Friday, March 24, 2006

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I love it when I see posts that remind me of the Madhouse Madman. I love them more when I see them as comments on my blog. Charity Doc left this comment on my primary Care post below. And...please take it with a sense of humor. I'll have no bickering on my blog:
Don't do it!! Spend the extra 2 years and do a fellowship.

Here are some ideas:

Cardiology - you will work like a dog and be consulted every time a patient c/o chest pain (which is roughly 30%+ of all ER visits). You'll cath every middle aged and old people that have a femoral pulse. If they don't, you put a pacemaker in. If they're also dizzy, make it a pacemaker/ICD combo. But on the other hand, you'll be stinkin' rich and paid very handsomely. As far as hospital politics go, you'll be coveted and treated like a god, while us lowly, replaceable ER docs wish we have your clout with the hospital administrators and other medical staffs. I've been at this hospital for over 5 years now and the CEO, COO and CFO of the hospital still don't know who the heck I am every time I see them at the staff meetings.

Nephrology - you'll work like an ox and get consulted for every Creatinine level above 1.5 But you'll make money out the wazoo because every dialysis patient is fully funded so your reimbursement rate is...CHACHING. You'll even volunteer to dialyze road kill if it has an AV shunt in. But somehow, and for some stinkin' reason, you'll moan and groan every time you look at your census list which takes up a whole page, front and back, single spaced. Those damn dialysis patients sure have a lot of medical problems. DM, CHF, PVD, HTN, CAD...the list is endless. You'll find yourself arguing with the cardiologist whether CHF is a disease of the heart or a disease of the kidneys.

Hem/Onc - You may find it too depressing. Consult the Happy Oncologist blog for this one.

Rheumatology - No pt. seems to get any better do they? Another depressing discipline.

Endocrine - how many endocrine consult have you done? As an ER doc, I've never had to called one. Maybe you should forget this one. The chaching bell ain't ringing here.

Pulmonary/Critical Care - I'm just not feeling the big chaching factor here either. They seem to bronch everybody and scan everyone's chest. Vent management ain't that much of a mystery. It just seems that way. They're the only ones that get all excited about sputum. Sloogy docs. Everyone gets PFT's. What would you do without the cigarette industry?

GI - Oh my God! While the rest of the world upchucks and toss their cookies whenever a GI bleeder shows up, the GI guys sniffs it all in and says..."Can you smell the money??!!!" Poopy docs and Golytely pushers. They do make a very decent salary though, scoping from above and below all day long.

Neurology - Every since the NIH touts tPA for ischemic strokes, these guys are consulted all the time now from the ER. They're all over the TV and radios being spokepersons as every hospital compete to get that Stroke Center designation. What a load of crap, heh? Stroke Center. The standard of care, the 3 hours window for thrombolytic from onset of symptoms is the flipping same at every hospital. Every hospital has a OT/PT department, too. So why should any "stroke center" be any different from any other hospital? Yet, they're all over the newspaper and radio touting so.

Don't get me wrong, we need primary care providers. But why be one, work just as hard as the other guys and get pay less? Do the extra 2-3 years fellowship. It's all worth it. If I had to do it all over again, and if someone were to point a gun at me and force me to, I'd choose cardiology and nephrology as a second choice. Just my thoughts. Good luck on your decisions.

www.fingersandtubesineveryorifice.blogspot.com
ER docs are crazy and because of that they have the best sense of humor in the entire hospital.

194 Comments:

Anonymous Ali said...

Ha, that's good stuff. Thanks for pointing me to a new blog. :)

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Hey, I represent that remark!

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Blogger Charity Doc said...

I didn't mean to disrespect any of those subspecialties nor primary care. Without you guys, I couldn't possibly empty my ED come shift change.

But c'mon...tit for tat, we ED docs know for certain that you guys think we're a bunch of incompetent lazy lug nuts who can't tell the difference between GERD and an acute coronary syndrome. You guys seem to think that we call and ask you to admit everyone and their mother's 3rd long lost cousin's preacher with chest pain. Heaven forbids, though, if something ever goes awry or missed, it's always the ED fault.

What? We're crazy? Naw!!! We ED docs are the sanest of them all. The aliens from the intergalactic tribunal beamed a message through the EMS radio the other day and told me so. And you can't run a Nut House without shaking the oak trees sometimes. That's the only way you can tell the difference between a squirrel and a groundhog.

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Anonymous Clinical Cases and Images said...

Make it scientific -- take an aptitude test to see which fellowship is right for you:

http://www.med-ed.virginia.edu/specialties/

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This comment has been removed by a blog administrator.

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Blogger DisappearingJohn said...

See, that's why I'm transferring to the ED in two weeks!

I love the pace, the humor, and the looniness (is that a word) in the trauma / ED...

And of course, the betting on the BAC numbers!

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Blogger Dr. Andy said...

One word: allergy

And I don't think seeing a specialty in the ED at all hours should be seen as an advantage!

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Anonymous emmy said...

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Anonymous bgp said...

You forgot one...psychiatry. There isn't anything more fun than talking to the crazy guy in the hall who says he commands 40 spaceships and plans to control the universe within the next 5 minutes. And don't forget research. At many academic medical centers, psychiatry departments bring in more research money than medicine and surgery departments combined.

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Anonymous Anonymous said...

All I have to say is.... BOO HOO! You don't the same respect as other physicians???? Think about that, the next time that you give someone of lower status, a hard time. ALL doctors basically do whatever they want. The rest of us have to put up with it. No sympathy here....

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