Does anyone else struggle with anxiety at work?

[han14tra]

I'm currently working in a single coverage 12 hour place. I start to dread going to work 2 days before I start my stretch and feel anxious.

1. If something happens to me or a family member during my shifts, I can't just leave. I have to wait for someone to replace me. The last time this happened, it took 10 hours for my replacement to get there.
2. When I'm working 4 (12s) in a row, I feel like I'm drowning. I wake up, go to work, eat, go to the gym, sleep and repeat. My dishes pile up. The house isn't clean during the stretch. I feel like I have no time to unwind after the day before I have to do it again.
3. Since COVID, we are working with a skeleton crew of mostly brand-new RNs or travel nurses. They aren't as skilled in treating critical patients (helping with chest tubes, ventilators, titrating pressors, etc).
4. With increased volumes, I am frequently walking into a hospital that is over-run and with very limited staffing. There might be 2 nurses for 18 active patients in the ED, one of whom is responsible for doing triage too. There is often 15-20 patients in the waiting room. This means that my orders are often delayed. Someone with pain may not get their analgesia for 30-45 minutes. Obviously, patient satisfaction is then poor.
5. The constant barrage of psychiatric patients who tend to always cause a ruckus at the worst possible times.
6. I have no specialty back-up or ICU. I'm often holding critically ill intubated patients for hours in the ER.

Overall, I just feel over-stretched given the resources we have, and I am constantly afraid that something disastrous is going to happen. I just try to get through my stretch, keeping everyone alive and not missing anything. Can anyone relate? How have you found to manage it?

---

Members don't see this ad.

 

[miacomet]

I'm currently working in a single coverage 12 hour place. I start to dread going to work 2 days before I start my stretch and feel anxious.

1. If something happens to me or a family member during my shifts, I can't just leave. I have to wait for someone to replace me. The last time this happened, it took 10 hours for my replacement to get there.
2. When I'm working 4 (12s) in a row, I feel like I'm drowning. I wake up, go to work, eat, go to the gym, sleep and repeat. My dishes pile up. The house isn't clean during the stretch. I feel like I have no time to unwind after the day before I have to do it again.
3. Since COVID, we are working with a skeleton crew of mostly brand-new RNs or travel nurses. They aren't as skilled in treating critical patients (helping with chest tubes, ventilators, titrating pressors, etc).
4. With increased volumes, I am frequently walking into a hospital that is over-run and with very limited staffing. There might be 2 nurses for 18 active patients in the ED, one of whom is responsible for doing triage too. There is often 15-20 patients in the waiting room. This means that my orders are often delayed. Someone with pain may not get their analgesia for 30-45 minutes. Obviously, patient satisfaction is then poor.
5. The constant barrage of psychiatric patients who tend to always cause a ruckus at the worst possible times.
6. I have no specialty back-up or ICU. I'm often holding critically ill intubated patients for hours in the ER.

Overall, I just feel over-stretched given the resources we have, and I am constantly afraid that something disastrous is going to happen. I just try to get through my stretch, keeping everyone alive and not missing anything. Can anyone relate? How have you found to manage it?

I like single-coverage places, but this place is understaffed, no way I would work there. Is this rural?

Honestly, it isn't you, it's the place. Try and find something better if you can, and at the very least stop working 4 12s in a row, and explain that if you have an emergency, you have to leave. Places love to try and pull this, but guess what? If you had a heart attack mid-shift they would figure out a way to replace you immediately and keep their ER staffed.

It's not you. It's the place. Get out.

 

[TooMuchResearch]

I like single-coverage places, but this place is understaffed, no way I would work there. Is this rural?

Honestly, it isn't you, it's the place. Try and find something better if you can, and at the very least stop working 4 12s in a row, and explain that if you have an emergency, you have to leave. Places love to try and pull this, but guess what? If you had a heart attack mid-shift they would figure out a way to replace you immediately and keep their ER staffed.

It's not you. It's the place. Get out.

Agreed. Some of that stuff is generally applicable, but some is not. A better job might help.

