Has EM gotten so bad that now you guys want to invade my field (pediatrics)?

[Socrates25]

There's been a ton of peds telemedicine companies opening up, home visit companies that specialize in pediatrics, etc

I'd say at least 90% of them are run by EM docs, not peds.

This is extremely curious because peds docs make substantially less than EM. Anybody going from EM to peds will take a 50-75% pay cut.

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[The Knife & Gun Club]

I mean an income sounds pretty good when many ER docs are currently making $0 an hour

 

[Socrates25]

The ERs aren't picking up yet? I'm already seeing a lot more sick kids than I did last year even though we're entering summer.

I have to imagine the ERs must be picking up as well at some point.

 

[sylvanthus]

Aye im sure we will all be fine in EM soon.....

 

[Arcan57]

EM allows time for side hustles. EM makes the transactional nature of modern medicine pretty explicit. It's not terribly surprising that some EM docs choose to branch out into related fields where they're owners and not worker bees.

 

[Tipsy McStagger]

Ugh. Well maybe this is an overreaction, but no EM doc is capable of practicing full-time pediatrics, even with a PEM fellowship. Pediatrics is an entire specialty for a reason, and even the EM programs with the strongest Peds components do not produce physicians capable of doing peds full-time.

In short, if EM starts making overtures towards invading the outpatient pediatric setting, I’d hope that actual pediatricians shut that down hard. I honestly, in my wildest dreams can’t imagine that happening. Emergency peds telemedicine sure, real-deal pediatrics heck no.

 

[Birdstrike]

Ugh. Well maybe this is an overreaction, but no EM doc is capable of practicing full-time pediatrics, even with a PEM fellowship. Pediatrics is an entire specialty for a reason, and even the EM programs with the strongest Peds components do not produce physicians capable of doing peds full-time.

In short, if EM starts making overtures towards invading the outpatient pediatric setting, I’d hope that actual pediatricians shut that down hard. I honestly, in my wildest dreams can’t imagine that happening. Emergency peds telemedicine sure, real-deal pediatrics heck no.

I don't like the idea of people practicing specialties they're not board certified in. But if a nurse can practice Emergency Medicine or Anesthesiology, can't an Emergency Physician can practice Pediatrics? Their rules, not mine.

 

[vm26]

I don't like the idea of people practicing specialties they're not board certified in. But if a nurse can practice Emergency Medicine or Anesthesiology, can't an Emergency Physician can practice Pediatrics? Their rules, not mine.

Sounds logical, particularly since a PA/NP essentially bounce around numerous subspecialties.

 

[Brigade4Radiant]

Ugh. Well maybe this is an overreaction, but no EM doc is capable of practicing full-time pediatrics, even with a PEM fellowship. Pediatrics is an entire specialty for a reason, and even the EM programs with the strongest Peds components do not produce physicians capable of doing peds full-time.

In short, if EM starts making overtures towards invading the outpatient pediatric setting, I’d hope that actual pediatricians shut that down hard. I honestly, in my wildest dreams can’t imagine that happening. Emergency peds telemedicine sure, real-deal pediatrics heck no.

They don’t practice peds however they practice telemedicine acute visits for pediatric complaints which they see in their training and all the time in the ED.

Also many NPs practice peds with no oversight.

 

[Tipsy McStagger]

I don't like the idea of people practicing specialties they're not board certified in. But if a nurse can practice Emergency Medicine or Anesthesiology...

I’d argue that they can’t, not fully. Are they practicing independently? Sure. Doesn’t mean they can though.

I think you either have a standard or you don’t. I don’t think we disagree on this. I honestly don’t known that physicians really have a future. Hard to say what medicine looks like in 20 years. We’ll see I guess.

 

[jw3600]

Lol if the “Peds words” response to EM Docs “doing Peds” is similar to them allowing the creation of a Peds hospitalist fellowship, no one is really shaking in their boots.

 

[Dred Pirate]

Sounds logical, particularly since a PA/NP essentially bounce around numerous subspecialties.

