I just worked my last shift in the ER, and I had an epiphany.
I have been living and working, for many years now, in a system which is the reverse of capitalism. Suffice it to say that because of federal law we can no longer say 'no' in the ER. Over many years this little nugget has passed into the public mind and those who would be barbarians absent a strong police presence are punishing us with no disincentive.
Unfortunately, our inability to say 'no' is now known by all the other services in the hospital, all of which (with the exception of the Hospitalists) CAN, in fact, say 'no'. Even the good old clinic docs know it and have, just today, bent me over a barrel and had their way with me. Example...
FP or IMed Doc: Hey it's Dr Beeper here... I'm sending you a patient by ambulance who needs to be admitted for something... I think they have ischemia or heart failure or babesiosis... Could you tuck them in to the Hospitalists for me?
Me: Did you call the Hospitalist, sir?
FP or IMed Doc: No.
Me: We will be happy to take care of it for you sir (per script handed down from on high).
And it is with this epiphany that I bid a way-too-late adios to the meat-grinder otherwise known as the ER. I'm done, and I do not suffer under the delusion that my problems are that important to anyone else. They are clearly not. However, when you consider that America is 50,000 boarded EM physicians short TODAY, my problem, in this particular case, will inevitably become yours. Here's how...
The hospital at which I now work is a gem. It is a community hospital with almost every specialty represented. We are a great facility. As a consequence of this, outlying hospitals have decreased their ER capabilities and out-of-county ambulance services now don't bother stopping at the local band-aid station anymore- they just drive to us. Sometimes they call ahead. Here's what's needed to bypass bumfoodle's ER... a patient request.
Now, as I leave this great facility, the ER is perpetually swamped with sick patients and not-sick patients, our hospital is often full and we end up transferring the patients from 50 miles away another 75 miles to whatever facility has beds. The beds are drying up there too.
Why is this? Because a bloated, parasitic host of administrators and paper shufflers are making a good living off our backs... can't run a hospital now and not be letter perfect with the huge governmental regulatory tome which can no longer be bound in a single large metropolitan area phone book and has to be stored on a 160GB hard drive. It is also because ER care for many is, de facto, FREE.
This is the reverse of capitalism, which would, were it allowed to function in health care, make it possible to turn a profit practicing medicine without the smoke and mirrors (and also have the salutary effect of helping people understand about taking care of themselves and get even a rudimentary knowledge of medicine). But profits are evil I'm told.
For all of you aspiring physicians, mid-levels, and nurses out there... you DO have job security, but you do not have any chance, by being excellent, of making an excellent wage or building an excellent business. They are coming with the long knives for all of you.
Twenty years ago they used to tell you in school to play sports but to have a backup plan because your odds of making a living playing sports were very slim, but I am here to tell you to lighten-up your academic pursuits... get out on the golf course or the basketball court or the football field. Pick up that electric guitar... move to Hollywood and do movies. Tinker in your basement and invent a better mousetrap. These are the last places in today's America that excellence is rewarded, and, professional sports will always be rewarded because we have become a nation of pantywaists, and pantywaists need their heroes and will not begrudge them their millions.