1. I would say that barring some ambition to take the medical world by storm; additionally with the knowledge that there are no bad medical schools and you can get into any kind of residency from any medical school...I would say that location is a very important factor as well as cost. So your state school might fit the bill even if it's not the so-called top-ten.

  2. Dude is a sleazeball, has done a bunch of plaintiff-side med-mal work against EM docs

  3. Absolutely...and why? He's old, wealthy, has nothing to prove. Just a douche.

  4. This is completely ridiculous. That’s basically a cube of water 150 feet on a side. That’s a literal drop in a bucket. Insignificant. Look at a lake. Imagine how much water is in it.

  5. Wow. If you don’t like Joe Rogan Russel Brand will make your head explode.

  6. Fascinating topic with some very insightful comments. I think however the rationale for using AI initially will be exactly the same as the rationale for using midlevels, essentially that because most of medicine is simple, low acuity, and algorithmic it does not require the nuanced skills of physician. There will be some pro forma supervision but not enough to keep medicine a viable profession.

  7. The public will almost certainly not want to see an "AI physician". Of course, that won't matter and someone may try it.

  8. To paraphrase, "Your public, Sir, is a beast." Most of them won't care as long as they get their free healthcare. They won't be able to tell the white-coated clerk from the AI behind the curtain, anyway.

  9. I think AI has the capability to free us from the worst part of our job, documenting on the EMR. Just tell the AI, “Sore throat with swollen, red tonsils,” and have it generate a perfect note with everything required for legal and billing.

  10. Then the AI will document patient with large swollen tonsils fever and elevated tongue etc. and not have any clinical clue what any of those words mean. AI can't deliver context. How does an AI know the patient doesn't have stridor or that you're not considering peritonsillar abscess etc? That sounds like a terrible idea.

  11. Usually, the staffing company makes their money by billing and collecting for the ER doctor's time. The hospital doesn't necessarily pay them anything although they might in a small, critical access hospital that doesn't have the volume to make up for billing. .

  12. I’m a salaried hospital employee, but other ER’s in my health system’s hospital ED’s are staffed by contract groups. The reasons why are unclear to me, why wouldn’t my health system want to all of their ED’s staffed by their own employees and skim off the top of the physicians billing and collecting like the CMG’s do?

  13. I am not an expert. But I understand that a lot of hospitals don't want the headaches associated with staffing as well as the overhead of the additional employees. So they're happy to "farm out" ER staffing. Additionally, while not small, the margins are not large enough to make it worthwhile.

  14. To be honest, I’d rather work eight hour shifts and just come in every day or night like normal working people. Eight hours is nothing. It’s like not working. You put your head down and the next time you put it up you only have three hours left on your shift. And if you are religious about leaving on time it’s a very easy life. I once worked at an ER with an 11PM to 7AM night shift. Perfect.

  15. We do 10’s but have a 2 hour overlap with oncoming team so we stop picking up at 8hr and have 2hrs to tidy things up. Often leave before the 10 hour mark.

  16. That is ideal. With 12s there is usually no overlap because of vagaries of scheduling. It causes butt hurt with the large minority of ER doctors who are lazy punks, see a few patients in the rack when they walk in, and get angry because they don’t think they should start working when they come to work.

  17. Under certain circumstances, CDC allows you to work with COVID. A year ago we had so many people doing their five-day COVID vacations that if one more of us called in sick we would have had to close the ER.

  18. Ha ha. I uncharitably thought the same thing...because the attitude expressed just perpetuates the system and blames the prisoners for the actions of their captors. If you don't tolerate rule-breaking, we'll take it out on the next group of residents...that's what I got out of it. It reminds me of the time when I was an intern that one of the other interns quit and we were not only encouraged to hate him for his few remaining months but also to blame him for the extra call we had to do...which is ridiculous. If you can't see why this is ridiculous then you have been completely co-opted by corporate medicine.

  19. Just an observation but many times what people perceive as threats from bureaucrats are actually begging. So they're not threatening you with repercussions, they're pleading with you not to report them. It only sounds aggressive because you don't see the trouble your program director will be in if he's allowing you to be worked above the duty hour rules. He's sweating, there is no reason on Earth for you to be. You won't get fired and the worst anybody in charge of you will do is act petulant and unprofessional...which shouldn't bother you at all. Medicine is stocked with petulant and unprofessional people. If you don't laugh at them it's because you're one of them...if you see my point.

  20. That people think transporting people to hospital is you Job said it all

  21. I’m confused. Isn’t that most of the job? Not being snarky, asking legitimately.

  22. Hey Ailuropoda0331… seen a lot of your posts and agree a lot with what you say about how to stay happy in this job (it’s a job, not a lifestyle, and fuck staying late). You mentioned 1099 and W2. If you had two job options and only difference was one was a 1099 and the other was a W2, what would you go for and why?

  23. Does it still bother you, even a little bit, that we’ve been reduced to this? It does me… regardless of how much I’ve tried to root out that nagging sense of regret. I didn’t build this system, and neither did you… so I don’t feel responsible for it… but the patients are the ones who ultimately suffer from the current dysfunctional corporate culture.

  24. Doesn’t bother me. I work hard when I’m working and without bragging, I’m usually one of the highest patient-per-hour guys everywhere I have worked. Definitely the top one where I work now with no competition. I just know how to be efficient and I actually like to work. Take something like charting. I don’t understand why my colleagues can’t do it as they go along. They certainly have time to complain and spin their wheels. I get anxious if I’m behind on charting so I make a point of doing it…while waiting for labs, imaging, phone calls, etc. Then I can relax and plan the end of my shift, something I make a religion of doing.