I have never gotten this - I know one PA who was bariatric surgery, then EM, Then GI, then hospitalist team, then back to urgent care, and now ortho surgery, He is a good guy, but there is no way you can even be close to competent when you do that. As a pharmacist it amazes me how many calls I get from "cardiology" NPs asking basic cards stuff. I get the questions on abx or other things outside of your "specialty" (I use that term loosely in these situations), but if you are cardiology, shouldn't you be able to dose lovenox? or know the definition of hypertensive urgency vs emergency? I it is so obviously they do not want to to call their attending and look like they don't know what they are doing (especially since this is on overnights and they don't want to make their doc angry by waking them up)

 

[Rekt]

I have never gotten this - I know one PA who was bariatric surgery, then EM, Then GI, then hospitalist team, then back to urgent care, and now ortho surgery, He is a good guy, but there is no way you can even be close to competent when you do that. As a pharmacist it amazes me how many calls I get from "cardiology" NPs asking basic cards stuff. I get the questions on abx or other things outside of your "specialty" (I use that term loosely in these situations), but if you are cardiology, shouldn't you be able to dose lovenox? or know the definition of hypertensive urgency vs emergency? I it is so obviously they do not want to to call their attending and look like they don't know what they are doing (especially since this is on overnights and they don't want to make their doc angry by waking them up)

"Please ask your supervising physician. Thanks. "

That's what you should be doing. You getting abused is making them look better for no reason.

 

[Lexdiamondz]

Ugh. Well maybe this is an overreaction, but no EM doc is capable of practicing full-time pediatrics, even with a PEM fellowship. Pediatrics is an entire specialty for a reason, and even the EM programs with the strongest Peds components do not produce physicians capable of doing peds full-time.

In short, if EM starts making overtures towards invading the outpatient pediatric setting, I’d hope that actual pediatricians shut that down hard. I honestly, in my wildest dreams can’t imagine that happening. Emergency peds telemedicine sure, real-deal pediatrics heck no.

Ideally sure, they should 'shut that **** down'

However, they didn't shut down the NPs who came for them. Nor did they shut down this ridiculous 'hospitalist fellowship'.

I generally agree that people should stay in their lane and do the jobs they are trained for...however nobody seems to follow this rule when it comes to EM, so why should EM docs respect it either? If we have gen peds folks doing PEM without a fellowship, FM doing EM without a fellowship etc why should we confine ourselves to the ED?

 

[vm26]

I have never gotten this - I know one PA who was bariatric surgery, then EM, Then GI, then hospitalist team, then back to urgent care, and now ortho surgery, He is a good guy, but there is no way you can even be close to competent when you do that. As a pharmacist it amazes me how many calls I get from "cardiology" NPs asking basic cards stuff. I get the questions on abx or other things outside of your "specialty" (I use that term loosely in these situations), but if you are cardiology, shouldn't you be able to dose lovenox? or know the definition of hypertensive urgency vs emergency? I it is so obviously they do not want to to call their attending and look like they don't know what they are doing (especially since this is on overnights and they don't want to make their doc angry by waking them up)

I asked the mid-levels how they felt about proposed expansion of residency spots and concern for saturating the job market. They were not too concerned as they can make moves (between specialties and geographically).

 

[Dred Pirate]

"Please ask your supervising physician. Thanks. "

That's what you should be doing. You getting abused is making them look better for no reason.

I do tell them that on something that is out of my lane - but some stuff it is "my job" but a lot comes when I see orders for lovenox 1 mg/kg and an indication of "VTE prophy" I have to call them. But it amazes me how little knowledge on infecious disease - there are a two (we are a fairly close knit group at night) that won't order abx without getting my recs - I appreciate the trust and all, but to have a newly diagnosed septic pt and only order vanc is down right malpractice.

 

[Dred Pirate]

Ideally sure, they should 'shut that **** down'

However, they didn't shut down the NPs who came for them. Nor did they shut down this ridiculous 'hospitalist fellowship'.

I generally agree that people should stay in their lane and do the jobs they are trained for...however nobody seems to follow this rule when it comes to EM, so why should EM docs respect it either? If we have gen peds folks doing PEM without a fellowship, FM doing EM without a fellowship etc why should we confine ourselves to the ED?

curious what types of hospitals do you see the last part in? I work at a large community hospital in a medium-large metro area with three main health systems (two are academic) and never see anything but EM residency/board certified physicians work (plus of course their midlevels)

 

[jw3600]

I do tell them that on something that is out of my lane - but some stuff it is "my job" but a lot comes when I see orders for lovenox 1 mg/kg and an indication of "VTE prophy" I have to call them. But it amazes me how little knowledge on infecious disease - there are a two (we are a fairly close knit group at night) that won't order abx without getting my recs - I appreciate the trust and all, but to have a newly diagnosed septic pt and only order vanc is down right malpractice.

