The lack of control of Emergency medicine

[VA Hopeful Dr]

He was cancelled by the sdn gestapo.

Man I wish. It takes way more effort to get banned than you'd think.

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[TooMuchResearch]

He was cancelled by the sdn gestapo

Really? Why? Can someone direct to the thread that led to it? I haven't been here in a couple years. Too much COVID posting and had to step away. I log in today and have to sign some new TOS.

 

[TooMuchResearch]

It says he was removed

Man I wish. It takes way more effort to get banned than you'd think.

 

[TrailRun]

Honest question:
I know we all complain about the ED and the nonsense that can go along with it. But, would you all really leave it behind with no hesitation if you didn’t have to do it?

I did a EM/IM/CC program so I have a good amount of flexibility. I’m currently thinking of giving up my EM practice altogether and just doing ICU but I worry that I will miss it.

For those that do EM, no chance you’d miss it?
For those that do no EM anymore, do you miss it?

A PRN EM job with scheduling restrictions seems like it wouldn’t mess with circadian rhythms too much while still letting you have your primary practice outside of the ED. Is this not doable or desirable?

Man, I wish I would miss it. That would mean I actually kind of like it. But I could leave in a heartbeat and never step foot into an ER and be overjoyed. If I ever did miss it, I would just watch ER or Trauma: Life in the ER or something on TV since that's what it was 'supposed' to be like. I started my career in surgery but the only thing I ever miss about that is the comparative quiet of the OR.

If I could work at a place with every subspecialty including Peds and OB, and I only had to see sick adults without needed to transfer, and could do it 7a-3p three or four weekdays a week, then would stay. But I don't think that exists... so my exit strategy is pain or palliative, since even urgent care has evenings and weekends.

 

[Apollyon]

It says he was removed

He went off the reservation too many times. Some people lionize him, but, he wasn't all that great. And, when you're told not to do something, and multiple times, at that, yet keep doing it, well, "you mess with the bull, you get the horns".

And, you know one definition of a fanatic? "Someone who can't change their mind, and won't change the subject."

 

[cyanide12345678]

Honest question:
I know we all complain about the ED and the nonsense that can go along with it. But, would you all really leave it behind with no hesitation if you didn’t have to do it?

I did a EM/IM/CC program so I have a good amount of flexibility. I’m currently thinking of giving up my EM practice altogether and just doing ICU but I worry that I will miss it.

For those that do EM, no chance you’d miss it?
For those that do no EM anymore, do you miss it?

A PRN EM job with scheduling restrictions seems like it wouldn’t mess with circadian rhythms too much while still letting you have your primary practice outside of the ED. Is this not doable or desirable?

If i had 300k+ of income From something else then i will stop. That something else will have to be better than the ER. So flexibility in my hours, flexibility in my work, where i have more control. Then yes, I’m done.

I wouldn’t look back honestly. But i need something better. So far i don’t have that something better yet.

Edit: honestly id walk away if i had 200k of income and had a job where i worked from home, 3-4 days a week, from 10 am till 4 pm or something. Yeah id walk away with 200k at that point.

 

[cyanide12345678]

He went off the reservation too many times. Some people lionize him, but, he wasn't all that great. And, when you're told not to do something, and multiple times, at that, yet keep doing it, well, "you mess with the bull, you get the horns".

And, you know one definition of a fanatic? "Someone who can't change their mind, and won't change the subject."

So what happened. What did he do?

 

[Apollyon]

So what happened. What did he do?

The last straw, IIRC, was a very political meme.

 

[EctopicFetus]

So what happened. What did he do?

I dont recall but the mods IMO have gotten real sensitive. He said something they didnt like and basically dared them to boot him and well he got booted. IMO a big loss. Dude told it like it was. Rules are rules and in the end the mods have to do what the bosses of the website say.

Regarding leaving the ED. I truly still enjoy my job but the joy is fading away. I spent inordinate amount of time and effort figuring out why the CT wasnt done yet or read yet. Why it is taking 3 hours for a lab to result. Also, hustling to see people in the WR or in some hall chair all while some clown from corporate is pushing me sit while i talk to patients and be nicer etc.

Im not at my breaking point yet but I have been pretty lucky. I need maybe 5 more years of status quo and then I will be able to retire with no discernable change in my life. at that point ill only have 1 kid at home with the others in college. i have very little debt other than my mortgage. I think ill get what I need.

all that being said If I hit the lottery, I am quitting. ill find something else to keep me busy. I dont think im ready to go out to pasture and do nothing but much of the nobleness of EM is gone with corporate BS. Non profits care only about money, for profits the same. Academic centers also only care about money. Im not saying they need to be mother Teresa but the complete disdain about patients and their outcomes is frankly pathetic.

