Just a few of my (additional) frustrations - my last ED employer installed Epic at Midnight on a Saturday night. I started my shift on Sunday morning at 8 am, with the ED backed up for 5 hours (it had never been backed up that much, before, in my experience). It took me 45 minutes to order meds and treatments for my first patient, an unstable CHFer. A colleague had to use Brutacaine to intubate someone as she couldn’t get meds from the Pyxis until the patient information was entered. I handed in my notice that day.
I was fired from my longest ED job (15 years) because I told an attending that I couldn’t move his patient to a bed, because every bed was filled, and patients were on stretchers in the halls, and ambulances were bringing more patients, despite our being on divert. He complained to the CEO of the hospital and I was given notice that day.
I handed in my notice in my last ED job when I was chewed out for transferring a patient who was as stable as I could make her in a hospital without any capacity to manage her problems, and nurses too new to have any idea of what to do. The week before, I had to put a chest in a attention, and no one, besides me, knew how to set things up.
I decided to retire from an ED residency I had helped to establish when the then current program chair threatened to punch me out in full sight (and sound) of the patients and staff. He had been at another program, and left there due to anger management issues.
I was thrown under the bus by the owner of an ED practice who didn’t have corporate malpractice coverage, because “it would cost me money to have a lawyer review the changes you wanted to make in your contract.”
So, yeah, I guess it’s all my fault that I decided I was a dinosaur, and concluded it’s better to retire 2 years too early than 15 minutes too late.
I'm no dinosaur, I'm 42 with 15 years as an ER doc. To be honest, I was working in probably the best set up for sanity in emergency medicine. Leaders are fundamentally decent people trying their best in a fukakta system. At the corporate level, they are focused on quality, but only metrics based quality, so doc w patients w a1c of 7.1=bad, 6.9=good regardless of QOL, other measures of health and wellbeing.
Anyway, I just haven't been able to get past how abandoned I felt during the pandemic. How we were asked to do more and more with less and less continuously for 3 years and there has been literally no acknowledgement of what we did or what we went through, or that we're all more broken than we wre before.
There was “training” - 10 hours for scribes, 1 hours for physicians and mid levels. However, like in war, all planning goes out the window with the first shot.
In a nutshell: Hire moronic, non-clinical middlemen, ie "administrators", in large numbers, to make decisions based primarily on financial/ industrial "quality" parameters - divorced from any actual bedside patient care experience - and then tie their compensation directly to such cost-cutting and efficiency metrics... What could possibly go wrong...? SMH in surprise! Sincerely, a dual borded ED doc/ director of 30 + years, forced to resign for refusing the jab, after having Covid twice as a front-line "hero". You can all burn in heck, good riddance...
Thank you for speaking out and trying to get legislators to understand that their committees need to talk with the doctors in the trenches, not the highly overrated administrators who are charged with making money over providing good care to patients. Reporters need to expose what is causing the exodus of doctors from practice.
In the course of the last two years of my 28 year EM career we had the owner of a multistate EM staffing company run off with all the money and neglect to pay us or our malpractice premium. The hospital CEO (a physical therapist by training) fired and walked out a partner who told dispatch to put us on divert when our coverage lapsed. We tried to for a local group but the owner of the hospital brought in a new staffing company that changed our pay from X dollars an hour 1099 to 0.67 X dollars an hour W2. We had a well staffed ER at the outset with experienced PAs - all the experienced PAs were let go because we were to precept a PA “EM fellowship” coverage went from 34 hours doc a day plus 24 hours PA to 24 hours doc and 10 hours PA. We had to sue the owner of the hospital to get back pay for shifts worked while the first group owner ran off with the collections.
Then came Covid. It’s March 15 2020 and I get a striderous 32 year old lady who I work up for PE and scope. She has a subglottic tracheal swelling that incompletely responds to steroids and antibiotics and get an ICU bed ordered. “Person under investigation “ send out Covid ordered cause her husband is a Peds resident at the local children’s hospital and has Covid patients. CMO calls and tells me to transfer her because “ID says to”
Me “ We don’t have ID “
CMO after doublespeak “well infection control. Same thing”
Me “three board certified doctors say admit this well insured patient to the ICU and she has orders and you are telling me to transfer her because a Clipboard nurse who has not seen the patient says to.
