We've all seen them. We all know who they are.
They all know who they are!
You see his name next to yours on the schedule, working alongside you, and you groan. Actually, sometimes you scream. Maybe you'll even try to switch your shift, using the excuse that you have to take your kids somewhere. Maybe you'll just happen to fall ill that day.
Yes, I'm talking about that wonderful emergency physician, the one who's been doing it for years. The one who sees patients at the whopping average rate of 1 per 90 minutes. Yet, he seems oblivious to the frustration he's causing. He smiles, apparently without reason, and is just so amazingly harmonious and agreeable to everyone. The secretaries like him. The nurses like him. Even his patients like him. Wouldn't you like your ER doc if he was able to pull a chair up and take the most detailed history you have ever had any physician take from you?
Those same ER docs are the ones who are fully aware that "they're going to have to kick me outta here, kicking and screaming, coz I aint leaving on my own." Yes you know who they are.
These doctors are the ones who inspire discussion about RVUs, and about productivity bonuses. These guys are often described as "well he's such a nice guy, but he's just so God awful slow". Whenever you work alongside him, the nurses repeatedly come up to you to see their critical patients, yet unassigned to a physician, even though you have 10 patients and he has 3.
Hell, the nurses will even come up to you for help with his patients!
So you either suck it up, or you do something about it. But what can you do? Can you complain to anyone? What can the medical director do? What can the nurses do? For that matter, what can the 'Nice But Slow' (NBS) doc do?
Occasionally, a petition from the nurses to the CEO may lead to a dismissal in such a scenario. But how likely is that, given he's just SO DAMNED NICE and actually quite a pleasant person to chat to. How can you possibly conspire to have someone fired who actually greets you with such a nice smile whenever you start your shift?
The medical director, I suppose, could tell the NBS doc to "speed up, or else". Or else what?
He's usually in his fifties, but he might even be in his thirties. There's no typical profile, except that he's always nice. The strange thing is, it's the fast docs who are not always so harmonious and pleasant. Maybe because they're so busy. Maybe because they get paid the same as the NBS doc but do 4 times as much work. Maybe because they consequently expose themselves to 4 times the medicolegal liability, and it's just getting old. Also, even though he's fast, there might be several nurses and other coworkers who would love to see him go. He makes them "work too hard" because he's constantly asking them to call physicians, put orders into the computer and get EKGs, orthostatics and blood sugars, at every opportunity. The coworkers just think he's a freaky stressed out guy, simply because he's carrying the workload. How interesting.
Mind you, there are some fast docs who are actually quite pleasant and all smiles. They have discovered the 'best of both worlds'. Be liked by your co-physicians as well as your other coworkers, as well as your patients. Is it such a tightrope? Is it such a big juggling act? Well, of course it is, but I do believe it's possible.
Providing quality, with quantity, as well as having a great spirit about, that is, being harmonious and agreeable and acting like you're enjoying your work, is actually possible.
So, getting back to Dr. NBS. What can we do about him? Short answer: nothing. Absolutely nothing. Let nature decide what happens to him. You just firmly plod along, doing your own thing, at YOUR own pace, no matter how fast or slow that may be, and do the very best for your patients. Don't be tempted to join in when people make comments about how slow Dr. NBS is being. Just let it slide and do your own work, and do it well.
That's all that matters.
So take it easy. Go to work. Smile. Enjoy yourself. Work like a Ferrari - fast and stunning, and nice to hang out with. Don't work like an old vintage classic, also nice to hang out with, but pretty darned slow. That's quaint, but practically useless in a modern emergency department.
As my Mom always says "You be good", and don't worry about the other guys.
Monday, April 23, 2007
Wednesday, April 11, 2007
Another day - another blog...
I was reading ACEP News (the March 10th issue, which reached my remote home in St. Louis, yesterday on April 10th) about the proposed merger between AAEM and ACEP.