It’s the same reason I don't speak to the pharmacy tech about anything other than the existence of a med or a tube station. I don’t call the ****ing pharmacy to get help from someone who isn’t qualified to help. The situation with midlevels is essentially the same. I think the ER is most bothered by it because when I need the emergent help from a specialist, it’s kind of ironic to get someone on the other line with less training than I have in the field I’m asking for help in.

 

[Lexdiamondz]

curious what types of hospitals do you see the last part in? I work at a large community hospital in a medium-large metro area with three main health systems (two are academic) and never see anything but EM residency/board certified physicians work (plus of course their midlevels)

Last I checked somewhere around 1/5 of physicians working in EDs nationwide are not EM trained, and that percentage is much higher in rural areas.

I'm in a fairly large metro area on the east coast and I know of multiple hospitals around here who still staff their EDs with FM and IM docs. We get their trainwreck transfers not infrequently.

 

[Dr Mantis Toboggan]

Last I checked somewhere around 1/5 of physicians working in EDs nationwide are not EM trained, and that percentage is much higher in rural areas.

I'm in a fairly large metro area on the east coast and I know of multiple hospitals around here who still staff their EDs with FM and IM docs. We get their trainwreck transfers not infrequently.

A lot of the ultra low volume places seem to be going midlevel only for their coverage.

 

[Lexdiamondz]

A lot of the ultra low volume places seem to be going midlevel only for their coverage.

We had a transfer from one of these ****eholes for "hand surgery consult"

Patient literally had a splinter in his hand.

American healthcare is in it's twilight years, folks.

 

[skougess]

We had a transfer from one of these ****eholes for "hand surgery consult"

Patient literally had a splinter in his hand.

American healthcare is in it's twilight years, folks.

Yep, had a transfer last year from a midlevel for a "burn surgery consult". 1 cm superficial burn to the hand. You know, the kind you get when you touch a too-hot pan and go "I'm a ******* " and move on with your day. Patient was essentially asymptomatic by the time he arrived. Thank god that midlevel had the heart of a nurse to balance the brain of a tree stump.

 

[Socrates25]

Listen guys, I don't want to get into a debate about how qualified EM docs are to practice peds.

My question is WHY would you want to?

How many of you EM guys actually like the clinic setting? That's what I thought. Every ER doc I know would run far far away from that.

Telemedicine for pediatrics for a non mental health, acute sick visit is bad patient care for anybody doing it, regardless of whether it's board certified peds, EM, NP, or anybody else.

 

[Socrates25]

EM allows time for side hustles. EM makes the transactional nature of modern medicine pretty explicit. It's not terribly surprising that some EM docs choose to branch out into related fields where they're owners and not worker bees.

Sure whatever floats your boat. But an hour spent working in peds instead of the ER is a 75% paycut. I don't undertsand that decision unless you consider working in peds as a charity and aren't trying to make money.

Ideally sure, they should 'shut that **** down'

However, they didn't shut down the NPs who came for them. Nor did they shut down this ridiculous 'hospitalist fellowship'.

I generally agree that people should stay in their lane and do the jobs they are trained for...however nobody seems to follow this rule when it comes to EM, so why should EM docs respect it either? If we have gen peds folks doing PEM without a fellowship, FM doing EM without a fellowship etc why should we confine ourselves to the ED?

Ironically even though NPs have invaded peds and I work in an NP independence state, I don't really consider them much of a threat now that I've been around them for awhile.

I own my practice and that's a huge advantage because my practice isn't dictated by some CEO/accountant at a hospital.

We get many new patient calls whose first question is "is Dr X a medical doctor or NP"

That question happens at least 2-3 times a week here.

You have to understand the mindset of NPs. I'm going to borrow a phrase from the movie "Boiler Room." NPs are pikers. They walk at the bell. They want to know how much vacation they get in their first year. I know lots of peds MDs who run small clinics in direct competition with NP clinics and the MDs are still turning away patients even if there's a clinic down the street run by a DNP.

Even in NP independent states I'd guess that 99.9% of them still choose to work for a group instead of starting their own practice. They don't want the extra workload that comes with running a business.

