Daily reminder to do the bare minimum

[Janders]

I think the general advice to come out of the gate and make lots of cash for the first 5-10 years makes a lot of sense; eliminate debt, get that compounding interest nest-egg going, you likely have the physical energy/stamina to do it. Obviously I wouldn't recommend 24 shifts a month, but 16 with a couple per diem here or there... absolutely.

For me being about 12yr out, the question of when to take the foot off the accelerator, and how much is reasonable to cut back... its a big question in my head. I like my kids, and my oldest has <7yr left in my house (assuming she moves out for college). That's not very long! I've cut out the moonlighting I was doing during the peak pandemic times (say 10-12% cut in income?), and dropped one shift from my core site in the past 6mo (say another 8% drop)... but I've picked some side gig stuff that basically adds back 8%.

at what point do i pull the ripcord and drop to say 9-10 shifts a month? My initial plan was to go hard to age 50 then cut hard to 6-7 shifts / month until I was ready to walk into the sunset, but now I think a more prolonged / gradual glideslope may make more sense, vis-a-vis having more family time now, not when my oldest is in college...

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[gutonc]

TL;DR: I think that routinely spending significant time engaging with one's kids, particularly when they're young, has profound and lasting effects on any future family relationships and on general behavior.

This is certainly true, but those profound and lasting effects can be positive OR negative depending on how that time is spent.

 

[RustedFox]

Daily reminder to do the bare minimum.

 

[BoardingDoc]

This is certainly true, but those profound and lasting effects can be positive OR negative depending on how that time is spent.

Well yeah. I recommend limiting the beatings to one day a week.

 

[EctopicFetus]

I’ll say this.. get your $$ right.. once thats done choices are easy.. dont work for thr trsiler trash rate… get paid properly. For those working under 300//hr im sad for u.. i havent worked for that that rate in a while. Find something better, if you can.

 

[sylvanthus]

I think the general advice to come out of the gate and make lots of cash for the first 5-10 years makes a lot of sense; eliminate debt, get that compounding interest nest-egg going, you likely have the physical energy/stamina to do it. Obviously I wouldn't recommend 24 shifts a month, but 16 with a couple per diem here or there... absolutely.

For me being about 12yr out, the question of when to take the foot off the accelerator, and how much is reasonable to cut back... its a big question in my head. I like my kids, and my oldest has <7yr left in my house (assuming she moves out for college). That's not very long! I've cut out the moonlighting I was doing during the peak pandemic times (say 10-12% cut in income?), and dropped one shift from my core site in the past 6mo (say another 8% drop)... but I've picked some side gig stuff that basically adds back 8%.

at what point do i pull the ripcord and drop to say 9-10 shifts a month? My initial plan was to go hard to age 50 then cut hard to 6-7 shifts / month until I was ready to walk into the sunset, but now I think a more prolonged / gradual glideslope may make more sense, vis-a-vis having more family time now, not when my oldest is in college...

How much is in your retirement accounts and emergency fund?

 

[DocEspana]

I heard some of you aren't doing the bare minimum.... CUT IT OUT.

 

[qwerty89]

If that were the case, children growing up in single parent families should not have any negative impacts on their upbringing.

My understanding is that its boys that have difficulties growing up in single mom households. The girls seem to do OK when controlled for education and income level.

 

[GonnaBeADoc2222]

I’ll say this.. get your $$ right.. once thats done choices are easy.. dont work for thr trsiler trash rate… get paid properly. For those working under 300//hr im sad for u.. i havent worked for that that rate in a whi8le. Find something better,

"Anyone who's not working for >90th percentile EM compensation is a SUCKER."

A take so hot i need sunglasses to look at it.

 

[EctopicFetus]

"Anyone who's not working for >90th percentile EM compensation is a SUCKER."

A take so hot i need sunglasses to look at it.

