When does taking it for the team become taking it up the you know what?

WilcoWorld

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Physicians pursue a higher calling that is beyond ego...I’d rather resuscitate someone in shock, but sometimes doing a rectal exam is the right thing for the patient. I’m a physician and a healer. Not a provider.
Agree 100%
 
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EctopicFetus

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Is this what EM docs are making? $400 an hour? Is this the norm? In the city? I had read on this very forum that those days are gone.
I agree with you though that these rural hospitals often don't want to pay city prices. But it seems like they do for surgeons.
However, let me counter your question with this. Before the advent on the EM path, these rural hospitals still existed. Why is it back then, the FM docs were good enough to staff these same rural hospitals but now 30 years later (I am not sure how long EM has been a specialty) or so, they aren't good enough to be rural hospitals, but are glorified urgent cares with a CT scanner? Are they all supposed to close down their ERs?

Rural people need ERs too you know. I say this as a travel doc who sees how deficient smaller towns are in physicians while in the city they are climbing all over each other like crabs in a damn bucket and fighting for jobs/shifts. Makes no sense.
No. But you have to pay for the pain of travel Make it $300/hr.. i dont know.. i do know paying way less than more desireable locations wont make people want to show up to work. EM is a newer field. Now that we have plenty of docs the use of substandard clinicians isnt ok. Why is ok for these rural people to receive substandard care. Lots have changed in 30 years. ATLS.. you know why that came about? Rural “EM” docs not knowing how to handle trauma. If a community can not support a hospital with an ED then either the government can dump even more money into rural hospitals Or consolidate. Near me there are a handful of under 10k annual EDs within an hour of “real hospitals”. Rural people need surgeons, dermatologists, cardiologists, urologists and orthopods too.

What’s your solution? They need EDs way less than good preventive care. resource barren hospitals are a financial sham. I will also point out that if you want to cure some of the primary care issue take the PCPs out of the EDs where they see 5-15 patients per 24 hours and get them into clinics where they can see more people in 1/3 the time.
 
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TikiTorches

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Admin just cares about money. People are just replaceable cogs. They want the cheapest cog
 
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Lexdiamondz

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Is this what EM docs are making? $400 an hour? Is this the norm? In the city? I had read on this very forum that those days are gone.
I agree with you though that these rural hospitals often don't want to pay city prices. But it seems like they do for surgeons.
However, let me counter your question with this. Before the advent on the EM path, these rural hospitals still existed. Why is it back then, the FM docs were good enough to staff these same rural hospitals but now 30 years later (I am not sure how long EM has been a specialty) or so, they aren't good enough to be rural hospitals, but are glorified urgent cares with a CT scanner? Are they all supposed to close down their ERs?

Rural people need ERs too you know. I say this as a travel doc who sees how deficient smaller towns are in physicians while in the city they are climbing all over each other like crabs in a damn bucket and fighting for jobs/shifts. Makes no sense.

They were never "good enough".

EM was literally founded by FM and IM docs (w a handful of surgeons as well) who realized that the aforementioned training pathways were wholly inadequate to safely treat the full breadth of EM pathology. The number of trainwreck transfers I've gotten from nearby ERs staffed by FM guys and IM guys is pretty staggering.

Rural people need ERs, and I'd argue that in a rural setting where there is less subspecialty care available they need ERs staffed by skilled EM trained physicians, not FM and IM docs trying to make a buck and definitely not unsupervised midlevels. Rural hospitals are willing to pay top dollar for surgeons, CRNAs and even FM docs to do primary care, but when it comes to the ED they can't pony up the cash to get people to do the job properly? That makes no sense.
 
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Fox800

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Rural hospitals continue to operate "emergency departments" because they want that sweet $$$ from facility fees, CT scans, unneeded labs, etc. 100% agreed they should be rebranded as urgent care if they cannot staff the right people (BC/BE emergency physicians).