I had a pre written resignation letter in my phone and I turned around and hit “send”
I’ve been out of nursing for a little over one year, and I am so very thankful that those silly comments (summarized as, Do more with less, we feel a bit sorry but no we can’t really help it) are a memory. The contribution of government intrusion by CMS to the healthcare crisis is, in my experience, vastly underestimated. The reimbursement rates are appalling. And its far-reaching power was shown when it, through financial stipulation, forced healthcare to implement vax mandates. Covid was an awful time for healthcare all around, but that felt pretty soul-crushing.
I agree. Thankfully, I quit ten years ago after several unsuccessful episodes finding a suitable place I could tolerate. I made several long distance moves in 1993 and 2007, finally winding up doing a contract stint for the DOD. It was a fun run. My advice to young MDs is to get an MBA and some other training and pivot as soon as you can. Keep your license and give free advice or do direct pay. Work out of a very small office; have one receptionist. Use AI and one assistant only when you are in the office. The battle is over...they won.
I remember when healthcare was sane and heath focused back in the 1970's and early 1980's. Surgeries for HS sports injuries, professional, careful, pleasant, and no nurses that were vicious male-hating Feminists, or not to the degree they became and are after having or involving in mass murder of our babies.
Today, considering the most recent medical care needs, I will pray to God to have me die without entering another, and with His Mercy in a State of Grace and Pleasing to Him.
Quick example. in 2006 I have a near death, for which I later found myself awake and aware, but unable to move (paralyzing drug), not even to blink, with a nurse to infrequently misting my eyes, and a doctor and my wife bending over my vision area and him with a pen light in my eyes.
After a 3-day coma in IC, and waking and thinking [mistakenly] I had a car accident, and since rarely drove without my child with me, I assumed he was dead, and although those I shared my deep concern said he was not dead, at least a day passed knowing they would lie to me if need-be and so likely he was dead, eventually I starting to cry in grief to be shouted at and lauch as by the two man-better-dead vile women nurses, and so I silently cried, and at some point the doctor found me so, and did what any human with a soul should have done soon after waking from my coma and expressing my belief, he got my wife to bring my son, and seeing him was such a relief, and to this day I know if it had been my wife in IC worried about our son, that putrid male-abusing vicious women nurses would have alerted the doctor and had me bring him in.
You know, because in this vile Fem-Nazi vicious torturing hell, she would have been treated as a human should because Vag-card.
As I learned from wife later - in the ER the doctor was trying to get her to approve organ donation, and it was too near a thing that later that day I was not taken to basement OR room, and with audience of hate-filled spectators the ghouls knowing I am awake and feeling every cut, taser zap to each organ, laughing and showing me each, cutting my eyes out, .. all while awake and unable to move.
No, kill me before I go near such a Hell-Hole of Satanic Torturous demon-filled vile evil pit, kill me and burn everyone to the ground, to keep you all safe!
We are all Palestinian now, and were always, but to naive to know it.
In a nutshell: Hire moronic, non-clinical middlemen, ie "administrators", in large numbers, to make decisions based primarily on financial/ industrial "quality" parameters - divorced from any actual bedside patient care experience - and then tie their compensation directly to such cost-cutting and efficiency metrics... What could possibly go wrong...? SMH in surprise! Sincerely, a dual borded ED doc/ director of 30 + years, forced to resign for refusing the jab, after having Covid twice as a front-line "hero". You can all burn in heck, good riddance...
Thanks, Ed. I am extremely glad that you are still in the trenches not just serving the frightened and the hurting, but taking snapshots with your mind and heart and sharing those snapshots with the rest of us. You articulate what the rest of us aren't talented enough to write nor have time to say. It's always sad to me whenever I see burned out doctors or hear them leaving the profession or specialty. Yes, I've been stressed and burned out, so I understand viscerally. I don't know the fix. However, I am Pollyannaish. I would not have chosen any other profession to devote my God-given talents to. My son's an MS-3 and I hope for him a long and rewarding career as I have had.
Very soon there will be little need for PCPs. Most questions can be handled by AI. it can even recommend treatments.(screened by a PCP) ..Specialists will reign once again.
Just a few of my (additional) frustrations - my last ED employer installed Epic at Midnight on a Saturday night. I started my shift on Sunday morning at 8 am, with the ED backed up for 5 hours (it had never been backed up that much, before, in my experience). It took me 45 minutes to order meds and treatments for my first patient, an unstable CHFer. A colleague had to use Brutacaine to intubate someone as she couldn’t get meds from the Pyxis until the patient information was entered. I handed in my notice that day.
