Why I love rural EM

[ohiovolffemtp]

Klenzalac from Zerowet:

(the top one)  is my go to

 

[ApolloPAS1]

Hello! I come to this forum alot because I see your replies to people and they are always very educational. I am really interested in EM also but I do not know what kinds of places I should be applying to job wise that will give me the support and room to grow as a clinician.

If I want to do lots of procedures and learn how to be as competent as you would you recommend a big hospital? rural? city? residency?

I'm worried working in a hospital the residents may take away a lot of my chances to grow and I want to be pointed in the direction on where you'd say a PA can grow the most? 

[EMEDPA]

start at a community hospital without residents and then go rural after a few years. 

[LT_Oneal_PAC]

1 hour ago, ApolloPAS1 said:

Hello! I come to this forum alot because I see your replies to people and they are always very educational. I am really interested in EM also but I do not know what kinds of places I should be applying to job wise that will give me the support and room to grow as a clinician.

If I want to do lots of procedures and learn how to be as competent as you would you recommend a big hospital? rural? city? residency?

I'm worried working in a hospital the residents may take away a lot of my chances to grow and I want to be pointed in the direction on where you'd say a PA can grow the most? 

Residency is the fastest way, definitely. In my opinion it’s the best way, but that depends on what’s important to you.

[ApolloPAS1]

8 hours ago, LT_Oneal_PAC said:

Residency is the fastest way, definitely. In my opinion it’s the best way, but that depends on what’s important to you.

Hello! Would you be able to elaborate on what you mean by what’s important to me? Do you mean the lower pay of residency?

[LT_Oneal_PAC]

@ApolloPAS1

you have to be willing to move to where there is a good residency, willing to take lower pay, willing to work more hours, willing to go through hoops, all at least for at least 12-18 months. Most, not all, of the good EM residencies are 18 months.

[ohiovolffemtp]

When the wind gusts are 40+ MPH and you can't fly anyone out, this shows up at our ambulance bay:

 

 

[GetMeOuttaThisMess]

That sir is a misplaced welcome from West Texas.  Usually accompanied by sand and red skies (and eyes).

[EMEDPA]

you can't make this stuff up: first pt of my shift today arrived via EMS for accidentally mixing his fentanyl with fuel injector cleaner instead of water and injecting it. Poison control not impressed. apparently it was just rubbing alcohol. 

[EMEDPA]

Working hard...13 entrant single elimination tournament with brackets and money to the winner

[ohiovolffemtp]

Or when the local movie theater brings its unsold popcorn to the ED:

 

 

[PAtoMD]

3 hours ago, ohiovolffemtp said:

Or when the local movie theater brings its unsold popcorn to the ED:

 

 

That looks incredible. My odd craving is day old movie theatre popcorn. 

[ohiovolffemtp]

It's now 2 day old, but you're welcome to come to Trinidad, CO and have as much as you like.

[DaPAGypsy]

Love this! Solo ER/Hospitalist in NY and ND here! Love the gig, and could tell you tons of stories. A few of my friends, and I have been look at broadening our resumes with some more areas haha. Does anyone know states that allow solo long shift practice? I currently do 24s in NY, and a week straight (168 hrs) in ND. 

[EMEDPA]

On 1/1/2023 at 7:04 AM, DaPAGypsy said:

Does anyone know states that allow solo long shift practice? I currently do 24s in NY, and a week straight (168 hrs) in ND. 

WA, MT, IA, KS. ND, SD, NE, AK, WY, NY, VT, ME, NH, MI, GA to start. If you are looking to do solo/rural in WA, send me a PM. 

[Boatswain2PA]

And sometimes rural ED sucks.  Like when you have to tube the 2 yo with massive tonsils due to respiratory depression from overdose after getting into parents recreational $hit.  Just a little bit of stress there.    Then have a wonderful elderly lady, very well known to the community, come in with massive stroke with NIH of 33, not managing secretions, easy intubation after discussion with family who said she wouldn't want to be on a vent but they acquiesce since her LKW was 2 hours ago, CT head shows likely acute MCA, takes 2 hours to get accepting doc because everyone is on closure, and then another hour to get flight crew here.  CTA showed complete ICA occlusion.   Then have combat wounded vet come in talking to us, and within 4 hours he goes to comfort care to declared.  Then another wonderful elderly lady, also well known to community, come in talking to us and takes the slow decompensation route to comfort care and passes. 

