Wednesday, September 30, 2009

Endangered Species

Be it a nursing home or a pulmonologist who is 'too busy' the ER in most hospitals has become a lot like a dump.

After years of this it is, frankly, quite difficult to get 'up' for work. The United States is short, by conservative estimates, 50,000 boarded EM physicians. It is getting worse every day as more and more of us succumb to the hopelessness and leave.

In the picture above, if you look really hard, you can see a patient with a true medical emergency... buried right under the 'emergency work note' and the 'emergency narcotic refill' and the 'emergency my doctor is too busy to see me today and I was too sick to see my doctor yesterday' patients. They could pay me five times what I make now and I would still walk away.

I await the derisive comments and then will fade quietly. I'm done. Very soon.


  1. Don't you dare quit blogging!

  2. oh amy,
    there's no way i'll quit blogging... only, from now on, it won't be nearly as interesting i think... example... saw a patient today with strep throat, they paid me, i treated them, the end.

  3. They paid you? What's this world coming to? I can't believe RICH DOCTORS, like you, are actually being paid. It's against nature's(meaning congress's) design!

    Next thing you know, honest men will be winning seats in Congress, lawyers will actually start believing the constitution, academia will truly believe in academic freedom(and not the PC kind)... ect ect.

  4. For me, EM lost the luster 13 years ago and I opened an urgent care center. Life has been better since; no nights, holidays; inane nursing policies and supervisors with clipboards.

    I have an identity in the community and people come to see me, not the 'ER doc". Life is good, but it started out rough as I am running a business, too.


  5. I'm sorry to hear that, Doc.

  6. What are the difficulties in attracting people to the EM specialty?

  7. anthony,

    i would say the number one difficulty is that people thinking about going into EM now realize that it is, in spite of how the academicians classify it, truly a primary care specialty. so, wanting to do emergency medicine (take care of medical emergencies) you end up doing primary care.

    secondly, because we are not paid directly by our patients there is a huge scheme in place to shuffle money around which eventually gets to us in the ratio of about 30 cents on the dollar. to get this 30 cents on the dollar the people with the real power... the administrators and the patients... have forbidden us to ever say 'no'. as a physician, the correct answer is often 'no', and we can't say it.


  8. Good for you, beachdoc.

    And you, too, 911. My girlfriend thinks me hateful for insisting upon paying cash, or working out payments, as her heart is big and she just doesn't get that the system could also hurt other people, namely doctors.

    I want access to doctors and facilities that accept cash, or payment plans. I don't want $17,000 removed from my paycheck, every year, to subsidize people that are medical consumers, as opposed to patients. My medical expenses do not accrue to $1,000, per year, but I haven't been able to get a catastrophic-only policy with a high deductible, since the early 1990s.

    There's your problem with "health Care," right there.

  9. But isn't it an emergency that Medicare (ie, us taxpayers) should cover when a woman breaks some ribs (no broken skin, no blood inside or outside) on Saturday, calls her doc on Tuesday before her already-scheduled appointment for something else and asks him to send her for x-rays before her appt and he says no, I have to see you before I make that referral and she says, FINE! I'll just go to the EMERGENCY ROOM then and you know what else? I'm changing doctors because you're so MEAN!

  10. hey doc,
    i feel your pain. one of the uninteded consequences of EMTALA and the rise of EM as a specialty is that folks have figured out not only that they can get their care for free (if they happen to be in the proper state of impecuniosity), they can get it NOW, and because of the customer service weenies WE CAN NOT SAY NO. we are chasing our tail and the crash will be ugly.

  11. FERN (F***'n ER Nurse) here ...

    Please ... stay as long as you can! We need you ... You speak sense when it's needed ... compassion on the (rare) times it's needed ... excellence in care when it's really an emergency! I know ... it sucks ... we pay the price for Washington ... and EMTALA ... and everything else ... but we are also the thumb in the dike that keeps our communities from disintegrating!

    off my soap box .. back to work!!