They COULD recruit EPs, but they'd rather maintain an "emergency department" and staff it with midlevels and FM/IM docs at a disservice to their patients. Guaranteed if you paid $300+/hr + travel you'd get EPs taking them up on their offer. Hell, my critical access hospital has locums pediatricians, ortho, etc. The ortho docs sit on their butts in their hotel room and play Xbox all day. They'll only come in for 1/3 consults I call, because "it's too complex - probably needs to go to a bigger hospital" after reviewing images on their iPhone. That's all they have to say. It's a sweet gig they've got going on.

It's all about money.
 
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EctopicFetus

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Exactly As others stated.. its all a game and simply the rural folks more than others actually need someone who knows what they are doing. To be clear I think IM/FP/ and MLPs dont know what they are doing in the ED. Some folks may be butt hurt about this.. It is the same as I’m/FP saying I dont know how to do primary care.. I would say yep. I know A little but they are spot on. I have no idea. Never learned it, never trained in it etc.
 
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CajunMedic

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Rural hospitals continue to operate "emergency departments" because they want that sweet $$$ from facility fees, CT scans, unneeded labs, etc. 100% agreed they should be rebranded as urgent care if they cannot staff the right people (BC/BE emergency physicians).

They COULD recruit EPs, but they'd rather maintain an "emergency department" and staff it with midlevels and FM/IM docs at a disservice to their patients. Guaranteed if you paid $300+/hr + travel you'd get EPs taking them up on their offer. Hell, my critical access hospital has locums pediatricians, ortho, etc. The ortho docs sit on their butts in their hotel room and play Xbox all day. They'll only come in for 1/3 consults I call, because "it's too complex - probably needs to go to a bigger hospital" after reviewing images on their iPhone. That's all they have to say. It's a sweet gig they've got going on.

It's all about money.

I contacted one of the hospitals I used to bring patients to as a medic before med school, was bluntly told "We can't hire you to work just the ED, Costs too much. You'd have to work in a clinic full time and the ED on a part-time basis" So, they have a brand-new hospital, with a 10 bed ED, full-sized trauma bay, 2 inpatient wings and an outpatient surgical center with no BC/BE EM docs, that they will only staff with PA and NP's
 
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RustedFox

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I contacted one of the hospitals I used to bring patients to as a medic before med school, was bluntly told "We can't hire you to work just the ED, Costs too much. You'd have to work in a clinic full time and the ED on a part-time basis" So, they have a brand-new hospital, with a 10 bed ED, full-sized trauma bay, 2 inpatient wings and an outpatient surgical center with no BC/BE EM docs, that they will only staff with PA and NP's

Lamesauce.

Welp. (You didn't want to go back to the gulf bend anyways, right?)
 

thegenius

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I am gonna say something unpopular with you and most FM docs who work In the ED. If they can't hire a residency-trained EP in 2020 then they shouldn’t be EDs. It’s real simple. Can you have a cath lab without an interventional cardiologist? No. Same thing. I get you don't like that. Some MLPs are better than FM docs in the ED I give you that. But both are far inferior to EM docs. That's my point. Keep those facilities, label them what they are which is urgent care with a CT scanner, and be done with the stupidity of the whole thing.

I don’t criticize MLPs for working wherever they are. I criticize the system. My criticism is of any doc or MLP who isn't equipped to do their job. My group staffs multiple rural EDs so let's stop there. You know what we did.. moved to as many EM trained docs as we could and got rid of the dead weight MLPs and brought on ones who both understood their role and were good at it.

Good docs and MLPs know and understand their limits. When I was a resident I cathed a patient, I did a PEG. I did a bunch of other stuff too. Today I don't do those things because I understand my limits. Many MLPs like to pretend they are equal to docs which is nonsense. (!!!) MLPs often know how to do something but not the why. It’s that missing bit that leads to mistakes. You don't know what you don't know. EM docs spent 4 years in school and 3 years in residency to minimize what they don't know. MLPs spend maybe 15% of the time learning before they are set free.

I have said this in the past, you have said this in the past, and it's true. Can't be an Emergency Department without an Emergency Medicine doc.
 
