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Why I love rural EM


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as many of you know I work 1 weekend/mo at a rural/critical access hospital about 3 hrs from my home. in my 2 shifts/mo at this facility I see more high acuity/sick/elderly/trying to die patients than I do in my other 15-16 shifts/mo at a busy urban trauma ctr.

I work double coverage with a doc here and alternate charts from the same chart rack. the pace is a bit slower than a busy trauma ctr so I can spend more time with folks and feel like I am delivering better care at 1-2 pts/hr than at 3-6 pts/hr.

the er docs are all great to work with and wonderful teachers. the in house hospitalist/intensivist is always good for a quick consult and never refuses an admission or makes me work up patients with ridiculous tests which change nothing like the hospitalist group at my home facility does with almost every admission.

we had an ugly shift yesterday so the doc on today put on a bbq at his expense for the whole dept right in the ambulance bay.

on top of that it's a small town so after 4 yrs of per diem work here everyone knows me. the hotel I stay at knows what room I like and when I call for a reservation the owner recognizes my voice before I say who I am. the local bartender knows my beer of choice( kona wailua). the local restaurant not only knows what I like to eat but stays open late for me to feed me if I show up right around closing time. unfortunately the schools here totally suck or I would be tempted to move down here full time. maybe when the kids go off to college.....or maybe I can talk my wife into moving to a similar practice in maine or vermont....

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EMEDPA,

 

I've lived in a small town for about 10 years now, and I am yearning for the day when they begin using PAs in their ED. I've stayed active as an EMT on my home ambulance service even through PA school so that I will have a good relationship with all the docs there such that my name is at the top of their list when they make the transition. I can feel it coming and I'm hoping for it because of all the reasons you just cited. The bigger EDs in the area (which are in cities 30+ miles away) are appealing, but IMO Dorothy had a point - there's no place like home.

 

Andrew

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EMDPA

 

there might be hope for my long term ER career after all

 

I managed to make about a year in an ER which I was glad to leave with out killing someone or getting sued.... sort of destroyed the ER field for me but I LOVED the delivery of care and the medicine...... reading your post makes me realize that there might be hope in the long run if I decide to return to ER medicine by very carefully choosing the ER I go to - your description of job and working in a small town was inspiring! thanks for sharing!!

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Definitely sounds like a job someone would fall in love with! I'm in a similar situation with kids/school/etc but my husband promises we can move anywhere I want when they graduate (3 & 9 more years). We'll see if I still have the drive to get out of town by then...

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Town and surrounding area approx 10,000 folks.popular retirement/vacation destination.

er volume varies 20-60/day skewed towards elderly folks. I can go a whole shift and see no one under 70.

4 trauma bays with 8 beds total.

24/7 er doc, pa's swing only.

in house hospitalist/intensivist.

ortho and surgery on call on alternating days. ob on call variable. all other specialties not locally available.

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I'm with you 100%, it's a great place to be a student too (I'm about 3 hours east of you in a similar set-up).

Doc hands me the chart, I go see the pt, my work-up and orders get a nod and a co-sign (most nurses get them cooking beforehand), when it's slow we go over procedures or cases, go do home visits at nursing homes, or I go hang out with anesthesia. Everyone knows your name and will call you over to help with something interesting. Nurses bring in eggs, berries, etc from their farm and everyone will tell you about their horses. Plenty of eldery (we call them pre-hospice) patients to go around, my doc's joke is his typical patient: little old lady of 80, best peak flow of 80, SBP of 80, BUN of 80, TSH of 80, O2 stat of 80......

 

It's pretty amazing how underserved the fragile elderly are in some of these rural areas in our state. I would love to practice out here but it's going to take some coaxing for the significant other to get on board.

 

Love the rural EM, great place to be a PA!

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Our local pharmacist cracked me up the other day. She needed to ask me a question regarding a script and was unable to get a hold of me at work. She called my cell phone, which I didn't have on me, so she called my wife's cell phone. I was standing right next to her and my wife just handed me the phone. Small town folks are fun!

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Our local pharmacist cracked me up the other day. She needed to ask me a question regarding a script and was unable to get a hold of me at work. She called my cell phone, which I didn't have on me, so she called my wife's cell phone. I was standing right next to her and my wife just handed me the phone. Small town folks are fun!