 

[FlaminHotER]

Get out of there op

That is not sustainable

crap like this quickly leads to burn out and continued destruction of our field (being taken advantage of)

 

[TrailRun]

Honestly doesn’t sound that different from where I work. Your staffing seems a little bit worse, but I have many of the same issues you mentioned. I’m surprised by all the posts telling you to leave because to be honest, talking to my friends it doesn’t sound much better elsewhere. You could probably find something a little better, but not by much. Like more stable nursing, but you’ll still have a full waiting room, be boarding ICU, can’t leave, etc.

For me, part of the stress is being single coverage with the worry of a pediatric or OB disaster. I intubated zero kids during residency, and now as a parent, I know how much is on the line…. I’m sure I could do it, but am scared. We also face challenges where our transfers often get rejected I have to call many places sometimes out of state, which adds to the logistical challenges. I think your first point is just one of the challenges inherent in single coverage ER; another thread recently touched on this.

 

[Mount Asclepius]

I intubated zero kids during residency,

Yeah, then I’d be pretty scared too. These are tougher because you infrequently do them in community EM. I intubated a bunch of kids though in residency between my pediatric anesthesia, neonatal and peds EM rotations. Super grateful for all that experience.

 

[Mount Asclepius]

I’m surprised by all the posts telling you to leave because to be honest, talking to my friends it doesn’t sound much better elsewhere. You could probably find something a little better, but not by much.

Jump ship. That’s a terrible environment. Trust me, it’s much better out there. I know of many places with better staffing and specialty support.

 

[Birdstrike]

Push The Button

@han14tra You work at an anxiety-provoking job site, in the most anxiety-provoking specialty, in an anxiety-provoking profession. Your reaction is normal. That you made it this far, proves you're made of The Right Stuff.

This is what you need to do:

1) Find a new job with a focus on work-environment quality.
2) Cut your hours appreciably and permanently (write it into your contract and enforce it).
3) Start asking yourself, "After completing steps 1 and 2, can I do this until retirement age?" If the answer is yes, congratulate yourself on a job well done, stop here and consider yourself lucky. If the answer is, "No,' then proceed to step 4.
4) Start planning your EM-exit strategy.
5) Leave EM and never look back.

Or, you can do what I did and skip ahead to steps 4 and 5 and push the Get-Out-Before-You-Stroke-Out button. I haven't met anyone that pushed it and regretted it, yet.

 

[Kryptocoin]

I'm currently working in a single coverage 12 hour place. I start to dread going to work 2 days before I start my stretch and feel anxious.

1. If something happens to me or a family member during my shifts, I can't just leave. I have to wait for someone to replace me. The last time this happened, it took 10 hours for my replacement to get there.
2. When I'm working 4 (12s) in a row, I feel like I'm drowning. I wake up, go to work, eat, go to the gym, sleep and repeat. My dishes pile up. The house isn't clean during the stretch. I feel like I have no time to unwind after the day before I have to do it again.
3. Since COVID, we are working with a skeleton crew of mostly brand-new RNs or travel nurses. They aren't as skilled in treating critical patients (helping with chest tubes, ventilators, titrating pressors, etc).
4. With increased volumes, I am frequently walking into a hospital that is over-run and with very limited staffing. There might be 2 nurses for 18 active patients in the ED, one of whom is responsible for doing triage too. There is often 15-20 patients in the waiting room. This means that my orders are often delayed. Someone with pain may not get their analgesia for 30-45 minutes. Obviously, patient satisfaction is then poor.
5. The constant barrage of psychiatric patients who tend to always cause a ruckus at the worst possible times.
6. I have no specialty back-up or ICU. I'm often holding critically ill intubated patients for hours in the ER.

Overall, I just feel over-stretched given the resources we have, and I am constantly afraid that something disastrous is going to happen. I just try to get through my stretch, keeping everyone alive and not missing anything. Can anyone relate? How have you found to manage it?

1) I had a colleague that had a stroke during his shift. The NP managed the ER until the next doctor came in. Then, at another site, they had the hospitalist staff the ED. Let the hospital figure that out.

2) Hire a maid during your stretch. You're a doctor. You can afford it—delegate tasks.

3) That's everywhere, unfortunately.

4)Your hospital is poorly staffed. Start looking for another gig.

5) See 4.

6)Welcome to working at single coverage rural/critical access sites. They are simultaneously the most unforgiving and rewarding places to work.

