Thoughts?

[hoot504]

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Feel free to discharge all the tachycardic patients you want. The lawyers love that. Perhaps they’ll serve you with papers written in crayon. At least that might make you laugh a little, which is sometimes all that you can do as a response in the ED when a tragedy like this happens and perhaps no one is at fault. There aren’t enough details to adequately MMQB this case and even that wouldn’t do it justice when we all know that the system including admitted boarding patients, low nursing staffing levels, and an overwhelming volume of worried well also might have affected this case. I applaud the father for seeking a path in health policy instead of placing his entire focus on litigation. At least it’s a search for a solution in a mess of a system. This site could use a little more of that and a little less toxic negativity. Perhaps, more crayons.

In my experience and practice, I generally do not discharge adults with a consistent HR above 110 without a very clear explanation. Yes the number is mostly arbitrary but if you’re discharging people with last documented HR above that you’re just asking for trouble. We’re paid in part based on our judgement and if I have someone with truly persistently abnormal vitals, I generally start digging and wouldn’t think twice about placing them in observation. It’s actually rare that I have a patient like this who would otherwise be discharged (nothing else concerning or abnormal found during the evaluation). I consider it one of the cardinal sins of EM to discharge grossly abnormal vital signs.

 

[WorkNoteEmergency]

I read the article when it came out and whole time I was imagining how the conversation with an admitting hospitalist/medicine resident would have gone but if I had decided I wanted to admit I would have done more workup. I think it's important to note that the autopsy, and remember the kid was found dead 2-ish days after ED discharge, couldn't identify a cause of death and who knows to what extent those autopsy findings were present at the last ED visit. That kid was dead man walking most likely. College students showed up in my ER every place I worked in my career and a bounce back for a viral syndrome usually got an expanded workup if not improving in a couple of days. I always, and I mean always, offered to call parents and if the kid declined, made sure to document. Made sure the kid had also the student health clinic info and sometimes on the bounce backs would communicate with the student health like a PCP office. I think an honest conversation with his parents at the time of the second visit may not have headed off a lawsuit but would have made this scenario look very different.

 

[Zebra Hunter]

I read the article when it came out and whole time I was imagining how the conversation with an admitting hospitalist/medicine resident would have gone but if I had decided I wanted to admit I would have done more workup. I think it's important to note that the autopsy, and remember the kid was found dead 2-ish days after ED discharge, couldn't identify a cause of death and who knows to what extent those autopsy findings were present at the last ED visit. That kid was dead man walking most likely. College students showed up in my ER every place I worked in my career and a bounce back for a viral syndrome usually got an expanded workup if not improving in a couple of days. I always, and I mean always, offered to call parents and if the kid declined, made sure to document. Made sure the kid had also the student health clinic info and sometimes on the bounce backs would communicate with the student health like a PCP office. I think an honest conversation with his parents at the time of the second visit may not have headed off a lawsuit but would have made this scenario look very different.

Viral syndrome college kids is like 3 patients a shift during flu season w/ probably 1/4th of them bouncing back to an ER within a few days because they aren't feeling better. Absolutely no way I'm calling the parents of an adult and kind of wild to document that an adult with capacity to make their own medical decisions is declining you calling their parents. Yeah, I would too and would be offended by that question. That seems...aggressively over-paternalistic.

 

[WhatJobDoIPick]

Maybe it’s just me but I’m not sure if you’ve ever made a post where you didn’t voice your displeasure for EM and medicine in general. While medicine (and EM) has its warts and it’s easy to fall into a negative attitude around SDN, I look forward to the day where you finally practice what you preach and leave the field. I hope you find the happiness you’re looking for but you seem like a chronically unhappy person.

Nice victim shaming.

I am a leader in my group, and consistently rated as someone other people want to work with.

I have my own wins and I'm happy about them; I am not chronically unhappy despite your gaslighting. I'm actually pretty happy at baseline, likely higher than the average American. EM has given me many, many things to be grateful for, but the juice isn't worth the squeeze.

I'm here to make sure lurkers know the truth about this field. People like you recommending it to students is malpractice.

 

[WorkNoteEmergency]

Viral syndrome college kids is like 3 patients a shift during flu season w/ probably 1/4th of them bouncing back to an ER within a few days because they aren't feeling better. Absolutely no way I'm calling the parents of an adult and kind of wild to document that an adult with capacity to make their own medical decisions is declining you calling their parents. Yeah, I would too and would be offended by that question. That seems...aggressively over-paternalistic.

Maybe if you tried it, you’d get fewer bounce backs.

 

[JacobMcCandles]

Nice victim shaming.

I am a leader in my group, and consistently rated as someone other people want to work with.

I have my own wins and I'm happy about them; I am not chronically unhappy despite your gaslighting. I'm actually pretty happy at baseline, likely higher than the average American. EM has given me many, many things to be grateful for, but the juice isn't worth the squeeze.

I'm here to make sure lurkers know the truth about this field. People like you recommending it to students is malpractice.

