Life after residency first day

36
LIFE AFTER RESIDENCY LECTURE SERIES Abhishek Katiyar Advocate Christ Hospital Oak Lawn, IL

description

 

Transcript of Life after residency first day

Page 1: Life after residency first day

LIFE AFTER RESIDENCY

LECTURE SERIESAbhishek Katiyar

Advocate Christ HospitalOak Lawn, IL

Page 2: Life after residency first day

Perils on Your First

Day

Page 3: Life after residency first day

Epidemiology/Intro

• In 1979, Emergency Medicine became a nationally recognized medical specialty

• 1988 – Last year for physicians to practice under “grandfather clause”

• Currently, the demand for board certified EP is ≥ 20,0000– Probably will not be achieved till next century– Rural >>> Urban/Suburban

Page 4: Life after residency first day

AGE-GROUP DISTRIBUTION FOR EPs

Page 5: Life after residency first day

Factors That the Demand for Emergency

Physicians1) Aging of US population2) General in US population3) Greater demand of the public for ambulatory care

services, but insufficient non-ED alternatives4) Demonstration that improved clinical outcomes are

assoc w/ emergency medicine trained EPs5) Expansion of out-of-care hospital services/systems6) Employment of US trained EPs in emergency health

care facilities outside the US

Page 6: Life after residency first day

Factors That Demand for Emergency

Physicians1) Closure of hospital EDs2) Use of “physician extenders” in place of EPs3) Refusal of payers to fund nonclinical duties by

EPs4) Transfer of ambulatory care cases currently

managed by EpPs to primary care practitioners outside the ED

Page 7: Life after residency first day

PREPARING FOR YOUR FIRST DAY

Page 8: Life after residency first day

3 Traditional Pillars for Job Satisfaction

• Professional and peer respect• Job security/relationship with

hospital• Financial Income

Page 9: Life after residency first day

US National Avg Salary for EP

$189,002 $212,295 $269,973 $298,769

10th% 25th% 75th% 90th%

Page 10: Life after residency first day

Salary for EPs have an avg of 14%

Page 11: Life after residency first day

QUALITY OF LIFE RATINGS FOR

EMERGENCY PHYSICIANPersonal satisfaction A

Job security A

Future growth B

Benefit to society A

Low stress D

Page 12: Life after residency first day

Why do they leave the Field… (1)

• AMA quotes the attrition rate for most medical specialty is about 2-3%– For EM: 1.5 to >12%– Anwar, RAH (1983) reported in his study:• 5% attrition rate 2 years after EM residency

training

Page 13: Life after residency first day

Why do they leave the Field… (2)

• Physicians who left the field– Long and irregular work schedule– Financial stability– Academic vs on your own– Single vs married– Board certification– STRESS

Page 14: Life after residency first day

What about the hours?

Page 15: Life after residency first day

Length of Shifts

“Length of the shift should depend on the physical and

mental load of the task”- Kanauth and Rutenfranz. J Human Ergol 1982 (11)

Page 16: Life after residency first day

Length of Shifts (1): 8 hours vs 12 hours

• In a manufacturer of synthetic yarn (Laundry & Lee)– Accidents when shifts changed from 8 to 12 hrs

• In an oil refinery plant (Gardner & Dagnall)– No change in days lost due to sickness and injury

• Study of 50 chemical companies (Kanauth & Rutenfranz)– No increase in accidents

Page 17: Life after residency first day

Length of Shifts (2): 8 hours vs 12 hours

• In a ammunition/explosives plant (Vernon)– Accidents increased when working 12 vs 8

• Review of all taxi drivers (Nozawa)– Fewer accidents seen in 8 hr shifts

• Study of all aircraft accidents and electrical power plants (Kelly & Schneider)– Increase in human errors when worked beyond 8 hrs• Due to fatigue and circadian upsetg]

Page 18: Life after residency first day

Length of Shifts: 8 hours vs 12 hours

8 hrs 12 hrs 8 & 12 hrs Other 8, 12, and Other

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

11%

32%

18%

26%

13%

% of shifts worked

% worked

Page 19: Life after residency first day

Length of Shifts: 8 hours vs 12 hours

8 hrs 12 hrs Other0%

100%

200%

300%

400%

500%

600%

700%

800%

900%

1000%

Series3Series2Preferred Shift

Page 20: Life after residency first day

Length of Shifts (3): 8 hours vs 12 hours

• In a study with residents (Steele et al)– 73% preferred 8hr shifts; 21% preferred 12 hr– Residents preferred evening/night shifts• No kids• Younger age• Have flexible sleep patterns• Love night shifts• Quick ability to overcome drowsiness

Page 21: Life after residency first day

Length of Shifts (4): 8 hours vs 12 hours

• Advantages of 12 hrs– Fewer shift changes

• Fewer transfer of pt care

– Longer time period for patient care

– Less time working after shift change

– Less commuting time– 1/3 more days

completely off

• Advantages of 8 hrs– More rest– alertness in the last 2-

4 hrs– Ability to participate in

personal activities on workdays

– Ability to apply circadian principles in rotating shifts

Page 22: Life after residency first day

Length of Shifts (5): 8 hours vs 12 hours

• Final thoughts about optimal shift– ED census– Stress level of work– Scheduling concerns (double coverage, # of nights)– Group size– Weekends vs weekdays• Social times• Family time

Page 23: Life after residency first day

WHAT DO YOUR FELLOW PEERS/

COLLEAGUES HAVE TO SAY?

