DogLovingPA

SE Virginia. Currently in UC with a very generous 5K for everything, no time off. Moving to ER at end of the month with $2500 for everything, no time off (but other benefits in ER much better).

But I agree, strange not to provide the patient with some direction if you are unable (or unwilling) to help them.

This. We had a very sweet elderly pt the other day come to UC for assistance in taking off their bandage after pacemaker placement as they were too nervous to do it at home. The doc I was with at first refused to do it as we had not placed it. My coworkers are so terrified of litigation they literally were scared to remove a bandaid.

The thyroid thing is just scary and as we all know, just plain wrong medicine. What I have done in the past when the physician I am working with says something that I know is just flat out wrong and I know they won't react well to that being pointed out is approach it like I am asking for their help. So I bring them the medical evidence (from Medscape, up to date, wherever) of the correct information and word it like "I'm confused" and ask for their "help" in explaining it. I've only done this a couple times but when I have done it, I've usually been answered with "crap, you're right". Folks I have a more collegial relationship with I just talk to them like a normal person of "Actually I think that's incorrect".

Agree 100%. Especially not with that volume. It takes time to work up to being able to see 3-4 per hour and do a good job. I've been doing UC for 6 years now. 3/hr is a solid, steady day. 4/hr is pure hell. This is not the place for a new grad to start solo.

Thanks. They have recently taken over a couple EM groups here as well (SE VA). Every time I search for other jobs to see what else is out there I'm pretty disheartened.

Anyone employed by Alteon Health that wouldn't mind sharing what they are like as an employer? They have a few ER positions open around me right now. Thanks.

What others have said. I don't know where you are, but I have a NP friend who does locums work in rural KS and often admits patients to himself from the ED (ie. he is both the ER provider and hospitalist while on).

Every shift. I work in UC. We send out chest xrays in folks >40 or smokers, any worker's comp complaint and any injury related to an MVA. Otherwise we read all of our own images. For internal quality control, the clinician over reads all images done the previous day (so there are 2-3 sets of eyes put on every xray). We do have the option to send out any xray we are uncertain about but to be honest the radiology group we use sucks and I don't trust a thing they say. Lol.

In general, I work every other weekend (work the entire weekend).

Agreed. As soon as a patient tells me that their throat only hurts in the morning (or other specific time of day) I almost immediately discount strep as a possibility.

UTI - looked great. Young 9 yo female who had some increased frequency, episode of overnight incontinence. Glucose in urine, which led to finger stick. Which led to a 20 min counseling session and explanation of DM while mom and daughter cried. So while a "simple/easy" pick up and diagnosis - definitely not a simple visit or case. Fall - nope. He said he "maybe" hit his head but his main complaint was his shoulder. No neuro signs. He did have some mild periorbital ecchymosis which clearly indicated that he did hit his head but he had zero neuro complaints. Rash - appearance. I then did a CBC Kidney stone - looked fabulous, laughing and joking. My colleague saw this one. It was a good pick up. Guy thought he was passing a stone because he had dark urine. Urine was clear on our sample. A lot of people would of just discharged him after a normal UA. But that's my point - you have to have TIME to ask these questions to make sure you aren't missing anything that would lead you to suspect your patient needs further work up. Cough - had been through 3 rounds of abx without improvement. Tachy and HTN. Minimal (and I mean minimal) ankle edema. I'm going to toot my own horn on this one because this one was my patient and a good catch. She was a female in her 20's. I was following her abnormal vitals (and the fact that she hadn't improved with previous treatment). Echo was done by cardiology later in the week, EF of 20%. Leg pain - this one I missed. Ecchymosis after a fall. Apparently must have had a small puncture that was not visible on exam and pt couldn't tell me because he didn't speak English. I diagnosed a contusion. Which is probably all it was at that point. But had I discovered the puncture I would of treated it much differently. 11 days later he was admitted for extensive I&D of his leg. I mean this very kindly..... but your questions indicate your knowledge as a new grad (example, you mean an "echo" not "ecmo" and my use of petechia is a description of a type of rash, etc). It's okay, you are a new grad!! You aren't supposed to know everything. No one is supposed to know everything. Every day I am constantly astounded by the amount I don't know. Medicine is a scary world out there. And you need to learn to ask questions, dig deeper, listen to those hairs on the back of your neck. That takes time to develop and there is no other way to develop those skills except by practicing medicine. And even the best clinician still misses things. But you can't be a good clinician and see 50-65 patients a day. You just simply can't. I don't care if you've been practicing for 2 months or 20 years. Working solo is also a very bad idea right out of school. I learned things by having my supervising physicians question me at first. You need someone who knows more than you to ask you "did you consider x, y or z?" Because right now, you don't even know "x, y and z" exist.

ps. Even 50-65 patients per day for one person is not sustainable. I would not take that job for $200/hour.

What emedpa just said. That sounds like a place you do not want to work.

Run. And run fast. That volume is insane and a terrible idea. It is unsafe and you will hate your life. I saw 62 the other day in 12 hours (not my norm, just a shitty co-worker and an insane flu season) and I wanted to die. And I've been doing this 5 years. Going that fast you WILL miss something. The more I think about it, I don't even know how it is physically possible to see 70-100 patients in a day (even a 12 hour day). I agree with emed on 3-4 an hour but even at 4/hr that means 48 patients/12 hours and a day like that in UC is a BUSY day. Too many of those days in a row and I start to question my life choices and my sanity. A new grad should be more at 2/hour. I also work in an UC where in general things are pretty low acuity but that doesn't mean bad things don't walk through that door. Just off the top of my head in the last couple weeks (not all mine, but seen at our UC): "UTI" = new onset DM I in a kid "Fall/shoulder pain" = clavicular fracture and a left temporal fracture with SAH and subdural "Rash" = petechia with platelet count of 9 "kidney stone" = rhabo with K 6.7 "headache" = SAH "sore throat" = PTA "cough" = heart failure "flu" = any number of things that aren't the flu including sepsis, pneumonia, AMI "leg pain" = tibial abscess