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Lexdiamondz

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I contacted one of the hospitals I used to bring patients to as a medic before med school, was bluntly told "We can't hire you to work just the ED, Costs too much. You'd have to work in a clinic full time and the ED on a part-time basis" So, they have a brand-new hospital, with a 10 bed ED, full-sized trauma bay, 2 inpatient wings and an outpatient surgical center with no BC/BE EM docs, that they will only staff with PA and NP's
Well fxck me for going to the hospital and expecting to see a doctor...
 
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alpinism

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I have said this in the past, you have said this in the past, and it's true. Can't be an Emergency Department without an Emergency Medicine doc.

The cold hard truth is that most rural hospitals don't respect EM physicians and think we're no better than FM physicians.
 
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sylvanthus

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I think everyone is scrambling during this covid situation so there has to be flexibility in hours and things that are asked of people. This is unprecedented


Can we outlaw this word? Im reminded of princess bride everytime I hear it.
 
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RustedFox

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Can we outlaw this word? Im reminded of princess bride everytime I hear it.

I (as well) hate the overuse of certain words, especially in the media. It's like "all the cool kids have to use this word, so it's everywhere".

Latest example: "optics" as used to describe the overall early impression of a situation.
 

GeneralVeers

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I (as well) hate the overuse of certain words, especially in the media. It's like "all the cool kids have to use this word, so it's everywhere".

Latest example: "optics" as used to describe the overall early impression of a situation.

My two least favorite gibberish phrases:

1. "Abundance of Caution"
2. "Near Miss"
 
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WilcoWorld

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I (as well) hate the overuse of certain words, especially in the media. It's like "all the cool kids have to use this word, so it's everywhere".

Latest example: "optics" as used to describe the overall early impression of a situation.

I'm sick of "existential threat".

A) These folks are never discussing Existentialism, so using this pseudo-Big Word is confusing at best in such contexts.
B) These folks are also very rarely actually discussing a real threat to our existence, so it's also false.
C) If you really do mean that something is a threat to something's existence, wouldn't it be more clear to say "This could mean the end of the world"

Too often these are just a sign of lazy writing that hopes to sound more intelligent than it is.
 
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RustedFox

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I see what you did there ;)

I was being sincere.
Being a journalist isn't a difficult skill (being able to write coherently in the English language, which most people who have passed 10th grade can do reasonably well), so when one of them uses a "new word", the others all generally follow suit and use that word too. However, a journalist's vocabulary generally isn't very profound - so they think they're all "trail blazers" by using the "cool word du jour".

I remember when the "cool kids" all started wearing Airwalk shoes in 8th grade, because one decided that they were "cool", so they all followed suit. That's about where the intellectual horsepower of your average journalist stops.
 
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WilcoWorld

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I was being sincere.
Being a journalist isn't a difficult skill (being able to write coherently in the English language, which most people who have passed 10th grade can do reasonably well), so when one of them uses a "new word", the others all generally follow suit and use that word too. However, a journalist's vocabulary generally isn't very profound - so they think they're all "trail blazers" by using the "cool word du jour".

I remember when the "cool kids" all started wearing Airwalk shoes in 8th grade, because one decided that they were "cool", so they all followed suit. That's about where the intellectual horsepower of your average journalist stops.
I thought you were trying to show that "hive mind" is among the overused terms of our current time.

Also, I prefer Converse All Stars.
 
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RustedFox

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I thought you were trying to show that "hive mind" is among the overused terms of our current time.

Also, I prefer Converse All Stars.

I thought about that; but I honestly haven't heard the term "hive mind" used a lot.
But - the average journalist is too dumb to realize that its generally self-referencing; not unlike a group of jocks mocking a group of greasers for their habitual "we go together/we think together/we do together" behavior.
 
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Apollyon

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I thought about that; but I honestly haven't heard the term "hive mind" used a lot.
But - the average journalist is too dumb to realize that its generally self-referencing; not unlike a group of jocks mocking a group of greasers for their habitual "we go together/we think together/we do together" behavior.


"We drink beer and wear Adidas!"
 