I was fired from my longest ED job (15 years) because I told an attending that I couldn’t move his patient to a bed, because every bed was filled, and patients were on stretchers in the halls, and ambulances were bringing more patients, despite our being on divert. He complained to the CEO of the hospital and I was given notice that day.
I handed in my notice in my last ED job when I was chewed out for transferring a patient who was as stable as I could make her in a hospital without any capacity to manage her problems, and nurses too new to have any idea of what to do. The week before, I had to put a chest in a attention, and no one, besides me, knew how to set things up.
I decided to retire from an ED residency I had helped to establish when the then current program chair threatened to punch me out in full sight (and sound) of the patients and staff. He had been at another program, and left there due to anger management issues.
I was thrown under the bus by the owner of an ED practice who didn’t have corporate malpractice coverage, because “it would cost me money to have a lawyer review the changes you wanted to make in your contract.”
So, yeah, I guess it’s all my fault that I decided I was a dinosaur, and concluded it’s better to retire 2 years too early than 15 minutes too late.
I'm no dinosaur, I'm 42 with 15 years as an ER doc. To be honest, I was working in probably the best set up for sanity in emergency medicine. Leaders are fundamentally decent people trying their best in a fukakta system. At the corporate level, they are focused on quality, but only metrics based quality, so doc w patients w a1c of 7.1=bad, 6.9=good regardless of QOL, other measures of health and wellbeing.
Anyway, I just haven't been able to get past how abandoned I felt during the pandemic. How we were asked to do more and more with less and less continuously for 3 years and there has been literally no acknowledgement of what we did or what we went through, or that we're all more broken than we wre before.
EPIC usually will. not go live or let anyone use it's EHR without training certification. Someone must have missed the ED.
There was “training” - 10 hours for scribes, 1 hours for physicians and mid levels. However, like in war, all planning goes out the window with the first shot.
In a nutshell: Hire moronic, non-clinical middlemen, ie "administrators", in large numbers, to make decisions based primarily on financial/ industrial "quality" parameters - divorced from any actual bedside patient care experience - and then tie their compensation directly to such cost-cutting and efficiency metrics... What could possibly go wrong...? SMH in surprise! Sincerely, a dual borded ED doc/ director of 30 + years, forced to resign for refusing the jab, after having Covid twice as a front-line "hero". You can all burn in heck, good riddance...
Sadly, I've heard several of the examples he gives.
Thank you for speaking out and trying to get legislators to understand that their committees need to talk with the doctors in the trenches, not the highly overrated administrators who are charged with making money over providing good care to patients. Reporters need to expose what is causing the exodus of doctors from practice.
In the course of the last two years of my 28 year EM career we had the owner of a multistate EM staffing company run off with all the money and neglect to pay us or our malpractice premium. The hospital CEO (a physical therapist by training) fired and walked out a partner who told dispatch to put us on divert when our coverage lapsed. We tried to for a local group but the owner of the hospital brought in a new staffing company that changed our pay from X dollars an hour 1099 to 0.67 X dollars an hour W2. We had a well staffed ER at the outset with experienced PAs - all the experienced PAs were let go because we were to precept a PA “EM fellowship” coverage went from 34 hours doc a day plus 24 hours PA to 24 hours doc and 10 hours PA. We had to sue the owner of the hospital to get back pay for shifts worked while the first group owner ran off with the collections.
Then came Covid. It’s March 15 2020 and I get a striderous 32 year old lady who I work up for PE and scope. She has a subglottic tracheal swelling that incompletely responds to steroids and antibiotics and get an ICU bed ordered. “Person under investigation “ send out Covid ordered cause her husband is a Peds resident at the local children’s hospital and has Covid patients. CMO calls and tells me to transfer her because “ID says to”
Me “ We don’t have ID “
CMO after doublespeak “well infection control. Same thing”
Me “three board certified doctors say admit this well insured patient to the ICU and she has orders and you are telling me to transfer her because a Clipboard nurse who has not seen the patient says to.
