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Best surgical lifestyle?

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  • CordMcNally CordMcNally 
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    If a patient you get on group call requires urgent intervention the patient can be sent to the ER. At that point whoever is on call for the ER has an obligation to manage it, at least acutely, regardless of the group affiliation of the surgeon covering the ER, even if someone else has established care with or even already operated on the patient.

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    If it isn’t emergent, I would be calling your group since the patient is established with you. Actually, even if it is emergent the established group would be my first call. If your group doesn’t want it, I would have a discussion with the patient, and the group covering the ED would likely get a new patient while your group loses a patient.

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    Zaphod Zaphod 
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    If a patient you get on group call requires urgent intervention the patient can be sent to the ER. At that point whoever is on call for the ER has an obligation to manage it, at least acutely, regardless of the group affiliation of the surgeon covering the ER, even if someone else has established care with or even already operated on the patient.

    Click to expand…

    If it isn’t emergent, I would be calling your group since the patient is established with you. Actually, even if it is emergent the established group would be my first call. If your group doesn’t want it, I would have a discussion with the patient, and the group covering the ED would likely get a new patient while your group loses a patient.

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    Thats what I would want, I dont want anyone operating on my pts and I want to be notified asap about any issues they have. But my call is pretty light so maybe it would be different if I were getting crushed or something.

    #215989 Reply
    abds abds 
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    “The sad thing is how fast you must decide on a path. Seems like you have less and less chance to observe before deciding.”
    Year 3 scheduling of rotations greatly impacts the residency applications. It’s ready, shoot, aim. Factor in the personalities of the attending and residents on that rotation, it’s kind of aiming with a blindfold.
    Probably the weakest link in med education. Data based decision making? Really? But, it seems to work.

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    Agree. The lack of exposure to a variety of fields before choosing a career is crazy.

    #216000 Reply
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    abds abds 
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    You would send one of your partner’s patients to the ER to get managed by someone from another group?

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    No. I wouldn’t. But if you don’t think that happens all the time then you must not take call at a tertiary center where it happens ALL the time. I don’t agree with it, I don’t think it’s the right thing to do, I don’t do it, but it’s the norm.

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    “I’m sorry, you said this was Dr. X’s patient? I’d call the person taking group call for him/her.” I’ve taken care of someone else’s postop hip dislocation one time, and that was only because I was standing right there in front of the patient when I found out who did the surgery. ED doc was a locums person not in touch with the local groups. I was too new to realize I had already missed the “Is this your problem?” fork in the algorithm. I had already spent my time, so I just took care of it. Not gonna fool me twice though.

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    Yes I agree the operating surgeon or his group should be called and ideally would manage. But if they would have said “no” for any reason (maybe its a weekend and the surgeon doesn’t want to come in, maybe he’s out of town and his hand partner is on group call and doesn’t want to do it, or maybe its a periprosthetic fracture and the hand guy doesn’t feel comfortable doing it), if you were on call for the ER then you would be responsible for it at least to “stabilize” per EMTALA. Which is federal law. For a hip dislocation that would probably mean reducing it at some point.

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    But you definitely need inpatient privileges, regardless of sub-specialty. I have them at multiple hospitals I don’t operate at; since my partners do and group call being what it is, there is a chance I could. Not to mention rounding if that’s your setup.

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    2 of my 4 hand partners don’t have inpatient privileges. The only reason in hand to have privileges is to take hand call. 4/5 sports partners don’t have inpatient privileges, the exception is the guy who does a lot of shoulders replacements, and also wants complex knee consults from the trauma guys. 1/2 of my foot and ankle partners don’t have inpatient privileges. 1 of my joints partners doesn’t have any privileges at any facility except the ortho hospital (which is for elective cases only and doesn’t have an ER).

    Now I realize some of this is unique for me anyway because 1) none of the hospitals I work at require call from surgeons on staff, and 2) my trauma partners cover 100% of the ER call in town at all 3 major hospitals. So if I send something to the ER while I’m on group call, I’m still sending it to my group, its just me sending it to the guy in my group actually getting paid to be on call.

    Maybe I should stop arguing that ortho lifestyle can be great. Maybe I should let everyone believe I work 80 hours a week and don’t see my kids, if that will help the medical community justify my income then I’ll do my best to maintain the façade.

    #216006 Reply
    Avatar akatsuki 
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    Status: Physician
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    Joined: 10/31/2017

    I can give you one opinion from POV of an anesthesiologist currently at a non-trauma hospital. Obviously I have little insight as to how much non-surgical management they have to do after hours. Most services have PAs/residents for floor calls though.

     

    Tier 1 (more favorable lifestyle):

    Plastics – Rarely see them nights/weekends. When we see them for call cases it’s usually for hand stuff. Long free flap cases can go late as scheduled cases.

    Urology – Usually septic patients who need stents or bleeding tumors. Quick cases for the most part and I have never seen them come in late at night.

    ENT – rarely see them in the OR on call, but they’ll for sure get calls for trach management and the occasional angioedema. Good chance of high acuity when they do have to come in.

     

    Tier 2:

    Ortho – In terms of frequency in OR, they are 2nd after Gen Surg. Majority of cases being hip fractures with some other inpatient washout/open fractures sprinkled in. Quite unusual to see them late at night.

    Thoracic – Don’t see them in the OR too often, but usually smaller group so coverage frequency is higher (lots of variability – obv being q1 call would be detrimental to lifestyle).

     

    Tier 3:

    Gen Surgery – by far the most unscheduled cases and will occasionally operate until close to midnight, rarely all night but it does happen. Cases tend to be shorter so that’s a plus.

    Vascular – From a case quantity standpoint, they are much closer to the ones lower on the list than above. However, their cases tend to be sicker and longer.

     

    Tier 4:

    Neuro – Sick patients, longer cases, good amount of floor management, decent potential for middle-of-night emergencies especially if they dabble in Neuro IR as well.

     

    Tier 5:

    Cardiac – Unscheduled case volume can be rough, some take-back potential as well. Often small group/frequent call, longer cases with longer set-up, plenty of floor management.

     

    Tier 6:

    Transplant – It’s a miracle there are any transplant surgeons.

    #216021 Reply
    Avatar Kuratz 
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    Where do you suppose IR falls in all this?

    #216049 Reply
    Avatar jacoavlu 
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    Where do you suppose IR falls in all this?

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    Depends if it’s a trauma site, and whether IR or vascular handle emergent endovascular cases, ditto for neuro, and whether they do lots of vascular access. lots of turf overlap so things can vary widely place to place.

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    ACN ACN 
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    Both hospitals in my town require you to take general call if you are on staff. Everyone in my group is on staff because we don’t have any employed traumatologists so everyone needs to have admitting privileges for group call basically.

    If you're ever having a bad day, just remember in 1976 Ronald Wayne sold his 10% stake in Apple for $2,300.

    #216061 Reply

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