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Emedpa

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View attachment 323647

Hot off the press.
You can find an article to support any position:
EMPAs better than EM residents:
Role of Physician Assistants in the accident and emergency departments in the UK
Ansari U, Ansari M, Gipson K. Accident and Emergency Department; Warwick Hospital, UK
Published in 11th International Conference on Emergency Medicine, Halifax, Nova SCotia, Canada, June 3-7 2006 and Journal of Canadian Emergency Medicine, May 2006, Vol 8 No 3 (Suppl) P583

Introduction: The Accident and Emergency departments in the UK are under severe pressure to expand their staffing levels in a bid to try and comply with the 98% target for 4-hour waiting times set by the government. Increasing staffing levels is proving to be very difficult when a majority of Staff Grades have already left or are leaving to become General Practitioners for financial gains and better working hours. This combined with a limited number of FY2 doctors being allowed to work in Accident and Emergency departments poses new challenges to staffing within Accident and Emergency. The objective of this study was to evaluate the training requirements, GMC regulations and supervision required to perform a suitable role in Accident and EMergency following the appointment of two Physician Assistants at City Hospital, Birmingham. Methods: The activities of two Physician Assistants at City Hospital were monitored for two months. All case records were reviewed and the number and type of patients seen by the assistants recorded. These were then compared with the records of those patients seen by Senior House Officers. Monitored information included number of patients seen, type of patients seen as well as the quality of the notes. Results: On average, Physician Assistants at City Hospital treated 3-5 patients/hour compared to 1.5-2.5/hour seen by Senior House Officers. Physician Assistants were able to deal with most medical, surgical, orthopaedic and gynaecological problems with minimal supervision. The medical records revealed that documentation was better by Physician Assistants. Conclusion: Senior Physician Assistants from the USA are an effective way to improve staffing within Accident and Emergency Departments with the UK. Physician Assistants saw more patients and required less supervision than Senior House Officers. Physician Assistants proved to be a cost effective method of supporting Accident and Emergency doctors at City Hospital, Birmingham.
 

Matthew9Thirtyfive

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You can find an article to support any position:
EMPAs better than EM residents:
Role of Physician Assistants in the accident and emergency departments in the UK
Ansari U, Ansari M, Gipson K. Accident and Emergency Department; Warwick Hospital, UK
Published in 11th International Conference on Emergency Medicine, Halifax, Nova SCotia, Canada, June 3-7 2006 and Journal of Canadian Emergency Medicine, May 2006, Vol 8 No 3 (Suppl) P583

Introduction: The Accident and Emergency departments in the UK are under severe pressure to expand their staffing levels in a bid to try and comply with the 98% target for 4-hour waiting times set by the government. Increasing staffing levels is proving to be very difficult when a majority of Staff Grades have already left or are leaving to become General Practitioners for financial gains and better working hours. This combined with a limited number of FY2 doctors being allowed to work in Accident and Emergency departments poses new challenges to staffing within Accident and Emergency. The objective of this study was to evaluate the training requirements, GMC regulations and supervision required to perform a suitable role in Accident and EMergency following the appointment of two Physician Assistants at City Hospital, Birmingham. Methods: The activities of two Physician Assistants at City Hospital were monitored for two months. All case records were reviewed and the number and type of patients seen by the assistants recorded. These were then compared with the records of those patients seen by Senior House Officers. Monitored information included number of patients seen, type of patients seen as well as the quality of the notes. Results: On average, Physician Assistants at City Hospital treated 3-5 patients/hour compared to 1.5-2.5/hour seen by Senior House Officers. Physician Assistants were able to deal with most medical, surgical, orthopaedic and gynaecological problems with minimal supervision. The medical records revealed that documentation was better by Physician Assistants. Conclusion: Senior Physician Assistants from the USA are an effective way to improve staffing within Accident and Emergency Departments with the UK. Physician Assistants saw more patients and required less supervision than Senior House Officers. Physician Assistants proved to be a cost effective method of supporting Accident and Emergency doctors at City Hospital, Birmingham.

This is your example?
 

Emedpa

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This is your example?
just proving a point that you can find an article to support any position. Obviously this study is fairly flawed with N=2 senior PAs vs a few residents. My article and the one posted above are not much better than anecdote. I know a PA who messed up is easily matched with I know a doc who missed xyz dx. Anyone with half a brain knows a seasoned residency trained and boarded EM physician is better equipped to see patients than the vast majority of PAs or NPs. I have never argued otherwise.
 