 

[TooMuchResearch]

Honestly doesn’t sound that different from where I work. Your staffing seems a little bit worse, but I have many of the same issues you mentioned. I’m surprised by all the posts telling you to leave because to be honest, talking to my friends it doesn’t sound much better elsewhere. You could probably find something a little better, but not by much. Like more stable nursing, but you’ll still have a full waiting room, be boarding ICU, can’t leave, etc.

For me, part of the stress is being single coverage with the worry of a pediatric or OB disaster. I intubated zero kids during residency, and now as a parent, I know how much is on the line…. I’m sure I could do it, but am scared. We also face challenges where our transfers often get rejected I have to call many places sometimes out of state, which adds to the logistical challenges. I think your first point is just one of the challenges inherent in single coverage ER; another thread recently touched on this.

I can have a colleague replace me within an hour, 24 hours per day, no exceptions.

 

[GonnaBeADoc2222]

This environment reminds me of my first attending job. 10/11 hr shifts, 2-2.5 pph, sickkk patients, difficult population, low resources. Even with decent consultants and easy-ish transfers it was very anxiety producing.

Your job is even worse. If you can, get out.

My favorite job was as a scab during the initial phase of PE system takeover / CMG ED takeover at a tiny 10k/yr site, single coverage 12s (maybe saw 15 to 20 in a shift if busy), but spent 1/3 of my shift wither playing games on tabletop simulator or watching movies. At night, I slept a few hours. You can guess what happened to this place.

 

[Brigade4Radiant]

Well OP are there any jobs in the area that you can leave? I don't work in places with no OBGYN. Is the pay per hour really good?

 

[bravotwozero]

Yeah, if I were in your shoes, I'd be anxious too. If you're going to work single coverage, you should be at a place with much lower volume. I think there are better jobs available than this.

 

[cyanide12345678]

Sounds like my last job. Routinely walked in to 22-25 in the ER as a nocturnist. used to have anxiety driving to work for the first 6 months of the job. When it got super busy and the mental list of tasks that i would be behind on kept growing, id feel significant anxiety there too.

The best thing you can do for yourself is find a lower volume. That’s what i did. The staffing at your shop is terrible, morale is probably going to be terrible too. At my old shop, nursing morale was so bad that 4 out of 5 new nurses that were hired immediately left after orientation finished for them.

Take a pay cut, find a lower volume gig. Be happier.

 

[RuralEDDoc]

I’d be anxious too!
Sounds like a job I used to have. The stress probably aged me three years for every year I worked. I’d plan an exit strategy knowing that EM is a dumpster fire in general so a major improvement might not be possible, but there are better gigs out there.

 

[miacomet]

Push The Button

@han14tra You work at an anxiety-provoking job site, in the most anxiety-provoking specialty, in an anxiety-provoking profession. Your reaction is normal. That you made it this far, proves you're made of The Right Stuff.

This is what you need to do:

1) Find a new job with a focus on work-environment quality.
2) Cut your hours appreciably and permanently (write it into your contract and enforce it).
3) Start asking yourself, "After completing steps 1 and 2, can I do this until retirement age?" If the answer is yes, congratulate yourself on a job well done, stop here and consider yourself lucky. If the answer is, "No,' then proceed to step 4.
4) Start planning your EM-exit strategy.
5) Leave EM and never look back.

Or, you can do what I did and skip ahead to steps 4 and 5 and push the Get-Out-Before-You-Stroke-Out button. I haven't met anyone that pushed it and regretted it, yet.

For the win. I picked 3, option A. Bird picked 4. They are both viable, but if you pick 3A, you at least have to have a decent/unicorn job. Had I not had a decent job until it soured, I would have followed Bird to an exit strategy.

1:9 nursing ratio is not normal, certainly not in single coverage.

 

[han14tra]

Sounds like my last job. Routinely walked in to 22-25 in the ER as a nocturnist. used to have anxiety driving to work for the first 6 months of the job. When it got super busy and the mental list of tasks that i would be behind on kept growing, id feel significant anxiety there too.

The best thing you can do for yourself is find a lower volume. That’s what i did. The staffing at your shop is terrible, morale is probably going to be terrible too. At my old shop, nursing morale was so bad that 4 out of 5 new nurses that were hired immediately left after orientation finished for them.

Take a pay cut, find a lower volume gig. Be happier.