I'm glad your online persona is different than your in-person persona but you must just show your happiness in a weird way online. It took about 45 seconds to find a handful of examples. Best of luck in your next chapter!

EM is very agitating to me and even when I'm off I find myself not fully present sometimes, so the sooner I can get out, the better.

Reason # 3758 why EM sucks.

Honestly awful. The amount of moral injury and external fire we take is unbelievable. I can't wait to get out.

EM is trash tier.

Get out ASAP.

EM sucks.

Don't do it.

EM is trash tier.

Run away and never look back.

This field is seriously a joke.

Another data point in the barrel of data points that show how done this field is.

EM is trash tier.

I'm happy that I only have a handful more years going full-time at this.

 

[HemeOncHopeful19]

 

[RustedFox]

@WhatJobDoIPick may complain a lot on here (so do I), but what he says is true.

It's as if the laws of common expectations for any reasonable line of work don't exist in EM, *and* we're told that if we don't like being kicked in the teeth, then that's an "us" problem. Nobody else in any other line of work would tolerate our special variety of horse$#it.

 

[JacobMcCandles]

Again, I'm not disagreeing that EM has problems but you'd be hard-pressed to find any industry without issues. My friends who aren't in medicine who are well-compensated all have various stressors and complaints and each of them would trade places with me in a heartbeat. When you deal with life and death, as we do in medicine, there's always going to be some unnecessary amount of BS that goes with that. While I'm not going to actively encourage my children to go into medicine, I'm not going to actively discourage them, either. You'll find people in every specialty (industry, actually) who will give the same advice as @WhatJobDoIPick. We all need to vent a little and express our frustrations but constant negativity just gets old. I guess this is my venting about constant venting.

 

[emergentmd]

We should stay on point in this thread and there are many other threads that are great for complaining about EM.

I am not going to say if EM is a good or bad job BUT I bet you most EM docs who are unhappy would not trade their job for 95% of their friend's jobs. I also bet they would not trade it for 50% of medicine jobs out there. Primary care is the most common job and I bet the vast majority of EM docs would not trade. I know I would never do Primary care so I have it better than 30% of docs.

 

[TooMuchResearch]

Lol

 

[deleted1223140]

This is the kind of content I look forward to

 

[VA Hopeful Dr]

We should stay on point in this thread and there are many other threads that are great for complaining about EM.

I am not going to say if EM is a good or bad job BUT I bet you most EM docs who are unhappy would not trade their job for 95% of their friend's jobs. I also bet they would not trade it for 50% of medicine jobs out there. Primary care is the most common job and I bet the vast majority of EM docs would not trade. I know I would never do Primary care so I have it better than 30% of docs.

Yep. I do primary care, enjoy it, and am paid shocking well to do it.

But, I would bet 90% of you wouldn't trade jobs with me given the chance.

 

[EctopicFetus]

Yep. I do primary care, enjoy it, and am paid shocking well to do it.

But, I would bet 90% of you wouldn't trade jobs with me given the chance.

The recent medscape survey had em at the bottom again. I can’t remember what it was asking like either satisfaction or If you would recommend the specialty. We can all say our bit but in the end while survey data has its weakness what can’t be doubted is how we are at the bottom of nearly every single survey. Yes it’s that bad.

 

[emergentmd]

The recent medscape survey had em at the bottom again. I can’t remember what it was asking like either satisfaction or If you would recommend the specialty. We can all say our bit but in the end while survey data has its weakness what can’t be doubted is how we are at the bottom of nearly every single survey. Yes it’s that bad.

I hear and get why some are so down on EM but I guess its all your prospective.

I grew up dirt poor. Parents minimum wage working on the railroad and cleaning homes. No vacations, never seen the inside of a restaurant, driving beaters. Poor throughout med school.

Residency sucked but that 35K/yr made me feel middle class. Had a nice apt, car with AC, and money to buy discretionary stuff.

Attending and my 1st bi monthly paycheck was I think 7K. Did the math, with taxes taken out it came to about 225K/yr Was promised more but still happy to be making 225k/yr. 2nd bi monthly check was like 20K so ended up about 350k/yr. Felt like a Rockerfeller.

Did 15 yrs in the hospital Pit, and always felt I had the best job making 1% money and working half the month. Sure EM and medicine in general has gotten worse but I still think EM is one of the best jobs compared to how I grew up.

Its like the rags to riches movies you see. Never did I think a 1st gen immigrant could put in the hard work and have one of the best jobs imaginable. Stopped doing hospital EM and now feel like I have the best job imaginable.

It is all perspective and even if I had to go back into the Pit, I still would think it is one of the best jobs. I have my health while making 400K+/yr in the Pit; I could put up with a lot.

 

[WhatJobDoIPick]

I hear and get why some are so down on EM but I guess its all your prospective.

I grew up dirt poor. Parents minimum wage working on the railroad and cleaning homes. No vacations, never seen the inside of a restaurant, driving beaters. Poor throughout med school.

