Thursday, September 06, 2012

the doctor won't see you in our ER

I'm out of my ER next spring one way or the other. Can't take it any more.

To say that the morale in my department is in the toilet is to vastly understate it. The negativity is out of control and makes it a miserable place to work.

It is rundown, way too small. The hospital doesn't give a shit. All the other hospital in our "corporate system" have been redone. Ours, that sits in the middle the ghetto ER has not (no accident there - poor folks don't need a nice ER). I don't see it happening anytime soon.

My ER is an embarassment. Walls with paint scraped off. Ceiling tiles with big round wet brown spots on them. Looks dirty. Is dirty. Equipment that is an embarassment. Whatever. Been like that for many years.

Now the straw that broke the camels back. There has been a decision made that our ER will be staffed by physician assistants. They will see the vast majority of our patients, except the criticals apparently. I admire NPs. I admire PAs. I think they are great. I work with NPs. They see our urgent care patients. They don't belong in the main ER. Sorry.

I don't think ER patients, other than urgent care patients, should be seen by anyone other than an ER doc. Apparently the PAs will "present" these patients to the docs. Not good enough. No doubt will greatly slow the process.

Here's my thought about the whole process personally: When I, or my relative, come to an ER, we EXPECT to be seen by a DOCTOR. We pay insurance to be seen by a DOCTOR. I won't bring myself or my relative, needs to be seen for an EMERGENCY, to an ER where chances are they will not be seen by a doctor. I will choose to go to another ER where they will be seen by a DOCTOR. I will also choose to work at an ER that employs DOCTORs to see patients.


whisker child said...

I've been reading your blog for some months now. I have learned a great deal about the medical field from you.

It also sounds like maybe they are going to close that particluar ER?

If so, it's a good thing, you're leaving. You deserve better.

A Fan

Anonymous said...

In my er in a big city we have both mid levels. They see most of the pts who are level 3's and below. They do all the suturing. One is in triage to see pts and put orders in the computer to start the process. Do you think it's realistic for an MD to see all the uti's and vag itchies and other bs that is the meat of the er? A md for a sore throat? Really? Our docs don't ever suture, that's a mid level job.

I think you're being unrealistic in today's market. These patients are a users of the system and there isn't a need for an md to see all the level 4 and 5 crap that comes in by the bus load.


girlvet said...

I get that. In our ER the NPs see the lacs, STDs, colds, urgent care type stuff.

Here's the thing: I don't know if this happens in other ERs, but there are two groups who come to ER these days:

1) clinic users - don't need to be there at all.

2) sick patients = those who are truly critically ill and also those who are ill and have chronic underlying illnesses that make their acute problem more complicated.

I, personally, as a nurse who has been in ER for a long time, don't think PAs should take care of the
2nd group.

I didn't mention that part of this is related to the fact that our doctor group is now going to cover 3 hospitals and can't come up with the number of doctors they need.

I can also see an ad campaign coming by ERs who staff with only MDs: "Come to our ER, where you will see an actual doctor, not a physician assistant".

ER medicine is getting more and more complicated. It needs doctors. Sorry, I don't want a PA to take care of my elderly mother.

Anonymous said...

The PAs in our ER see all the level 4 stuff, and some of the level 3 stuff. Sometimes they'll start to see a patient, and then pass it off to a physician if there's a higher acuity involved. I like it that way because it ensures the physicians are more available to those who are really truly sick. But, I'm still fairly new. We will see if I feel the same way in a year or two when I have more experience under my belt.

jimbo26 said...

I'm in the UK ; my local hospital used to have an ER department which was downgraded to an Urgent Care Centre . To go to an ER , we now have to travel an extra 10 miles . My local hospital is going to be shut down and something else to be built on the site . All comes down to money .

Anonymous said...

We can want what we want, but there aren't enough doctors. Midlevel practitioners are here to stay, and docs are facing a lot of the challenges nurses have been facing for years. Somebody is going to have responsibility over those PAs like RNs have responsibility over techs and CNAs, and very little time to oversee what they do.

Mal said...

To be fair, as a nurse, you won't be going to the ER for a cough, sore throat, chronic n/s abdo. pain, possible STD, or any other of the myriad don't-need-an-ER visit crap that clogs up the system.

At my local ER there's a combined ER/minor injuries/illnesses clinic, and the triage nurse decides which you go to. Basicly, the clinic churns through minor crap without MDs. It's great for efficiency, and if the nurse or PA ID's something missed in triage, then they fast-track the patient over to the ER to see an MD.

It's great, and cuts waiting times for everyone.

Anonymous said...

I like PA's and have seen them in the ER for various reasons. However, there are some things that need an MD's attention.

Anonymous said...

Why do people go to an ER for non emergency problems? Health insurance difficulties? Poverty? Lack of local clinics in inner city areas? Lack of preventive care and education? I have worked in the medical system in the U.S., Saudi Arabia and the U.K. The problems are massive everywhere. Society does not see health care as either a human right or a priority.

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