Resources recommended for new ER locums job?

[alpinism]

Are you willing to take the job for collections, which would work out to about $100/hour? On a good day?

Or to put it more precisely, you agree that we should triple the number of EM residencies?

The one thing some physicians do not realize is that it is like Lucy on the chocolate factory line: The patients keep coming and have to be seen.

You have one of three options:

1) Dramatically increase the number of EM residencies.
2) Have ED's staffed in some places with non-EM physicians.
3) Avoid #1 or #2 and have them staffed with non-physician "mid-level" providers.

The car crash victim or heart attack can't reschedule those events so they can see their primary care provider during working hours.

You're forgetting the 4th option:

Shut down rural emergency departments that don't have the patient volume to be staffed by emergency physicians and have the critical patients transported by helicopters staffed by critical care flight doctors and nurses to referral emergency departments.

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[Dr Mantis Toboggan]

You're forgetting the 4th option:

Shut down rural emergency departments that don't have the patient volume to be staffed by emergency physicians and have the critical patients transported by helicopters staffed by critical care flight doctors and nurses to referral emergency departments.

politicians and their constituents love their critical access hospitals. they are not going anywhere.

 

[Vandalia]

politicians and their constituents love their critical access hospitals. they are not going anywhere.

Exactly. In the United States, rural politicians have disproportionate power. Look at the most powerful U.S. Senators over the last 50 years. This is even more true when it comes to state government.

You're forgetting the 4th option:

Shut down rural emergency departments that don't have the patient volume to be staffed by emergency physicians and have the critical patients transported by helicopters staffed by critical care flight doctors and nurses to referral emergency departments.

A few problems:

First, that doesn't work given geography and weather in most of the United States.

Second, these operations have a terrible safety record as it is. Are you going to risk your life with far worse pilots, far worse maintenance, flying even worse equipment, operating at the edge of their operational limits? Heck, there are a lot of EM residents who refuse to fly even under pretty much ideal circumstances.

Finally, see the comments from the first quote in this reply. This option has been discussed before. Here is a hint: Check out the history of the Jon Michael Moore Trauma Center at West Virginia University.

 

[Apollyon]

You're forgetting the 4th option:

Shut down rural emergency departments that don't have the patient volume to be staffed by emergency physicians and have the critical patients transported by helicopters staffed by critical care flight doctors and nurses to referral emergency departments.

That's already what happens. However, have you been to rural PA, NY, NH, VT, MI, WI, MN, ND, SD, MT, NE, or WY in the winter? Guess what you don't have? A helicopter flying.

But, why are you so bent out of shape over this? First, in rural areas, there are some pts that have literal, true, time-dependent emergencies. Any doctor is better than no doctor. Who is going to babysit if these hospitals are "shut down"? Your untenable idea of rebranding the EDs as "urgent cares" (which changes nothing)?

Also, the C Suite just won't pay for ABEM. That's unfortunate, but, true.

But, you tilting at windmills on this just sounds like bluster.

 

[goodoldalky]

Really the problem here is the healthcare system.

the money mainly flows through repair and replace elective surgical procedures. Provision of medical care, resuscitations, sepsis, etc., frankly doesn’t keep the lights on (anywhere). That’s why your hospitals with terrible boarding problems during covid are continuing elective procedures like mine... they don’t want those ER patients... we need those ICU rooms for the elective microdiscectomy!! I’d rather be on permanent diversion than wreck my finances trying to break even on a COVID patient on VA ECMO!

Similarly, these critical access hospitals need financial support to provide poorly reimbursed medical care. They likely need support to stay open to begin with (and most are subsidized in a variety of ways).

On no planet should a finger dislocation reduction pay more than an emergent RSI, but it does on planet earth here in the good old USofA.

If the flow of money were fixed, then the provision of qualified emergency care even in rural locations might be more feasible.

 

[Angry Birds]

You're forgetting the 4th option:

Shut down rural emergency departments that don't have the patient volume to be staffed by emergency physicians and have the critical patients transported by helicopters staffed by critical care flight doctors and nurses to referral emergency departments.

This is simply not possible.

 

[Alvarez13]

That's already what happens. However, have you been to rural PA, NY, NH, VT, MI, WI, MN, ND, SD, MT, NE, or WY in the winter? Guess what you don't have? A helicopter flying.

Reindeer and sleigh, whatever.

