Proceduralist gun for hire

[sylvanthus]

I was brainstorming with a nurse the possibility of setting up a gun for hire, independent contract, proceduralist job, where a person gets called by small area hospitals to do procedures they cannot get done in house for whatever reason and it piqued my interest. What do you guys think of the possibility of making it viable? Get contracted by several small hospitals to take care of procedures they cannot do in house ( no one trained in LPs and you have a r/o meningitis at night on the floor? paras for SBP or therapeutic? US guided lines?, others?), be available certain hours or on call, get called to come in, bang out the procedure, peace out, and bill for it. Lucrative? Viable as a side gig? How in the heck would one even set it up? Thoughts?

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[deleted245139]

I like it. Concept sounds good. Any precedent?

 

[cyanide12345678]

You will be needing multiple small hospital agreements to have even one or two procedures a night. That will be long travel distances.

The large places which regularly perform procedures always have in house docs that can perform these procedures

 

[southerndoc]

Some small hospitals with FP's staffing their ER's use general surgeons for their lines, chest tubes, etc.

As cyanide pointed out, you would need a lot of agreements. You probably wouldn't get more than one or two procedures at night. Remember, small hospitals = small volumes = small number of procedures. I doubt you would make enough to make it worth your while.

You could possibly sell it to larger hospitals as well as you could come do the procedure thereby freeing up their staff to continue seeing patients.

 

[alpinism]

Similar to this I’ve always toyed with the idea of working as a resuscitationist.

Basically contracting with the hospital group to take care of all the level 1s and procedures in the emergency department.

Regarding your question I can see it being a huge pain to set up initially with all the regulations and credentialing requirements. Otherwise it would basically just be a matter of doing enough procedures to make the job financially worthwhile. I’ve never heard of an EM trained person doing this but wouldn’t hurt to put it out there and talk to some of the local hospitals.

 

[DrGasPasser]

I was told that Moses Cone in Greensboro, NC is developing proceduralist PA’s for US-guided lines, paracentesis, thoracentesis, etc. I have no idea if the program has developed beyond the concept phase.

 

[EctopicFetus]

GasPasser there is a group in california that uses their MLPs only to do procedures. It frees up the docs to see the patients, not get bogged down with procedures and is a financial win. Splints, lacs, reductions, LPs, central lines etc. I doubt it is a financial win but thats how they like it.

 

[Vandalia]

That is basically the reason hospitalists were born except in reverse: primary care physicians found that doing inpatient rounds with travel time built in for relatively low reimbursement wasn't worth it. The problem with the original poster's idea is that he is going to do a lot of travel - and on call time - for relatively minimal reimbursement. If there is a need for such services you are going to be in the middle of nowhere.

 

[RustedFox]

GasPasser there is a group in california that uses their MLPs only to do procedures. It frees up the docs to see the patients, not get bogged down with procedures and is a financial win. Splints, lacs, reductions, LPs, central lines etc. I doubt it is a financial win but thats how they like it.

So is it, or is it not, a financial win?

 

[thegenius]

A lot of those procedures, like LP, para, thora, central line, intubation are all worth 2-4 RVUs. That isn’t a lot of money. Given that you have to drive to/from the hospital, say on average it’s 20 mins one way. Your basically making 2-4 RVUs per 60-90 mins of time.

It’s not a lot of money at the end of the day. Prob not worth it. That is unless you negotiate higher reimbursement with the hospital itself. E.g. you might make 2.5 RVUs (~$90) for a paracentesis, but maybe you charge the hospital 2x standard RVU reimbursement (e.g. 5 RVUs).

 

[Rekt]

A lot of those procedures, like LP, para, thora, central line, intubation are all worth 2-4 RVUs. That isn’t a lot of money. Given that you have to drive to/from the hospital, say on average it’s 20 mins one way. Your basically making 2-4 RVUs per 60-90 mins of time.

It’s not a lot of money at the end of the day. Prob not worth it. That is unless you negotiate higher reimbursement with the hospital itself. E.g. you might make 2.5 RVUs (~$90) for a paracentesis, but maybe you charge the hospital 2x standard RVU reimbursement (e.g. 5 RVUs).