 

[sylvanthus]

All your base are belong to us.

 

[Fox800]

There's been a ton of peds telemedicine companies opening up, home visit companies that specialize in pediatrics, etc

I'd say at least 90% of them are run by EM docs, not peds.

This is extremely curious because peds docs make substantially less than EM. Anybody going from EM to peds will take a 50-75% pay cut.

Are we talking "acute care" visits, the kind that would walk into a regular community ED or an urgent care? Because regular vanilla EPs (non-PEM trained) see those kids day-in and day-out. We see all-comers, and are infinitely better trained than a midlevel. Like it or not, those kids are coming to see us every day of the year.

Or are you talking telemedicine visits for a "pediatrics practice" ala outpatient primary care?

We, as EPs, get all the joys of handling:
-Fever for 1 hour, didn't give Tylenol or Motrin. Straight to the ED. Wants RXs for both.
-Fever that wasn't a fever (99.3 F)
-Runny nose. Has a pediatrician but decided to come to the ED at noon on a weekday. Mom wants a work note.
-Coughing at home, not coughing at all in the ED.
-Fever, kid totally unvaccinated. Mom refusing work-up (labs, cath UA, x-rays, swabs). "Do we really need to do that? That seems like a lot". Yes, we do. Because of your stupidity.
-Vomited one time, straight to the ED. Not vomiting here.
-Wants antibiotics for viral URI.
-Fever, parent knows it "must be an ear infection". Normal exam. Upset that you won't prescribe amoxicillin bc viral URI.
-"Constipation", has a pediatrician, who they haven't tried to see. Suddenly an emergency at 9:30 PM on a weeknight.
-Diarrhea, cultures turn positive 2 days later. No primary care. Unable to reach family to prescribe Abx because parents gave a fake phone number and address to prevent getting a bill.

And every other type of nonsense.

 

[Socrates25]

Are we talking "acute care" visits, the kind that would walk into a regular community ED or an urgent care? Because regular vanilla EPs (non-PEM trained) see those kids day-in and day-out. We see all-comers, and are infinitely better trained than a midlevel. Like it or not, those kids are coming to see us every day of the year.

Or are you talking telemedicine visits for a "pediatrics practice" ala outpatient primary care?

We, as EPs, get all the joys of handling:
-Fever for 1 hour, didn't give Tylenol or Motrin. Straight to the ED. Wants RXs for both.
-Fever that wasn't a fever (99.3 F)
-Runny nose at home. Has a pediatrician but decided to come to the ED at noon on a week day. Mom wants a work note.
-Coughing at home, not coughing at all in the ED.
-Fever, kid totally unvaccinated. Mom refusing work-up (labs, Cath UA, swabs). "Do we really need to do that? That seems like a lot". Yes, we do. Because of your stupidity.
-Vomited one time, straight to the ED.
-Wants antibiotics for viral URI.
-"Constipation", has a pediatrician, who they haven't tried to see. Suddenly an emergency at 9:30 PM on a weeknight.
-Diarrhea, cultures turn positive 2 days later. No primary care. Unable to reach family to prescribe Abx because parents gave a fake phone number and address to prevent getting a bill.

And every other type of nonsense.

I'm talking about both types of visits.

My question is why would you choose to spend extra hours "moonlighting" to see those kids after hours when not on your EM shifts, and by the way, take a massive pay cut to do so.

It seems like you guys would want to run away from those visits, not embrace them yet I see lots of EM guys trying to get in on this action.

 

[Fox800]

I'm talking about both types of visits.

My question is why would you choose to spend extra hours "moonlighting" to see those kids after hours when not on your EM shifts, and by the way, take a massive pay cut to do so.

It seems like you guys would want to run away from those visits, not embrace them yet I see lots of EM guys trying to get in on this action.

Telemedicine acute care is totally within our scope, if it's the kind of thing that would walk into an urgent care.

Why? Telemedicine is convenient. You can do it in your pajamas. Some of the platforms are totally text-based. You can do it on your own schedule. Yes, the pay sucks. But when people are underemployed, it becomes more appealing.

 

[Socrates25]

Telemedicine acute care is totally within our scope, if it's the kind of thing that would walk into an urgent care.

Why? Telemedicine is easy. You can do it in your pajamas. Some of the platforms are totally text-based. You can do it on your own schedule. Yes, the pay sucks. But when people are underemployed, it becomes more appealing.

