disagree. Residency was way better!
1. Lots of cushy off-service rotations
2. Less responsibility
3. No patient satisfaction issues
4. Scheduled vacation
5. Less politics
6. No CMG issues
7. Fewer evaluations

Also, that video was highly unhelpful.

 

[ShockIndex]

I realize this is a joke, but this is actually not that dissimilar from the AI I did. They said openly that the rotation was meant to mirror the life of an attending, not an intern.

We had a timer for all ESI level +3s, admit or d/c within 2 hrs. We did our own admissions and bed placements for everyone we saw, including having a full, billable/codable note done on every patient by 24hrs post-shift. We had a social worker to help, but if your Pt needed a SNF, follow up coordinated, or psych placement, etc that was our job. 2/3 was in the low acuity/medically complex pod, 1/3 in the high acuity pod.

We didn’t have press ganey scores as students, but the attendings were very clear that they did, and if they got a bad one it’d be considered when ranking your sloe.

No exams, no quizzes, no sims, or OSCEs. Just shifts where your efficiency, throughput, note writing, and ability to put together a competent work up were numerically measured against the other rotators.

It was quite an experience.

That sounds like an excellent AI. The bolded portion is simply outstanding.

 

[TheSingularity]

I realize this is a joke, but this is actually not that dissimilar from the AI I did. They said openly that the rotation was meant to mirror the life of an attending, not an intern.

We had a timer for all ESI level +3s, admit or d/c within 2 hrs. We did our own admissions and bed placements for everyone we saw, including having a full, billable/codable note done on every patient by 24hrs post-shift. We had a social worker to help, but if your Pt needed a SNF, follow up coordinated, or psych placement, etc that was our job. 2/3 was in the low acuity/medically complex pod, 1/3 in the high acuity pod.

We didn’t have press ganey scores as students, but the attendings were very clear that they did, and if they got a bad one it’d be considered when ranking your sloe.

No exams, no quizzes, no sims, or OSCEs. Just shifts where your efficiency, throughput, note writing, and ability to put together a competent work up were numerically measured against the other rotators.

It was quite an experience.

That sounds like an excellent AI. The bolded portion is simply outstanding.

Come on this is just ridiculous. Medical student and interns should be LEARNING MEDICINE. Not stressing on this of the bullshyt.

 

[ShockIndex]

Come on this is just ridiculous. Medical student and interns should be LEARNING MEDICINE. Not stressing on this of the bullshyt.

Learning how to quickly and safely dispo level 3s is a foundational skill in EM. It separates the productive from the marginal and has implications for resource utilization and cost-effective practice. Learning how to properly document an ED note is also a core competency.

Do I think that every AI in the 4th year needs to emphasize these core aspects of daily practice? No. But having a month where students are evaluated on these aspects of EM is outstanding, IMHO.

 

[TheComebacKid]

To the OP: You are a little over half way through intern year. News flash: you suck as a doctor right now.

Wait til you are a PGY3, you understand the system better, and you see yourself actually making a difference in the lives of patients. Everything you are saying now has been said by countless other docs in training, including myself. As a PGY4 I am now more hungry than ever for EM. The reason is simple and is embodied by a quote from the ortho consult resident at my program: "You are making serious gains, bro."

While I am drinking the EM Kool Aid right now, I recognize personally it is not sustainable for me long term. I'm doing fellowship, maybe getting an MPH, carving out a research/academic career, doing more teaching, etc with the hopes of some clinical buy down in the long run. It's not an easy path by any means, but I'll take it over working in a CMG sweat shop for the rest of my career.

For now, you are counting your chickens before they hatch with respect to thinking about other careers, etc. Despite it's issues, EM is a great field, and you'll start to develop a better sense for where your interests lie and what kind of career you'll have post graduation.

 

[RuralEDDoc]

It was implied above but realize that UC is not necessarily easier or lower stress. Depending on the pace it can be harder. Same goes for low acuity shifts in an ED. Consistently over 4pph and 6pph for hours at times is just brutal even with a great scribe and functional EMR.

 

[alpinism]

Seriously though I really think people in academics do med students a disservice by only showing them the sexy parts of emergency medicine.
Hell when I was a senior resident I used to do it all the time when I had a 4th year med student. The problem is that it leads to a huge culture shock when they finally start intern year. That specialty that you thought was fun and exciting with tons of interesting patients and cool procedures is instead not so fun or exciting with mostly psychotic hypochondriacs with nothing even remotely close to an emergency medical condition.

 

[RustedFox]

I will echo the posters above when it comes to:

(1.) You're an intern; it gets far better in the PGY2 and 3 years.
(2.) Try to identify what it is that you dread.

I was like you.
I was an intern, and had a terrific case of the "intern blues". I hated going in to every shift. It got a little better after I knew how to "medicine" better.
One thing has stuck with me, though; and it really does undermine my work satisfaction to this day. It's the reason that I want to cut down on hours, or take up a non-clinical job after some time.

I've said it before on here dozens of times, but it bears repeating:

The number one cause of burnout is the patient.

...