Yes, morale is bad. Nurses usually quit within a few weeks or months. I see 2-2.5pph on average for dayshift. On a 12 hr night shift, I usually see about 18. Pay is $250/hr, which I believe is higher than average for my state. But it comes at the cost of poor nursing staffing, no RT, no OB/gyn, and no ICU.

 

[miacomet]

Yes, morale is bad. Nurses usually quit within a few weeks or months. I see 2-2.5pph on average for dayshift. On a 12 hr night shift, I usually see about 18. I think our daily volume is somewhere around 90-100. Pay is $250/hr, which I believe is higher than average for my state. But it comes at the cost of poor nursing staffing, no RT, no OB/gyn, and no ICU.

You are single coverage with 90-100? That's insane. That's 4 pph, with insufficient nursing. Do you have a midlevel, at least. No RT, like who runs the vents? Love to know what part of the country you are in that this flies for $250 an hour; are they able to get docs.

I don't know whether you want to stay in hospital-based EM on the Miacomet ten year plan, or find alternative income on the @Birdstrike or @emergentmd plan, but it sounds like it's time to leave this gig.

 

[GonnaBeADoc2222]

250 an hour is about 1/2 what I would accept for this environment

 

[han14tra]

You are single coverage with 90-100? That's insane. That's 4 pph, with insufficient nursing. Do you have a midlevel, at least. No RT, like who runs the vents? Love to know what part of the country you are in that this flies for $250 an hour; are they able to get docs.

I don't know whether you want to stay in hospital-based EM on the Miacomet ten year plan, or find alternative income on the @Birdstrike or @emergentmd plan, but it sounds like it's time to leave this gig.

There is a PA as well. But yes, volumes average 90-100 during the winter, maybe slightly less in the summer when flu/covid/cold season winds down

 

[emergentmd]

The update essentially has him at $250/hr single coverage with volume around 45pt/dy. So avg is around 2pp/hr. Not a terrible gig except when the place crashes and 10 shows up in an hr it kind of sucks.

I would say I have worked at busier places making about the same in my earlier career. I just hate single coverage places esp poorly staffed because

1. new nurses suck and esp when they are poorly staffed. 2pph feels like 3
2. 250/hr is not enough unless they are all UC type pts
3. I feel isolated when I don't have another doc to talk to.

So overall not a terrible job but if it messing with your sanity, you need to get out. 12 hrs 4 dys straight really sucks b.c u are essentially eating or sleeping. I did a few 12 shifts in my career and unless they are less than 1pph, that is just a really long shift. The least I took for these 12 hr shifts were 450/hr.

Now if you have no options and have to work then I would do 2 things

1. Ask for a raise
2. Ask to split the shifts up to max 2 straight.
3. Change your mindset to, "I am going to work at a reasonable pace and not worry how busy the waiting room is". You need to see the sick, the others can wait. Make sure you take food, bathroom, internet relaxing breaks.

 

[GonnaBeADoc2222]

The update essentially has him at $250/hr single coverage with volume around 45pt/dy. So avg is around 2pp/hr. Not a terrible gig except when the place crashes and 10 shows up in an hr it kind of sucks.

I would say I have worked at busier places making about the same in my earlier career. I just hate single coverage places esp poorly staffed because

1. new nurses suck and esp when they are poorly staffed. 2pph feels like 3
2. 250/hr is not enough unless they are all UC type pts
3. I feel isolated when I don't have another doc to talk to.

So overall not a terrible job but if it messing with your sanity, you need to get out. 12 hrs 4 dys straight really sucks b.c u are essentially eating or sleeping.

Is this 250/hr total comp? Because if it is, this job sucks.

W2 or 1099?

I'm paid $250/hr w2 total comp plus health insurance to see 1.5 pph, no nights.

 

[emergentmd]

250/hr is not terrible seeing about 2pph. I mean, I wouldn't but its not like he is getting completely screwed.

If he is walking in every shift with a full waiting room, he needs to learn that this is standard of care for the hospital and leave the waiting room full when he leaves.

I don't understand for a daily volume of 45 pts how the waiting room can be 20 deep and 18 pts in the ER.

I would demand to hire a 24 hr APC so they should be able to see 20-30 easy pts.