I would love a position like this, but this is what I've always been told. Most procedures, unless they're orthopedic related, are terrible for reimbursement. I really doubt a hospital would pay you all the RVUs x2 for a procedure for nearly any circumstance.

 

[VA Hopeful Dr]

I would love a position like this, but this is what I've always been told. Most procedures, unless they're orthopedic related, are terrible for reimbursement. I really doubt a hospital would pay you all the RVUs x2 for a procedure for nearly any circumstance.

If you have a good efficient set up, procedures can pay very well. For example, a joint injection is worth roughly $40 for me. If everything is set up before I walk in the room, I can be in and out in under 5 minutes easily. If I can get 4 of those an hour, that's decent money for FM but very few doctors can fill a schedule with that even in orthopedics.

If you can do an LP in 10-15 minutes, that 1.5 rvu isn't too shabby. But you'd have to be fast and have a steady stream of procedures to make it worth while.

 

[Uranium678]

There is a nurse Picc team , midline IV team. I don’t know why there couldn’t be a doctor similarly doing procedures on call. Maybe you could get them to pay you a steady retainer fee or on call hourly fee so you’re not sitting around for nothing

 

[thegenius]

I would love a position like this, but this is what I've always been told. Most procedures, unless they're orthopedic related, are terrible for reimbursement. I really doubt a hospital would pay you all the RVUs x2 for a procedure for nearly any circumstance.

While this is a good idea...I think its something that is just economically not feasible. Small hospitals would have a need for this but I think unwilling to pay a physician to be on a retainer (because procedures overnight are rare). Large hospitals with 500+ beds probably have 24/7 staff to do just about everything, e.g. the intensivists to do just about all the procedures listed above.

Are ICU docs credentialed to do LPs? Just curious. (I don't consider an LP a procedure that has to be done emergently, they can almost always wait until the AM to be done.)

 

[DrGasPasser]

So is it, or is it not, a financial win?

I was simply told about the plan to use PAs on the wards and ICUs for US guided procedures. I have no knowledge of the financials and I never worked in the ConeHealth System. My info is second hand.

However, I suspect that some of the impetus for the idea was delays getting these done by radiology or the in-patient team. I imagine the indirect cost savings accrued by turning over an in-patient bed faster can be significant.

 

[DrGasPasser]

Are ICU docs credentialed to do LPs? Just curious. (I don't consider an LP a procedure that has to be done emergently, they can almost always wait until the AM to be done.)

We do them with some regularity.

 

[thegenius]

It's sad that procedural competency among board certified internal medicine physicians has just gone down the tubes. 20 years ago they were more apt to do things like paras, thoras, simple lac suturing, etc. Now they don't do it. It's not even a part of their RRC. I think their RRC procedure requirements for IM has like three tiny procedures.

 

[NITRAS]

If you have a good efficient set up, procedures can pay very well. For example, a joint injection is worth roughly $40 for me. If everything is set up before I walk in the room, I can be in and out in under 5 minutes easily. If I can get 4 of those an hour, that's decent money for FM but very few doctors can fill a schedule with that even in orthopedics.

If you can do an LP in 10-15 minutes, that 1.5 rvu isn't too shabby. But you'd have to be fast and have a steady stream of procedures to make it worth while.

The problem is it takes an hour to do an LP for me. Print off the consent, order lidocaine which has to come from pharmacy, get a couple extra needles and kit from central supply, find someone to help position/hold lidocaine. All assuming you aren’t waiting on CT or INR. Then hand carry down to microbiology.

I thought it was 1.37 wRVU for diagnostic LP.

And any FM or IM doc should be able to do LP. Most just don’t want to.

 

[thegenius]

Yea, ideally it takes 10-15 minutes. Like from the time everything is all set up, you have already found your help (if needed), you have all the tools and needles, etc. In reality is like 45 minutes. I hate doing LP's. It's such a time suck, and every now and then you just can't get it despite seemingly good odds. Or the patient starts whining and complaining and wiggling around.

Pelvic take 1 minute. Easy peasy. I want to walk into the room, I want the woman in lithotomy position and everything all set up next to me on the mayo tray and everything at the right height. I want to walk in, say hi to the patient and boom just do it. Takes literally 1 minute.

In reality it's 10!!!!