After 10 years of being an EM physician, the fact that 90% of my shift was spent doing things that had no point, or could have been obviated if the patient exercised the tiniest bit of self-care or common sense, I began to hate the patients. Sure, there were the resuscitations, and the really sick ICU admits, but those are/were a tiny fraction of the daily work, and ended up just taking too much time. The other patients were sure to let me know that they've been waiting "too long" when I finished actually doing the medicines (sic) and could get around to them. I began to hate them.

When signing up for the SAME diabetic foot wound that I have seen 4x before, I began to hate the patient.

When being asked for "a work note" by 3-4 people in the room who absolutely had no reason to be there. I began to hate them, too.

When the noncompliant gastroparetic screamed at me for more narcotics with an empty McDonald's bag at the beside, I began to hate her.

When that very same noncompliant gastroparetic threw herself on the floor from her bed after being denied more Dilaudid, I hated her more.

When that VERY SAME noncompliant gastroparetic found the bed removed from her room and the mattress on the floor during her next visit as a result of her bad behavior, and she screamed loud enough for the entire department to go temporarily deaf, I hated her the most.

When the BOOMER female screamed at me to admit her (thereby committing medicare fraud) because her apartment was being fumigated and she didn't want to have to find alternate lodging, I began to hate her.

When the same BOOMER female called her PMD so "he can tell you that you need to admit me", I hated her more.

When the patient had been in the US for 20+ years and STILL didn't speak a lick of English, I began to hate them.

When the obese old man with chest pain argued with me that I was wrong that his chest pain was high-risk and almost certainly coronary in nature (complete with EKG changes!) because I "wasn't old enough to know what I was talking about", I hated him.

When the old woman with too much money and not enough courtesy snapped her fingers at me while I was running thru the lobby to go to a CODE BLUE and said "Booyyy! - Bring me that wheelchair", I hated her.

When mom and dad brought their completely non-sick kid to the ER at 3:15 AM, and both are too stoned to remember why they're there, I hated them.

Every day became poisonous with resentment.

Couple that with the fact that Americans aren't getting any healthier, and the knowledge that the heathcare train is running straight down the tracks and towards the cliff, and hatred turned into despair. Every day became a merry-go-round of the failures of humanity.

My dad came down to visit me recently. We went out for breakfast one day. Great breakfast/lunch restaurant near my place.
I looked around the restaurant while waiting for my sandwich.

All I saw around me were *patients* that I had learned to hate.

Now, these hungry patrons weren't people that I had actually recognized from the ER, but rather; their archetypes were everywhere, surrounding me. The obese BOOMER greedily shoveling French Toast and bacon into his pie-hole, dripping syrup into his chest hair over his CABG scar was one table away. Beyond him sat a white-trash family of 5. All obese. Mama June is forcefeeding the toddler pure sugar while the other children scream and grind scrambled eggs into the floor with their sneakers when dad takes their gaming devices away. Dad is on his fourth Mountain Dew. Behind me, I heard a gravelly voice say: "I already had my breakfast cigarette." I turn and see a ghastly, emaciated frame of a mustached man wearing what was originally an off-white baseball cap that had now turned fully brown from the nicotine and tar. The Noo Yawkers sitting in the booth were sure to complain about every little thing, and had to throw in: "its not like back home in Noo Yawk; you just can't get good food down here". I'm pretty sure I saw a woman sitting at the bartop take a stick of butter out of her purse and peel it like it was a banana before taking a large bite.

I didn't say much during our meal. Dad noticed and asked me what I was thinking about. I promised I'd tell him when we were back in the car.

Back in the car, I let it all fly. "All I saw when I looked around that restaurant were the things that work has taught me to hate."

Dad sat silently for a bit before saying: "Wow. There's so much venom in your words. I get it. But something has to change, or else you're headed for an early grave."

It's a shame.

I used to be such a people person.

Then, people ruined it.

 

[namethatsmell]

After 10 years of being an EM physician, the fact that 90% of my shift was spent doing things that had no point, or could have been obviated if the patient exercised the tiniest bit of self-care or common sense, I began to hate the patients.

When signing up for the SAME diabetic foot wound that I have seen 4x before, I began to hate the patient.

When being asked for "a work note" by 3-4 people in the room who absolutely had no reason to be there. I began to hate them, too.

When the BOOMER female screamed at me to admit her (thereby committing medicare fraud) because her apartment was being fumigated and she didn't want to have to find alternate lodging, I began to hate her.

When the old woman with too much money and not enough courtesy snapped her fingers at me while I was running thru the lobby to go to a CODE BLUE and said "Booyyy! - Bring me that wheelchair", I hated her.

No sage words from me, but I TOTALLY agree that a major segment of our unique brew of patients fans the burnout fires. Many are patients whose personalty disorders and abusive behavior have pretty much precluded any other physician from being willing to see them. But EMTALA ensure we have to. And they know it. I've always wondered what would happen if we had the option to charge these jokers $500 on the spot for a work note if we thought it was for a bogus reason and see how ED utilization responds. Wouldn't that be a delightful experiment?