Then a young lady with chief complaint of "I think I have a uterine prolapse".  Who knew that one could get angioedema of the labia minora?  I didn't....just glad that suspected "uterine prolapse" wasn't a baby coming out.

Meanwhile I'm sitting on a NSTEMI for 15 hours because everyone is full, and transport is full taking everyone else everywhere else.  Nitro and heparing gtt's manage to get his troponin trending down, so that's something.

Here's hoping the rest of the year goes better than the first day...

Edited January 4, 2023 by Boatswain2PA

[EMEDPA]

Welcome to my life. Currently holding 6 boarders, 3 waiting for nursing home placement that will never happen and 3 bat$hit crazy psych patients who should never see the light of day again (think homicidal maniacs) who will be released by psych when the meth and alcohol are out of their systems. Oh, and waiting on a transfer to Idaho for an ERCP for a crashing pt with ascending cholangitis and a retained pancreatic ductal stone because there are no ICU beds with GI within 1000 miles of here. . Some folks call it hell. Around here we call it tuesday. 

[ohiovolffemtp]

That's one of the worst things of working in small communities, even if you don't live there.  Your patients are often folks you know and it hurts when bad things happen to them.  The only consolation is that often the families feel better because the patient's care came from someone they know and whom they know cares.

[EMEDPA]

5 hours ago, ohiovolffemtp said:

That's one of the worst things of working in small communities, even if you don't live there.  Your patients are often folks you know and it hurts when bad things happen to them.  The only consolation is that often the families feel better because the patient's care came from someone they know and whom they know cares.

Indeed. My CT tech just had to call in someone else to do a study because the patient was a close family friend with a new terminal dx and she could not handle it. 

[Boatswain2PA]

On 1/4/2023 at 5:38 PM, ohiovolffemtp said:

That's one of the worst things of working in small communities, even if you don't live there.  Your patients are often folks you know and it hurts when bad things happen to them.  The only consolation is that often the families feel better because the patient's care came from someone they know and whom they know cares.

Yeah, reading the posts over at SDN about EDs being on fire.  Wow!!

The "big" place I work at has nothing on what the big cities are seeing.  Wow!

[CAdamsPAC]

On 8/6/2022 at 4:59 PM, EMEDPA said:

You know you work at a rural hospital when you have 2 unrelated pts on your tracking board with a c/o "stepped on by cow". Great, we have a serial stomping cow in the community. 

When you get called in over the weekend to treat a Sea Lion bite you are out in an Aleutian fishing village!

[CAdamsPAC]

On 1/1/2023 at 10:04 AM, DaPAGypsy said:

Love this! Solo ER/Hospitalist in NY and ND here! Love the gig, and could tell you tons of stories. A few of my friends, and I have been look at broadening our resumes with some more areas haha. Does anyone know states that allow solo long shift practice? I currently do 24s in NY, and a week straight (168 hrs) in ND. 

I've worked multiple contracts in AK & MT where I was the only provider on site for days to weeks on end!

 

[EMEDPA]

Have been doing solo coverage at 5- 11 bed facilities for more than 20 years now. Doing my first solo overnight at one of my regular double coverage jobs in a few days. 17 beds. They can't find a doc to cover a bunch of shifts after a few retired and a few quit so myself and one other PA have been cleared for solo coverage. They started with offering 3rd yr EM residents the shifts and they took a few, leaving a handful completely uncovered. We are getting a significant bonus for this, equivalent to about 1.5x regular rate

[EMEDPA]

So shift is almost over. Just caught up. Started with a rapid response on the floor for a pt who needed bipap, followed by a peds code and a fairly sick DKA pt. We worked the peds code for 2 hrs. Every rhythm in the book. intubated , central line, 2 finger thoracostomies for good measure, 2 pressors, pacing, you name it. A few brief episodes of ROSC, but poor eventual outcome. This one was rough. 

[SedRate]

5 hours ago, EMEDPA said:

So shift is almost over. Just caught up. Started with a rapid response on the floor for a pt who needed bipap, followed by a peds code and a fairly sick DKA pt. We worked the peds code for 2 hrs. Every rhythm in the book. intubated , central line, 2 finger thoracostomies for good measure, 2 pressors, pacing, you name it. A few brief episodes of ROSC, but poor eventual outcome. This one was rough. 

Man, that's a rough shift.