Page 24: Life after residency first day

Assessment of EM Graduates Pereception of the Adequacy of Their Training

• Highest Rated– Resuscitation and

stabilization– Principles of emergency

care– General assessment– Ability to treat multiple

patients– Ability to provide timely

care

• Lowest Rated– Physician interpersonal

skills– Disorders related

immune system– Cutaneous disorders– Hormonal, metabolic,

and nutritional disease– Administration/hospital

politics

Page 25: Life after residency first day

Advice From Your Fellow Colleagues at ACH (1)

• Get the nurses on your side (D. Girzadas)– “it’s like starting residency all over again…”

• Show up early or on time (H. Zerth)– “or colleagues will resent you forever”

• Things move faster than ACH, have a plan before leaving the patient room (H. Zerth)– “adding on tests after tests will delay disposition

for 2-3 hrs and are generally frowned upon”

Page 26: Life after residency first day

Advice From Your Fellow Colleagues at ACH (2)

• Don’t be afraid to ask your senior co-attending a question (D. Strasburger)– “asking for a second opinion is not forbidden”

• It’s not as hard to admit someone (H. Zerth)– “don’t fight tooth and nails, if you aren’t

comfortable discharging someone then admit”• You are going to be nervous (H. Zerth)– “just trust your training and you will do fine ”

Page 27: Life after residency first day

Advice From Your Fellow Colleagues at ACH (3)

• Ask for an orientation of your ED (C Kulstad)– “never want to be in a situation where you have to

look around for something in a hurry (central lines, ET tubes, chest tubes, etc)”

• Become a “good citizen” by asking how you could contribute (M.Felder)– “allows you to find a nitche, both security and

longevity”

Page 28: Life after residency first day

Advice From Your Fellow Colleagues at ACH (4)

• Say thank you a lot, act like you want the business (S Altman)– “when you are paid full salary, there is no such thing

as an ‘inappropriate’ ED Visit”• Be involved early and as much as possible(PJ

Konicki)– “get to know as many attendings outside the ED”– “attend social and charitable events run by hospital

and medical staff office” – “Make ED consultation friendly ”

Page 29: Life after residency first day

Advice From Your Fellow Colleagues at ACH (5)

• Walk in the door calling your fellow attending by their first name (S Altman)– “if you act deferential, you will be treated as a

resident”• Try to accept all requests for shift trades when

possible, even if they don’t seem fair (S Altman)– “you will become known as a team player”– “just keep track of the shifts, beware of anyone who

tries to take advantage of you”

Page 30: Life after residency first day

Advice From Your Fellow Colleagues at ACH (6)- Shadow Shifts -

• Do a shadow shift in a place you are not familiar (A. Kiernicki-Sklar)– “important to know how certain processes work before

you start (e.g. transfer, admission, running codes, etc)”– “allows you to be familiar with the kinds of equipment

they have available”• Need to know the competency of the staff around

you (A. Kiernicki-Sklar)– “ancillary staff may not know the medications you are

familiar with”– “will they be able to recognize a sick patient?”

Page 31: Life after residency first day

Advice From Your Fellow Colleagues at ACH (7)- Watch your words-

• Listen first, talk last (T. Ross)• Give advice/opinion ONLY when asked (T. Ross)

• Do not get in an argument for any reason – DO NOT raise your voice (T. Ross)– “remember, you are under watch at all times”

• Never engage in any talk complaining about one of your colleagues (T. Ross)– If someone asks, respond back by saying: “you haven’t noticed

that, but how about them Bears”

Page 32: Life after residency first day

Advice From Your Fellow Colleagues at ACH (8)- Watch your words-

“I think you will find that if you stop complaining you might not need to do it as much anymore. One you

start, it is hard to stop. Think of complaining like cigarettes and stay away... (Oh, how I would love

to have a smoke!!)” (T. Ross)

Page 33: Life after residency first day

Advice From Your Fellow Colleagues at ACH (9)- Financial Help-

• Live like a resident for 2 more years (S Altman)– “a dollars saved today is worth more than one saved

tomorrow”– “put off that temptation of buying that Lexus/Porsche”– “ONLY EXCEPTION IS BUYING A HOUSE”

• Maximize tax deferred opportunities (S. Altman)– “money saved in this account is untouchable in case of

divorce, law suit, or even criminal activity”

• Look for a good team to manage your investments/retirements/disability (A Katiyar)

Page 34: Life after residency first day

MOST IMPORTANT NOTE:

DON’T FORGET ABOUT THE EMERGENCY MEDICINE

BOARDS

AND YOUR TAXES!!!

Page 35: Life after residency first day

Upcoming Events/Notice

• LAR Dinner on February 8th, 2010– Place: TBA– Topic: TBA

• For 3rd years, have your contract reviewed by someone– Contact Mila for any help

• For 2nd years, start working on your CV– Contact anyone of us for help/guidance

Page 36: Life after residency first day

References• Hall, KN et al. Factors Associated with Career Longevity in Residency-Trained EP.

Annals of EM. March 1992 (21:3)• Holliman CJ et al. Workforce Projections for Emergency Medicine: How Many

Emergency Physicians Does the United States Need?” Academic Emergency Medicine. Vol 4 (7), Sept 2008

• Moorhead, J et al. An Assessment of EM Residency Graduates’ Perceptions of the Adequacy of Their Residency Training. Annals of EM. June 1989 (18:6)

• Thomas, H et al. Eight-Versus 12 Hr Shifts: Implications for Emergency Physicians. Annals of EM, May 1994 (23:5)

• Steele, M et al. Emergency Medicine Residents’ Shiftwork Tolerance and Preference. Academic Emergency Medicine. Jun 2008, vol 7 (6)

• http://www.aaem.org/media/updates_content.php?contentid=263• http://www1.salary.com/ER-Physician-salary.html• http://www.careermd.com/employers/ci_em.shtm• http://money.cnn.com/magazines/moneymag/bestjobs/2009/snapshots/70.html