 

[RustedFox]

I was simply told about the plan to use PAs on the wards and ICUs for US guided procedures. I have no knowledge of the financials and I never worked in the ConeHealth System. My info is second hand.

However, I suspect that some of the impetus for the idea was delays getting these done by radiology or the in-patient team. I imagine the indirect cost savings accrued by turning over an in-patient bed faster can be significant.

Gotcha, homey.
I replied to EctopicFetus. Not you.
Keep on rocking in the free world.

 

[RuralEDDoc]

I looked into this before as an independent contractor at local rural EDs. Not financially viable without a hospital stipend. Better off seeing patients in the ED. 2.3 patients per hour of moderate to high acuity is hard to beat by any procedure except certain orthopedic procedures.

 

[sylvanthus]

What if combined with something like telemedicine? Do a bit of tele icu, tele med, tele ER even from home, RV, sailboat?, then head in to the hospital when called for procedures?


Would be pretty sweet to roll around in an RV doing telemed work, maybe a bit of botox/concierge med stuff, then when called go in for procedures. Retirement part time gig perhaps?

 

[VA Hopeful Dr]

The problem is it takes an hour to do an LP for me. Print off the consent, order lidocaine which has to come from pharmacy, get a couple extra needles and kit from central supply, find someone to help position/hold lidocaine. All assuming you aren’t waiting on CT or INR. Then hand carry down to microbiology.

I thought it was 1.37 wRVU for diagnostic LP.

And any FM or IM doc should be able to do LP. Most just don’t want to.

It is, I rounded up for convenience. Your post is exactly what I was getting at - most places aren't set up to do things quickly enough to make a career of doing hospital based procedures like the OP was describing.

I'm FM and have done exactly 1 LP and that was in med school.

 

[Groove]

A- for creativity. D+ for practicality.

Hospitals without someone on staff to perform procedures are going to be rare and probably very far apart. Plus, how many rural ERs out there have docs that have no ability to place a line or LP, etc..? I've worked in some tiny ass places and have never worked with someone that was THAT incompetent for an EP. Then you have to ask yourself, what EP would actually WANT to give up all their procedures?

 

[EctopicFetus]

So is it, or is it not, a financial win?

I think it depends on what those docs can do with their time instead. As they are an SDG I think it is more about preference. Every patient sees a doc and the docs don't have to do procedures that take up time.

Im guessing its a wash at best.

Also, keep in mind the RVUs are one thing but you would have to contract directly with the hospital. Otherwise (using the example of rural Eds) many of your patients (usually about half) are medicaid or self pay. So the 2 RVUs where medicare might pay you $72 you would probably average half this for the patients mentioned. Your $/RVU will be less than medicare $36. Also if you come in and do a procedure that is 3 RVUs thats $100. Are you willing to wake up at 2 am drive 20 mins each way, spend time consenting the patient realize the RN forgot to get you lidocaine (or whatever else you need). at best it is 1 hour. Are you willing to wake up at 2am for $100? Hell no.

 

[EctopicFetus]

A- for creativity. D+ for practicality.

Hospitals without someone on staff to perform procedures are going to be rare and probably very far apart. Plus, how many rural ERs out there have docs that have no ability to place a line or LP, etc..? I've worked in some tiny ass places and have never worked with someone that was THAT incompetent for an EP. Then you have to ask yourself, what EP would actually WANT to give up all their procedures?

Its not the EP. its the Fm doc masquerading as an EP.

Some of the local Eds have a CT surgeon, an ENT dropout, and an OB GYN moonlighting.

When I moonlit in residency I had an OB GYN who was also a veterinarian. her workups were nonsensical.

 

[Groove]

Its not the EP. its the Fm doc masquerading as an EP.

Some of the local Eds have a CT surgeon, an ENT dropout, and an OB GYN moonlighting.

When I moonlit in residency I had an OB GYN who was also a veterinarian. her workups were nonsensical.

Crazy... I've worked with some incompetent people but never THAT incompetent. Apparently, I've gotten lucky.

 

[thegenius]

I think it depends on what those docs can do with their time instead. As they are an SDG I think it is more about preference. Every patient sees a doc and the docs don't have to do procedures that take up time.

Im guessing its a wash at best.

