Man, if your institution has an ED that is as ****ty as you make it out to be, I'd be surprised if the other services in the hospital aren't lacking as well.
While this might be true, I don't think you can make that assumption, to be honest. That's like saying that because your program has one resident who is an idiot, that it's necessarily a bad program or that all the residents in that program are idiots. It could be....or it might not be.
I think that, especially in smaller community hospitals without a lot of residents, there is a lot of motivation for most services to be better, but there are a lot of factors that motivate the ER to be worse.
For example, in my hospital, there are 2-3 competing cardiology groups. If one group is terrible (grumbles at every consult, does half-assed workups, snaps at the nurses), then there is nothing stopping the hospitalist/PCP services from consulting the competing group. If one PCP does nothing but refer EVERYTHING out, and never starts a workup, then the specialists rarely send their patients back - they have every right to recommend a different PCP (and they often do).
There is also an ER attending who routinely pages the hospitalists (or even in some cases, the on-call resident) and literally asks them to come and "lay eyes" on the patient because she's "not sure if the patient can go home yet." This would make sense if the hospitalist or the resident had ever seen the patient before, but this is always for a patient who hasn't seen a doctor in 15 years. While the idea that an attending is asking a RESIDENT to come down for a "second opinion" is kind of amusing at 11 AM, it's significantly less funny at 3 AM.
Now, is anyone going to tell this ER attending to stop doing this? No, of course not. Because if she's not sure if the patient should go home, and the hospitalist refuses to come down and "lay eyes," then she'll just admit them. It's usually a BS admission, so the patient's LOS is pretty short, the hospital gets paid, and makes money. No hospital administrator is going to pull her aside and tell her to stop calling residents at 3 AM for stupid reasons. Since she's an ER attending, she doesn't have to answer or explain every single one of her actions. If the residents complain about this (and oh, we have), we just get told not to be obstructionist and to "play nice" with other departments. The hospitalists complain, but since they work shift work, they don't care as much. The only way that she's going to be told that this is unacceptable behavior is if Medicare tightens down on what kinds of admissions they're willing to pay for. But until that happens, she's going to keep pulling this kind of crap, and getting away with it.