Telemedicine is **** medicine, whether it's done by an intern or a board certified pediatrician.

 

[Fox800]

Telemedicine is **** medicine, whether it's done by an intern or a board certified pediatrician.

I don't disagree. However, obviously, there is a demand. You aren't going to snap your fingers and make these platforms disappear overnight. Especially with satanic organizations insurance companies pushing for their utilization....

 

[Socrates25]

I don't disagree. However, obviously, there is a demand. You aren't going to snap your fingers and make these platforms disappear overnight. Especially with satanic organizations insurance companies pushing for their utilization....

The dirty little secret about telemedicine is that it drives costs higher, not lower because utilization is increased.

Before telemed was an option, if the doctors office is closed they would just wait it out (exception is Medicaid patients in which case ER visits are "free")

Now with telemed, instead of waiting a day or two, they want instant gratification and therefore call Teladoc or whatever company at 2 AM.

Apparently there's a lot of doctors willing to work at 2 AM for the $10 pittance that Teladoc pays per visit because they have no problem scheduling 24/7 visits.

What a life! Congratulations you have an MD and board certified in your specialty and now your job is to sit behind a computer for $10 a visit. In old days, the "bad" doctors who had license problems or other crap on their record would go work in the prison system or IHS where they don't care about your credentials. Now telemedicine is where they go to work, because they don't have any other options.

We are just a few years away from Walmart hiring doctors directly. Doctors would have said HELL NO to that before, but apparently there are so many desperate doctors out there willing to do anything for minimum wage that Walmart would have no problem finding MDs to join them now.

 

[sylvanthus]

Its all by design. Plunge medical students into 100s of thousands of dollars of debt, force them through a grueling training pathway where they learn they have no control and cant fight, flood the market with “providers”, and people will be fighting over the scraps and pleased to get whatever leftovers they get.

 

[sloh]

Doctors would have said HELL NO to that before, but apparently there are so many desperate doctors out there willing to do anything for minimum wage that Walmart would have no problem finding MDs to join them now.

Because you would need to unify a large and significant swath of doctors who all agree to say "hell no" to even move the needle. And that isn't happening when job security and income are on the line—especially with significant debt, mortgage, car payments, and families to support.

"If each player has chosen a strategy — an action plan choosing their own actions based on what has happened so far in the game — and no player can increase their own expected payoff by changing their strategy while the other players keep theirs unchanged, then the current set of strategy choices constitutes a Nash equilibrium."

 

[Socrates25]

Its all by design. Plunge medical students into 100s of thousands of dollars of debt, force them through a grueling training pathway where they learn they have no control and cant fight, flood the market with “providers”, and people will be fighting over the scraps and pleased to get whatever leftovers they get.

I don't know, it seems to be more than just that.

My specialty is doing fine, there's no great oversupply of peds who cant get jobs across the country. Sure there's a few cities where job opps are harder but for the most part it's easy to find a job.

But even in peds I see people who are taking **** jobs like telemedicine WHEN THEY DONT HAVE TO. It's like they don't want to go through the effort of seeking out better options. They would rather just make $100k per year working part time at home when 250-300k is out there.\

IMO people who choose that pathway are not professionals. They wasted their education and racked up debt for nothing.

I don't get it.

 

[GeneralVeers]

I don't know, it seems to be more than just that.

My specialty is doing fine, there's no great oversupply of peds who cant get jobs across the country. Sure there's a few cities where job opps are harder but for the most part it's easy to find a job.

But even in peds I see people who are taking **** jobs like telemedicine WHEN THEY DONT HAVE TO. It's like they don't want to go through the effort of seeking out better options. They would rather just make $100k per year working part time at home when 250-300k is out there.\

IMO people who choose that pathway are not professionals. They wasted their education and racked up debt for nothing.

I don't get it.

I'm planning to switch to 100% telemedicine next year if I can. Granted I've worked for 12 years, but it just doesn't make sense to continue practicing in our current environment with lower pay. I wouldn't say it's wasted. Making $100K working part time from home is better than working full time in the ED and taking abuse.

 

[sylvanthus]

Im a bit leery of telemedicine after someone posted his experience of being reported to that national provider database for quitting. Any reputable companies that wont hose you?

