I wish patients knew what the ER was for

[Mount Asclepius]

Ultimately we’re all on the same team so just take this as a colleague’s opinion but to me this is quite muddled.

I don’t think the people who don’t want to work in a dumpster fire with poorly functioning staff, angry patients and families, and unnecessarily high medicolegal risk are ‘burned out on the essence of EM’. If these are the circumstances you find yourself in every shift, I honestly wonder if your care doesn’t ultimately suffer for it.

Most of my shifts when I do have those 3 - 5 critically ill patients, I’m actually able to devote myself to them, again thanks to not working in an understaffed dumpster fire.

I work in a decently high functioning ED. You missed who this post is directed towards.

Emergency medicine is about emergencies. Not one inch puts. To use another analogy, buckle up and be a driver.

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[skougess]

I wish some Emergency Physicians knew what the ED was for.

We all have come across various types of EPs. The resuscitationists, the academically inclined, the clinically savvy, the adrenaline junkies, the entrepreneurs, and the PCPs in the wrong building. Some were really never meant for true EM. Sure, maybe it’s a pipe dream, but EM in its imagined form is acuity, resuscitation, critical care and life/death. Those of us with that mindset will always stay 1-2 hours after a shift to deal with someone at death’s door. Even the most jaded of us see that as very high billing and income producing. We’ve also adapted pragmatically to earn the top dollar even though we were sold the wrong bill of goods.

Some though enter EM or receive training that is geared more so with the mind sight of acute care medicine, consultation dependent, desire for shift based medicine and leaving not one minute past ‘time.’ Alternatively, these EPs are burned out on the essence of EM and really have one foot out to pasture.

We are leaders of every dumpster fire of an ED. Run your shop. Get paid for your productivity. Don’t let those that are burned out, never meant for EM in the first place, and/or in positions far removed from the current EP try to tell you that their ‘experience’ trumps yours.

Are you trying to tell me and everyone here that if we don’t want to be abused by employers (stay hours late after shifts just for the love of the game) that we are somehow not true ER docs?

I can be proud of my work AND have self respect. It’s not mutually exclusive.

 

[GonnaBeADoc2222]

Ultimately we’re all on the same team so just take this as a colleague’s opinion but to me this is quite muddled.

I don’t think the people who don’t want to work in a dumpster fire with poorly functioning staff, angry patients and families, and unnecessarily high medicolegal risk are ‘burned out on the essence of EM’. If these are the circumstances you find yourself in every shift, I honestly wonder if your care doesn’t ultimately suffer for it.

Most of my shifts when I do have those 3 - 5 critically ill patients, I’m actually able to devote myself to them, again thanks to not working in an understaffed dumpster fire.

Are you trying to tell me and everyone here that if we don’t want to be abused by employers (stay hours late after shifts just for the love of the game) that we are somehow not true ER docs?

I can be proud of my work AND have self respect. It’s not mutually exclusive.

@Mount Asclepius has always been a contrarian white knight. I usually take whatever judgemental high horse thing he says w a grain of salt.

 

[Mount Asclepius]

Are you trying to tell me and everyone here that if we don’t want to be abused by employers (stay hours late after shifts just for the love of the game) that we are somehow not true ER docs?

I can be proud of my work AND have self respect. It’s not mutually exclusive.

No. You missed who comments directed towards.

If you run a FSED and are far removed from hospital based EM, you are mostly not taking care of emergencies or interested in the true practice of EM.

Additionally, many EPs enter EM or through the training process end up not likening to take care of emergencies. I think everyone knows one or several in their own group who would be better served working in a FSED, UCC or another environment.

You shouldn’t be abused by an employer. You should be paid for your productivity.

 

[Mount Asclepius]

@Mount Asclepius has always been a contrarian white knight. I usually take whatever judgemental high horse thing he says w a grain of salt.

