F'd up shops

[startupquick]

per title, I am looking for some recommendations regarding the craziest, highest acuity shops you all have had opportunity to work in. Not looking for academic or tertiary centers. Small to mid size. Non academic. Community. Where you finish a shift having tubed multiple patients, thrown in a line or two, reduced a couple fractures and run a trauma. A place where your skills really get put to use.

Any state okay.

As a note, have a great job with sdg, level 2 trauma center w moderate acuity but just looking for few shifts a month elsewhere where the adrenaline really pumps.

Recs? Thoughts?

Suq

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[Fox800]

North Memorial Health in Minnesota. Community level 1 trauma center. Has residents rotate there but doesn't have an EM residency of their own. Plenty of trauma and sick medical patients.

 

[The White Coat Investor]

per title, I am looking for some recommendations regarding the craziest, highest acuity shops you all have had opportunity to work in. Not looking for academic or tertiary centers. Small to mid size. Non academic. Community. Where you finish a shift having tubed multiple patients, thrown in a line or two, reduced a couple fractures and run a trauma. A place where your skills really get put to use.

Any state okay.

As a note, have a great job with sdg, level 2 trauma center w moderate acuity but just looking for few shifts a month elsewhere where the adrenaline really pumps.

Recs? Thoughts?

Suq

Not sure the adrenaline really pumps anywhere by the time you finish residency. Eventually, every job becomes routine and you're making widgets on the factory floor. Dead patient you're trying to bring back to life- routine. Crazed methed out psych patient screaming at the staff while being held down in restraints- routine. Funky rhythm in an executive- routine. Trauma patient with a PTX, liver lac, and glass in his face- routine. Doesn't mean some places don't have higher acuity or higher volume or higher patient to doctor ratios, but don't expect much adrenaline after a few years. Emergency docs might go into EM for adrenaline, but they certainly don't stay in EM for adrenaline because there isn't any other than what you inject into the deltoid of anaphylactics.

 

[Yadster101]

Not sure the adrenaline really pumps anywhere by the time you finish residency. Eventually, every job becomes routine and you're making widgets on the factory floor. Dead patient you're trying to bring back to life- routine. Crazed methed out psych patient screaming at the staff while being held down in restraints- routine. Funky rhythm in an executive- routine. Trauma patient with a PTX, liver lac, and glass in his face- routine. Doesn't mean some places don't have higher acuity or higher volume or higher patient to doctor ratios, but don't expect much adrenaline after a few years. Emergency docs might go into EM for adrenaline, but they certainly don't stay in EM for adrenaline because there isn't any other than what you inject into the deltoid of anaphylactics.

Even though you are use to everything by now, was there every a situation as a student, resident, or attending that really freaked you out that you still remember?

 

[e30ftw]

looking to get yourself in some sketchy situations, huh?

I'd probably just keep the day job and get a faster motorcycle..

 

[Venko]

I can't say first hand but I think that Kentucky and West Virginia have some crazy shops that see lots of people who let conditions get out of hand. I believe that Sam Ghalis twitter account suggests that his shop sees amazing stuff every single day. I don't know first hand and possibly these places are academic.


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[shoal007]

im not sure the of the reasoning of the OP. These shops dont sound like much fun to me. My residency program was exactly like the OPs request and 3 years was enough for me. North Memorial is a good suggestion. but as for 1 shift a month locums not sure a shop would take that.

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[DissocativFugue]

Maybe you could check with an academic shop nearby and work during resident conferences only.


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[The White Coat Investor]

Even though you are use to everything by now, was there every a situation as a student, resident, or attending that really freaked you out that you still remember?

Absolutely. Lots of them. But do you really want an emergency doc taking care of you that would get freaked out by just about anything? Probably not.

 

[alpinism]

per title, I am looking for some recommendations regarding the craziest, highest acuity shops you all have had opportunity to work in. Not looking for academic or tertiary centers. Small to mid size. Non academic. Community. Where you finish a shift having tubed multiple patients, thrown in a line or two, reduced a couple fractures and run a trauma. A place where your skills really get put to use.

Any state okay.

As a note, have a great job with sdg, level 2 trauma center w moderate acuity but just looking for few shifts a month elsewhere where the adrenaline really pumps.

Recs? Thoughts?

Suq

As I've said before if you truly want to practice high acuity EM you'll have to leave the country.