 

[alpinism]

That's already what happens. However, have you been to rural PA, NY, NH, VT, MI, WI, MN, ND, SD, MT, NE, or WY in the winter? Guess what you don't have? A helicopter flying.

But, why are you so bent out of shape over this? First, in rural areas, there are some pts that have literal, true, time-dependent emergencies. Any doctor is better than no doctor. Who is going to babysit if these hospitals are "shut down"? Your untenable idea of rebranding the EDs as "urgent cares" (which changes nothing)?

Also, the C Suite just won't pay for ABEM. That's unfortunate, but, true.

But, you tilting at windmills on this just sounds like bluster.

I've spent time in three of those states and we definitely still flew helicopters during the winter months.

 

[alpinism]

This is simply not possible.

That's basically how its done in the Australian Outback with the Royal Flying Doctors.

 

[Apollyon]

I've spent time in three of those states and we definitely still flew helicopters during the winter months.

OK, as you perseverate, could those helicopters fly unfettered, every day? Could you predict which day that would be? No, you couldn't, because I couldn't, and the HEMS company couldn't. It was a very granular, second by second procedure. Or, are you saying that you directed flight professionals what to do?

No matter what you say, reality and history doesn't agree with you.

 

[Angry Birds]

That's basically how its done in the Australian Outback with the Royal Flying Doctors.

From my experience at said critical access hospital it is hit or miss whether or not the choppers fly on any given day due to weather conditions.

My suspicion is that people going Outback take on a level of risk, knowing that they are no longer in a reliable distance from a hospital.

That's just lowering the care of rural areas in the US if you want to treat them the same as being Outback.. all because you have a creedal view to uphold. A creedal view that i am sympathetic to though.

 

[Airborne Flt Doc]

Try to get in with anesthesia to do a few intubations if you haven’t done this in awhile.

I agree with investing in your own video laryngoscope if needed as many rual hospitals don’t have.

Get the Butterfly Ultrasound

Handheld portable ultrasound machine | Purchase your Butterfly probe

store.butterflynetwork.com

Go to a Difficult Airway Course and ACEP procedure courses when available again at National conference. Subscribe for Online videos of past conference.

https://em.umaryland.edu/page/essentialproceduresinem

Advanced EM Boot Camp - Center for Medical Education

Why Should You Take The All-New Advanced EM Boot Camp Course? • The Advanced EM Boot Camp is an intensive, 23.5 hour course designed especially for PAs, NPs and primary care physicians who currently work or intend to work in a contemporary emergency department. • Built on the foundation of...

courses.ccme.org

The Difficult Airway Course

The Definitive Source For Airway Management Education

www.theairwaysite.com

The Heart Course (Self‑Study Program) - Center for Medical Education

courses.ccme.org

Rual and critical care hospitals will often prefer IM/FP since they function as ED doc and Hospitalist in a hybrid role. EM residency trained docs have been working in these roles in higher numbers now that the EM market is saturated.


Thank you for your service to these rural patients!

 

[Lexdiamondz]

I mean honestly...if you're asking the internet how to do a job which requires a board certification and 3-4 years of intensive training, you shouldn't be doing that job.

 

[Angry Birds]

I mean honestly...if you're asking the internet how to do a job which requires a board certification and 3-4 years of intensive training, you shouldn't be doing that job.

Well, it's a great place to ask such questions anonymously and to crowd source an answer from practitioners in the field.

 

[Rekt]

Well, it's a great place to ask such questions anonymously and to crowd source an answer from practitioners in the field.

"Practitioner"

Is he asking for MLP advice?

 

[Lexdiamondz]

Well, it's a great place to ask such questions anonymously and to crowd source an answer from practitioners in the field.

Yeah, but there's a marked difference between picking brains over nuanced topics vs "how do I intubate?"

Maybe I'm unnecessarily militant about this, but imagine us wandering into the gas forum saying "hey, I took an anesthesia gig in SD, where can I learn how to use inhaled anesthetics real quick" would be poorly received.

 

[Angry Birds]

Yeah, but there's a marked difference between picking brains over nuanced topics vs "how do I intubate?"

Maybe I'm unnecessarily militant about this, but imagine us wandering into the gas forum saying "hey, I took an anesthesia gig in SD, where can I learn how to use inhaled anesthetics real quick" would be poorly received.

I got ya. We've been debating this issue in the thread. I don't think it's completely analogous but some others did.

"Practitioner"

Is he asking for MLP advice?

Agh. I have internalized the programming!