Also, keep in mind the RVUs are one thing but you would have to contract directly with the hospital. Otherwise (using the example of rural Eds) many of your patients (usually about half) are medicaid or self pay. So the 2 RVUs where medicare might pay you $72 you would probably average half this for the patients mentioned. Your $/RVU will be less than medicare $36. Also if you come in and do a procedure that is 3 RVUs thats $100. Are you willing to wake up at 2 am drive 20 mins each way, spend time consenting the patient realize the RN forgot to get you lidocaine (or whatever else you need). at best it is 1 hour. Are you willing to wake up at 2am for $100? Hell no.

Right, I can envision, if this were to work, that you provide a fee schedule for various services to the hospital. So you tell them

Procedure.......................8a - 8p.................................8p - 8a
LP........................................$100.....................................$200
Intubation........................$125.....................................$225
Central Line.....................$150.....................................$250
Paracentesis....................$100.....................................$200


As I said...if the hospital is small enough they are probably unwilling to pay for the time to do this. If it's big enough it will be staffed with people who can do this 24/7.

 

[thegenius]

Its not the EP. its the Fm doc masquerading as an EP.

Some of the local Eds have a CT surgeon, an ENT dropout, and an OB GYN moonlighting.

When I moonlit in residency I had an OB GYN who was also a veterinarian. her workups were nonsensical.

Just curious...
Why would an OB Gyn feel comfortable at all dealing with the crap that comes into the ED on a regular basis? Their scope of knowledge is narrow and deep within their field of medicine. Do they just consult everyone when then don't know what to do for VT, hemoptysis, corneal FB, etc?

It makes me feel like a schmuck that I spent 4 years doing ER residency and there are OB Gyn's and CT Surgeons who try to do my job in various parts of America. You know the opposite isn't true. There ain't no ER doc seeing CT Surgery pts. Or heaven forbid OB Gyn complaints.

 

[EctopicFetus]

Right, I can envision, if this were to work, that you provide a fee schedule for various services to the hospital. So you tell them

Procedure.......................8a - 8p.................................8p - 8a
LP........................................$100.....................................$200
Intubation........................$125.....................................$225
Central Line.....................$150.....................................$250
Paracentesis....................$100.....................................$200


As I said...if the hospital is small enough they are probably unwilling to pay for the time to do this. If it's big enough it will be staffed with people who can do this 24/7.

Would you come in at 2 am for a central line 30 mins from your house for $250. I wouldn't. I can find a job locally working 12 hours or 24 and get $190/hr seeing barely over 1pph. I would rather that than be bothered for the BS above.

I think the real way to make it work is to do this list above plus $500/day to be on call. No one will pay you that. The issue is as mentioned above. small shops don't have the volume or money to do this. Big shops have docs who know what they are doing and don't need it.

 

[EctopicFetus]

Just curious...
Why would an OB Gyn feel comfortable at all dealing with the crap that comes into the ED on a regular basis? Their scope of knowledge is narrow and deep within their field of medicine. Do they just consult everyone when then don't know what to do for VT, hemoptysis, corneal FB, etc?

It makes me feel like a schmuck that I spent 4 years doing ER residency and there are OB Gyn's and CT Surgeons who try to do my job in various parts of America. You know the opposite isn't true. There ain't no ER doc seeing CT Surgery pts. Or heaven forbid OB Gyn complaints.

Is this like some sort of revelation to you? who staffs the rural Eds? Who used to staff urban EDs. there is a CMG run local ed with volumes of 50k with maybe 1-2 EM docs. rest were FP/IM and a gang of MLPs. Quality was as you would expect... terrible. I think they are changing now because of all the new grads willing to work a crap job at borderline pay.

What do those docs do? who knows. risk their license for a paycheck.

I would rather a CT surgeon than an FP doc. Show an FP doc an unstable patient and ill show you someone with a brown streak in their shorts. If they don't then it is even scarier. You don't know what you don't know.

 

[thegenius]

Would you come in at 2 am for a central line 30 mins from your house for $250. I wouldn't. I can find a job locally working 12 hours or 24 and get $190/hr seeing barely over 1pph. I would rather that than be bothered for the BS above.

