CAH without losing skill

[Buckeye1992]

Thinking about moving back to my hometown and getting a job at the CAH there. It’s a 9000k annual volume. I am currently on a 3 year contract in my first job out from residency. It’s a large community shop where I average 2pph+MLP patients. I came from a community residency. I am just not wanting to lose procedural skills by going to a small shop so early in my career. Is it too early to go to a rural CAH?

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[Groove]

Thinking about moving back to my hometown and getting a job at the CAH there. It’s a 9000k annual volume. I am currently on a 3 year contract in my first job out from residency. It’s a large community shop where I average 2pph+MLP patients. I came from a community residency. I am just not wanting to lose procedural skills by going to a small shop so early in my career. Is it too early to go to a rural CAH?

3 years is plenty for polish and internalization of skillset. If you'd rather be back home for personal reasons, I think that's great and am happy or you. I think your skillset would be absolutely fine at a CAH. Keep in mind, you can be as active as you want to be from a procedural standpoint. Ironically, my first gig out was at a busy trauma center seeing around ~75-90K/yr and I did FEWER procedures than I did for my second gig which was at a ~55K community shop. I wouldn't worry excessively about losing skills 3 yrs post residency though. You'll be fine. Good luck with the new job!

 

[cyanide12345678]

Lol I'm seeing 16 - 20 in 12 hours morning shift at a place that was supposed to be 8000 annual volume.

My last airway disaster was there too a few days ago.

Your skills will be tested much more when every large hospital around you will be on diversion and you will struggle to get the critical people out. Every place I try to transfer to has a 1 day wait these days.

 

[Angry Birds]

If you can find a CAH that pays well, you should jump on it. Those kinda gigs may disappear soon.

 

[cyanide12345678]

If you can find a CAH that pays well, you should jump on it. Those kinda gigs may disappear soon.

Yes, quality of life is better at a critical access. I feel patients give a little more respect in rural America. I happily took a paycut to be at a critical access. Went from 1099 260/hr to w2 200/hr. But it was a good change for my general happiness and overall well being.

 

[cyanide12345678]

There's also something really nice about seeing 6-10 patients in 12 hours on night shift that just rejuvenates the soul. Sometimes you just get paid to sleep 2-4 hours. Which is also very nice.

 

[miacomet]

You will absolutely not lose skills. Same sick patients with absolutely no back up. Your skills will increase.

 

[turkeyjerky]

You will absolutely not lose skills. Same sick patients with absolutely no back up. Your skills will increase.

Depends on the local acuity and hospital culture. I moonlit at a small place where it was unheard of to place central lines. I had a dry, hypotensive septic old lady once and and asked them to grab me the kit, and the nurses were like, "uhh, we usually just transfer them out". They didn't have any kits. I ended up doing a fem stick for labs and placed two IO's and then shipped her out.

Granted, the volume there was more like 3k a year, so somewhat of a different situation than the OP's. But to think that everyone working at a critical access hospital is some sort of procedural badass would be incorrect. Maybe they have the RTs intubate, who knows?

 

[Vandalia]

There's also something really nice about seeing 6-10 patients in 12 hours on night shift that just rejuvenates the soul. Sometimes you just get paid to sleep 2-4 hours. Which is also very nice.

That is why where I was at before I retired the old folks jumped on those rural night shifts in our system. A CAH, but actually closer to where most of us lived than the main place.

Nights are not fun, but nights with four patients beats days with 20-30 when the years add up.

It is hyperbole, but I always say that anyone can practice EM at a Level I place. But when it is you, a couple of nurses, and a questionable radiology tech and a tornado hits, along with an MI or two, and a stroke all at the same time, that is when you really need the EM training.

 

[TheComebacKid]

It is hyperbole, but I always say that anyone can practice EM at a Level I place. But when it is you, a couple of nurses, and a questionable radiology tech and a tornado hits, along with an MI or two, and a stroke all at the same time, that is when you really need the EM training.

I would say your sentiment is largely true. But I can tell you at my academic shop I never get the luxury of seeing 4 patients on a night shift and getting to sleep.

The volume is much higher, the acuity is there, and while I have way more backup support/consultants, residents, somewhat competent nurses etc I am still wiped out after many shifts.

That being said I'd choose this any day over being single coverage in some rural CAH without backup and questionable ancillary staff.

 

[p1acebo]

I would say your sentiment is largely true. But I can tell you at my academic shop I never get the luxury of seeing 4 patients on a night shift and getting to sleep.

The volume is much higher, the acuity is there, and while I have way more backup support/consultants, residents, somewhat competent nurses etc I am still wiped out after many shifts.

That being said I'd choose this any day over being single coverage in some rural CAH without backup and questionable ancillary staff.

After doing both, I would have to agree the job is much easier at an academic shop. Sure you don’t have only 4 patients at night but you have residents, a trauma team, a stroke team, etc. Very easy to handle multiple sick patients at once… and only addendums for the resident notes!