 

[Mr. Vandemar]

This sounds basically like the job I just left. Two years and I've had anxiety before every stretch of shifts. At least you're still going to the gym. I stopped, started drinking, sleep like ****, got fat. Moving on to a place with all the consultants, no single coverage, no signing PA/NP charts and hoping for the best. Maybe once I pay off some of these loans I'll look into a fellowship...

 

[miacomet]

Is this 250/hr total comp? Because if it is, this job sucks.

W2 or 1099?

I'm paid $250/hr w2 total comp plus health insurance to see 1.5 pph, no nights.

How late is your latest swing shift (and yay no nights)?

 

[GonnaBeADoc2222]

How late is your latest swing shift (and yay no nights)?

1am

 

[Brigade4Radiant]

What state is this? Even though the job market is bad I’m sure if this board looks we can find you a 250 job that isn’t awful with coverage

 

[emergentmd]

12 hr shifts unless its less than 1pph just is not sustainable especially if you have a family.

7a-7p shift essentially is waking up at 6am working til 8pm cleaning up. Go home/eat/shower and its 9pm. You have essentially 1-2 hrs to wind down until bed.

 

[cyanide12345678]

There is a PA as well. But yes, volumes average 90-100 during the winter, maybe slightly less in the summer when flu/covid/cold season winds down

90-100 average with just 1 Mlp? Ouch.

The days where i had 80+ in my single coverage shop with 1 mlp were one of the worst days. Just a constant grind from start to finish.

You need a better job. I’ve literally been in your shoes. Went from 260/hr to $200/hr. It feels much better when a busy day in my ER is 30-35 in 24 hours 🤣🤣🤣

 

[GonnaBeADoc2222]

Decision making capacity maxes out for me at about 10 hours, which is why I am glad I work 9s now.

In my old job, if a complex patient came in after the 10 hr mark they were essentially getting someone marginally better than a PLP.

 

[JacobMcCandles]

For me, part of the stress is being single coverage with the worry of a pediatric or OB disaster. I intubated zero kids during residency, and now as a parent, I know how much is on the line….

Your residency failed you and this is only getting worse.

 

[GonnaBeADoc2222]

Your residency failed you and this is only getting worse.

I only intubated a handful of kids at a 4 year "powerhouseeeeee" residency.

What a scam.

 

[FlaminHotER]

Your residency failed you and this is only getting worse.

and the bums at acgme keeps approving to open sh.i.tty programs

 

[Rekt]

I only intubated a handful of kids at a 4 year "powerhouseeeeee" residency.

What a scam.

I think people vastly overestimate how many pediatric intubations are done. You can just search the frequency of these procedures on Pubmed. It’s shockingly low. Even for tertiary and quaternary pediatric centers.

Not everyone can do a pediatric gas rotation. Even then it doesn’t simulate real life. My anesthesia was half and half but i still didn’t really consider it real experience.

 

[Mount Asclepius]

I think people vastly overestimate how many pediatric intubations are done. You can just search the frequency of these procedures on Pubmed. It’s shockingly low. Even for tertiary and quaternary pediatric centers.

Not everyone can do a pediatric gas rotation. Even then it doesn’t simulate real life. My anesthesia was half and half but i still didn’t really consider it real experience.

I agree overall rates of pediatric intubation are low and controlled OR anesthesia intubations aren’t equivalent to emergent intubations.

In residency we felt as residents, and our program leadership agreed, that pediatric airway exposure (also all types of airway management) was critical and so heavily emphasized. Between neonatal resuscitation, pediatric anesthesia and peds EM we had many different types of encounters with the neonatal and pediatric airway. I don’t feel this is common to the majority of programs, and particularly new programs coming online. Our job is hard. You need this experience for that rare occasion. Just because it’s uncommon doesn’t mean it isn’t worth the training. It’s not the same as other even more rare events such as floating a transvenous pacer or a resuscitative hysterotomy where it doesn’t make sense to extensively train.