I think the real way to make it work is to do this list above plus $500/day to be on call. No one will pay you that. The issue is as mentioned above. small shops don't have the volume or money to do this. Big shops have docs who know what they are doing and don't need it.

If my life involved working regular daytime hours I wouldn't wake up at 2:00 AM to put a central line in for $1000. $1000 won't materially change my life one bit. By the time it takes to actually wake up and be awake and not a zombie to the time you actually fall back to sleep you're looking at 2+ hours. Even if the line takes 20 minutes to put in.

Same reason why consults don't want to come in for $200-$300 in the middle of the night.
Problem is they are making money to be on call. So they will take the money and then do everything possible not to come in. If you don't want to come in, then you shouldn't make money to be on call.

 

[thegenius]

Is this like some sort of revelation to you? who staffs the rural Eds? Who used to staff urban EDs. there is a CMG run local ed with volumes of 50k with maybe 1-2 EM docs. rest were FP/IM and a gang of MLPs. Quality was as you would expect... terrible. I think they are changing now because of all the new grads willing to work a crap job at borderline pay.

What do those docs do? who knows. risk their license for a paycheck.

I would rather a CT surgeon than an FP doc. Show an FP doc an unstable patient and ill show you someone with a brown streak in their shorts. If they don't then it is even scarier. You don't know what you don't know.

it's a relevation that an OB gyne wants to work in the ER for some money, yes. I knew IM / FM works there. And frankly that's much better than an ENT, CT Surgeon, or OB Gyne. Most complaints in the ED are medical in nature. Just hope they don't get obstructive angioedema, then nobody will do anything. Even the CT Surgeon. You think the CT Surgeon will know how to set up for an advanced airway and be prepared to intubate? Nah. They will call anesthesia.

 

[VA Hopeful Dr]

Is this like some sort of revelation to you? who staffs the rural Eds? Who used to staff urban EDs. there is a CMG run local ed with volumes of 50k with maybe 1-2 EM docs. rest were FP/IM and a gang of MLPs. Quality was as you would expect... terrible. I think they are changing now because of all the new grads willing to work a crap job at borderline pay.

What do those docs do? who knows. risk their license for a paycheck.

I would rather a CT surgeon than an FP doc. Show an FP doc an unstable patient and ill show you someone with a brown streak in their shorts. If they don't then it is even scarier. You don't know what you don't know.

That seems unnecessary.

 

[Angus Avagadro]

Would you come in at 2 am for a central line 30 mins from your house for $250. I wouldn't. I can find a job locally working 12 hours or 24 and get $190/hr seeing barely over 1pph. I would rather that than be bothered for the BS above.

I think the real way to make it work is to do this list above plus $500/day to be on call. No one will pay you that. The issue is as mentioned above. small shops don't have the volume or money to do this. Big shops have docs who know what they are doing and don't need it.

When I worked in the Northeast where reimbursement was worse than crappy, we would get paid about $35 from medicaire for central line placement. Good luck finding someone who knows where the central line kits even are when you arrive
Minimum of an hour or worse to do a 10 min procedure. Then had to wait for x ray to come and take the chest x raybecause radiologists wouldn't look at it at night. It's not like this everywhere now, but I dont think reimbursement and nursing support is much better.

 

[DrDrummer]

That seems unnecessary.

Haters gonna hate. I think almost everyone in this forum recognizes that there are some damn good family medicine-trained doctors working in emergency departments across the United States providing quality care, especially in in rural and underserved areas. It would be nice if we could separate ourselves from every other specialty in medicine by being the one that didn't constantly badmouth the others (you'd think we of all people would know better) but specialist hegemony knows no bounds.

 

[gro2001]

it's a relevation that an OB gyne wants to work in the ER for some money, yes. I knew IM / FM works there. And frankly that's much better than an ENT, CT Surgeon, or OB Gyne. Most complaints in the ED are medical in nature. Just hope they don't get obstructive angioedema, then nobody will do anything. Even the CT Surgeon. You think the CT Surgeon will know how to set up for an advanced airway and be prepared to intubate? Nah. They will call anesthesia.

What surprises me is not so much that people in other specialties may have the hubris to think they could do ER work. What I am curious about is why aren't these people working in OB/GYN? Presumably even if they think they can handle the ER, surely they'd feel more comfortable in a gig they've had more experience with?