I had a pre written resignation letter in my phone and I turned around and hit “send”
I’ve been out of nursing for a little over one year, and I am so very thankful that those silly comments (summarized as, Do more with less, we feel a bit sorry but no we can’t really help it) are a memory. The contribution of government intrusion by CMS to the healthcare crisis is, in my experience, vastly underestimated. The reimbursement rates are appalling. And its far-reaching power was shown when it, through financial stipulation, forced healthcare to implement vax mandates. Covid was an awful time for healthcare all around, but that felt pretty soul-crushing.
I agree. Thankfully, I quit ten years ago after several unsuccessful episodes finding a suitable place I could tolerate. I made several long distance moves in 1993 and 2007, finally winding up doing a contract stint for the DOD. It was a fun run. My advice to young MDs is to get an MBA and some other training and pivot as soon as you can. Keep your license and give free advice or do direct pay. Work out of a very small office; have one receptionist. Use AI and one assistant only when you are in the office. The battle is over...they won.
My wife is an OTA, and she has many of the same concerns.
At 87, I can see what I am looking forward to.
I remember when healthcare was sane and heath focused back in the 1970's and early 1980's. Surgeries for HS sports injuries, professional, careful, pleasant, and no nurses that were vicious male-hating Feminists, or not to the degree they became and are after having or involving in mass murder of our babies.
Today, considering the most recent medical care needs, I will pray to God to have me die without entering another, and with His Mercy in a State of Grace and Pleasing to Him.
Quick example. in 2006 I have a near death, for which I later found myself awake and aware, but unable to move (paralyzing drug), not even to blink, with a nurse to infrequently misting my eyes, and a doctor and my wife bending over my vision area and him with a pen light in my eyes.
After a 3-day coma in IC, and waking and thinking [mistakenly] I had a car accident, and since rarely drove without my child with me, I assumed he was dead, and although those I shared my deep concern said he was not dead, at least a day passed knowing they would lie to me if need-be and so likely he was dead, eventually I starting to cry in grief to be shouted at and lauch as by the two man-better-dead vile women nurses, and so I silently cried, and at some point the doctor found me so, and did what any human with a soul should have done soon after waking from my coma and expressing my belief, he got my wife to bring my son, and seeing him was such a relief, and to this day I know if it had been my wife in IC worried about our son, that putrid male-abusing vicious women nurses would have alerted the doctor and had me bring him in.
You know, because in this vile Fem-Nazi vicious torturing hell, she would have been treated as a human should because Vag-card.
As I learned from wife later - in the ER the doctor was trying to get her to approve organ donation, and it was too near a thing that later that day I was not taken to basement OR room, and with audience of hate-filled spectators the ghouls knowing I am awake and feeling every cut, taser zap to each organ, laughing and showing me each, cutting my eyes out, .. all while awake and unable to move.
No, kill me before I go near such a Hell-Hole of Satanic Torturous demon-filled vile evil pit, kill me and burn everyone to the ground, to keep you all safe!
We are all Palestinian now, and were always, but to naive to know it.
God Bless., Steve
In a nutshell: Hire moronic, non-clinical middlemen, ie "administrators", in large numbers, to make decisions based primarily on financial/ industrial "quality" parameters - divorced from any actual bedside patient care experience - and then tie their compensation directly to such cost-cutting and efficiency metrics... What could possibly go wrong...? SMH in surprise! Sincerely, a dual borded ED doc/ director of 30 + years, forced to resign for refusing the jab, after having Covid twice as a front-line "hero". You can all burn in heck, good riddance...
Quite a collection!
Thanks, Ed. I am extremely glad that you are still in the trenches not just serving the frightened and the hurting, but taking snapshots with your mind and heart and sharing those snapshots with the rest of us. You articulate what the rest of us aren't talented enough to write nor have time to say. It's always sad to me whenever I see burned out doctors or hear them leaving the profession or specialty. Yes, I've been stressed and burned out, so I understand viscerally. I don't know the fix. However, I am Pollyannaish. I would not have chosen any other profession to devote my God-given talents to. My son's an MS-3 and I hope for him a long and rewarding career as I have had.
This NP happily retired 18 months ago. I worked in healthcare for 45 years as a nurses aid, LPN, RN, and NP. So many changes, many of them not good.
Very soon there will be little need for PCPs. Most questions can be handled by AI. it can even recommend treatments.(screened by a PCP) ..Specialists will reign once again.
Wondering what you think about future of EM docs - those that are still practicing EM as well as those who have gone into Urgent Care / other ?