 

[Apollyon]

IMO a big loss.

Not at all. And, it was a distasteful meme, and he deserved the boot. Again, mess with the bull...

 

[RustedFox]

Not at all. And, it was a distasteful meme, and he deserved the boot. Again, mess with the bull...

I don't exactly remember the meme, but I'll wager that I played hopscotch on that line in worse ways that he did at times, and I'm still here.

 

[Apollyon]

I don't exactly remember the meme, but I'll wager that I played hopscotch on that line in worse ways that he did at times, and I'm still here.

I disagree. You have not been as oppositional or disrespectful, and some hold me to know as much about SDN as anyone.

 

[RustedFox]

I disagree. You have not been as oppositional or disrespectful, and some hold me to know as much about SDN as anyone.

You are kinda the de facto SDN oracle.

 

[TooMuchResearch]

If i had 300k+ of income From something else then i will stop. That something else will have to be better than the ER. So flexibility in my hours, flexibility in my work, where i have more control. Then yes, I’m done.

I wouldn’t look back honestly. But i need something better. So far i don’t have that something better yet.

Edit: honestly id walk away if i had 200k of income and had a job where i worked from home, 3-4 days a week, from 10 am till 4 pm or something. Yeah id walk away with 200k at that point.

Mortgage, HELOC, retirement savings. I couldn't afford to quit on $200k anymore. I think the disability insurance premiums alone are almost $8k per year. Then again, I wouldn't qualify for such a big policy if I quit.

 

[cyanide12345678]

Mortgage, HELOC, retirement savings. I couldn't afford to quit on $200k anymore. I think the disability insurance premiums alone are almost $8k per year. Then again, I wouldn't qualify for such a big policy if I quit.

Lol i pay $2400/yr for disability.

Some of you guys need to control your expenses. 200k isn’t enough ??!?!? Gosh….

 

[evert1de101]

Lol i pay $2400/yr for disability.

Some of you guys need to control your expenses. 200k isn’t enough ??!?!? Gosh….

I pay 8K a year for a GSI plan. It's pricey but the payout is much more guaranteed than the majority of plans people buy which are non-GSI. The goal with disability insurance is always to get rid of it as soon as possible, so I use it as a motivator to save more and FIRE sooner.

 

[RuralEDDoc]

Lol i pay $2400/yr for disability.

Some of you guys need to control your expenses. 200k isn’t enough ??!?!? Gosh….

It’s unlikely you have enough coverage at that price point!

 

[sylvanthus]

Honest question:
I know we all complain about the ED and the nonsense that can go along with it. But, would you all really leave it behind with no hesitation if you didn’t have to do it?

I did a EM/IM/CC program so I have a good amount of flexibility. I’m currently thinking of giving up my EM practice altogether and just doing ICU but I worry that I will miss it.

For those that do EM, no chance you’d miss it?
For those that do no EM anymore, do you miss it?

A PRN EM job with scheduling restrictions seems like it wouldn’t mess with circadian rhythms too much while still letting you have your primary practice outside of the ED. Is this not doable or desirable?

Thats what im doin.

 

[cyanide12345678]

It’s unlikely you have enough coverage at that price point!

Eh…11.5k per month of coverage. Own occupation policy with principal. Family expenses around 7k a month all in. Plus a physician wife’s backup income. So it’s more than enough even without accounting my passive streams of income.

The disability policy won’t make me rich, but it will continue our current standard of living. Which is the whole point.

 

[WilcoWorld]

Honest question:
I know we all complain about the ED and the nonsense that can go along with it. But, would you all really leave it behind with no hesitation if you didn’t have to do it?

I did a EM/IM/CC program so I have a good amount of flexibility. I’m currently thinking of giving up my EM practice altogether and just doing ICU but I worry that I will miss it.

For those that do EM, no chance you’d miss it?
For those that do no EM anymore, do you miss it?

A PRN EM job with scheduling restrictions seems like it wouldn’t mess with circadian rhythms too much while still letting you have your primary practice outside of the ED. Is this not doable or desirable?

I split time, and when I'm away from the ED I start to miss things about the job. Then I do a few shifts and I'm ready for my other workflow.
Rinse, repeat. It works pretty well for li'l ol' me.

 

[NYEMMED]

Anybody else hear about the TeamHealth “meetings” recently. Sounds like they are not doing well….

 

[thegenius]

Anybody else hear about the TeamHealth “meetings” recently. Sounds like they are not doing well….

Pray tell! What did you hear?