 

[Hercules]

What surprises me is not so much that people in other specialties may have the hubris to think they could do ER work. What I am curious about is why aren't these people working in OB/GYN? Presumably even if they think they can handle the ER, surely they'd feel more comfortable in a gig they've had more experience with?

Quite simply because they no longer can. Most ob/gyns that move on to other fields do so because they have been kicked out of their ob/gyn groups either for bad outcomes, lawsuits, declining surgical skills, or other reasons. Obviously that’s a blanket statement and I’m sure there may be exceptions to the rule.

 

[EctopicFetus]

Why do we accept non ed docs working in the eds. Imagine the outcry if we decided we wanted to do dermatology or rheum or any other similar field. Why do you think they can do our job?
I know the history but I stand by my position. This is 2019 not 1979.

it’s an unpopular position but I’ll say it again if they can’t have an ed doc there the hospitals should re-brand their service as an urgent care.

I’ve worked with some amazing non ed docs. Outside of a few though most are way out of their league. Sure the acuity is low and it’s mostly medical but most are fm docs and have little to no experience taking care of actually sick people.
The IM guys know little about peds etc. the thought that any other specialty should do our job devalues our training.

 

[NITRAS]

Wait! How’d we get here?

Silly SDN, where threads always end up in like 5 different endpoints.
ED docs bitching about anyone doing their job.
Residents/med students complaining the older docs sold them out and they will be in servitude relegated to buying Honda’s.
Anesthesia complaining about CRNAs
Hospitalists bitching about EM docs (and vice versa).
IM vs FM arguing a bout who can be a better Hospitalist.

 

[VA Hopeful Dr]

Why do we accept non ed docs working in the eds. Imagine the outcry if we decided we wanted to do dermatology or rheum or any other similar field. Why do you think they can do our job?
I know the history but I stand by my position. This is 2019 not 1979.

it’s an unpopular position but I’ll say it again if they can’t have an ed doc there the hospitals should re-brand their service as an urgent care.

I’ve worked with some amazing non ed docs. Outside of a few though most are way out of their league. Sure the acuity is low and it’s mostly medical but most are fm docs and have little to no experience taking care of actually sick people.
The IM guys know little about peds etc. the thought that any other specialty should do our job devalues our training.

You absolutely could open a dermatology clinic. One of the botox/filler places in town is run by an EM-trained guy. Another opened a chain of weight loss clinics.

I'd also bet you'd be better at rheumatology than one of the guys in our hospital system. Don't even get me started on the endocrinologists.

 

[Groove]

Just curious...
Why would an OB Gyn feel comfortable at all dealing with the crap that comes into the ED on a regular basis? Their scope of knowledge is narrow and deep within their field of medicine. Do they just consult everyone when then don't know what to do for VT, hemoptysis, corneal FB, etc?

It makes me feel like a schmuck that I spent 4 years doing ER residency and there are OB Gyn's and CT Surgeons who try to do my job in various parts of America. You know the opposite isn't true. There ain't no ER doc seeing CT Surgery pts. Or heaven forbid OB Gyn complaints.

I agree, seeing an OB/GYN would seem very odd in the ED. I can't imagine them being in their comfort zone. I've worked with an ENT (Foreign trained, then IM trained in the US) that was pretty good. Interested related story that I can't help but tell since I'm talking about him. So, this ENT guy was middle eastern, very hyper, a lot of fun to work with. He would bounce from room to room at 100mph like a pinball machine. Very thorough and almost like an academic attending. Smoked cigarettes, talked extremely fast, LOTS of coffee. One day, him and one of our "retired" cardiologists who had transitioned to full time ER work were handling a nightmare airway that turned into a cric. After the ENT doc gets done with the cric, he goes pale, starts sweating, rubs his chest and the nurses talk him into him into stepping into one of the rooms for a quick EKG. Shortly after, a nurse throws the EKG in front of our retired cardiologist for signature and he starts cursing like a sailor "What the hell?! Dammit people, I SAID DAMMIT TO HELL THIS IS A STEMI. Where the hell is this patient?" The nurse gets all wide eyed and points towards one of the side rooms and says "It's Dr. ENT's EKG!" So, the ENT doc had a heart attack while he was performing a cric and gets whisked away to the cath lab for a couple of stents. True story!