Emergentmd and I do have at least one thing in common. We both perhaps found somewhat unicorn situations and try to share idealized positions with others out of hope that it will generate an uprising of EPs fighting for positive change. Serving as leadership in my own group has resulted in me seeking out problems and trying to correct them for the betterment of the group. I apologize if this comes across as 'holier than thou.' I'm not immune from the same pressures that burn us all out. Patients themselves contributing to a significant degree. As RustedFox says... I've just tried to find ways to survive in a field that probably isn't most suited for me. I might have found a better fit in CCM, or something else like cardiac anesthesia, subspecialty surgery or IR. My golden handcuffs and interests outside of medicine have prevented me from a course correction. In that sense, I should hold me tongue from blaming others for their own decisions. I can still offer my contrarian opinion in hopes that it will spark some internal dialogue for others. I disagree extensively at times with physicians such as Emergentmd, but don't block them and keep coming back because hearing alternative views is healthy in formulating your own opinions and occasionally causing a change in thought. If you'll keep taking mine even with a grain of salt, then that's all I can ask.

 

[emergentmd]

I wish some Emergency Physicians knew what the ED was for.

We all have come across various types of EPs. The resuscitationists, the academically inclined, the clinically savvy, the adrenaline junkies, the entrepreneurs, and the PCPs in the wrong building. Some were really never meant for true EM. Sure, maybe it’s a pipe dream, but EM in its imagined form is acuity, resuscitation, critical care and life/death. Those of us with that mindset will always stay 1-2 hours after a shift to deal with someone at death’s door. Even the most jaded of us see that as very high billing and income producing. We’ve also adapted pragmatically to earn the top dollar even though we were sold the wrong bill of goods.

Some though enter EM or receive training that is geared more so with the mind sight of acute care medicine, consultation dependent, desire for shift based medicine and leaving not one minute past ‘time.’ Alternatively, these EPs are burned out on the essence of EM and really have one foot out to pasture.

We are leaders of every dumpster fire of an ED. Run your shop. Get paid for your productivity. Don’t let those that are burned out, never meant for EM in the first place, and/or in positions far removed from the current EP try to tell you that their ‘experience’ trumps yours.

What a joke. Anyone know knows me as an ER doc will tell you I am a top 10% clinical ER doc in almost any metric you want to use. I would put my skills at running an EM dept against anyone and confident I could clear it out faster than most docs.

There is a reason I have been Med Dir at almost every site I work at and it had nothing to do with me kissing A$$ or asking for the job. I have been asked to be President of a national CMG EM division and multiple public well known CMGS that I have turned down b/c I know the game I need to play would cause me to lose me soul. I will leave it at that.

I can care less if docs want to be known as well known acute care soldiers. Being leaders of every dumpster fire is not something to be proud of. I don't see anyone here saying their "position" trumps anyone else's experience. I for sure am not or ever been burned out from EM, and I dare to say I have worked in the pit many more years than you; If you have worked more than 17yrs then I stand to be corrected. But come on, you are essentially who CMGs love; give me more and more because I can take it while they keep raking in cash running EDs to the bare bones.

 

[emergentmd]

Emergentmd and I do have at least one thing in common. We both perhaps found somewhat unicorn situations and try to share idealized positions with others out of hope that it will generate an uprising of EPs fighting for positive change. Serving as leadership in my own group has resulted in me seeking out problems and trying to correct them for the betterment of the group. I apologize if this comes across as 'holier than thou.' I'm not immune from the same pressures that burn us all out. Patients themselves contributing to a significant degree. As RustedFox says... I've just tried to find ways to survive in a field that probably isn't most suited for me. I might have found a better fit in CCM, or something else like cardiac anesthesia, subspecialty surgery or IR. My golden handcuffs and interests outside of medicine have prevented me from a course correction. In that sense, I should hold me tongue from blaming others for their own decisions. I can still offer my contrarian opinion in hopes that it will spark some internal dialogue for others. I disagree extensively at times with physicians such as Emergentmd, but don't block them and keep coming back because hearing alternative views is healthy in formulating your own opinions and occasionally causing a change in thought. If you'll keep taking mine even with a grain of salt, then that's all I can ask.