So much of our shift is already spent fighting the entire system to get patients the appropriate care they need. Nothing puts a turd in the pool like a well patient requesting an admission for a bogus reason...and then, even after explaining why it's unnecessary and bad for them, they still insist and find other ways to waste your time/resources and/or threaten you despite you doing them a favor by not putting them upstairs next to the latest ebola-corona-sars-plague varient for them to catch.

Perhaps a change of scenery for a bit could help? Seeing rural patients and vets put some wind back in my sails and could maybe do the same for you. Or you could do a stint in Australia or New Zealand. 100% of my EM buds who have done time down there loved it and said the patients were great.

 

[19pieces19]

I will echo the posters above when it comes to:

(1.) You're an intern; it gets far better in the PGY2 and 3 years.
(2.) Try to identify what it is that you dread.

I was like you.
I was an intern, and had a terrific case of the "intern blues". I hated going in to every shift. It got a little better after I knew how to "medicine" better.
One thing has stuck with me, though; and it really does undermine my work satisfaction to this day. It's the reason that I want to cut down on hours, or take up a non-clinical job after some time.

I've said it before on here dozens of times, but it bears repeating:

The number one cause of burnout is the patient.

...

After 10 years of being an EM physician, the fact that 90% of my shift was spent doing things that had no point, or could have been obviated if the patient exercised the tiniest bit of self-care or common sense, I began to hate the patients. Sure, there were the resuscitations, and the really sick ICU admits, but those are/were a tiny fraction of the daily work, and ended up just taking too much time. The other patients were sure to let me know that they've been waiting "too long" when I finished actually doing the medicines (sic) and could get around to them. I began to hate them.

When signing up for the SAME diabetic foot wound that I have seen 4x before, I began to hate the patient.

When being asked for "a work note" by 3-4 people in the room who absolutely had no reason to be there. I began to hate them, too.

When the noncompliant gastroparetic screamed at me for more narcotics with an empty McDonald's bag at the beside, I began to hate her.

When that very same noncompliant gastroparetic threw herself on the floor from her bed after being denied more Dilaudid, I hated her more.

When that VERY SAME noncompliant gastroparetic found the bed removed from her room and the mattress on the floor during her next visit as a result of her bad behavior, and she screamed loud enough for the entire department to go temporarily deaf, I hated her the most.

When the BOOMER female screamed at me to admit her (thereby committing medicare fraud) because her apartment was being fumigated and she didn't want to have to find alternate lodging, I began to hate her.

When the same BOOMER female called her PMD so "he can tell you that you need to admit me", I hated her more.

When the patient had been in the US for 20+ years and STILL didn't speak a lick of English, I began to hate them.

When the obese old man with chest pain argued with me that I was wrong that his chest pain was high-risk and almost certainly coronary in nature (complete with EKG changes!) because I "wasn't old enough to know what I was talking about", I hated him.

When the old woman with too much money and not enough courtesy snapped her fingers at me while I was running thru the lobby to go to a CODE BLUE and said "Booyyy! - Bring me that wheelchair", I hated her.

When mom and dad brought their completely non-sick kid to the ER at 3:15 AM, and both are too stoned to remember why they're there, I hated them.

Every day became poisonous with resentment.

Couple that with the fact that Americans aren't getting any healthier, and the knowledge that the heathcare train is running straight down the tracks and towards the cliff, and hatred turned into despair. Every day became a merry-go-round of the failures of humanity.

My dad came down to visit me recently. We went out for breakfast one day. Great breakfast/lunch restaurant near my place.
I looked around the restaurant while waiting for my sandwich.

All I saw around me were *patients* that I had learned to hate.

Now, these hungry patrons weren't people that I had actually recognized from the ER, but rather; their archetypes were everywhere, surrounding me. The obese BOOMER greedily shoveling French Toast and bacon into his pie-hole, dripping syrup into his chest hair over his CABG scar was one table away. Beyond him sat a white-trash family of 5. All obese. Mama June is forcefeeding the toddler pure sugar while the other children scream and grind scrambled eggs into the floor with their sneakers when dad takes their gaming devices away. Dad is on his fourth Mountain Dew. Behind me, I heard a gravelly voice say: "I already had my breakfast cigarette." I turn and see a ghastly, emaciated frame of a mustached man wearing what was originally an off-white baseball cap that had now turned fully brown from the nicotine and tar. The Noo Yawkers sitting in the booth were sure to complain about every little thing, and had to throw in: "its not like back home in Noo Yawk; you just can't get good food down here". I'm pretty sure I saw a woman sitting at the bartop take a stick of butter out of her purse and peel it like it was a banana before taking a large bite.

I didn't say much during our meal. Dad noticed and asked me what I was thinking about. I promised I'd tell him when we were back in the car.

Back in the car, I let it all fly. "All I saw when I looked around that restaurant were the things that work has taught me to hate."

Dad sat silently for a bit before saying: "Wow. There's so much venom in your words. I get it. But something has to change, or else you're headed for an early grave."

It's a shame.

I used to be such a people person.