 

[wendalltwolf]

We are just a few years away from Walmart hiring doctors directly. Doctors would have said HELL NO to that before, but apparently there are so many desperate doctors out there willing to do anything for minimum wage that Walmart would have no problem finding MDs to join them now.

It’s already starting with mental health services at Walmarts and your local pharmacy:

Therapy on Aisle 7: Retailers Are Entering the Mental Health Market (Published 2021)

Call it the ultimate in “retail therapy.” Now you can shop for mental health services at CVS, Rite Aid and other national chains.

www.nytimes.com

 

[Arcan57]

Sure whatever floats your boat. But an hour spent working in peds instead of the ER is a 75% paycut. I don't undertsand that decision unless you consider working in peds as a charity and aren't trying to make money.

1) If we own the business, we're probably not taking a 75% pay cut.

2) EM usually has a bunch of this gray area time where you're not working and technically awake but still recovering from your last shift. Filling in that time with another ED shift is the most lucrative choice, but leads to burn out pretty quickly. Filling it in with something that still makes money but isn't nearly as emotionally/cognitively complex can look attractive. Traditional side hustles tended to involve real estate or consulting. Given our ability to navigate byzantine rules and systems that are designed to fail, getting into the more niche areas of modern medicine makes sense also.

 

[BoardingDoc]

Im a bit leery of telemedicine after someone posted his experience of being reported to that national provider database for quitting. Any reputable companies that wont hose you?

I think the previous post about this was someone who worked for Teladoc? I don't remember if that was the company they used or not. Either way, I used to use them and I quit. I have a clean NPDB report (literally just paid the 4 bucks to check now) and I formally quit with them many months ago. I still don't necessarily recommend them given how poor the compensation is, but at least I don't have to sue them for defamation over some BS NPDB complaint.

 

[Socrates25]

1) If we own the business, we're probably not taking a 75% pay cut.

2) EM usually has a bunch of this gray area time where you're not working and technically awake but still recovering from your last shift. Filling in that time with another ED shift is the most lucrative choice, but leads to burn out pretty quickly. Filling it in with something that still makes money but isn't nearly as emotionally/cognitively complex can look attractive. Traditional side hustles tended to involve real estate or consulting. Given our ability to navigate byzantine rules and systems that are designed to fail, getting into the more niche areas of modern medicine makes sense also.

If you have an army of MD/NP/PA employees at your disposal doing the calls for you then sure you can make a lot of money.

At that point though, why go into EM at all? If being an entrepreneur and running a business is your goal, EM (or any of the hospital based specialties) seems like a very poor choice.

I get the distinct impression that many of the EM people start these companies don't work in EM anymore and have abandoned your field.

 

[deleted1066189]

We are just a few years away from Walmart hiring doctors directly. Doctors would have said HELL NO to that before, but apparently there are so many desperate doctors out there willing to do anything for minimum wage that Walmart would have no problem finding MDs to join them now.

Probably not wrong.

Alice Walton plans new nonprofit medical school

The new school is part of a larger plan to address a broken healthcare system.

www.fayettevilleflyer.com

 

[Socrates25]

Probably not wrong.

Alice Walton plans new nonprofit medical school

The new school is part of a larger plan to address a broken healthcare system.

www.fayettevilleflyer.com

ah yes, another crappy med school opening in nowhere with zero hospital resources.

Bentonville Ark has a population of 50k. How the hell are you going to run a med school in a town with 50k people?

I'll tell you how -- by forcing all of their med students to go live in other cities across the USA and set up their own clinical rotations, while paying 50k per year in tuition for Walmart Med School to outsource their entire 3rd and 4th years of clinical education.

 

[GeneralVeers]

ah yes, another crappy med school opening in nowhere with zero hospital resources.

Bentonville Ark has a population of 50k. How the hell are you going to run a med school in a town with 50k people?

I'll tell you how -- by forcing all of their med students to go live in other cities across the USA and set up their own clinical rotations, while paying 50k per year in tuition for Walmart Med School to outsource their entire 3rd and 4th years of clinical education.

No......you see they are trying to "address a broken healthcare system", by training substandard doctors, and ruining them with debt.

 

[docB]

I don't know, it seems to be more than just that.

My specialty is doing fine, there's no great oversupply of peds who cant get jobs across the country. Sure there's a few cities where job opps are harder but for the most part it's easy to find a job.

