Rural EM

[Spleen]

What is the smallest sized hospital that could support a full time EM doc before it is more feasible to have the local FM docs do coverage?

20-30 beds? 30-40beds?

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[docB]

It isn't about size as much as it's about money. To support BC EPs you need to have a census x payor mix that will pay enough. You coud have an ED that sees 1000 patients per year but if you can collect ~300 dollars per patient you could attract BC EPs. One reason that no BC docs are willing to work in low volume EDs is that they usually augment their incomes with other activities like working in a clinic.

 

[iatrosB]

On a similar note...do you think one would loose skills working in a rural ED. I imagine you'd do a whole lot less intubatios and chest-tubes...Would this cause atrophy of skills? Or is it like riding a bike?

 

[docB]

On a similar note...do you think one would loose skills working in a rural ED. I imagine you'd do a whole lot less intubatios and chest-tubes...Would this cause atrophy of skills? Or is it like riding a bike?

Good question. I don't know. I don't do trauma any more but I don't really feel like I can't deal with it when it does roll in.

Do rural EPs lose their skills? Sounds like an interesting paper. You'd have to look at objective data points like what percentage of airways wind up with a surgical airway and so on 'cause no one will reliable admit they are rusty. You'd also have to look at training and address the great BCEM vs. other debate.

I know the rural ED I occasionally work in has low volume but they're out there all by themselves so they see it all, peds, trauma, peds trauma, MIs (no cath lab), etc.

 

[Rockhouse]

On a similar note...do you think one would loose skills working in a rural ED. I imagine you'd do a whole lot less intubatios and chest-tubes...Would this cause atrophy of skills? Or is it like riding a bike?

I can't say personally, but my hometown is pretty rural, single coverage ED, 20 beds i think, atleast 15, and there was a guy who started working there straight after residency. I met him after he had been working there a year, and he said it was a scary place to be, because it was just big enough to see just about anything (if maybe not that often) but he was it. No help, nobody to bounce ideas off of, not a whole lot of other physicians in house at night. From that point of view I imagine a guy could stay pretty sharp.

 

[f_w]

True rural EDs see everything including level 1+2 trauma. It tends to be less of the knife and gun club variety. Around here it is mostly MVA, 4-wheeler and snowmobile related, but occasionally you will have the oddball
- fell out of deer-stand
- got hit by deer-stand falling of tree
- shot himself in leg while on deer-stand, falls off deer-stand
- chain-saw injuries
- crush injuries, logging accidents, heavy equipment

And you are it. At night there is nobody else around. And in order to fly someone out you need the weather to cooperate and a way to survive the time until that transfer can happen.

(I am a radiologist covering a rural 35bed hospital covered by a group of mostly FPs doing full-time ED work)

 

[DropkickMurphy]

Around here it is mostly MVA, 4-wheeler and snowmobile related, but occasionally you will have the oddball
- fell out of deer-stand
- got hit by deer-stand falling of tree
- shot himself in leg while on deer-stand, falls off deer-stand
- chain-saw injuries
- crush injuries, logging accidents, heavy equipment

Similar mechanisms of injury
-Broadhead arrow to the crotch
-Mauling by a deer
-Closed head injury as a result of being hit in the head by a stump that the patient was trying to remove using 2 fulls sticks of dynamite
-Low-speed rollover tractor accidents
-"Combine versus pedestrian with entrapment" (yes, you read that right and it is as gruesome as you would expect *shudders*)
-Car vs. cow (hint: the cow won, the car didn't)

 

[Arctic Char]

so then here's a question - if one was interested in practicing EM in a rural area, and participating in patient transports - could they just as easily land in that position as an FP? i know that in alaska its the FP's that arrange the medevacs around the state. but anyway, medevac aside, is FP just as direct a path to practicing in a rural area that offers EM-type work? from what i'm reading, its sounds a but like "yes" . . . i'd love to hear more from those who know more about it

thnx all

 

[southerndoc]

so then here's a question - if one was interested in practicing EM in a rural area, and participating in patient transports - could they just as easily land in that position as an FP? i know that in alaska its the FP's that arrange the medevacs around the state. but anyway, medevac aside, is FP just as direct a path to practicing in a rural area that offers EM-type work? from what i'm reading, its sounds a but like "yes" . . . i'd love to hear more from those who know more about it

thnx all

You can get jobs in rural ED's as an FP. However, I don't think your training is sufficient, and neither do many hospitals. As EM gains more recognition as a bonafide specialty, and as more EM trained physicians are available, FP's will soon find themselves out of work. Many hospitals -- even rural hospitals -- now require EM physicians to be board-certified in emergency medicine. FP's will never have that option, unless you become "board certified" in Florida by the other organization. It is unlikely that other states will recognize this "board certification."

 

[deleted77919]

so then here's a question - if one was interested in practicing EM in a rural area, and participating in patient transports - could they just as easily land in that position as an FP? i know that in alaska its the FP's that arrange the medevacs around the state.

Many areas in AK have started looking for board certified EPs (even in places as far away as Bethel). http://hotjobs.yahoo.com/job-JC8JU0S0D-l-Bethel-AK-c-Healthcare

 

[Arctic Char]

haha, dude, bethel is a regional hub (pop. 5700). but, point taken

thanks for the input guys

 

[f_w]

MtMed

If you want to practice EM, do an EM residency.

If you want to do FP, do a FP residency (and if you happen to practice in a cow-town like mine that is not interested in having EM docs in the hospital, maybe you can even pick up some ER shifts)

 

[Dr. Dukes]

-Closed head injury as a result of being hit in the head by a stump that the patient was trying to remove using 2 fulls sticks of dynamite

Nice, that must have been quite a boom.

-Car vs. cow (hint: the cow won, the car didn't)

I had moose vs. car a couple of months ago. All four (moose, car, driver, and ambulance) lost. Moose lost its intestines all over the car and the road, but somehow didn't die until it hit the grass. Car lost all its glass, its hood, and most of its roof. Driver lost all of his clothing (covered in moose..."stuff") and his car. I lost about 45 minutes after the call cleaning out the back of the ambulance. Literally every surface needed to be cleaned twice.