 

[RustedFox]

Pray tell! What did you hear?

Hark!
What light thru yonder window breaks!

 

[BoardingDoc]

Hark!
What light thru yonder window breaks!

Did you watch it twice?

 

[RustedFox]

Did you watch it twice?

No, but it was pretty great.
I'm surprised by just how clever it was.

 

[NYEMMED]

Pray tell! What did you hear?

Company is not doing well financially so they need to tighten up on finances.

“We don’t want to cut salaries”

So instead Teamhealth is cutting hours and coverage and pushing productivity to its limits.

Nevermind they haven’t given a pay raise, ever….

 

[Fox800]

I'm dropping down to about 50% clinical and 50% telemedicine. This summer I walked away from a CMG sweatshop that was taking years of my life and giving me gray hairs at an exponential rate, that was having you do the work of 1.5-2 FTEs while barely paying you a mediocre salary for one person, with a well-insured patient population.

My ultimate goal is 1/3 clinical (500 hrs/year is the minimum I think to be considered competent by some credentialing bodies and medical boards) and 2/3 telemedicine. Then get on this passive income train with real estate syndications or something. I don't know.

I'm moving to a west coast HCOL area to be closer to my SO and have more time to spend on the water, SCUBA dive, and enjoy life. Ironically that makes me more valuable to the telemedicine companies as I can arbitrage the time zone difference - my late mornings and afternoons are afternoons/evenings on the east coast, which people don't want to work. So that's a small win.

My next goal is to do some trial runs on cruise ships that are advertising reliable, fast internet to see if I can do telemedicine from a cruise ship (Royal Caribbean/Celebrity are installing Starlink, Princess, Virgin). Stay tuned.

 

[RustedFox]

Company is not doing well financially so they need to tighten up on finances.

“We don’t want to cut salaries”

So instead Teamhealth is cutting hours and coverage and pushing productivity to its limits.

Nevermind they haven’t given a pay raise, ever….

They haven't given a pay raise, ever.... to the docs.
I'll bet those assistant-vice-regional-mid-managers get nice COL adjustments, and there's room for a DEI officer.

 

[thegenius]

They haven't given a pay raise, ever.... to the docs.
I'll bet those assistant-vice-regional-mid-managers get nice COL adjustments, and there's room for a DEI officer.

Well they also do shiiit like go out to dinner on the company dollar, go to offsites and spend an extra 1-2 days there for vacation, their work hours are 9-5 and they roll into the office at 9:45 and leave at 4:30, taking a 45 minute lunch.

I can't remember the last time I took even a 5 minute lunch break.

 

[MechEDoc]

I'm dropping down to about 50% clinical and 50% telemedicine. This summer I walked away from a CMG sweatshop that was taking years of my life and giving me gray hairs at an exponential rate, that was having you do the work of 1.5-2 FTEs while barely paying you a mediocre salary for one person, with a well-insured patient population.

My ultimate goal is 1/3 clinical (500 hrs/year is the minimum I think to be considered competent by some credentialing bodies and medical boards) and 2/3 telemedicine. Then get on this passive income train with real estate syndications or something. I don't know.

I'm moving to a west coast HCOL area to be closer to my SO and have more time to spend on the water, SCUBA dive, and enjoy life. Ironically that makes me more valuable to the telemedicine companies as I can arbitrage the time different - my late mornings and afternoons are afternoons/evenings on the east coast, which people don't want to work. So that's a small win.

My next goal is to do some trial runs on cruise ships that are advertising reliable, fast internet to see if I can do telemedicine from a cruise ship (Royal Caribbean/Celebrity are installing Starlink, Princess, Virgin). Stay tuned.

What are your experiences with telemedicine?

 

[Arcan57]

Company is not doing well financially so they need to tighten up on finances.

“We don’t want to cut salaries”

So instead Teamhealth is cutting hours and coverage and pushing productivity to its limits.

Nevermind they haven’t given a pay raise, ever….

I love the group punishment aspect that CMGs have brought to EM. Some FMD in the NE went off the reservation and has been staffing at 1.0 pph for the last two years... while now you can't add hours for your Texas ED that's seen a 50% increase in patient volume from last year. I swear we're only a couple of years from making you do pushups because the Mid-America region missed it's LWOT goals and one of their contracts went on yellow.

 

[RustedFox]

I love the group punishment aspect that CMGs have brought to EM. Some FMD in the NE went off the reservation and has been staffing at 1.0 pph for the last two years... while now you can't add hours for your Texas ED that's seen a 50% increase in patient volume from last year. I swear we're only a couple of years from making you do pushups because the Mid-America region missed it's LWOT goals and one of their contracts went on yellow.