This is rather an exciting development. Does it mean that AAEM, who proposed the merger, will finally abandon their ideology that only those ER docs who did ER residencies should be working in the ERs? Perhaps they have finally realized that such an ideology cannot possibly be consistent with:
Anyway, the important thing is unity. All Emergency Physicians must be treated equally if they are 'core competent'. They do not have to be board certified, but if they are, they should be praised. There should be no antagonism against ABEM or BCEM, just because people belong to one group or another. There should be universal embracing of all cloths, and all types of training, whether it is in a supervised arena or an unspervised 'in-the-field' arena.
The important thing is core competencies. AAEM may finally be realizing this and that they are doomed if they do not merge with common sense - that is - merge with the majority - that is, ACEP.
Well done AAEM, for being able to see beyond your outdated ideologies.
Sonny
This is rather an exciting development. Does it mean that AAEM, who proposed the merger, will finally abandon their ideology that only those ER docs who did ER residencies should be working in the ERs? Perhaps they have finally realized that such an ideology cannot possibly be consistent with:
- staffing all the emergency departments in the USA
- providing adequate emergency medical care to all our patients
- practising good medicine, because a certain training (any) does not equal core competency
- long-overdue unification of all ER docs
Anyway, the important thing is unity. All Emergency Physicians must be treated equally if they are 'core competent'. They do not have to be board certified, but if they are, they should be praised. There should be no antagonism against ABEM or BCEM, just because people belong to one group or another. There should be universal embracing of all cloths, and all types of training, whether it is in a supervised arena or an unspervised 'in-the-field' arena.
The important thing is core competencies. AAEM may finally be realizing this and that they are doomed if they do not merge with common sense - that is - merge with the majority - that is, ACEP.
Well done AAEM, for being able to see beyond your outdated ideologies.
Sonny
Tuesday, April 10, 2007
Sitting around waiting for a new patient? Really?
It's a funny state of affairs.
You want the hospital to do well, really well, so that it's financially better-off, it develops a great reputation, or maintains it if it already has one, and perhaps even ups your pay a little. At the same time, you don't want too many patients. You don't want to work too bloody hard, or else it won't seem worth it.
Some departments have come up with methods to reward productivity amongst emergency physicians: bonuses based on number of patients seen, RVUs, and other methods which are largely based on one's CV rather than on how hard one actually works. I guess you're getting paid for having studied a few years earlier!
Tic, tic, tic, the clock advances rather slowly when one is waiting for something to do. So we sit and wait for patients, and write blogs like this one, or we work our asses off and go home and complain how hard we're working! If we sit and wait too long for a patient, like my buddy Jeff who works in a 3,000 census ED in the middle of Nowheresville, TX, then one runs the risk of atrophying those procedure lobes in the brain. But then, isn't riding a bike, essentially a procedure?
Oops, the CEO just walked through the ED and saw me typing. I didn't minimize my screen, and wow, he smiled and just walked out, probably under the impression that I'm hard at work or something. Oh well, I can just say this blog was pure fantasy and bears no reflection in reality whatsoever. Or maybe someone else was using my name and blogging away..
I love some busy shifts. The ones where you don't even have a chance to check your email or call your wife. When all the patients have something genuinely wrong with them. When no drug-seeker seems to be awake or they managed to lose their way to your particular ED. When all the specialists are extremely responsive and appropriate. When all the nurses are so hard-working, you find yourself realizing how lucky you are to be a doc, while not doing all the really hard work that nurses have to do. When the team works smoothly, and every patient seems to have a good outcome, and all the ED staff are all smiles. When your cohort is pulling his weight and seeing as many, if not more, patients as you are.
Yes, those shifts are great. Those are the shifts that make you think your work is easy and that you you might even be overpaid.
Although it is nice to have that occasional shift when you can read a good book, chat with coworkers and catch up with what's going on in their lives, or just surf the net. It doesn't last very long though.
So, even though there are those shifts, like this one, where nothing could be described as actual 'work', it does seem that I'm working all the time. I should rephrase. It does seem like I'm away from my wife and kids all the time.
Perhaps that's the modern definition of work: when you're not with family. I don't subscribe to the 'when you're not having fun' definition, because I believe that work can be fun.