Residency sucked but that 35K/yr made me feel middle class. Had a nice apt, car with AC, and money to buy discretionary stuff.

Attending and my 1st bi monthly paycheck was I think 7K. Did the math, with taxes taken out it came to about 225K/yr Was promised more but still happy to be making 225k/yr. 2nd bi monthly check was like 20K so ended up about 350k/yr. Felt like a Rockerfeller.

Did 15 yrs in the hospital Pit, and always felt I had the best job making 1% money and working half the month. Sure EM and medicine in general has gotten worse but I still think EM is one of the best jobs compared to how I grew up.

Its like the rags to riches movies you see. Never did I think a 1st gen immigrant could put in the hard work and have one of the best jobs imaginable. Stopped doing hospital EM and now feel like I have the best job imaginable.

It is all perspective and even if I had to go back into the Pit, I still would think it is one of the best jobs. I have my health while making 400K+/yr in the Pit; I could put up with a lot.

Was waiting for @emergentmd to say that EM is better than growing up and a Cambodian war prison

 

[emergentmd]

I was chief of EM for 8 years. Medical Director/Board for the past 8 years at out FSER. Managed many docs and nurses in different environments.

You always have a hand full of docs who always complain no matter what and no matter what changes happen. You have some that goes with the flow. You have the rest that are happy no matter what and do the best in all situations.

Same environment, same job, same pay but such a discrepancy in the attitude and levels of complaining. Typically a small minority complains and creates the vast majority of the drama. I have learned its not the job but the person and no matter what they will complain. I have a theory it has nothing to do with the job but their personal life. Happy personal life + happy marriage = Rarely ever complain on the job.

I choose to make the best of all situations. If I don't like something, know I can't fix it, and can't deal with the situation then I move on. The last thing I would do is complain, complain, complain and then go to work making everyone around me miserable. If you are the few who are miserable, then maybe its not the job?

 

[endo]

I’m also an ED Director and have never complained to leadership when I was just a frontline doc. I agree that 10% of the docs do 90% of the complaining. I’m still a realist. If you choose EM you will have zero clout with admin and will only be looked at like a liability. You are a second class citizen in the hospital - a robot making widgets that is monitored for efficiency by the minute.

It is likely your longevity will be substantially shorter than those in other specialties. You will never get away from nights, weekends or holidays.

The positives are already apparent - no call, relatively good pay, less overall hours and if you’re doing locums you have a good deal of control over your schedule.

Still, it is a young man’s job and you’ll feel that about 10-15 years in.

It’s better than many non-medical jobs, but you’re talking to people who have a choice of other physician specialties.

Mostly I just think many med students can’t see past a 5 or 10 year window and it’s a 30 year decision.

 

[AlmostAnMD]

You are a second class citizen in the hospital - a robot making widgets that is monitored for efficiency by the minute.

Yeah that's why I didn't mesh well i it....not that I want to feel important per se, but I have ideas, I like to see how things can run better, I like to work on projects....I ran ideas by our directors and they didn't have anything to do with Press-Ganey, etc, so it was all ignored. So EM was definitely not well suited for me.

If you want a job where you're nobody and you overall contribute essentially nothing to the world, but have no responsibility outside the 9 shifts a month you work and get paid high $/hr, it's a good thing I guess.

But if you want to feel like you're making a contribution to healthcare, it's definitely not a place to be. Found out the hard way, and now I'm out.

 

[emergentmd]

It may shock you but not many specialty have clout. Actually, very few and even the NSG/ortho are only valuable until someone else is willing to take their job for less pay/less benefits.

I had an Ophthalmologist complain to me that he was just a widget and hospital was too cheap to buy him some equipment.

Any doc who thinks they are something special is sorely mistaken. But this is life. Unless you own something, you are just a widget that is replaceable.

This is the problem with man specialty, they think they are special but in reality we all are widgets. Some just more valuable and hard to find.

The only way to not be a widget is to own something, but if you are not willing to own something then you still a widget.

 

[TooMuchResearch]

I’m also an ED Director and have never complained to leadership when I was just a frontline doc. I agree that 10% of the docs do 90% of the complaining. I’m still a realist. If you choose EM you will have zero clout with admin and will only be looked at like a liability. You are a second class citizen in the hospital - a robot making widgets that is monitored for efficiency by the minute.

It is likely your longevity will be substantially shorter than those in other specialties. You will never get away from nights, weekends or holidays.

The positives are already apparent - no call, relatively good pay, less overall hours and if you’re doing locums you have a good deal of control over your schedule.

Still, it is a young man’s job and you’ll feel that about 10-15 years in.

It’s better than many non-medical jobs, but you’re talking to people who have a choice of other physician specialties.

Mostly I just think many med students can’t see past a 5 or 10 year window and it’s a 30 year decision.

Our group doesn't really track metrics other than production which we need for pay.

Edit: And I don't even look at mine anymore.