  25. You picked two of the highest cost of living cities in the entire country and are shocked that the cost per student is much higher than the average? Are you kidding me?

  26. The average is around $12,000. The lowest is Utah, I believe. $12,000 is a lot of money and, the way education is organized it's impossible to cut costs in any way, even if it's justified. My largely rural state spends slightly more than the average and our public schools are abysmal.

  27. Look, idk what's going on in your state, if you think it's corrupt or inefficient I'm not going to tell you that you're wrong, because I have no idea.

  28. Washington DC has some of the worst-performing schools in the country. And American public education, by any measure, is generally substandard and in any measurable way falls below countries with generally very high costs of living who spend a a lot less in the developed world. I think we’re 24th in Math out of 35. Not stellar.

  29. Halsted built up the whole residency program to hide the fact that he was an addict that couldn't function. He basically created a hierarchical and pyramidal residents structure, so that the highest residents could basically do his job for him and they supervised and trained the lower ones. No doubt the graduates of his training structure were super competent, and they evangelized that residency structure to all the places they went and it eventually became the norm.

  30. You know, Reddit can be wasteland of stupidity…I often contribute…but every now and then you learn something interesting that explains the world in a clear, succinct way.

  31. This mentality extends past residency, especially in hospital employed physicians or those who work for various contract management groups. Their employers put tremendous pressure on them to stay late for free or do their charts, a huge part of medical practice, on their own time. And it's not just their employers. Their fellow physicians, suffering as they do from a Stockholm Syndrome-like affliction, also put pressure on each other, allowing their consciences and work ethic to be used as a bludgeon by corporations.

  32. The receptionist at my vet's office wears scrubs. To be fair my dog is large and sheds a bit.

  33. Point taken. Not looking to leave already. Question was more gauged towards always having a plan/backup and always looking towards the future. Can never be too prepared. Of course I plan to maximize my time practicing as a physician. Question was more towards understanding how to get a seat at the table. It has long been an interest of mine to an extent and just curious about logistics. This is not to take away from my desire to practice medicine but more to expand my horizons and exploring interests that I otherwise would never get to explore during residency. Have you had experience doing med-mal or is this just your opinion?

  34. You might consider law school. Emergency medicine can be a part time job if you want it to be. Four or five shifts a month to pay the bills? Then you’d have something.

  35. What's the deal with you and boomers and why are you blaming them for the current problems in medicine? I don't see younger physicians acting any differently and a lot of CEOs and administrators are not boomers in any sense of the word. Additionally I thought all you younger folks were altruistic and not about the money, pace the frequent posts on this sub about how you all would be happy to get some arbitrarily low salary because it's "enough" and higher than the median income.

  36. Let me tell you a story. I once worked for a really crappy rural ER. I'm not bragging because I'm just an average ER doctor but I was doing them a favor working shifts there. We had a really drunk guy come in once with a pretty nasty looking head injury. He was ridiculous, combative, uncooperative, and highly abusive to the staff. I decided not to let him leave even though he wanted to go as soon as EMS brought him.

  37. For patient satisfaction reasons I usually go with “sir” instead of “motherfucker”….

  38. Having been raked over the coals as a very lower level health care worker by an attorney, they will look at everything to prove you are the a--hole that contributed to their loved ones demise.

  39. I agree with you. I have been sued. But I think, "Met his creator peacefully," is a beautiful expression that will have no consequences. If you are ever deposed you can call it an expression of your religious faith and they will move on.

  40. Having been sued I can attest to this. Fortunately I never put anything flippant in the chart.

  41. We’re all that moron and in the face of idiocy we all still push on. Regardless of staffing ratios, lack of staffing/resources, and the hordes of people that come through our ED doors (and the EMS crew bus doors that bring them in) we continue to serve our communities, bc for some reason or another we have the desire to serve our fellow man, woman, and child in the brink of watching our healthcare system collapse. I’ll proudly wear a shirt that says “I’m that Moran.”

  42. I appreciate the intent...and I was a Marine infantryman myself...but I reject the metaphors administrators and private equity use as an excuse to get people to burn themselves out for the greater glory of Team Health and profit forever and ever amen. In other words, staffing shortages and overcrowding are strictly corporate business practices and we shouldn't kill ourselves to compensate. That's what they want you to do; as long as you stay late, work at a malignant pace, and skip lunch and bathroom breaks the private equity firm that owns your hospital or practice group doesn't have to hire more staff and can just count their money while laughing at you.

  43. Yeah I’m sure you love the Russian military hating that’s allowed. But F me for being critical of one who kills innocent people because they have a bit extra melanin while halliburtons and Cheney’s get rich.

  44. That was kind of a non sequitur. I don't hate any soldier or Marine. And I'm an Orthodox Christian, not an atheist. Come down from the ledge. It's cool. You don't have to approve of our bloated military industrial complex to show a little respect to other professions, in this case a very hard and challenging one. I was a Marine infantryman myself. Infantrymen are generally a good bunch of guys and make solid citizens later in life.

  45. Everyone saying EM has forgotten that no CT scanner and on call radiologist exists on the plane.

  46. I’m an ER doctor. In an inflight emergency I’d probably say, “What do you mean there’s no CT scanner on the plane? What kind of crappy airline are you running?”

  47. I'm an ER doctor. If I have my laptop I can document the shit out of whatever happens. I think I have dot phrase for that.

  48. Emergency Medicine. It’s a low-stress job for the most part. If you’re 70 there’s not much anybody can do to threaten you.

  49. Not to say "rosk" when they mean Return of Spontaneous Circulation. ROSC. Same with saying "pearla" when you mean Pupils Equal, Round, etc.

  50. What are the specifics? You say healthcare doctorate that does surgery but.. what is it?

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