FMD?

 

[Fox800]

FMD?

Facility medical direktor, comrade.

 

[Fox800]

What are your experiences with telemedicine?

Mostly good. Repetitive. Mind numbing but hey, you can work in a hoodie and sweatpants while sipping coffee on your couch, on your own schedule. So that's nice.

 

[MechEDoc]

Mostly good. Repetitive. Mind numbing but hey, you can work in a hoodie and sweatpants while sipping coffee on your couch, on your own schedule. So that's nice.

Is it just z-packs and prednisone all day or somewhat better than that? Also, how's the income ($/hr). Asking for a friend...

 

[Fox800]

Is it just z-packs and prednisone all day or somewhat better than that? Also, how's the income ($/hr). Asking for a friend...

Most gigs are like $100-150/hr. So you have to temper your expectations a little bit. $150/hr to chill is not bad, though.

 

[EctopicFetus]

Any specific details on teamhealth. It’s no shock all cmgs are struggling. Here in TN bcbs went out of network with them (anesthesia, radiology and em) the same bcbs claimed they were gonna save $65m by doing this across the state. That $65m is profit cut to cmgs and eventually pay cuts for docs. That’s from one pretty average state population wise.

That’s also before all of medicine takes a potential 9% cut from Medicare and state budgets get squeezed for Medicaid.

But the Acep idiots think the future is bright lol.

Oh yeah we won’t even mention basic economics of supply and demand with 10k too many docs.

Envision is hurting, app is hurting. Team is hurting. Usacs is quiet but I imagine they fall off a cliff so as to keep their “owners” working like b*t*hes til the last moment.

Schumacher? Who knows. Hard to imagine from a macro perspective everyone isn’t hurting some.

 

[Apollyon]

Not at all. And, it was a distasteful meme, and he deserved the boot. Again, mess with the bull...

Ok, I had forgotten something, and the "dislike" I got for this post reminded me. Veers online became more stridently conservative, regularly moving rightward. However, "real life", he tried to get me a job with the tele place he worked, and was just a normal guy; he was not the living embodiment of a meme.

 

[cyanide12345678]

Ok, I had forgotten something, and the "dislike" I got for this post reminded me. Veers online became more stridently conservative, regularly moving rightward. However, "real life", he tried to get me a job with the tele place he worked, and was just a normal guy; he was not the living embodiment of a meme.

As a left leaning guy who is fairly liberal, you shouldn’t just block conservative and rightward voices if you disagree with it. Politics matter and it shouldn’t be so difficult to discuss political issues especially if they affect our healthcare reimbursements and our career futures.

 

[RustedFox]

As a left leaning guy who is fairly liberal, you shouldn’t just block conservative and rightward voices if you disagree with it. Politics matter and it shouldn’t be so difficult to discuss political issues especially if they affect our healthcare reimbursements and our career futures.

I'll argue that we are the most politically-impacted specialty in the house of medicine.

 

[cyanide12345678]

I'll argue that we are the most politically-impacted specialty in the house of medicine.

Agreed. We have a target on our backs because of the huge ER bills hospitals charge people. Too bad i don’t see a penny of those outrageous hospital fees 😅

We’re the Great unifier - everyone hates their ER bills. Whether you are a democrat, a Republican, an independent, or an insurance company 😅

 

[WilcoWorld]

As a left leaning guy who is fairly liberal, you shouldn’t just block conservative and rightward voices if you disagree with it. Politics matter and it shouldn’t be so difficult to discuss political issues especially if they affect our healthcare reimbursements and our career futures.

I engaged with Veers for over a decade, and we found areas of agreement. I also think we should not ban people for their political views. In my recollection what was inappropriate about his behavior was that he seemed to consistently and actively work to derail every discussion into a Red vs Blue discussion.

But I'm not a mod, so I'm not actually knowledgeable about what happened behind the scenes.

 

[VA Hopeful Dr]

I engaged with Veers for over a decade, and we found areas of agreement. I also think we should not ban people for their political views. In my recollection what was inappropriate about his behavior was that he seemed to consistently and actively work to derail every discussion into a Red vs Blue discussion.

But I'm not a mod, so I'm not actually knowledgeable about what happened behind the scenes.

That's about the size of it.

 

[cyanide12345678]

That's about the size of it.

I engaged with Veers for over a decade, and we found areas of agreement. I also think we should not ban people for their political views. In my recollection what was inappropriate about his behavior was that he seemed to consistently and actively work to derail every discussion into a Red vs Blue discussion.