 

[EctopicFetus]

It may shock you but not many specialty have clout. Actually, very few and even the NSG/ortho are only valuable until someone else is willing to take their job for less pay/less benefits.

I had an Ophthalmologist complain to me that he was just a widget and hospital was too cheap to buy him some equipment.

Any doc who thinks they are something special is sorely mistaken. But this is life. Unless you own something, you are just a widget that is replaceable.

This is the problem with man specialty, they think they are special but in reality we all are widgets. Some just more valuable and hard to find.

The only way to not be a widget is to own something, but if you are not willing to own something then you still a widget.

This is incredibly accurate. Also your value in whatever specialty is directly aligned with what the hospital wants and the difficulty in replacing you. At a local hospital i know they are trying to push their OB/GYN right now. It is empowering the OB docs. They need the docs to align with the hospital goals. Ortho / CT surg /NSurg align with the hospitals desire for $$. Hence they universally have a lot of power.

On the other hand, Ophtho, ENT and 100 other specialities dont align with the hospitals desire to make a lot of money so they are on their own. This works for many specialties.

When I go to work, the overhead lights dont work, there is no hand sanitizer in the dispensers. I could go on with my examples but the key is this is them showing me they dont care about me/us. Another system I work in is the opposite, they were a disaster and my group took over the contract and they appreciated us. I made a comment about the computer monitors to the IT person and voila, 2 days later (literally) we had new/better screens and setup. In the end I am not foolish to think once my usefulness is gone or taken for granted the behavior will change.

To be fair to the hospital docs act the same way, this is capitalism. Capitalism is considered mutually beneficial because it operates on voluntary exchanges where both parties in a transaction believe they will gain.

All the folks on here who cant wait to retire etc. in the end, a healthy degreee of respect for the hospital and a decent bit of selfishness is needed to make it work.

I show up to work and work hard, if my pay gets cut substantially I will quit. It’s that simple. My pay stays strong, I am in an SDG I like, I’ll keep coming to work.

 

[AlmostAnMD]

Any doc who thinks they are something special is sorely mistaken. But this is life. Unless you own something, you are just a widget

Hard disagree. Your experiences have narrowed your view considerably in this area. It's not, "own a FSED or bust." Success has many flavors, as does respect.

When I was in the ER specialists didn't even want to return my calls.

When I'm in UM and a liver transplant gets denied, they call begging me to get it overturned. When half million dollar commercial cases are denied a system VP personally calls and begs for me to recoop the money.

The similarity between what I do and what FSED ownership has does overlap slightly, in that we are controlling the flow of money. When you're controlling the flow of money, people that want it kiss your ass.

 

[JacobMcCandles]

Hard disagree. Your experiences have narrowed your view considerably in this area. It's not, "own a FSED or bust." Success has many flavors, as does respect.

When I was in the ER specialists didn't even want to return my calls.

When I'm in UM and a liver transplant gets denied, they call begging me to get it overturned. When half million dollar commercial cases are denied a system VP personally calls and begs for me to recoop the money.

Don’t be fooled. You’re still a widget to the insurance company. They just need someone with a medical degree “making decisions”. Also, an EM physician has no business determining if a liver transplant is needed or not.

 

[AlmostAnMD]

Don’t be fooled. You’re still a widget to the insurance company. They just need someone with a medical degree “making decisions”. Also, an EM physician has no business determining if a liver transplant is needed or not.

Um

You are confused

I don't work for an insurance company

I fight insurance companies on behalf of the system

 

[JacobMcCandles]

Um

You are confused

I don't work for an insurance company

I fight insurance companies on behalf of the system

My bad. I got confused by the liver transplant and was thinking you were on the behalf of the insurance company.

 

[AlmostAnMD]

My bad. I got confused by the liver transplant and was thinking you were on the behalf of the insurance company.

Here's some technical information since you indirectly asked

Transplant surgeons talk to transplant surgeons at insurance companies to approve the procedure. this is essentially automatic since even though they're evil they're gonna recognize the necessity.

BUT if a patient comes in in fulminant liver failure and needs a transplant the transplant approval can't happen until the inpatient medical necessity is established (ie, inpatient vs observation status). So what the insurance companies will do is try to say the entire stay is observation which prevents the transplant evaluation for formal auth for transplant happening

In other words, the following needs to happen
Patient admitted to hospital
Made inpatient status
Inpatient status allows for transplant team to do evaluation
Transplant team agrees with necessity of transplant
Insurance transplant doc does p2p with our transplant surgeons and approves surgery

Where insurances can try to **** us stopping us at the inpatient status level and say the evaluation can be done outpatient even if they're too sick to leave

Insurance is a game. I play to win loool

 

[RustedFox]

Where insurances can try to **** us stopping us at the inpatient status level and say the evaluation can be done outpatient even if they're too sick to leave

Insurance is a game. I play to win loool

Your Approval-Fu is strong.