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Matthew9Thirtyfive

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just proving a point that you can find an article to support any position. Obviously this study is fairly flawed with N=2 senior PAs vs a few residents. My article and the one posted above are not much better than anecdote. I know a PA who messed up is easily matched with I know a doc who missed xyz dx. Anyone with half a brain knows a seasoned residency trained and boarded EM physician is better equipped to see patients than the vast majority of PAs or NPs. I have never argued otherwise.

Right but there are actually quality studies showing that MLP care is inferior (tbh most of the studies I’ve seen center around NPs).
 

Emedpa

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Right but there are actually quality studies showing that MLP care is inferior (tbh most of the studies I’ve seen center around NPs).
What you call a quality study would be countered by a study showing NP care is as good or better than primary care docs at treating XYZ condition. All studies are suspect unless proven to be unbiased. A survey of my kids says I am the best dad in the world. It must be true. A study done with me punching a time clock looking at the hours I am home might infer I am not a great father, and it would be more accurate.
 

thegenius

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I'm sick of "existential threat".

A) These folks are never discussing Existentialism, so using this pseudo-Big Word is confusing at best in such contexts.
B) These folks are also very rarely actually discussing a real threat to our existence, so it's also false.
C) If you really do mean that something is a threat to something's existence, wouldn't it be more clear to say "This could mean the end of the world"

Too often these are just a sign of lazy writing that hopes to sound more intelligent than it is.

I'm sick of people PIVOTING to another topic while being interviewed. And they say "lets PIVOT to this topic."
Fxcking stupid.

Awesome and amazing. The two most disregarded words used in our lexicon today.

Wanna know what's amazing? Space flight. Space flight is amazing. The burrito you are eating cannot be by definition amazing. It's just rice and beans with some flavored meat. Perhaps its delicious. But it isn't amazing.
 
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RustedFox

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I'm sick of people PIVOTING to another topic while being interviewed. And they say "lets PIVOT to this topic."
Fxcking stupid.

Awesome and amazing. The two most disregarded words used in our lexicon today.

Wanna know what's amazing? Space flight. Space flight is amazing. The burrito you are eating cannot be by definition amazing. It's just rice and beans with some flavored meat. Perhaps its delicious. But it isn't amazing.

Remember (not so long ago) when everyone just had to use the word "row" as in "an uncomfortable dispute" on the major news media outlets?
 
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Maybe it is true that the residents were a bit inefficient compared to the midlevels in the study. But a residency is not a job in the strict meaning of the word. It a training process. The salary of the resident can be seen partly as a scholarship.
In the same way a midlever practitioner in training is worse than a resident. Just as I would rather be seen by a board certified doctor than a midlevel I would rather be seen by a resident than a midlevel in training.
The argument can be extended to even students. Medical students are one of the brightest and have shown repeatedly that they are more efficient than other students. That's why they were accepted in med school in the first place.
Saying this to the media in today's postmodern world full of political correctness when everyone is portrayed as bright and intelligent and as good as LeBron is heresy of course.
 
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turkeyjerky

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Maybe it is true that the residents were a bit inefficient compared to the midlevels in the study. But a residency is not a job in the strict meaning of the word. It a training process. The salary of the resident can be seen partly as a scholarship.
In the same way a midlever practitioner in training is worse than a resident. Just as I would rather be seen by a board certified doctor than a midlevel I would rather be seen by a resident than a midlevel in training.
The argument can be extended to even students. Medical students are one of the brightest and have shown repeatedly that they are more efficient than other students. That's why they were accepted in med school in the first place.
Saying this to the media in today's postmodern world full of political correctness when everyone is portrayed as bright and intelligent and as good as LeBron is heresy of course.
Also keep in mind that they study referenced compared specific (likely highly selected) PAs to senior house officers, who are probably the equivalent of transitional year interns in our system. And then they try to turn around and say brand-new PAs are the equivalent of residents or some ish like that. They're not.
 
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