Slowing down in the Psych ER

[NeuroKlitch]

---

Members don't see this ad.

Anyone ever feel like they are being too efficient to the point where it feels like your colleagues are taking advantage . Last few days I feel like I'm seeing the vast majority of patients in the psych ED while my Co resident is averaging like 1 patient every 2 or so hours. I'm seeing double the amount of patients some days . I'm starting to become resentful but I feel like it's probably my own fault . I wouldn't mind it if atleast there was a little praise thrown my way , but it largely goes unnoticed or even taken advantage of. This week I'm going to purposefully match everyone else's pace and stop my own neurotic need to clear the board asap. Is this how it is in the real world beyond residency, or is there atleast a financial incentive for being efficient in the setting of a Psych ED?

 

[Monocles]

Anyone ever feel like they are being too efficient to the point where it feels like your colleagues are taking advantage . Last few days I feel like I'm seeing the vast majority of patients in the psych ED while my Co resident is averaging like 1 patient every 2 or so hours. I'm seeing double the amount of patients some days . I'm starting to become resentful but I feel like it's probably my own fault . I wouldn't mind it if atleast there was a little praise thrown my way , but it largely goes unnoticed or even taken advantage of. This week I'm going to purposefully match everyone else's pace and stop my own neurotic need to clear the board asap. Is this how it is in the real world beyond residency, or is there atleast a financial incentive for being efficient in the setting of a Psych ED?

Lol this is a problem as old as time itself. The better and more efficient at your job, the more work will be given to you. 😉

I learned this as a research intern at age 19... on my first day I had gone through 6 charts before one of the more seasoned research assistants pulled me aside and told me to slow down or else everybody will get more work. I ended up cutting back to 3 charts a day and had a very leisurely paced summer work experience.

If you're getting paid the same, why not take more coffee breaks and walk around more? ;p

 

[comp1]

Do it at a speed you enjoy. That's ultimately more important than whether you're technically going faster or slower than anyone else.

 

[Stagg737]

Is this how it is in the real world beyond residency, or is there atleast a financial incentive for being efficient in the setting of a Psych ED?

Regardless of if this is actually happening to an attending, it's a great reason to not take a purely salary based position and at least negotiate for some form of RVU-related bonus.

 

[Mass Effect]

Anyone ever feel like they are being too efficient to the point where it feels like your colleagues are taking advantage . Last few days I feel like I'm seeing the vast majority of patients in the psych ED while my Co resident is averaging like 1 patient every 2 or so hours. I'm seeing double the amount of patients some days . I'm starting to become resentful but I feel like it's probably my own fault . I wouldn't mind it if atleast there was a little praise thrown my way , but it largely goes unnoticed or even taken advantage of. This week I'm going to purposefully match everyone else's pace and stop my own neurotic need to clear the board asap. Is this how it is in the real world beyond residency, or is there atleast a financial incentive for being efficient in the setting of a Psych ED?

You should slow down. For one, there will always be more patients to see and if you're speeding through, you're going to be seeing them all. For another, give your colleague a break. I don't know what year you are, but not everyone is as advanced as everyone else. Your colleague could be trying to make sure he/she is getting the recs right or writing the note the way the attending wants it. Not everyone is as good a note-writer as everyone else and your colleague may be getting feedback that his/her notes aren't up to par.

 

[Bartelby]

A few thoughts here.

1- given the complexity of patients and resources available at your program, who is the outlier, you or the other resident? If the other resident is the outlier you risk gaining a bad reputation by intentionally slowing down to match their pace. If you are the outlier, it may be worthwhile to slow things down.

2- allowing yourself some time tends to make work less stressful and more rewarding. I think it can also provide a meaningful (though hard to capture) benefit to the patient. I think that is one major drive toward cash practice in our field: there is only so much you can do if you severely limit your time spent with the patient in order to grind out volume.

3- keep in mind if you are pushing yourself at speeds beyond your comfort zone, even if your employer is applying pressure, it will be your license on the line when any mistakes happen. Of course in residency you need to take feedback and you have little choice other than to get with the program, but as you grow professionally keep in mind that "you can't be forced to practice below your own standard of care."

 

[robellis]

Anyone ever feel like they are being too efficient to the point where it feels like your colleagues are taking advantage . Last few days I feel like I'm seeing the vast majority of patients in the psych ED while my Co resident is averaging like 1 patient every 2 or so hours. I'm seeing double the amount of patients some days . I'm starting to become resentful but I feel like it's probably my own fault . I wouldn't mind it if atleast there was a little praise thrown my way , but it largely goes unnoticed or even taken advantage of. This week I'm going to purposefully match everyone else's pace and stop my own neurotic need to clear the board asap. Is this how it is in the real world beyond residency, or is there atleast a financial incentive for being efficient in the setting of a Psych ED?

1 patient per 1-1.5 hrs is reasonable, if your colleague is slower than this then he’s slow and if you’re much faster then you can afford to slow down if you want, just do what makes you happy not a big deal..also you shouldn’t be working for the praise of others, you’re doing this for your patients and also yourself

 

[Merovinge]

Working "efficiently" is the name of the game in most attending jobs and heavily incentivized, so the skills you are learning are certainly broadly applicable. The residents who worked faster in my program certainly found more financial success than the slower ones. That said, residency is a time to be as through as could be beneficial and should be setup so you have time to review outside records, talk to collateral, spend enough time with the patient (you know, the things that actually impact MDM). Just like in medical school, you want to cast as broad a net as possible while learning, then pair it back with experience.

Also, It can be hard to not compare oneself to those around us (literally human nature), but it is an invaluable life skill. Trying to keep up with the Jones', or in this case, keep down with the Jones', is a surefire path to an unhappy life. You are not in competition with your co-residents, in fact they should be your lifelong allies in the cause of practicing good medicine. If you end up seeing more patients that just = more experience you have to utilize on day 1 of attendinghood.

 

[the5thelement]

Dont slow down,dont compare self to others. Adversity and pressure is a gift.
What would have become of Hercules do you think if there had been no lion, hydra, stag or boar – and no savage criminals to rid the world of? What would he have done in the absence of such challenges? Obviously he would have just rolled over in bed and gone back to sleep. So by snoring his life away in luxury and comfort he never would have developed into the mighty Hercules. And even if he had, what good would it have done him? What would have been the use of those arms, that physique, and that noble soul, without crises or conditions to stir into him action?

 

[Taddy Mason]

Just last week two of our junior residents were complaining to me about how slow and inefficient some of the other residents (both their peers and more senior residents....) are in the ED, spending too much time on notes, etc. The two individuals complaining are well known for frequently admitting flagrant malingerers and their notes tend not to be the most reliable when admitting someone or for reference/collateral with frequent flyers in the ED. Just some perspective to consider....

 

[TexasPhysician]

Residency is not unlike medical school in that a lot of what you get out of it is what you put into it. The more reading, planning, and efficiency that you build now, the more prepared you will be upon graduation.

 

[rjs2131]

I was in your shoes - it's frustrating when the reward for being efficient is...more work. Learn the skills to be efficient as a resident/fellow but don't let that be the expectation (unless you're being rewarded for it - which in a productivity model, you can/will be). I would reward myself for my efficiency and rather than jump to the next patient, I'd take a walk, get some food, read something interesting, etc. I think 1-2 hours for an adult patient eval in the ED (interview + note + collateral) is reasonable.