 

[EctopicFetus]

Don’t be fooled. You’re still a widget to the insurance company. They just need someone with a medical degree “making decisions”. Also, an EM physician has no business determining if a liver transplant is needed or not.

As I said if you offer something the hospital needs like CT Surgery/ Ortho / NSG they will kiss your ass (The system will). Those specialties generate a lot of money for the hospital. As soon as that changes the experience changes. General surgery.. treated like ass. No money for hernia repairs, gall bags or appys.

To be fair this is how it is in every business. You are the best salesman of a widget, they will kiss your ass and make different rules for you. As former football coach Jimmy Johnson said “ I treat everyone fairly, but I don't treat everyone equally“. When people say know your worth think about this quote.

It’s applicable in every way to us. Even FSED ownership, sell that business and you’ll be treated like a widget. Once you dont control the purse, payroll and future of employees things change.

My best friend and his wife owned a health care practice, in their mind they treated people well etc. They sold their business to PE. Then the employees felt no fear in “reporting” any behavior they didnt like from him and his wife. It’s the reality, it exists everywhere and the sooner you accept this reality and reframe your mindset the happier you will be and the world order will make sense.

 

[BoardingDoc]

.

As I said if you offer something the hospital needs like CT Surgery/ Ortho / NSG they will kiss your ass (The system will). Those specialties generate a lot of money for the hospital. As soon as that changes the experience changes. General surgery.. treated like ass. No money for hernia repairs, gall bags or appys.

To be fair this is how it is in every business. You are the best salesman of a widget, they will kiss your ass and make different rules for you. As former football coach Jimmy Johnson said “ I treat everyone fairly, but I don't treat everyone equally“. When people say know your worth think about this quote.

It’s applicable in every way to us. Even FSED ownership, sell that business and you’ll be treated like a widget. Once you dont control the purse, payroll and future of employees things change.

My best friend and his wife owned a health care practice, in their mind they treated people well etc. They sold their business to PE. Then the employees felt no fear in “reporting” any behavior they didnt like from him and his wife. It’s the reality, it exists everywhere and the sooner you accept this reality and reframe your mindset the happier you will be and the world order will make sense.

Yeah, the profound shift in the way I was treated by admin and the amount of resources I was provided to do my actual job when I switched from EM to pain was astonishing. All about whether or not we generate money.

 

[RustedFox]

.Yeah, the profound shift in the way I was treated by admin and the amount of resources I was provided to do my actual job when I switched from EM to pain was astonishing. All about whether or not we generate money.

Reason #658 why pain is better than EM?

 

[AlmostAnMD]

As former football coach Jimmy Johnson said “ I treat everyone fairly, but I don't treat everyone equally“. When people say know your worth think about this quote.

That is an amazing quote.

I truly never thought of things this way in med school....or residency....even a few years into being an attending I sensed that something was wrong but couldn't quite tell what it was. It's a powerfully difficult thing to describe to someone that hasn't experienced it.

True enough, when I left my EM world they found another warm body to fill my shifts and life just moved on, like a drop of water was missing from the ocean

 

[JacobMcCandles]

True enough, when I left my EM world they found another warm body to fill my shifts and life just moved on, like a drop of water was missing from the ocean

This is everybody, though. They’ll find another physician, they’ll find another person for UM, they’ll find another CEO, they’ll find another quarterback. The world continues to move on without people and it always will. Thats why it’s important to spend meaningful time with family and friends and do things you enjoy.

 

[emergentmd]

Again, unless you own something you are a widget. Some are more special but all replaceable. The only person who calls the shot, leave on their own term, not a widget is an owner.

Look at football. When Aaron Rodgers was slinging it everywhere at an MVP level, he could do whatever he wanted/play out of system. When his skills waned, he became a widget and special treatment lapsed. Look at Jerry Jones who has done some really dumb/questionable stuff and a team that never wins at anything. But guess what, he owns it so he can do whatever he wants.

Any doc who thinks they are not a widget is just fooling themselves. Piss off the decision makers, and at the end of the day just a widget like the rest of us.

Owners and widgets play by different rules. If you are not an owner, don't think you are invaluable or call the shots. You call the shots because you are allowed to until you are not.

 

[emergentmd]

Hard disagree. Your experiences have narrowed your view considerably in this area. It's not, "own a FSED or bust." Success has many flavors, as does respect.

With all due respect and utmost respect, you are widget who has blinders on. If they find someone cheaper, you are out.

 

[AlmostAnMD]

This is everybody, though. They’ll find another physician, they’ll find another person for UM, they’ll find another CEO, they’ll find another quarterback. The world continues to move on without people and it always will. Thats why it’s important to spend meaningful time with family and friends and do things you enjoy.

With all due respect and utmost respect, you are widget who has blinders on. If they find someone cheaper, you are out.

Narrow views, both. With respect, what qualifications do either of you have to pontificate on these issues?