 

[Mount Asclepius]

Yes, morale is bad. Nurses usually quit within a few weeks or months. I see 2-2.5pph on average for dayshift. On a 12 hr night shift, I usually see about 18. Pay is $250/hr, which I believe is higher than average for my state. But it comes at the cost of poor nursing staffing, no RT, no OB/gyn, and no ICU.

han14tra said:
Yes, morale is bad. Nurses usually quit within a few weeks or months. I see 2-2.5pph on average for dayshift. On a 12 hr night shift, I usually see about 18. I think our daily volume is somewhere around 90-100. Pay is $250/hr, which I believe is higher than average for my state. But it comes at the cost of poor nursing staffing, no RT, no OB/gyn, and no ICU.


Something doesn’t add up and I see you edited your post. I think you misrepresented your volume. If you see 24-36 during the day and 18 at night as single coverage, that’s only 42-54/day between 2 EPs. Your single midlevel (or even 2 if covering all 24 hours) likely isn’t seeing the remaining 40-50 patients if your overall volume is reported to be 90-100 today. I doubt your site is tolerating substantial LWOBS. I suspect your daily volume is lower. Care to clarify?

Either way, I think you should look for a different job given your very understandable and reasonable frustrations.

Busy single coverage with no support is hard and not usually sustainable. Single coverage works best for experienced EPs. Low volumes in those situations is preferred given higher likelihood of being mid to end of career with a baseline degree of burnout.

 

[miacomet]

Your residency failed you and this is only getting worse.

This here is why we need to cut the number of residencies, and why the rules and requirements for EM residencies need to be much, much stricter

 

[TrailRun]

I think people vastly overestimate how many pediatric intubations are done. You can just search the frequency of these procedures on Pubmed. It’s shockingly low. Even for tertiary and quaternary pediatric centers.

Not everyone can do a pediatric gas rotation. Even then it doesn’t simulate real life. My anesthesia was half and half but i still didn’t really consider it real experience.

Agreed. My residency has been around since the mid 1980's, level 1 trauma center, PEM attendings, etc; pedi intubations are just pretty rare. Anesthesia wasn't willing to give them up in the OR ('we need them for our residents,')

"In a 2008 survey, pediatric emergency medicine fellows reported performing a median of 3.5 intubations per year, with some reporting that they performed zero. In a 2008 survey of pediatric ED directors, 62% reported that their volume of intubations was insufficient to maintain ongoing competency." Resident exposure to critical patients in a pediatric emergency department - PubMed

https://pemcincinnati.com/blog/wp-content/uploads/2016/10/Green-editorial-for-RSI-paper.pdf

 

[GatorCHOMPions]

Agreed. My residency has been around since the mid 1980's, level 1 trauma center, PEM attendings, etc; pedi intubations are just pretty rare. Anesthesia wasn't willing to give them up in the OR ('we need them for our residents,')

"In a 2008 survey, pediatric emergency medicine fellows reported performing a median of 3.5 intubations per year, with some reporting that they performed zero. In a 2008 survey of pediatric ED directors, 62% reported that their volume of intubations was insufficient to maintain ongoing competency." Resident exposure to critical patients in a pediatric emergency department - PubMed

https://pemcincinnati.com/blog/wp-content/uploads/2016/10/Green-editorial-for-RSI-paper.pdf

Concur with the above. I went to a big center residency as well. I bet residents got like a couple ER peds tubes each by the time of graduation. We did get a dedicated NICU month which of course was overkill on the medical management side, but gave you another few key resuscitations and airways.

 

[John Rawls]

Off topic but has anyone attended an airway course and found it useful?

 

[Mount Asclepius]

I also went to a well established residency program around for decades. Doesn’t mean it was perfect. It’s what not resting on your laurels means. Our program partially driven by resident input actively worked to improve pediatric airway experience by setting up pediatric anesthesia and neonatal resuscitation rotations. Traded places with anesthesia residents having them do a month in the ED along side the interns to spend some time on acute medicine, while we took their spots in the OR with the pediatric anesthesiologists. Also spent a rotation responding to deliveries and resuscitating premature and full term neonates. Abandoned a PICU rotation due to less value in management and limited access to procedures. Perhaps trading places with the anesthesia residents benefited us more than them, but was an improvement for the EM program and our training. Other changes also very helpful.

 

[Apollyon]

At the job that burned me out and ruined my career, I would not be able to sleep the night before a shift, wondering which incompetent I would be stuck with the next day.