So you're an emergency physician, knocking around 40 or 45 years old, and you're wondering what's happening for the next 15 years. Is this it? Should I write a book? Should I start a business? Should I invest in the stockmarket or real estate? Should I become an internist? Hmm. Why do we have these questions?
Well quite simply, because we know, deep down, that we're not going to be Speedy Gonzalez the ED doc forever. We're gonna get older and slower and possibly even crabbier and more cynical. Or maybe we'll always have a pleasant disposition, while the new kids on the block are running rings around us, and mumbling behind our backs how slow we are, just like we're saying about the old chaps these days. What goes around comes around.
Perhaps, because we all believe in the karma of such back-biting, we don't want to stick around long enough to have such talk commence about us... That's probably it.
So what should we do instead of this job? What? Really? You're just sitting around waiting for a new patient? Well that sounds a lot like retirement to me already. What a life!
You want the hospital to do well, really well, so that it's financially better-off, it develops a great reputation, or maintains it if it already has one, and perhaps even ups your pay a little. At the same time, you don't want too many patients. You don't want to work too bloody hard, or else it won't seem worth it.
Some departments have come up with methods to reward productivity amongst emergency physicians: bonuses based on number of patients seen, RVUs, and other methods which are largely based on one's CV rather than on how hard one actually works. I guess you're getting paid for having studied a few years earlier!
Tic, tic, tic, the clock advances rather slowly when one is waiting for something to do. So we sit and wait for patients, and write blogs like this one, or we work our asses off and go home and complain how hard we're working! If we sit and wait too long for a patient, like my buddy Jeff who works in a 3,000 census ED in the middle of Nowheresville, TX, then one runs the risk of atrophying those procedure lobes in the brain. But then, isn't riding a bike, essentially a procedure?
Oops, the CEO just walked through the ED and saw me typing. I didn't minimize my screen, and wow, he smiled and just walked out, probably under the impression that I'm hard at work or something. Oh well, I can just say this blog was pure fantasy and bears no reflection in reality whatsoever. Or maybe someone else was using my name and blogging away..
I love some busy shifts. The ones where you don't even have a chance to check your email or call your wife. When all the patients have something genuinely wrong with them. When no drug-seeker seems to be awake or they managed to lose their way to your particular ED. When all the specialists are extremely responsive and appropriate. When all the nurses are so hard-working, you find yourself realizing how lucky you are to be a doc, while not doing all the really hard work that nurses have to do. When the team works smoothly, and every patient seems to have a good outcome, and all the ED staff are all smiles. When your cohort is pulling his weight and seeing as many, if not more, patients as you are.
Yes, those shifts are great. Those are the shifts that make you think your work is easy and that you you might even be overpaid.
Although it is nice to have that occasional shift when you can read a good book, chat with coworkers and catch up with what's going on in their lives, or just surf the net. It doesn't last very long though.
So, even though there are those shifts, like this one, where nothing could be described as actual 'work', it does seem that I'm working all the time. I should rephrase. It does seem like I'm away from my wife and kids all the time.
Perhaps that's the modern definition of work: when you're not with family. I don't subscribe to the 'when you're not having fun' definition, because I believe that work can be fun.
So you're an emergency physician, knocking around 40 or 45 years old, and you're wondering what's happening for the next 15 years. Is this it? Should I write a book? Should I start a business? Should I invest in the stockmarket or real estate? Should I become an internist? Hmm. Why do we have these questions?
Well quite simply, because we know, deep down, that we're not going to be Speedy Gonzalez the ED doc forever. We're gonna get older and slower and possibly even crabbier and more cynical. Or maybe we'll always have a pleasant disposition, while the new kids on the block are running rings around us, and mumbling behind our backs how slow we are, just like we're saying about the old chaps these days. What goes around comes around.
Perhaps, because we all believe in the karma of such back-biting, we don't want to stick around long enough to have such talk commence about us... That's probably it.
So what should we do instead of this job? What? Really? You're just sitting around waiting for a new patient? Well that sounds a lot like retirement to me already. What a life!
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