This is a field where ideas are welcomed. I've transformed significant parts of our system to the point i just earned a medical director pay bump. I've found new and creative ways to transform our system whilst simultaneously bringing in an extra few million over the last few months. And with early success, more people buy in, allowing me to mold significant parts of the "invisible" aspect of the hospital you never seen in my image and methods.

I won't say I'm irreplaceable, but I'm clearly valued, and the more success I have, the more lift and hold my ideas take.

Just as I won't pontificate on you on FSED ownership, you've no real qualification or reason to assume I'm a widget. I'm rather finding a nice stride and calling, actually. Dismantling insurance bureaucracy is deeply gratifying.

"Find someone cheaper?" Not even sure what that means. I'm a cash cow for our system. They don't care what they pay me, they care about the revenue I generate, and it's rather drawing considerable attraction. I feel it's important to rebut you in strictest terms because people reading this need to know it IS possible to matter-- I'm making more "difference" now for healthcare than I ever did clinically.

 

[JacobMcCandles]

Narrow views, both. With respect, what qualifications do either of you have to pontificate on these issues?

In the grand scheme, basically the same as you.

Honest question: what do you think they’ll do if you all of a sudden weren’t in that job? I’m not trying to minimize that job as you’ve clearly found happiness and feel valued but everybody in this world will be replaced at some point. If you quit today there’s a decent chance nobody at that hospital would even know your name in 20 years. That doesn’t mean you don’t matter or your work isn’t valued. That’s just how time works.

 

[AlmostAnMD]

In the grand scheme, basically the same as you.

Honest question: what do you think they’ll do if you all of a sudden weren’t in that job? I’m not trying to minimize that job but everybody in this world will be replaced at some point. If you quit today there’s a decent chance nobody at that hospital would even know your name in 20 years. That doesn’t mean you don’t matter or your work isn’t valued. That’s just how time works.

I dunno man

I'm a big believer in Ai replacing most everything, even clinical docs one day. That's why I'm so active in stocks to pump up my own net worth and be ready for anything.

Oh I'm not trying to run for some legendary status where people build statues of me. Some part of me graduated medical school wanting to "make a difference", and if I can transform how our state is reimbursed or enforces inpatient authorizations I'll feel like I accomplished something.

Yeah ultimately work is work. But my work is also full remote, so I'm actually traveling with parents wife and kids now, something I'm doing more often and could never do in the er. Finding a way to find meaning in life, fulfillment, spend time with family and experience life. Loving it.

Will it all disappear? Sure. Might as well try to do something though

 

[VA Hopeful Dr]

Narrow views, both. With respect, what qualifications do either of you have to pontificate on these issues?

This is a field where ideas are welcomed. I've transformed significant parts of our system to the point i just earned a medical director pay bump. I've found new and creative ways to transform our system whilst simultaneously bringing in an extra few million over the last few months. And with early success, more people buy in, allowing me to mold significant parts of the "invisible" aspect of the hospital you never seen in my image and methods.

I won't say I'm irreplaceable, but I'm clearly valued, and the more success I have, the more lift and hold my ideas take.

Just as I won't pontificate on you on FSED ownership, you've no real qualification or reason to assume I'm a widget. I'm rather finding a nice stride and calling, actually. Dismantling insurance bureaucracy is deeply gratifying.

"Find someone cheaper?" Not even sure what that means. I'm a cash cow for our system. They don't care what they pay me, they care about the revenue I generate, and it's rather drawing considerable attraction. I feel it's important to rebut you in strictest terms because people reading this need to know it IS possible to matter-- I'm making more "difference" now for healthcare than I ever did clinically.

I think there's an important point in this.

We are all replaceable (everyone in pretty much any job is). What makes a difference is how hard you are to replace and how much money will your employer lose between you leaving and finding a replacement.

 

[JacobMcCandles]

Yeah ultimately work is work. But my work is also full remote, so I'm actually traveling with parents wife and kids now, something I'm doing more often and could never do in the er. Finding a way to find meaning in life, fulfillment, spend time with family and experience life. Loving it.

I’m happy you’ve found what works for you and makes you happy. Working clinically and EM aren’t for everybody and that’s ok. If you do want to work clinically then EM is probably one of the top specialties for working full time and still being able to travel. Sounds like your EM job was pretty bad.

 

[WhatJobDoIPick]

In the grand scheme, basically the same as you.

Honest question: what do you think they’ll do if you all of a sudden weren’t in that job? I’m not trying to minimize that job as you’ve clearly found happiness and feel valued but everybody in this world will be replaced at some point. If you quit today there’s a decent chance nobody at that hospital would even know your name in 20 years. That doesn’t mean you don’t matter or your work isn’t valued. That’s just how time works.

Difference between internal and external validation

 

[WhatJobDoIPick]

I’m happy you’ve found what works for you and makes you happy. Working clinically and EM aren’t for everybody and that’s ok. If you do want to work clinically then EM is probably one of the top specialties for working full time and still being able to travel. Sounds like your EM job was pretty bad.