 

I was working in our little satellite ED last month, and one of the other PA's on was talking to a pediatrician about a couple of her patients in the ED; before hanging up, she announced, "does anyone else need Dr. **** ?". I jokingly said yes, my daughter needed a refill on her fluoride drops. 10 minutes later, she called back to let me know that the prescription was all set at our local pharmacy! Sometimes I love working in a small community; it's not often in the city I end up speaking with my kid's pediatrician on a daily basis :)

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Just curious how small is small? I am doing locum work in a small ER, town of 3000 people, average shift of 6 people/day.

 

Small is smaller than us. Fifteen in-patient beds with 3 clinic docs (2 FP and 1 IM) and myself rotating in-patient call, no ICU, no specialty services except part-time ortho and working on locum general surgery, mostly teleradiology. Like others have posted many are older with high percentage of co-morbid disease plus large seasonal influx of tourists who come to the beach to do stupid things that they would be embarrassed to do at home sober or not. I have had to treat my in-laws and family when no other providers are in town (i.e. DNR form for my mother-in-law). On the other hand to go to school/community events and have kids wave and say hi is great. I can’t imagine a big city practice.

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It is great to hear everyones positive experiences with rural medicine. My wife is pre-med and I, of course am pre-pa. We have the intentions of settling down in rural medicine, hopefully in the mountains of CO. Keeping our fingers crossed. I grew up in a small town north of Kansas City, MO and it was very much like most of you describe. Great place to raise a family. Looking forward to getting back to those days again.

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It is great to hear everyones positive experiences with rural medicine. My wife is pre-med and I, of course am pre-pa. We have the intentions of settling down in rural medicine, hopefully in the mountains of CO. Keeping our fingers crossed. I grew up in a small town north of Kansas City, MO and it was very much like most of you describe. Great place to raise a family. Looking forward to getting back to those days again.

 

It would be interesting the dynamics of your practice when all the school is done. Will your wife be your sponsoring physician? That would seem to add a twist to not only your practice but your marriage.

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It would be interesting the dynamics of your practice when all the school is done. Will your wife be your sponsoring physician? That would seem to add a twist to not only your practice but your marriage.

 

I told her that I would want a hospital near where I could work. Her brother-in-law just finished residency in rural medicine and he was heavily recruited by hospitals. Assuming my wife will be the same, I don't think we will have to worry about the sp/pa relationship. We talked about it though. As much as we love each other...It would probably be best we not have a working relationship. Now to think about it, not sure if there would be a conflict of interest if she did happen to be my sp. Anyone know if that would be a problem or have any experience in that realm?

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  • 7 months later...
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more per diem rural stuff:

walked into my favorite local restaurant last night. owner sees me, calls me by name and hands me a new(free) t-shirt they just created with the restaurant logo and hands me a free beer because I am a regular loyal customer.

low volume/high acuity today(my favorite):

teenager with meningitis

chainsaw vs knee

hhnk, blood sugar 1200, k=7

alcoholic ketoacidosis, ck=30,000, hypohtermic, hypotensive found down by friends after no contact x 4 days

95 yr old svt after ingesting grandkids stash accidentally....(it was in baked goods.....)

couple h/a's and minor lacs, a few crazies, etc

it's so nice being able to see 1-2 pts/hr and really work them up well as opposed to turfing them to the hospitalist to make room for the next one at a rate of 4- 6/hr like at my regular job.

if they had a full time job I would be tempted to take it....

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Emed, it sounds a lot like my spot, exactly, actually. Swap the charts and they make me take the cases i try and avoid haha. And yup, gettin known in 'town' (here I live is about 300), 8000 in town (the sheriffs all wave to me). Same, one Doc and a NP and I alternate the swing ... guess who brought the better books lol oh now im teasing ... I brought better books than the docs lol .. life is learning! And I still have a lot to learn as well. One of my Peds preceptors had worked for 40 years yet said she knew but a drop in the bucket.

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  • 11 months later...
working my rural job today.

in the waiting room we have:

"ate squirrel raw, now chest pain"

"rat bite"

"hatchet wound"

 

1, 2, or 3 separate patients? Because I totally see skarfing down a squirrel quick like before the rats get to it, but you need to defend your food from those filthy vermin and a hatchet makes a fine rat killer...unless you miss.

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1, 2, or 3 separate patients? Because I totally see skarfing down a squirrel quick like before the rats get to it, but you need to defend your food from those filthy vermin and a hatchet makes a fine rat killer...unless you miss.

separate pts....he ended up being mostly psych...did get a chest ct to eval for PE and security had to go with him because he was getting...you guessed it....squirrelly....:)

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