Day in the life of a medical toxicologist

[swamprat]

Can one of you med tox guys gimme a glimpse into your day to day work? I've always had an interest in tox but I don't really understand what you guys do on a day to day basis. I know most guys are ER docs first, tox second and you cover shifts in the ED, so perhaps a week in the life would be more appropriate? Thanks!

Edit: sorry this was meant for the med tox sub-forum, if a mod could move it

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[Daiphon]

Can one of you med tox guys gimme a glimpse into your day to day work? I've always had an interest in tox but I don't really understand what you guys do on a day to day basis. I know most guys are ER docs first, tox second and you cover shifts in the ED, so perhaps a week in the life would be more appropriate? Thanks!

Edit: sorry this was meant for the med tox sub-forum, if a mod could move it

Truthfully, it depends and is somewhat varied from person to person.

I work in an academic center, so some of my ED shifts are comped so I can cover my inpatient consults as well as the fellowship obligations; I also have time for research & writing endeavors. Some who work in community settings or quasi-academic shops may not.

It also depends if you're primarily EM-trained or peds/OccMed. You won't be working ED shifts most likely in these setups.

But, to answer your question, here's a week in my life:

2 ED overnights/week (by choice)

Round 2x weekly (on both my patients in my hospital split with one other MT attending, as well as the medical backup patients my fellows get from the PCC). Time varies depending on the census, but figure 5-6h total.

Administrative stuff (meetings, growing service) - about 2h on average.

Educational stuff (lectures, small groups) - about an hour.

Writing/research - depends on what I have going on.

And I'm on call 24/7 1 week per month (it's how myself & my other MT attending have it structured).

Total: 24h +/- a few hours a week.


Does this help?
-d

 

[link2swim06]

Does doing tox and EM change your salary (pos/neg) in an academic or community setting?

 

[alpinism]

Just curious, how often on average do you get called in while on call?

This might be program dependent but do they consult you for most tox cases or only the complex/serious ones?

Thanks d.

 

[Daiphon]

Does doing tox and EM change your salary (pos/neg) in an academic or community setting?

Academic - typically not too much, as straight salaried +/- bonus pool. The department "buys" my time with faculty support.

Community - it may, especially depending on the payment structure (RVU-based, etc) as, is the case with most other nonprocedural subspecialties, reimbursement may be lower for the time I spend on a consult vis a vis ED time.

Take home point: discuss this with your potential boss when job hunting, and get it in writing.

-d

 

[Daiphon]

Just curious, how often on average do you get called in while on call?

This might be program dependent but do they consult you for most tox cases or only the complex/serious ones?

Thanks d.

Called? Frequently - but we have our residents & fellow attendings pretty well trained to call us on almost anything.

Called *in* ? - well, it's case dependent. I'm not running in for a straightforward APAP overdose or simple stuff, just like a stable UGIB when GI can see in the morning. But, *sick* patients who may need some delicate management, or antidotal therapy, or a really rare/dangerous/cool poisoning, I can be at my hospital in 15min. This happens maybe once every month or so... If it's during normal hours, then I'll see them regardless.

Cheers!
-d

 

[swamprat]

What is your bread and butter cases? What are some of the strange/odd poisonings/ODs you've treated?

 

[Daiphon]

What is your bread and butter cases? What are some of the strange/odd poisonings/ODs you've treated?

Bread & Butter is typically one of three things:
1) AMS & "could this be tox?"
2) Unexplained AGMA or lab abnormality & "could this be tox?"
3) Some kind of ingestion - known or unknown

Oddest I can't really comment on per HIPAA, but suffice it to say: always be *very* wary of any poisoning involving a medical professional or lab employee.

Cheers!
-d

Edit: forgot another B&B - "we wanna send this pt to the state psych facility, but they'll only take 'em with a formal tox consult." This one, I dislike.

 

[BADMD]

I spend most of my time in residency related activities. I am on call for fox 4 days a month.

When on call, I'm usually back up to fellow, who is the first point of contact from 7a-7p. The morning is for seeing any consults that came in overnight. We then review the patients in hospitals that are being managed by the Poison Control Center remotely. Specific educational related activities, such as chapter review for the fellow(s), journal review, research topic presentation (we like our fellows to do focused, in-depth review of select topics) and similar. For months when we have a tox rotation, there are the addition of core content lectures.

Night time is going to be related to whatever I get called about. Sometimes it is silent, sometimes there are multiple sick patients and sleep is a luxury. Most of the time I get one or two calls from hospitals looking for help overnight.

 

[DeadCactus]

What's a typical census on a tox service?

 

[Daiphon]

What's a typical census on a tox service?

Depends. My inpatients are typically 2-3, and then anywhere from 5-15 more we're following over the phone as backup for our PCC.

Some places have more, others less. Totally dependent on the local setup.

Cheers!
-d