Some people don't want the cyclical grind of shifts, travel, shifts, travel. Some people want to improve the system and leave it better off than they found it. Sounds like @AlmostAnMD has found a niche where he feels like his effort and intellect are being rewarded not only by his system but by the nature of his work. Clinical EM really isn't for human work. It's for robots. Task switching and constant visual and audio stimuli are harmful for us. We fool ourselves into adapting, but it's not healthy work. People kill themselves. People crash out on shifts. I've seen it. I've watched people I thought were well adapted physically damage (aka punch) computers while working in the ED. You can go on and on how it "isn't for everyone and that's ok" like some gaslighting admin speak, but the truth is, it's not for the majority of humans.

 

[JacobMcCandles]

Some people don't want the cyclical grind of shifts, travel, shifts, travel. Some people want to improve the system and leave it better off than they found it. Sounds like @AlmostAnMD has found a niche where he feels like his effort and intellect are being rewarded not only by his system but by the nature of his work. Clinical EM really isn't for human work. It's for robots. Task switching and constant visual and audio stimuli are harmful for us. We fool ourselves into adapting, but it's not healthy work. People kill themselves. People crash out on shifts. I've seen it. I've watched people I thought were well adapted physically damage (aka punch) computers while working in the ED. You can go on and on how it "isn't for everyone and that's ok" like some gaslighting admin speak, but the truth is, it's not for the majority of humans.

That’s why the majority of humans aren’t EM docs. We’re dealing with life and death sometimes so of course it’s going to be high stress. That’s just a part of the job and there’s really no changing that. I can think of a lot less meaningful jobs. It’s been mentioned before but 95% of the world would trade positions with us in a heart beat. As we both agree, it’s not for everyone.

 

[AlmostAnMD]

Some people don't want the cyclical grind of shifts, travel, shifts, travel. Some people want to improve the system and leave it better off than they found it. Sounds like @AlmostAnMD has found a niche where he feels like his effort and intellect are being rewarded not only by his system but by the nature of his work. Clinical EM really isn't for human work. It's for robots. Task switching and constant visual and audio stimuli are harmful for us. We fool ourselves into adapting, but it's not healthy work. People kill themselves. People crash out on shifts. I've seen it. I've watched people I thought were well adapted physically damage (aka punch) computers while working in the ED. You can go on and on how it "isn't for everyone and that's ok" like some gaslighting admin speak, but the truth is, it's not for the majority of humans.

No joke.

Honestly i can speak to why I left in an entirely separate topic but the final "push" was witnessing what you described. A 65 year old partner in the group just absolutely lost his ****, cursing and throwing stuff....and it hit me...like, my god....if I don't make a change...that's going to be me in a few decades

And I was out

 

[WhatJobDoIPick]

That’s why the majority of humans aren’t EM docs. We’re dealing with life and death sometimes so of course it’s going to be high stress. That’s just a part of the job and there’s really no changing that. I can think of a lot less meaningful jobs. It’s been mentioned before but 95% of the world would trade positions with us in a heart beat. As we both agree, it’s not for everyone.

It's actually deeper than "not for most humans."

It's not for "most doctors."

The life and death situations are the easiest thing we do in EM.

There's a reason why physicians, who are already self selected to be strong headed and resilient crash out in EM. It's the nature of the work, it's not the person.

You think people make it through organic chem, MCAT, USMLE, MS3 and residency (where you are constantly fed a diet of harassment and crap sleep), and then all of a sudden crash out as attendings because they have a character flaw? Lol nah man. The work is brutal and beats up the best of us. People KILL themselves.

 

[JacobMcCandles]

It's actually deeper than "not for most humans."

It's not for "most doctors."

The life and death situations are the easiest thing we do in EM.

There's a reason why physicians, who are already self selected to be strong headed and resilient crash out in EM. It's the nature of the work, it's not the person.

You think people make it through organic chem, MCAT, USMLE, MS3 and residency (where you are constantly fed a diet of harassment and crap sleep), and then all of a sudden crash out as attendings because they have a character flaw? Lol nah man. The work is brutal and beats up the best of us. People KILL themselves.

That’s why the majority of physicians aren’t EM doctors. Look, I won’t sit here and minimize mental health and physician suicide. Suicide isn’t just a phenomenon associated with only medicine. Mental health is terrible in this country for a lot of reasons. There’s all different kinds of stresses that people react to differently. Stressed that don’t bother me may bother other people and vice versa. Yes, the work is brutal but nobody is forcing you to do the work.

 

[emergentmd]

Ok

This is a field where ideas are welcomed. I've transformed significant parts of our system to the point i just earned a medical director pay bump. I've found new and creative ways to transform our system whilst simultaneously bringing in an extra few million over the last few months. And with early success, more people buy in, allowing me to mold significant parts of the "invisible" aspect of the hospital you never seen in my image and methods.