You are giving yourself wayyyyy toooo much credit and in no way do we have this in common. FSER is great if it is Doc owned, democratic, and docs can make changes. The work is many times easier and the pay many times greater. This is what true capitalism is and its a chance for docs to take back clinical control and income from CMGs and hospital. When covid hit, and all the hospitals/EDs required N95 masks for all staff. Guess what, we gave each EDs the autonomy to decide what mask protocol they wanted to implement.

I find it unbelievably bizarre of you to say on one side of your mouth that you want differing dialogue and then have an extensive history of marking posts as inappropriate which you did twice last page. You don't want to block other posters, when you have a history of complaining about others who you disagree with.

Just a place bizarre world you live in that I can just describe as Karen-ism.

 

[emergentmd]

If you run a FSED and are far removed from hospital based EM, you are mostly not taking care of emergencies or interested in the true practice of EM.

Got it, let me go tell all of my partners that they are not interested in the true practice of EM whatever this means even though most have spent more time in the "Pit" than you have. I have done 17 yrs, tell me how many years you have logged in the Pit.
While I am at it, I will go tell my surgeon friend who wanted to get out of the call game and do a clinic only practice that they do not practice true surgery. I will tell my OB/GYN friends who does Gyn only that they really are not OB/GYN docs.

A very large judgmental blanket you just threw for someone who in political threads are always so open minded.

 

[Mount Asclepius]

Looks like I hit a nerve.

Edit (follow-up as I don’t feel deserves a new post, this discussion is a little off topic with this thread, had time to reflect on, and needs final clarification):

Got it, let me go tell all of my partners that they are not interested in the true practice of EM whatever this means

When I was deciding on a specialty, I did not pick EM b/c I was fascinated with acute care

14 x 1 inch puts and 2 x 2 inch puts. The days of training in shock trauma and having 2+ feet puts all shift is not something an attending wants.

You will be happy finding career jobs with 1 inch puts and not 30 feet chip shots.

I will never understand the frustration with 1 inch puts.

Yeah, it’s more appropriate for direct admission but I got bills too and want a bag full of 1 inch level 4/5 puts.

You implied you don’t like acute care (‘emergencies’) and only want 1 inch puts. That was my point. True EM IMHO is emergencies. Real emergencies. Not what I’d refer to as puts.

Yes, over time in medicine everything becomes more routine and maybe you just want something easy instead of working as hard as you once did. Your 100th intubation isn’t near as exciting as your first one. When you are at the end of your career though it isn’t helpful to tell everyone else at various stages in their career not to like emergencies because you no longer do after 17+ years. If you didn’t like acute care much in the first place it also may explain why you don’t like taking care of emergencies. That’s okay. Some do like taking care of critically ill patients though. Others move on to find areas where they don’t take care of emergencies as much.

nope, people like you don’t bother me. I’m just calling you out for your hypocritical nature. Now carry on

What a joke.

You are giving yourself wayyyyy toooo much credit and in no way do we have this in common.

Just a place bizarre world you live in that I can just describe as Karen-ism.

Doubtful. Definitely hit a nerve. Tried to be somewhat collegial and relay where there is overlap despite obvious disagreement. Sure, maybe I was a little too personal and confrontational. Your posts are much more antagonistic though calling a post a joke, calling someone hypocritical, and referring to as Karen-ism.

We’ll likely just have to agree to disagree on this as we have fairly divergent views on this topic.

 

[emergentmd]

Looks like I hit a nerve.

nope, people like you don’t bother me. I’m just calling you out for your hypocritical nature. Now carry on

 

[gruemd]

Which season?

I'm so far behind.

Been meaning to catch up but I'm knee deep in Elden Ring right now.

The latest season, 7 I believe? The new voice actors did a great job IMO. I brought my Steam deck with me and meant to play some games but I just haven't had anything I've been feeling lately. I need an expansive game to get lost in.