 

[Brigade4Radiant]

Again in medschool exciting becomes anxiety as an attending

A “boring” pcp clinic doesn’t lead sleepless nights or high stress on any random day

 

[miacomet]

I also went to a well established residency program around for decades. Doesn’t mean it was perfect. It’s what not resting on your laurels means. Our program partially driven by resident input actively worked to improve pediatric airway experience by setting up pediatric anesthesia and neonatal resuscitation rotations. Traded places with anesthesia residents having them do a month in the ED along side the interns to spend some time on acute medicine, while we took their spots in the OR with the pediatric anesthesiologists. Also spent a rotation responding to deliveries and resuscitating premature and full term neonates. Abandoned a PICU rotation due to less value in management and limited access to procedures. Perhaps trading places with the anesthesia residents benefited us more than them, but was an improvement for the EM program and our training. Other changes also very helpful.

I don't know where you trained, but in the NE they just assume you will never see kids again and don't focus on peds stuff beyond making residents available as cheap labor for the peds ED.

 

[GonnaBeADoc2222]

I don't know where you trained, but in the NE they just assume you will never see kids again and don't focus on peds stuff beyond making residents available as cheap labor for the peds ED.

Lol we must have went to the same residency because the amount of abuse at the hands of maladjusted PEM attendings was unreal.

 

[miacomet]

Lol we must have went to the same residency because the amount of abuse at the hands of maladjusted PEM attendings was unreal.

Those folks are not normal. Weirdest field ever, I don't think it's limited to one site. What is their problem?

 

[bravotwozero]

I consider myself extremely fortunate that I got to to peds anesthesia my 3rd year of residency. Was the best off service rotation we had. The attendings gave us a quite a bit of autonomy in the OR with giving meds and managing vent settings.

I know it’s not like ED intubation situations but a million times better than nothing.

 

[EthylMethylMan]

Again in medschool exciting becomes anxiety as an attending

A “boring” pcp clinic doesn’t lead sleepless nights or high stress on any random day

So true. Really wish more students would be fully aware of this. I sure as hell wasn't.

 

[Groove]

I'm currently working in a single coverage 12 hour place. I start to dread going to work 2 days before I start my stretch and feel anxious.

1. If something happens to me or a family member during my shifts, I can't just leave. I have to wait for someone to replace me. The last time this happened, it took 10 hours for my replacement to get there.
2. When I'm working 4 (12s) in a row, I feel like I'm drowning. I wake up, go to work, eat, go to the gym, sleep and repeat. My dishes pile up. The house isn't clean during the stretch. I feel like I have no time to unwind after the day before I have to do it again.
3. Since COVID, we are working with a skeleton crew of mostly brand-new RNs or travel nurses. They aren't as skilled in treating critical patients (helping with chest tubes, ventilators, titrating pressors, etc).
4. With increased volumes, I am frequently walking into a hospital that is over-run and with very limited staffing. There might be 2 nurses for 18 active patients in the ED, one of whom is responsible for doing triage too. There is often 15-20 patients in the waiting room. This means that my orders are often delayed. Someone with pain may not get their analgesia for 30-45 minutes. Obviously, patient satisfaction is then poor.
5. The constant barrage of psychiatric patients who tend to always cause a ruckus at the worst possible times.
6. I have no specialty back-up or ICU. I'm often holding critically ill intubated patients for hours in the ER.

Overall, I just feel over-stretched given the resources we have, and I am constantly afraid that something disastrous is going to happen. I just try to get through my stretch, keeping everyone alive and not missing anything. Can anyone relate? How have you found to manage it?

Low dose beta blocker (propranolol, etc.) on your work days can work wonders for maintaining calm in the midst of chaos, eliminating any hand tremors during procedures and snipping that hyperadrenergic physiologic feedback loop.

That being said....it really sounds like you need a new job. I think I'd rather work locums than pull your gig....and I HATE locums.

 

[RustedFox]

Low dose beta blocker (propranolol, etc.) on your work days can work wonders for maintaining calm in the midst of chaos, eliminating any hand tremors during procedures and snipping that hyperadrenergic physiologic feedback loop.

That being said....it really sounds like you need a new job. I think I'd rather work locums than pull your gig....and I HATE locums.

Propranolol backfired on me.
Couldn't "wake up enough".

Wait. Hold the eff up.

We shouldn't be drugging ourselves to make it "through a shift". Hard stop.