What would be your ideal ER job…

[HoosierdaddyO]

What would be your ideal ER situation or hospital dynamics. Would you prefer a smaller slower community shop where there was minimal in house staff that required transports and transfers out for specialized items. Or a large tertiary academic center where everything was resident run, everything was in house, but with the caveats of teaching requirements (free labor) and multiple icus with strict admission criteria for the cvicu vs neuro icu vs sicu etc etc etc.

Seeing patients with PAs or seeing patients by yourself and not having to deal with other peoples liability. Would you only want to see esi 1s and 2s or a fair mix of it all!! Rvu based vs salary vs a combo?

Inner city nitty gritty or more fancy community where patient scores/complaints are more of an issue. Like is there a nirvana kinda job out there or it really is so different and diverse based on peoples and what they like/want ?!

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[bravotwozero]

Academic job with community pay would be great. The opposite is more common however, and is truly the worst of both worlds.

I'll take inner city nitty gritty over country club community all day every day, regardless of what problems the homeless drug addicts bring.

 

[The Knife & Gun Club]

It would be nice to be at a fee-for-service county site. I know that’s an oxymoron but the best thing about county is the patients, acuity, and entertaining circus nature of it all. The part that sucks you’re soul is that every single person is salaried and will do everything in their power to avoid doing their job.

Just once I would like to put someone up for admission and have them get a bed in the desired location. Not “oh this person is too sick for the medicine floor, need ICU, ICU says it’s actually a post-surgical issue, call SICU, SICU says not sick enough for SICU, call Gen surg, Gen surg says it’s non-op, call medicine.” In an endless excruciating loop

 

[CajunMedic]

I'm a Podunk General Hospital, Airport, Hair Care, Tire Center, and Crawfish Hut kind of doc. For me, I'd like rural, about 10-12 beds, little better equipped and staffed than a Critical Access. Good mix of medical, with the occasional serious trauma that needs stabilized and shipped. Can admit simple surgical and medical patients, maybe an ICU bed or 2. Everything else goes to the mothership 30 mins-1 hour away. 2-3 Truck Hospital based EMS agency that runs the transfers and local 911 that I can be medical director of. Solo 12's with hourly rate, maybe an RVU bonus. Hospital employed.

 

[namethatsmell]

<10k visit rural place w/OB and one-call transfer to mothership that has all specialties. Superbonus = 24hr rads reads via mothership

 

[Apollyon]

<10k visit rural place w/OB and one-call transfer to mothership that has all specialties. Superbonus = 24hr rads reads via mothership

That just makes me think of some "Nighthawk" docs. One, when I spoke with her, told me that she understood, because her husband was a doc in the pit, and, she did, and another, when I texted her a pic of the kid's head, it matched up with the CT for fractures, and, she told me, "Everytime I talk to you, it's real pathology". I was just, what is it, gratified with that.

 

[thegenius]

What would be your ideal ER situation or hospital dynamics. Would you prefer a smaller slower community shop where there was minimal in house staff that required transports and transfers out for specialized items. Or a large tertiary academic center where everything was resident run, everything was in house, but with the caveats of teaching requirements (free labor) and multiple icus with strict admission criteria for the cvicu vs neuro icu vs sicu etc etc etc.

1. at least 3/4 of all complaints are legit uses of the ER. They don't all have to be medical emergencies, (ones can be ruled out), but legit complaints
2. consult services that will come in without complaining
3. have all consult services available
4. easily get 24-48 hr followup
5. the ER is stocked with everything you need
6. nurses don't complain
7. patients hand you a urine sample when the register with triage
8. no midlevels
9. seeing 1.5/hr max
10. make $400/hr
11. patients waive all rights for legal action

Oh that was fun.

 

[namethatsmell]

That just makes me think of some "Nighthawk" docs. One, when I spoke with her, told me that she understood, because her husband was a doc in the pit, and, she did, and another, when I texted her a pic of the kid's head, it matched up with the CT for fractures, and, she told me, "Everytime I talk to you, it's real pathology". I was just, what is it, gratified with that.

In my experience the beauty of mothership rads group giving reads is that they’re are real, complete and non-BS reads. Not only does it aid decision making, but prevents downstream work on dealing full reads/overreads. Also find it makes mothership transfers/consults easier because they already have the images to look at themselves.

 

[CJack]

my ideal ER is full of kitties and candy and pinot grigio and only nice/funny people and cozy couches and no poop nor mean/annoying people
EDIT: and also 24 hour rads reads

 

[nexus73]

What's the realistic psych access you'd desire at these smaller places?

 

[deleted1114045]

my ideal ER is full of kitties and candy and pinot grigio and only nice/funny people and cozy couches and no poop nor mean/annoying people
EDIT: and also 24 hour rads reads

Most of my best ER stories are about poop. You can’t have the best turkey sammies without some stories about the poop they produced. The air filled retching of the cannabinoid induced vomiter, the heavy tongued slur of the severely intoxicated, the unmistaken smell of someone who hasn’t showered in months, the pungent odor of dead flesh from a neglected diabetic ulcer, and last, but not least, the satisfying pile of poo you just mined from an 80 year old’s rectum. It just isn’t an ER without these.

 

[bravotwozero]

...don't forget about the maggots! The best are the festering wounds with maggots in them!

Had somebody like that 1 month post op from a bka. Paged the surgery resident, sees the patient.