But I'm not a mod, so I'm not actually knowledgeable about what happened behind the scenes.

But ironically the entire US political system is based on a 2 party red vs blue system. So what if things end up being red vs blue? That’s literally how this country runs 😅

For example abortion rights is the biggest red vs blue issue right now. Every damn politician is making it a talking point on both sides of the aisle. ER doctors and OB doctors are the ones who really are in the center of this because i literally don’t know what to do if there’s an ectopic with fetal heart beat on the ultrasound- do we just delay care until the heart beat goes away???

So yeah…i live in a state where the attorney general was saying publicly on TV that the OB gyn who carried out the abortion of the 10 year old raped Ohio girl was carrying out malpractice. Literally the state attorney general on TV was threatening the doctor that he will be reporting her to the medical board. Now you have that OB gyn suing the attorney general of my state for slander. Yeah….. the world is political. Opinions exist. But we cannot extricate politics from discussion when our laws can change the way we practice. And our laws are red vs blue. Will i get the attorney general going after me if i give methotrexate for an ectopic?

Doctors should have a voice in politics. When the trauma victims roll in after mass shootings, we are the ones caring for these people. And it’s 100% a red vs blue issue.

These things matter. Doctors should have a voice on these matters. Red vs blue who cares. Stop the cancel culture 😅

 

[RustedFox]

But ironically the entire US political system is based on a 2 party red vs blue system. So what if things end up being red vs blue? That’s literally how this country runs 😅

For example abortion rights is the biggest red vs blue issue right now. Every damn politician is making it a talking point on both sides of the aisle. ER doctors and OB doctors are the ones who really are in the center of this because i literally don’t know what to do if there’s an ectopic with fetal heart beat on the ultrasound- do we just delay care until the heart beat goes away???

So yeah…i live in a state where the attorney general was saying publicly on TV that the OB gyn who carried out the abortion of the 10 year old raped Ohio girl was carrying out malpractice. Literally the state attorney general on TV was threatening the doctor that he will be reporting her to the medical board. Now you have that OB gyn suing the attorney general of my state for slander. Yeah….. the world is political. Opinions exist. But we cannot extricate politics from discussion when our laws can change the way we practice. And our laws are red vs blue. Will i get the attorney general going after me if i give methotrexate for an ectopic?

Doctors should have a voice in politics. When the trauma victims roll in after mass shootings, we are the ones caring for these people. And it’s 100% a red vs blue issue.

These things matter. Doctors should have a voice on these matters. Red vs blue who cares. Stop the cancel culture 😅

TL/DNR:

FREE GENERALVEERS

 

[VA Hopeful Dr]

TL/DNR:

FREE GENERALVEERS

No

 

[miacomet]

I'm dropping down to about 50% clinical and 50% telemedicine. This summer I walked away from a CMG sweatshop that was taking years of my life and giving me gray hairs at an exponential rate, that was having you do the work of 1.5-2 FTEs while barely paying you a mediocre salary for one person, with a well-insured patient population.

My ultimate goal is 1/3 clinical (500 hrs/year is the minimum I think to be considered competent by some credentialing bodies and medical boards) and 2/3 telemedicine. Then get on this passive income train with real estate syndications or something. I don't know.

I'm moving to a west coast HCOL area to be closer to my SO and have more time to spend on the water, SCUBA dive, and enjoy life. Ironically that makes me more valuable to the telemedicine companies as I can arbitrage the time zone difference - my late mornings and afternoons are afternoons/evenings on the east coast, which people don't want to work. So that's a small win.

My next goal is to do some trial runs on cruise ships that are advertising reliable, fast internet to see if I can do telemedicine from a cruise ship (Royal Caribbean/Celebrity are installing Starlink, Princess, Virgin). Stay tuned.

Are you finding telemedicine lucrative? I've heard mixed things, and that some are downright toxic.

 

[Birdstrike]

Really? Why? Can someone direct to the thread that led to it? I haven't been here in a couple years. Too much COVID posting and had to step away. I log in today and have to sign some new TOS.

He said one too many controversial, unpopular, but true things, and was forcefully silenced for it.

 

[thegenius]

He said one too many controversial, unpopular, but true things, and was forcefully silenced for it.

Specifically he violated SDNs ToS several times if I recall. He was warned several times and continued to violate it.

 

[VA Hopeful Dr]

Specifically he violated SDNs ToS several times if I recall. He was warned several times and continued to violate it.

Yep.

Basically if we tell you to stop turning every thread into a democrats v. republican debate, you should stop doing that.

It wasn't his views that were the problem, it's that he wouldn't stop making every thread political despite multiple warnings that was the problem.