Then, people ruined it.

No sage words from me, but I TOTALLY agree that a major segment of our unique brew of patients fans the burnout fires. Many are patients whose personalty disorders and abusive behavior have pretty much precluded any other physician from being willing to see them. But EMTALA ensure we have to. And they know it. I've always wondered what would happen if we had the option to charge these jokers $500 on the spot for a work note if we thought it was for a bogus reason and see how ED utilization responds. Wouldn't that be a delightful experiment?

So much of our shift is already spent fighting the entire system to get patients the appropriate care they need. Nothing puts a turd in the pool like a well patient requesting an admission for a bogus reason...and then, even after explaining why it's unnecessary and bad for them, they still insist and find other ways to waste your time/resources and/or threaten you despite you doing them a favor by not putting them upstairs next to the latest ebola-corona-sars-plague varient for them to catch.

Perhaps a change of scenery for a bit could help? Seeing rural patients and vets put some wind back in my sails and could maybe do the same for you. Or you could do a stint in Australia or New Zealand. 100% of my EM buds who have done time down there loved it and said the patients were great.

As a med student considering EM, looking back, would you have decided to choose a different specialty if you could? Considering radiology.

 

[RustedFox]

As a med student considering EM, looking back, would you have decided to choose a different specialty if you could? Considering radiology.

Looking back, I have to say that I would rather walk away from medicine altogether.

Lets take a look at the other fields of medicine:

1.) FM/IM/Peds: No freaking way.
2.) Radiology: Mouthbreather in the dark. No, thanks.
3.) Anesthesiology: Too close to surgeons. Also, giving their specialty away to the CRNAs.
4.) ANY surgical subspecialty: Uh, no.
5.) ANY IM subspecialty: Uh, no. I'm not doing 3 years of IM just to do 2-3 years MORE of whatever fellowship and start making money at age 33.
6.) PM&R: hahahahahahahaha.

I think that about covers it.

 

[namethatsmell]

As a med student considering EM, looking back, would you have decided to choose a different specialty if you could? Considering radiology.

Consider that the root of much dissatisfaction in life is when expectations don't meet reality.

Read this forum and you'll see many folks are displeased for a number of reasons. While we are happy to take care of the truly sick, we are being pushed to increasingly prioritize the management of non-emergencies while dealing with unruly and abusive patients who we are also expected to get great patient satisfaction scores from, while also trying to wrangle consultants and admitting docs who want as little to do with ED patients as possible, and at the same time handle administrators and other "stakeholders" of all sorts who all want you to jump through their numerous hoops-de-jour, many of which are not-compatible with each other. An outsider would think that witnessing all the human suffering and tragedy that washes up on our shore--and trying to treating that which can be treated--is what fuels the burnout of EM. Yet, that turns out to be only a very very small component of burnout for most folks in EM. And when you think about that for a minute, that's kind of messed up.

So, as it is not possible in most parts of the country to open up your own ED, most of us worker bees have very little control to change the reality of our work environment as the hospital dictates it (aside from swapping jobs which can make a huge difference, but the new job can also turn to crap suddenly too). And so our main option is to change our expectations of what practicing EM should entail. Some people do that better than others. If you have flexibility to move anywhere to a unicorn job or can mold your expectations and still stay truly happy, EM can be a good option. The medicine of our field is cool.

A big part of me thinks EM is still among the best fields of what medicine today has left to offer...provided your personal life has flexibility and you can line up the right job, which is getting very hard to find. If I had to do residency again it would come down to EM vs a field that would allow me to practice outside of the hospital where I could mold the reality of the workplace rather than only having the option to continually change my expectations.

 

[Frazier]

I will echo the posters above when it comes to:

(1.) You're an intern; it gets far better in the PGY2 and 3 years.
(2.) Try to identify what it is that you dread.

I was like you.
I was an intern, and had a terrific case of the "intern blues". I hated going in to every shift. It got a little better after I knew how to "medicine" better.
One thing has stuck with me, though; and it really does undermine my work satisfaction to this day. It's the reason that I want to cut down on hours, or take up a non-clinical job after some time.

I've said it before on here dozens of times, but it bears repeating:

The number one cause of burnout is the patient.

...

After 10 years of being an EM physician, the fact that 90% of my shift was spent doing things that had no point, or could have been obviated if the patient exercised the tiniest bit of self-care or common sense, I began to hate the patients. Sure, there were the resuscitations, and the really sick ICU admits, but those are/were a tiny fraction of the daily work, and ended up just taking too much time. The other patients were sure to let me know that they've been waiting "too long" when I finished actually doing the medicines (sic) and could get around to them. I began to hate them.

When signing up for the SAME diabetic foot wound that I have seen 4x before, I began to hate the patient.

When being asked for "a work note" by 3-4 people in the room who absolutely had no reason to be there. I began to hate them, too.

When the noncompliant gastroparetic screamed at me for more narcotics with an empty McDonald's bag at the beside, I began to hate her.

When that very same noncompliant gastroparetic threw herself on the floor from her bed after being denied more Dilaudid, I hated her more.