Comes out there retching, "You could have warned me there were maggots in the wound!!! lol"

 

[RustedFox]

1. at least 3/4 of all complaints are legit uses of the ER. They don't all have to be medical emergencies, (ones can be ruled out), but legit complaints
2. consult services that will come in without complaining
3. have all consult services available
4. easily get 24-48 hr followup
5. the ER is stocked with everything you need
6. nurses don't complain
7. patients hand you a urine sample when the register with triage
8. no midlevels
9. seeing 1.5/hr max
10. make $400/hr
11. patients waive all rights for legal action

Oh that was fun.

If just the bolded came true, there would be radically less burnout in EM.

 

[thegenius]

If just the bolded came true, there would be radically less burnout in EM.

Totally

 

[Janders]

I would reduce a nursemaids elbow every 30-40 minutes, and otherwise enjoy my coffee. *aaaaaahhhh*

 

[thegenius]

Actually I have only one request for the ideal ER job:

Hospital Admin backs me up (e.g. supports me) whenever I discharge someone after they receive their screening medical exam. Irrespective of patient complaints. (I will take responsibility if I discharge someone who HAD an EMC that I did not stabilize. That's my promise.)

 

[The kitchen sink]

1. at least 3/4 of all complaints are legit uses of the ER. They don't all have to be medical emergencies, (ones can be ruled out), but legit complaints
2. consult services that will come in without complaining
3. have all consult services available
4. easily get 24-48 hr followup
5. the ER is stocked with everything you need
6. nurses don't complain
7. patients hand you a urine sample when the register with triage
8. no midlevels
9. seeing 1.5/hr max
10. make $400/hr
11. patients waive all rights for legal action

Oh that was fun.

#10 would certainly make the rest of the list more bearable lolol

 

[EctopicFetus]

Academic job with community pay would be great. The opposite is more common however, and is truly the worst of both worlds.

I'll take inner city nitty gritty over country club community all day every day, regardless of what problems the homeless drug addicts bring.

Depends. What resources are available. A lot of inner city places have minimal specialty call also the country club folks tend to reimburse better.

I would rather work and take care of high maintenance rich folks with a great call panel and make $250 per patient than no call panel and homelessness for $100/pt. Maybe im in the minority here.

I worked in a country club type place before. Tons of patients were a pain in the ass. A bunch were just nice decent people who were being abused by a terribly run system. Most of them were nice and understood a few were horrid. For an extra $150/pt idgaf. Will allow me to quit sooner.

 

[RustedFox]

Depends. What resources are available. A lot of inner city places have minimal specialty call also the country club folks tend to reimburse better.

I would rather work and take care of high maintenance rich folks with a great call panel and make $250 per patient than no call panel and homelessness for $100/pt. Maybe im in the minority here.

I worked in a country club type place before. Tons of patients were a pain in the ass. A bunch were just nice decent people who were being abused by a terribly run system. Most of them were nice and understood a few were horrid. For an extra $150/pt idgaf. Will allow me to quit sooner.

We have different experiences at Country Club Medical Center.

The patients at my country club job were so intolerably difficult that I quit and took time away from medicine.
It didn't help that admin did NOT understand that these people are made of the same stuff that any human is made out of, and that no amount of medicine can reverse decades of poor health choices.

Stodgy, buttery, cigar-smokey old fat men and beach-ball shaped old metabolic catastrophes of women can't always be fixed; but they don't want to hear that because they're friends with some C-suiter.

Christ, I hate those people.

 

[EctopicFetus]

Yep. I

We have different experiences at Country Club Medical Center.

The patients at my country club job were so intolerably difficult that I quit and took time away from medicine.
It didn't help that admin did NOT understand that these people are made of the same stuff that any human is made out of, and that no amount of medicine can reverse decades of poor health choices.

Stodgy, buttery, cigar-smokey old fat men and beach-ball shaped old metabolic catastrophes of women can't always be fixed; but they don't want to hear that because they're friends with some C-suiter.

Christ, I hate those people.

Yep its different for sure. Never had an issue with the care I provided. Admin was incredibly hands off as the ED was run well and patients were happy enough. IMO the #1 cure for burnout is working less. The key to working less is either saving a ton or spending a little or some combo of both.

I have a high pain threshold.. Ill take my beatings for the right price and do so with a smile. What I cant do is take beatings for avg pay. Hard pass. Ill go to the CAH and see 1 pph 75% of which are urgent care type visits and those people generally listen to you.

For the right money they can ride me like a 2 bit hooker. I’m not afraid to be honest about it.

 

[The kitchen sink]

Yep. I

Yep its different for sure. Never had an issue with the care I provided. Admin was incredibly hands off as the ED was run well and patients were happy enough. IMO the #1 cure for burnout is working less. The key to working less is either saving a ton or spending a little or some combo of both.

I have a high pain threshold.. Ill take my beatings for the right price and do so with a smile. What I cant do is take beatings for avg pay. Hard pass. Ill go to the CAH and see 1 pph 75% of which are urgent care type visits and those people generally listen to you.

For the right money they can ride me like a 2 bit hooker. I’m not afraid to be honest about it.

If the price is right…..

 

[WilcoWorld]

If just the bolded came true, there would be radically less burnout in EM.

Totally

I am actually trained and qualified to take care of those.

 

[RustedFox]

I am actually trained and qualified to take care of those.

I don't understand this reply.

 

[WilcoWorld]

I don't understand this reply.

I'm actually qualified and trained to take care of "legitimate" ED visits. Whereas I am neither trained nor qualified to take care of chronic HTN/workman's comp/smoldering mental illness.