in your experience as an EM doc, which surgical subspecialty do you find has to actually physically come into the hospital when there's a consult?? (gen surg, uro, ortho, ent, etc...) on the flip side, who needs to come in the least and can handle the majority of consults over the phone?
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Trauma too... depending on your setup may be different from Gen Surg (and more business)
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In the last couple months I haven't had to have gensurg come in at all (except in the morning), and have had ortho need to come in emergently 3 times. Then again, I've somehow avoided seeing a single appendicitis case in 3 months, but even then.
That said, I'm at a non-trauma center.
That said, I'm at a non-trauma center.
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Ha! I just left work, and had Interventional Cardiology, the cath team, Neurology, General Surgery, and the endoscopy team in the ED when I left. (midnight)
We use IR a lot too. I know you're asking about surgeons, though. I have no neurosurg or ENT, but see a lot of my general surgeons and orthos. Uro comes in a lot because they're just awesome. CV only comes in for crazy stuff.
I'm at a high-acuity community hospital. No major trauma unless it gets shot on my doorstep.
We use IR a lot too. I know you're asking about surgeons, though. I have no neurosurg or ENT, but see a lot of my general surgeons and orthos. Uro comes in a lot because they're just awesome. CV only comes in for crazy stuff.
I'm at a high-acuity community hospital. No major trauma unless it gets shot on my doorstep.
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I think a lot of it has more to do with where you work and the practice patterns. I'd say the general tone is that GNS, ortho, and then ENT/NSG/Optho prevailed at my last job. At my current non-trauma community hospital, general surgery has slowly slipped down in frequency as they've embraced delayed surgical intervention on appendicitis (i.e., waiting until morning to operate). Additionally, our ortho coverage rarely if ever comes in - they have excellent follow up, and will see patients the next day either as an outpatient or as an inpatient.
Whereas our ENT specialists have come in on several occasions thanks to the run of adult epiglottis we're seeming to have in our community; and the urologists admitting/stenting the kidney stone population.
But to get to the question I suspect you're really asking: don't base your decision on what to do on this topic. There is enough ebb and flow in the sub-specialities that you can find a hospital that will fit what kind of practice you desire in any of the disciplines.
Whereas our ENT specialists have come in on several occasions thanks to the run of adult epiglottis we're seeming to have in our community; and the urologists admitting/stenting the kidney stone population.
But to get to the question I suspect you're really asking: don't base your decision on what to do on this topic. There is enough ebb and flow in the sub-specialities that you can find a hospital that will fit what kind of practice you desire in any of the disciplines.
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This reminds me of a shift I had as a new resident.. Guy with a total knee replacement that didn't take... diabetic, poorly controlled, the knee was just oozing pus and had been like this for a month. He wasn't septic, but it's obvious he was going to lose the leg eventually. Had all his care at the hospital across the street and just decided to show up in the ED that night.
Friday night... 11p.m. PD says "Hey... tell ya what, if you can call the ortho guy on call at the hospital across the street and facilitate transfer of this patient over to said hospital, I'll advance you a year in this residency program." I was like...really? Hell yea, piece of cake! After much angst, frustration, and outright yelling on the phone...red faced... I realized just how difficult it is to convince an orthopod to come in on a Friday night. I looked over at the PD to see a slight grin on his face. Lesson learned.
Friday night... 11p.m. PD says "Hey... tell ya what, if you can call the ortho guy on call at the hospital across the street and facilitate transfer of this patient over to said hospital, I'll advance you a year in this residency program." I was like...really? Hell yea, piece of cake! After much angst, frustration, and outright yelling on the phone...red faced... I realized just how difficult it is to convince an orthopod to come in on a Friday night. I looked over at the PD to see a slight grin on his face. Lesson learned.