When that VERY SAME noncompliant gastroparetic found the bed removed from her room and the mattress on the floor during her next visit as a result of her bad behavior, and she screamed loud enough for the entire department to go temporarily deaf, I hated her the most.

When the BOOMER female screamed at me to admit her (thereby committing medicare fraud) because her apartment was being fumigated and she didn't want to have to find alternate lodging, I began to hate her.

When the same BOOMER female called her PMD so "he can tell you that you need to admit me", I hated her more.

When the patient had been in the US for 20+ years and STILL didn't speak a lick of English, I began to hate them.

When the obese old man with chest pain argued with me that I was wrong that his chest pain was high-risk and almost certainly coronary in nature (complete with EKG changes!) because I "wasn't old enough to know what I was talking about", I hated him.

When the old woman with too much money and not enough courtesy snapped her fingers at me while I was running thru the lobby to go to a CODE BLUE and said "Booyyy! - Bring me that wheelchair", I hated her.

When mom and dad brought their completely non-sick kid to the ER at 3:15 AM, and both are too stoned to remember why they're there, I hated them.

Every day became poisonous with resentment.

Couple that with the fact that Americans aren't getting any healthier, and the knowledge that the heathcare train is running straight down the tracks and towards the cliff, and hatred turned into despair. Every day became a merry-go-round of the failures of humanity.

My dad came down to visit me recently. We went out for breakfast one day. Great breakfast/lunch restaurant near my place.
I looked around the restaurant while waiting for my sandwich.

All I saw around me were *patients* that I had learned to hate.

Now, these hungry patrons weren't people that I had actually recognized from the ER, but rather; their archetypes were everywhere, surrounding me. The obese BOOMER greedily shoveling French Toast and bacon into his pie-hole, dripping syrup into his chest hair over his CABG scar was one table away. Beyond him sat a white-trash family of 5. All obese. Mama June is forcefeeding the toddler pure sugar while the other children scream and grind scrambled eggs into the floor with their sneakers when dad takes their gaming devices away. Dad is on his fourth Mountain Dew. Behind me, I heard a gravelly voice say: "I already had my breakfast cigarette." I turn and see a ghastly, emaciated frame of a mustached man wearing what was originally an off-white baseball cap that had now turned fully brown from the nicotine and tar. The Noo Yawkers sitting in the booth were sure to complain about every little thing, and had to throw in: "its not like back home in Noo Yawk; you just can't get good food down here". I'm pretty sure I saw a woman sitting at the bartop take a stick of butter out of her purse and peel it like it was a banana before taking a large bite.

I didn't say much during our meal. Dad noticed and asked me what I was thinking about. I promised I'd tell him when we were back in the car.

Back in the car, I let it all fly. "All I saw when I looked around that restaurant were the things that work has taught me to hate."

Dad sat silently for a bit before saying: "Wow. There's so much venom in your words. I get it. But something has to change, or else you're headed for an early grave."

It's a shame.

I used to be such a people person.

Then, people ruined it.

Reminds me when I was in middle of a full arrest resus in the ED and an uninvolved nurse enters the bay, taps me on the back, and says "room 30 wants pain meds" (a guaranteed stone). In near disbelief, I give a quick verbal order, say "thank you, goodbye", and nurse leaves.

After resus... and subsequent lengthy family meeting... so, like 30 min later, I go to check on the pt that requested pain meds, soon as I walk in on the husband and wife duo "oh, look who was FINALLY able to find the time to see us!"

[cue my standard apology for the wait]

I ask how the pain is now. "Still a 10. Never got meds." I typically don't like to wave the triage card in patient faces about much sicker pts than them taking priority, so stay vague with "my apologies, there must have been some bottlenecks with the pain meds."

Response from spouse, raising their tone and pointing, "NO! YOU ARE THE BOTTLENECK! Our nurse told us YOU wouldn't order anything after he asked you repeatedly! Explain THAT...'DOC'!"

Unfortunate way to kick off a shift.

 

[homebaseddad112818]

I realize this is a joke, but this is actually not that dissimilar from the AI I did. They said openly that the rotation was meant to mirror the life of an attending, not an intern.

We had a timer for all ESI level +3s, admit or d/c within 2 hrs. We did our own admissions and bed placements for everyone we saw, including having a full, billable/codable note done on every patient by 24hrs post-shift. We had a social worker to help, but if your Pt needed a SNF, follow up coordinated, or psych placement, etc that was our job. 2/3 was in the low acuity/medically complex pod, 1/3 in the high acuity pod.

We didn’t have press ganey scores as students, but the attendings were very clear that they did, and if they got a bad one it’d be considered when ranking your sloe.

No exams, no quizzes, no sims, or OSCEs. Just shifts where your efficiency, throughput, note writing, and ability to put together a competent work up were numerically measured against the other rotators.

It was quite an experience.

Wow, mind sharing where this was? That’s insane

 

[TheSingularity]

You need to be willing / able to change jobs if your first one sucks. People change jobs all the time in EM. No reason to be loyal to one place.

