Saturday, August 18, 2007

The Exodus Continues

Scratch one more surgical sub-specialty at my semi-rural facility. The burden of the uninsured, the lack of a surplus of these particular surgeons in general, and on-call responsibilities have combined to drive another necessary capability out of our town. Under EMTALA we can not transfer these patients either because, while, due to our bylaws, these particular sub-specialists are not obligated to call anymore, we do technically have the service available. Therefore, accepting facilities elsewhere will be able to refuse these transfers as they can say that it is a service that we have. Well, on paper we have it, in reality we don't. The Titanic is listing and the boats are away.


  1. And yet you, as an emergency physician, are expected to meet some ill-defined attorney's creation of "standard of care" which probably expects you to arrange for prompt consultation for those patients who might benefit from the sort of expertise the absent surgical subspecialist could provide. Lacking availability of said subspecialist, assuming it were the sort of case you might be able to attempt to repair yourself to the best of your ability, you would likely be held to the same "standard of care" in a subsequent tort case as the unavailable specialist.

    That's a bad situation. Damned if you do, and damned if you don't.

  2. There are no lifeboats for ED docs. We'll just have to eat the rats that are left scampering to and fro on the floating hunks of ship that don't go to the bottom.

  3. Pick up a coffee cup and bail like hell, 911. Maybe they'll get done fixing the lightbulbs, or whatever the hell it is they're doing, before we sink all the way.

    'Cat, the rats jumped ship long ago. We're all gonna starve, my friend.

    But hey guys, some of us die-hard ER junkies will be there until the bitter end, too. We'll shoot you docs up with a B-52 when you have your psychotic break, and have a "Kumbaya" sing-a-long.

  4. I just want to be comfortably numb. I love the line from Office Space when Peter is at the "occupational therapist" and he asks if there is any way the therapist could just "knock him out for a while so he doesn't know he is at work, maybe make him think he has been fishing". When someone invents that drug, I'm first in line.

  5. Good Sunday evening on the iceberg to you, Doc.
    Scalpel said it quite well. As did Monkeygirl.