The experience gave him an excuse not to work nights or late swing shifts due to "cardiac risk", so when I first took over the scheduling responsibilities, I wasn't allowed to put him on any night shifts or late swings so that he wouldn't have another heart attack. At first, I felt sympathetic until I found out he still was smoking like a chimney! Funny guy. Works in California now I think.

Anyway, so I've worked with ENT and cardiologists in the ED that were fine, but never OB. I know surgeons seem to moonlight in the ED from time to time, but I've never worked with one.

 

[gro2001]

Wait! How’d we get here?

Silly SDN, where threads always end up in like 5 different endpoints.
ED docs bitching about anyone doing their job.
Residents/med students complaining the older docs sold them out and they will be in servitude relegated to buying Honda’s.
Anesthesia complaining about CRNAs
Hospitalists bitching about EM docs (and vice versa).
IM vs FM arguing a bout who can be a better Hospitalist.

You forgot the political endpoint which is actually two threads in one: taxation is theft and climate change isn't real.

 

[gro2001]

Quite simply because they no longer can. Most ob/gyns that move on to other fields do so because they have been kicked out of their ob/gyn groups either for bad outcomes, lawsuits, declining surgical skills, or other reasons. Obviously that’s a blanket statement and I’m sure there may be exceptions to the rule.

Yeah, I suspected that's the case. But shouldn't that make everyone even more concerned? Even if someone out there believes that an ob/gyn could probably manage an ER, surely a ****ty ob/gyn is a questionable hire? I guess this is more rhetorical than anything. Desperate hospitals and desperate docs. I just can't imagine either the doc or the hospital surviving any lawsuit resulting from this hiring practice.

 

[Fox800]

You'd never hire an FM doc to do pathology. Or a pediatrician to do colorectal surgery. But everyone thinks EM is easy and an FM, IM, XYZ specialty doc, or a brand-new FNP can do it. It's disgusting.

If your ED is that crappy, it shouldn't be open. Period. The care you're delivering to your patients is substandard.

 

[EctopicFetus]

You'd never hire an FM doc to do pathology. Or a pediatrician to do colorectal surgery. But everyone thinks EM is easy and an FM, IM, XYZ specialty doc, or a brand-new FNP can do it. It's disgusting.

If your ED is that crappy, it shouldn't be open. Period. The care you're delivering to your patients is substandard.

100% this. Any EM trained doc should feel this way. I think it’s insane we accept this at all.

 

[sylvanthus]

A- for creativity. D+ for practicality.

Hospitals without someone on staff to perform procedures are going to be rare and probably very far apart. Plus, how many rural ERs out there have docs that have no ability to place a line or LP, etc..? I've worked in some tiny ass places and have never worked with someone that was THAT incompetent for an EP. Then you have to ask yourself, what EP would actually WANT to give up all their procedures?

Im considering floors also. There are a ton of IM attendings that cant do an LP or place a line. Eapecially now that very few procedures are required to graduate from an IM residency.

 

[deleted109597]

100% this. Any EM trained doc should feel this way. I think it’s insane we accept this at all.

Well, what are the options? Refuse to work at places that don't hire only ABEM? Figure out a way to bring down every staffing company?
Or, you know, open a kajillion new residencies. Because that's about it.

 

[Fox800]

Well, what are the options? Refuse to work at places that don't hire only ABEM? Figure out a way to bring down every staffing company?
Or, you know, open a kajillion new residencies. Because that's about it.

The state should not license these hospitals to have an ED if they don't have a physician on duty. And if you're an FP doc working in the ED, you'd better be taking every Difficult Airway Course, FCCS, ATLS, APLS/PALS, EM-board review course, etc that you can get access to.

 

[EctopicFetus]

Well, what are the options? Refuse to work at places that don't hire only ABEM? Figure out a way to bring down every staffing company?
Or, you know, open a kajillion new residencies. Because that's about it.

lobby congress to not pay these hospitals who don't staff BC/BE EM docs? I mean what should a hospital do if they want to be a chests pain center but can't hire an interventionalist but you know some FP doc is willing to try?