Also helps to have a spouse that makes money. My wife makes over 200k. I could quit my job today if I wanted and we'd be FINE. Sure, maybe I couldn't have wagyu beef or take a glitzy vacation whenever I want to, but we would be more than fine.

 

[deleted109597]

You need to be willing / able to change jobs if your first one sucks. People change jobs all the time in EM. No reason to be loyal to one place.

Also helps to have a spouse that makes money. My wife makes over 200k. I could quit my job today if I wanted and we'd be FINE. Sure, maybe I couldn't have wagyu beef or take a glitzy vacation whenever I want to, but we would be more than fine.

The wife and I have talked. We would life for awhile during the time I figured out what I'm doing. But we'd be fine. It would be like, instead of having Kobe beef in Kobe, to having Wagyu beef at home. So, a bit less, but it's not like we are rationing food for the winter, or selling off a kid or anything.

 

[BoardingDoc]

Reminds me when I was in middle of a full arrest resus in the ED and an uninvolved nurse enters the bay, taps me on the back, and says "room 30 wants pain meds" (a guaranteed stone). In near disbelief, I give a quick verbal order, say "thank you, goodbye", and nurse leaves.

After resus... and subsequent lengthy family meeting... so, like 30 min later, I go to check on the pt that requested pain meds, soon as I walk in on the husband and wife duo "oh, look who was FINALLY able to find the time to see us!"

[cue my standard apology for the wait]

I ask how the pain is now. "Still a 10. Never got meds." I typically don't like to wave the triage card in patient faces about much sicker pts than them taking priority, so stay vague with "my apologies, there must have been some bottlenecks with the pain meds."

Response from spouse, raising their tone and pointing, "NO! YOU ARE THE BOTTLENECK! Our nurse told us YOU wouldn't order anything after he asked you repeatedly! Explain THAT...'DOC'!"

Unfortunate way to kick off a shift.

I agree I don't like to bring up the triage thing when the person is being reasonable, but when they start off the interaction abrasive like that, I will always explain that I was taking care of someone who is much sicker than they are and that's why they were waiting. I feel this is always the correct thing to do as the patient will either
1: Apologize, or at least be adequately mollified
2: Become even more irrational and irate and I can consider treating them with haldol or an escort out of the ED.

Both ways yield a more pleasant experience.

 

[deleted859535]

I absolutely do bring up the fact that something horrible was happening that required my immediate bedside presence in a HIPAA-friendly yet pointed way.

Period. Unapologetically. I was there doing the number one priority of my job first.

 

[TooMuchResearch]

I do this as well.

I absolutely do bring up the fact that something horrible was happening that required my immediate bedside presence in a HIPAA-friendly yet pointed way.

Period. Unapologetically. I was there doing the number one priority of my job first.

 

[Apollyon]

I do this as well.

"I'm sorry for the wait. But, if you have to wait in the ED, that means there's some other unfortunate person in worse condition than you."

 

[bravotwozero]

At the risk of stating the obvious, America is largely a mercantile society. Most people here who made it big did so by going into business. If you wanna do non clinical, I think that's the way to go. Develop a niche online business that can create a passive income stream, and you will be able to create revenue that offsets revenue losses from a tanking job market/economic forces.

 

[Zebra Hunter]

Reminds me when I was in middle of a full arrest resus in the ED and an uninvolved nurse enters the bay, taps me on the back, and says "room 30 wants pain meds" (a guaranteed stone). In near disbelief, I give a quick verbal order, say "thank you, goodbye", and nurse leaves.

After resus... and subsequent lengthy family meeting... so, like 30 min later, I go to check on the pt that requested pain meds, soon as I walk in on the husband and wife duo "oh, look who was FINALLY able to find the time to see us!"

[cue my standard apology for the wait]

I ask how the pain is now. "Still a 10. Never got meds." I typically don't like to wave the triage card in patient faces about much sicker pts than them taking priority, so stay vague with "my apologies, there must have been some bottlenecks with the pain meds."

Response from spouse, raising their tone and pointing, "NO! YOU ARE THE BOTTLENECK! Our nurse told us YOU wouldn't order anything after he asked you repeatedly! Explain THAT...'DOC'!"

Unfortunate way to kick off a shift.

That isn't the time to apologize or make up alternative excuses to reality. I am blunt as possible with these patients that complain before I can get a word out. "I'm sorry, I was attempting to restart the heart of someone's mother, I'm sure you can understand how that takes priority. Now what can I do for you now that I am free?"

I had one couple profusely apologize multiple times to myself and the nurse after this explanation. The other time I had to do this they escalated, and given it was a chronic complaint, I had them escorted out.

Gator don't play no ****!

 

[TooMuchResearch]

I'm lucky in that many of our patients come to that conclusion. "Hey, the nurse told me you were busy with someone so I've just been napping. I'm glad I'm not the most important one here."

"I'm sorry for the wait. But, if you have to wait in the ED, that means there's some other unfortunate person in worse condition than you."