Look into places that are only a short flight from the US like Haiti or Jamaica. The pay is horrible or nonexistent but you'll see your fair share of crazy **** on a daily basis.
Hospital Bernard Mevs in Port-Au-Prince would be a good place to start: http://www.emdocs.net/international-emergency-medicine-a-reflection-on-haiti/

 

[emergentmd]

He is not looking for F'ed up places. F'ed up places are high acuity places with poor specialists back up, poor nurse staffing, and forever holds in the ED.

What he is looking for is a high acuity hospital. Almost any inner city hospital would be your choice as these pts don't come in until they are super sick.

I had a shift where I took care of 4 crashing pts in a 30 min span by myself. Think two intubation/central line, unresponsive newborn, hypoxic/unresponsive toddler. I actually enjoy this now and then. But what made it stressful was the nurses running around with their heads cut off yelling at each other for stuff. The only other person calm was my scribe.

 

[startupquick]

He is not looking for F'ed up places. F'ed up places are high acuity places with poor specialists back up, poor nurse staffing, and forever holds in the ED.

What he is looking for is a high acuity hospital. Almost any inner city hospital would be your choice as these pts don't come in until they are super sick.

I had a shift where I took care of 4 crashing pts in a 30 min span by myself. Think two intubation/central line, unresponsive newborn, hypoxic/unresponsive toddler. I actually enjoy this now and then. But what made it stressful was the nurses running around with their heads cut off yelling at each other for stuff. The only other person calm was my scribe.

Yes. What emergentMd said. Perhaps I should clarify. I'm looking for super high acuity. I love my current job. No desire to leave or do anything else. I just really love leaving a shift knowing that I have made a difference in crashing patients. I was just hoping to get a list of community shops where acuity is high, you have plenty of autonomy, little oversight and can keep skills on point. Just a few shifts a month locums style.

Otherwise I'm quite happy with my day to day moderate acuity ED. Great group, location and people.

Thanks for input thus far. I very much appreciate it and a couple pms that I received.

 

[CliveStaples]

I can't say first hand but I think that Kentucky and West Virginia have some crazy shops that see lots of people who let conditions get out of hand. I believe that Sam Ghalis twitter account suggests that his shop sees amazing stuff every single day. I don't know first hand and possibly these places are academic.

He does put up some amazing clinical scenarios and images. I think his shop is uniquely positioned to being the only level 1 trauma center for half the state and covering a very rural, Appalachian population. Probably makes for seeing a lot of the "natural history of disease."

 

[Venko]

He does put up some amazing clinical scenarios and images. I think his shop is uniquely positioned to being the only level 1 trauma center for half the state and covering a very rural, Appalachian population. Probably makes for seeing a lot of the "natural history of disease."

I think it's probably the latter more than the former. Our shop has a multi-state level one catchment area and we don't see quite the same things. Our crazy stuff is very medical complex (transplants, cancers, LVADs, etc)c whereas his patients seem very advanced single disease folk....

Either way, pretty cool if it's all really coming in as frequently as it seems.




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[Cerberus]

per title, I am looking for some recommendations regarding the craziest, highest acuity shops you all have had opportunity to work in. Not looking for academic or tertiary centers. Small to mid size. Non academic. Community. Where you finish a shift having tubed multiple patients, thrown in a line or two, reduced a couple fractures and run a trauma. A place where your skills really get put to use.

Any state okay.

As a note, have a great job with sdg, level 2 trauma center w moderate acuity but just looking for few shifts a month elsewhere where the adrenaline really pumps.

Recs? Thoughts?

Suq

Undercover malpractice attorney?

 

[seebelcherrun]

I think it's probably the latter more than the former. Our shop has a multi-state level one catchment area and we don't see quite the same things. Our crazy stuff is very medical complex (transplants, cancers, LVADs, etc)c whereas his patients seem very advanced single disease folk....

Either way, pretty cool if it's all really coming in as frequently as it seems.




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We see a lot of folks who have NEVER seen a doctor. And a lot of folks with absolutely no health literacy and all the unhealthy habits. Paracentesis are frequently performed by our (supervised) med studs as we tire of doing them in our LARGE cirrhotic populations. Our predicted mortality index is in the top 5 in the nation. We see a lot of craziness but also get the usual run of the mill. Busy but fun place to work.

 

[southerndoc]

why is a high volume shop an "f'd up shop"? I personally like it.

 

[startupquick]

why is a high volume shop an "f'd up shop"? I personally like it.

It was a terrible title to the thread. I also love the high acuity, volume shops. was looking to hear about hospitals that have great acuity, plenty of autonomy and pathology.