"Find someone cheaper?" Not even sure what that means. I'm a cash cow for our system. They don't care what they pay me, they care about the revenue I generate, and it's rather drawing considerable attraction. I feel it's important to rebut you in strictest terms because people reading this need to know it IS possible to matter-- I'm making more "difference" now for healthcare than I ever did clinically.

I am glad you feel like you are making a difference b/c this is very imp for a gratifying job. But your assertion that you make more a difference than clinical EM docs is quite subjective. By your definition of a difference then I would say the CEO/CNO/CMO makes more of a difference as they makes the final decisions.

But my 1st 3 highlighted phrases are the definition of a widget no diff than a NSG. You are a cash cow. They care that you generate them money. You found ways to make the owners/company millions. Your raise pales in comparison to the company profit and someone is pocketing this $$$ be it the owner or the C-suite who are getting larger bonuses.

A widget is someone/something that helps a bigger entity function better thus making more money. The vast majority of $$$ goes to the owner while you got a sliver of profits. You actually are the best widget. Someone who does a fantastic job, creates great value for the company, who gets a pay bump to grease the widget making them feel valued, but the bottom line is the owner/C-suite are sitting back collecting all the profits taking the vast majority of the credit.

Once you stop producing or they find someone else who does a better job or willing to take less $$ for the same performance, guess what happens to your job?

 

[WhatJobDoIPick]

Ok

I am glad you feel like you are making a difference b/c this is very imp for a gratifying job. But your assertion that you make more a difference than clinical EM docs is quite subjective. By your definition of a difference then I would say the CEO/CNO/CMO makes more of a difference as they makes the final decisions.

But my 1st 3 highlighted phrases are the definition of a widget no diff than a NSG. You are a cash cow. They care that you generate them money. You found ways to make the owners/company millions. Your raise pales in comparison to the company profit and someone is pocketing this $$$ be it the owner or the C-suite who are getting larger bonuses.

A widget is someone/something that helps a bigger entity function better thus making more money. The vast majority of $$$ goes to the owner while you got a sliver of profits. You actually are the best widget. Someone who does a fantastic job, creates great value for the company, who gets a pay bump to grease the widget making them feel valued, but the bottom line is the owner/C-suite are sitting back collecting all the profits taking the vast majority of the credit.

Once you stop producing or they find someone else who does a better job or willing to take less $$ for the same performance, guess what happens to your job?

And what happens to your UC if CMS stop reimbursing at the level they do? Owning a POS doesn't make it less of a POS.

 

[emergentmd]

I am not saying his job, my job, your job is better or worse. I am not saying an owner or a worker is any better than the other. I am just saying that if you work for someone, you are a widget and eventually most will find out that they are a widget.

I have been in management from line doc, Medical director at a large receiving hospital. Been through too many MECs and meetings to count. No one who works for the hospital (actually any business) eventually find out they are a widget. Do you think I made any material changes when I was a medical director? Went to bunch of meetings, gave my opinions, and they did what they want and typically ended up what made them more money. Yeah they threw us a few bones to make us feed good but bottom line is $$$ and hospital reputation.

Knew of a specialist surgeon who came in doing everything the hospital wanted, followed the company line, brought bunch of $$$. He thought he could do no wrong until he crossed the wrong person and was out the door quite quickly.

My only point is that unless you own something, your job security is at the whim of the next CEO of the hospital. Our SDG thought we were some unicorn b/c he did "aligned" with the hospital and didn't cost them any stiped with great metrics. New C suite guy came and thought it was a great idea to bring in a CMG strictly for financial reasons.

 

[EctopicFetus]

Ill say the majority of docs arent surgeons either. Ill admit on the happy spectrum of work. I find meaning in my admin stuff and honestly, more importantly to me is that i am well compensated for my clinical and non clinical work. If that disappears truly i think my work satisfaction will go down.

I am fully aware thatthat may seem shallow to some on here. My take is this. If someone wants to pay me $200/hr for 0.5pph its a job I would consider if I could do a 72 hour shift. If someone offers me 300/hr to see 2 pph im laughing in their face. All that to say my compensation is very directly tied to the job that I want and will be happy with. There are hospital level issues we deal with. If I owned the hospital or ED I would have 0 tolerance for this. But im a cog and we all are in the ED. I may be a "leader" in my group but that only means I bang my head against the wall when interacting with hospital admin.

They like me, I like them. I have to decide when to make a big fuss about things. Cant complain about everything to the high level folks. I think as humans it is important we find meaning in our work. For some thats clinical medicine. I still legit enjoy it. I work 10-14 clinical shifts a month. I still view myself as a clinician unlike the fake CMG leaders who say they are doctors but work 50 clinical hours a year.

In the end my main point to the young people on here. Get your finances in order. You will be so much happier at your clinical work. You can and should invest wisely. It can be the stock market, it can be real estate, really anything that will get your 10% returns annually. Its the only way to grow your wealth. I think almost any EM doc can be FI in 15 years. For many folks that puts you in your mid 40s and you can be out. Obviously this depends on your spending / needs. There is no downside to FI.