 

[Groove]

The wife and I have talked. We would life for awhile during the time I figured out what I'm doing. But we'd be fine. It would be like, instead of having Kobe beef in Kobe, to having Wagyu beef at home. So, a bit less, but it's not like we are rationing food for the winter, or selling off a kid or anything.

@Dr.McNinja Weren’t you looking at that UC job a little while back? What’s the status on that? Did you decide to make the jump? (I might be getting you mixed up with someone else.)

 

[deleted109597]

@Dr.McNinja Weren’t you looking at that UC job a little while back? What’s the status on that? Did you decide to make the jump? (I might be getting you mixed up with someone else.)

I had a UC offer. I ultimately didn't take it. Hours increase, pay cut, and more of the stuff that drove me nuts at work.
I'm sure some people enjoy it.
Talked to a few people doing CC fellowships. Would require living apart from spouse.
So instead I've simply started reading a lot of philosophy and not caring about the small stuff, and realizing it's nearly all small stuff. Got a gig that requires some travel, but it's driveable.

 

[ShockIndex]

Dad sat silently for a bit before saying: "Wow. There's so much venom in your words. I get it. But something has to change, or else you're headed for an early grave."

Your Dad is probably right and knows you better than anyone except your Mom. It sounds like you are in need of a fundamental career restructuring. Hopefully you will find a way to get back to not hating all of humanity; 50% is a more reasonable and healthy number.

 

[deleted1027621]

RustedFox is pretty much the reason I made an account and quit just lurking. I see so much of myself in his posts. As he became more burned out, it mirrored my progression to burn out. I almost felt like he is my friend even though all I did was read his posts and laugh, agree, shake my head and somehow feel a little better about myself. After reading his posts, I feel so much less alone somehow and less.... faulty. No point to this post other than to say thanks to RustedFox. I hope this gets better for you. I am rooting for all of us.

 

[docB]

Gotta agree with Rusted on a lot of stuff.

I get that question a lot from students and residents, "Well if this sucks so bad what specialty do you wish you were in?" I echo Rusted's "It's not the specialty. It's the industry." I couldn't do any other specialty. I think that if you are in medicine EM is one of the better places to be. I don't think that some other specialty has it easy and we got screwed. I think all of healthcare is a disaster.

I do think that students get a skewed view of EM. I wouldn't put them on the hook personally for PG scores but I do think we should tell them what we're up against. No one should be matched before they've ever heard of customer satisfaction.

Bit of a tangent but a good example of how disconnected the student view is from the attending view is with procedures. Students think EM is all about doing lots of fun, challenging procedures. I, like many attendings, dread procedures. I describe them as being put in the penalty box for 30 minutes while the patients keep swarming in.

 

[RustedFox]

Gotta agree with Rusted on a lot of stuff.

I, like many attendings, dread procedures. I describe them as being put in the penalty box for 30 minutes while the patients keep swarming in.

1. Thank you.
2. The only procedure I like anymore is a reduction, or an ultrasound-guided IJ. I pretty much hate everything else. Especially LPs. Before anyone asks why; remember that my average patient is a 76 year old female, likely with outstanding scoliosis and calcified spine. Everywhere. Bone spurs. Ligamentum whatever. Its all crunch, crunch, crunch.

 

[RustedFox]

RustedFox is pretty much the reason I made an account and quit just lurking. I see so much of myself in his posts. As he became more burned out, it mirrored my progression to burn out. I almost felt like he is my friend even though all I did was read his posts and laugh, agree, shake my head and somehow feel a little better about myself. After reading his posts, I feel so much less alone somehow and less.... faulty. No point to this post other than to say thanks to RustedFox. I hope this gets better for you. I am rooting for all of us.

Thank you for the kind words.
Feel free to PM me anytime.

I actually took a 3-week leave back in January.
I'm back now.
I feel a bit better, but the game is the same.
I set a hard "ceiling" of 130 hours/month, and I won't pick up a shift unless its the "right thing to do" (someone's kid is sick, someone has a family member coming into town, etc).

We typically have a PA scheduled daily from 12pm-12am.
Today, she called out. Cervical disc herniation.
OtherDoc and I braced for impact.
I saw 31 patients in 8 hours, for 3.875 patients/hour.
I'll sleep well tonight.
There were few soul-sucking patients today.
That's a very good thing.

 

[ShockIndex]

Gotta agree with Rusted on a lot of stuff.

I get that question a lot from students and residents, "Well if this sucks so bad what specialty do you wish you were in?" I echo Rusted's "It's not the specialty. It's the industry." I couldn't do any other specialty. I think that if you are in medicine EM is one of the better places to be. I don't think that some other specialty has it easy and we got screwed. I think all of healthcare is a disaster.

I do think that students get a skewed view of EM. I wouldn't put them on the hook personally for PG scores but I do think we should tell them what we're up against. No one should be matched before they've ever heard of customer satisfaction.

Bit of a tangent but a good example of how disconnected the student view is from the attending view is with procedures. Students think EM is all about doing lots of fun, challenging procedures. I, like many attendings, dread procedures. I describe them as being put in the penalty box for 30 minutes while the patients keep swarming in.