But even in peds I see people who are taking **** jobs like telemedicine WHEN THEY DONT HAVE TO. It's like they don't want to go through the effort of seeking out better options. They would rather just make $100k per year working part time at home when 250-300k is out there.\

IMO people who choose that pathway are not professionals. They wasted their education and racked up debt for nothing.

I don't get it.

I suspect it's not about wanting to do peds. There may be some ignorant "Peds is easy" attitude there but I bet it's mostly about doing telemedicine. Telemedicine is turning into the Uber for doctors. Have some free time and need some cash, don't ferry drunks around town, hop on the computer instead. I guess it's more like being a cam girl than driving Uber. Take off you clothes, turn on the camera and $$$. I already feel like a prostitute and a drug dealer doing what I'm doing now. I just do it in a grimier place.

 

[RoyBasch]

Are we talking "acute care" visits, the kind that would walk into a regular community ED or an urgent care? Because regular vanilla EPs (non-PEM trained) see those kids day-in and day-out. We see all-comers, and are infinitely better trained than a midlevel. Like it or not, those kids are coming to see us every day of the year.

Or are you talking telemedicine visits for a "pediatrics practice" ala outpatient primary care?

We, as EPs, get all the joys of handling:
-Fever for 1 hour, didn't give Tylenol or Motrin. Straight to the ED. Wants RXs for both.
-Fever that wasn't a fever (99.3 F)
-Runny nose. Has a pediatrician but decided to come to the ED at noon on a weekday. Mom wants a work note.
-Coughing at home, not coughing at all in the ED.
-Fever, kid totally unvaccinated. Mom refusing work-up (labs, cath UA, x-rays, swabs). "Do we really need to do that? That seems like a lot". Yes, we do. Because of your stupidity.
-Vomited one time, straight to the ED. Not vomiting here.
-Wants antibiotics for viral URI.
-Fever, parent knows it "must be an ear infection". Normal exam. Upset that you won't prescribe amoxicillin bc viral URI.
-"Constipation", has a pediatrician, who they haven't tried to see. Suddenly an emergency at 9:30 PM on a weeknight.
-Diarrhea, cultures turn positive 2 days later. No primary care. Unable to reach family to prescribe Abx because parents gave a fake phone number and address to prevent getting a bill.

And every other type of nonsense.

All daaay err'y daaay.

 

[calvnandhobbs68]

I suspect it's not about wanting to do peds. There may be some ignorant "Peds is easy" attitude there but I bet it's mostly about doing telemedicine. Telemedicine is turning into the Uber for doctors. Have some free time and need some cash, don't ferry drunks around town, hop on the computer instead. I guess it's more like being a cam girl than driving Uber. Take off you clothes, turn on the camera and $$$. I already feel like a prostitute and a drug dealer doing what I'm doing now. I just do it in a grimier place.

telemed is rookie level

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[GeneralVeers]

I suspect it's not about wanting to do peds. There may be some ignorant "Peds is easy" attitude there but I bet it's mostly about doing telemedicine. Telemedicine is turning into the Uber for doctors. Have some free time and need some cash, don't ferry drunks around town, hop on the computer instead. I guess it's more like being a cam girl than driving Uber. Take off you clothes, turn on the camera and $$$. I already feel like a prostitute and a drug dealer doing what I'm doing now. I just do it in a grimier place.

Clothes off costs extra. Need that tip money for that Z-pac prescription and some skin.

 

[GassYous]

telemed is rookie level

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more like calvnandhobbs69

 

[Dred Pirate]

It’s the same reason I don't speak to the pharmacy tech about anything other than the existence of a med or a tube station. I don’t call the ****ing pharmacy to get help from someone who isn’t qualified to help. The situation with midlevels is essentially the same. I think the ER is most bothered by it because when I need the emergent help from a specialist, it’s kind of ironic to get someone on the other line with less training than I have in the field I’m asking for help in.

I sit literally right next to the doc's at our place - and we have these wonderful vocera devices so everybody gets to hear both sides of ever conversation - and the eye rolls we both get when having those kinds of convos - some of the mid levels are great, but we have that same convo when someone with less training is giving advice - and if I had a dollar for ever time the ED MD overruled them because, well they were simply wrong.

 

[turkeyjerky]

Clothes off costs extra. Need that tip money for that Z-pac prescription and some skin.

Guys can we stop. This is getting a little too close to the truth