A big part of the compassion fatigue that accompanies EM is the industry’s expectation that the ED is the “judgement-free zone.” We are to be dispassionate robots; delivering care to those in need without addressing the life choices that landed them in an emergency department...at 3 in the AM. Heaven forbid that you upset someone by telling them that the reason why their baby is wheezing is because the entire family smells like an ashtray.

Unfortunately, that is not how the psyche works for most people with the initiative to become emergency physicians. Bottling all that up wears on the soul. So, we offload this on our families by being hypercritical and letting them know exactly what we think. Pretty soon, it’s a viscous cycle with a very short feedback loop.

 

[RustedFox]

You know. I had one real soul sucker today.
Drunk woman kicked me in the head. Really, more of a knee - but she still got me in the melon.

Why was she there? Skin tear to knee. Not healing. 10 days old. Apparently I took the bandage off too fast. BAM. She was on the young side for skin tears, too. 63, I think? Welp. That's what happens when you're a two pack a day girl who thinks she can still dine out on her looks. Those deep, hyperpigmented cracks on the perioral region told the tale. I smelled the stale wine from the doorway. One thing I'm damn good at is detecting even the faintest whispers of alcohol. I can even tell them what they were drinking. Guess that's what happens when you're the only one in the family without a DUI.

But this skin tear was minor at best. Apparently, some doggo jumped in her lap a week or so ago, and her fragile and smokey skin tore like tissue paper. This sixty-something cried like a second grader that had lost her lunch money.

I walked out of the room. "I'll give you all time to calm down; but we have to address this wound."

I returned 10 minutes later. She's still blubbering. Uncomplicated skin tear. Nurse will provide wound care. Discharged.

That was my only soul sucker for the shift.

 

[NYEMMED]

1. Thank you.
2. The only procedure I like anymore is a reduction, or an ultrasound-guided IJ. I pretty much hate everything else. Especially LPs. Before anyone asks why; remember that my average patient is a 76 year old female, likely with outstanding scoliosis and calcified spine. Everywhere. Bone spurs. Ligamentum whatever. Its all crunch, crunch, crunch.

I thought I was the only one that hated procedures.
Actually I wouldn’t mind the procedures if I had the time to do them.
Time is literally money with RVUs, if I am doing this procedure I’m losing money not seeing some other patients.

Also then I have to deal with nurse mcClipboard and Director idontworkclinically, explaining why I didn’t see xx number of patients that shift.
Sorry I had to intubate, they lost pressures and needed a central line, had no source so needed a tap...and the trauma next door needed a chest tube, but I’ll worry about my patients per hour instead.

It’s not EM that burns me out, it’s who we work for...

 

[BoardingDoc]

I thought I was the only one that hated procedures.
Actually I wouldn’t mind the procedures if I had the time to do them.
Time is literally money with RVUs, if I am doing this procedure I’m losing money not seeing some other patients.

Also then I have to deal with nurse mcClipboard and Director idontworkclinically, explaining why I didn’t see xx number of patients that shift.
Sorry I had to intubate, they lost pressures and needed a central line, had no source so needed a tap...and the trauma next door needed a chest tube, but I’ll worry about my patients per hour instead.

It’s not EM that burns me out, it’s who we work for...

Sometimes. I'll take that prosthetic hip dislocation any day of the week. Procedure plus chart for the visit is easily worth 3 lvl 5 charts and takes less than 20 minutes door to door.

That said, in general I agree with you.

 

[RustedFox]

Sometimes. I'll take that prosthetic hip dislocation any day of the week. Procedure plus chart for the visit is easily worth 3 lvl 5 charts and takes less than 20 minutes door to door.

That said, in general I agree with you.

It takes my motley crew of nurses 20 minutes just to write down the chief complaint and get the patient to a room.
Then, there's 10 minutes of pointless questions about travel history, suicidality, etc.
Then, for sedation - RT has to finish their cigarettes and get down to the ER, only to have to leave again to go get the stuff they need.

Its not 20 minutes.

 

[BoardingDoc]

It takes my motley crew of nurses 20 minutes just to write down the chief complaint and get the patient to a room.
Then, there's 10 minutes of pointless questions about travel history, suicidality, etc.
Then, for sedation - RT has to finish their cigarettes and get down to the ER, only to have to leave again to go get the stuff they need.

Its not 20 minutes.

1: why the hell is RT involved in a sedation?
2: in fairness, I didn't count the time involved in triage, as during that time I haven't had any involvement with the patient yet. I was just talking about how long the actual procedure ties me up for. 20 min to get the patient on a monitor while I consent them, the nurse to get and push prop, me to pop the hip back in and leave the room.

 

[RustedFox]

1: why the hell is RT involved in a sedation?
2: in fairness, I didn't count the time involved in triage, as during that time I haven't had any involvement with the patient yet. I was just talking about how long the actual procedure ties me up for. 20 min to get the patient on a monitor while I consent them, the nurse to get and push prop, me to pop the hip back in and leave the room.

1. Hospital policy. RT at all sedations.
2. I understand better.