Smarter interpretation is dont forgo current income for hopes of better future income. yes I realize that 300/hr isnt easy to find nor is it an option in many parts of the country and im not a big locums guy. Thats what i meant. Even an SDG should be paying really close to market rate for their pre-partners. I would highly discourage a new grad from earning 50-100/hr less than market just to work at an SDG. of course those market based pay cuts are coming for everyone and some SDGs are ill equipped to handle it.

 

[Janders]

How much is in your retirement accounts and emergency fund?

How much until you would feel comfortable dialing back?

My initial feeling was retirement + investment accounts + pessimistic valuation of home - mortgage > 3million would feel reasonable to take the foot of the gas, though I’ve had others say their number would be higher.

 

[TooMuchResearch]

Smarter interpretation is dont forgo current income for hopes of better future income. yes I realize that 300/hr isnt easy to find nor is it an option in many parts of the country and im not a big locums guy. Thats what i meant. Even an SDG should be paying really close to market rate for their pre-partners. I would highly discourage a new grad from earning 50-100/hr less than market just to work at an SDG. of course those market based pay cuts are coming for everyone and some SDGs are ill equipped to handle it.

Our price of admission is lower pay increasing until partnership, and we have no shortage of applicants. You're right though, there is some risk. When I calculated it out before making a job choice, the break even on the SDG versus an employed position I considered was about 4.5 years for equal hours, but now I should be pulling ahead by something like $70-100k annually until the music stops.

 

[EctopicFetus]

How much until you would feel comfortable dialing back?

My initial feeling was retirement + investment accounts + pessimistic valuation of home - mortgage > 3million would feel reasonable to take the foot of the gas, though I’ve had others say their number would be higher.

Find your coastFI number. A single number rarely works cause much depends on your age. If I had $2m at age 35 I would feel pretty good about cutting back as compared to being 60 and having $2m.

Also this number depends on what your life looks like. Are you traveling and staying at 4 seasons or camping and paying $10/night for a campsite.

Kids in private school? Medical issues in your family etc.

 

[EctopicFetus]

Our price of admission is lower pay increasing until partnership, and we have no shortage of applicants. You're right though, there is some risk. When I calculated it out before making a job choice, the break even on the SDG versus an employed position I considered was about 4.5 years for equal hours, but now I should be pulling ahead by something like $70-100k annually until the music stops.

Every partnership has some version of this. No one is fully equal on day 1 save for some employed jobs. The question is if market rate is 200 are you paying 180 that’s one thing. Paying 110 is another.

Most places are gonna be pretty close nowadays. I’m as big an sdg fan as there is but there are some crooked ones. Down the line wages will drop drastically in my opinion and I would rather be locked into an sdg than a cmg.

 

[sylvanthus]

How much until you would feel comfortable dialing back?

My initial feeling was retirement + investment accounts + pessimistic valuation of home - mortgage > 3million would feel reasonable to take the foot of the gas, though I’ve had others say their number would be higher.

For me, im going to stop picking up extra shifts at 1 million, cut back to 0.8 FTE at 2 million, 0.6 FTE at 2.5 million, retire at 3 million. I could bust my ass and retire earlier but I want to do things with the kids while they are young.

 

[RustedFox]

Daily reminder to do the bare minimum.

 

[Ceke2002]

-admin doesn't care about your well being

-nursing wants path of least resistance , regardless of how it harms you or patients

Therefore:

1) take good care of your patients

2) do the right thing

3) don't do any extra work

4) all charts done at work

5) go home on time

Working to rule? Is there some sort of industrial action happening in US hospitals that we're not aware of? If so you have my full support.

 

[Arcan57]

I heard some of you aren't doing the bare minimum.... CUT IT OUT.

To those going above and beyond, I understand and sympathize. For your own well being, realize that the game is rigged. It always has been. But now it's been weaponized against us. People that never experience the consequences of their actions deliberately withhold resources so that every day is designed to be a just barely avoided disaster.

And not because that's the way it has to be, but because these people dream that turning our EDs into burnout factories will get them wealth and a promotion that will give them the chance to do the same thing to even more people. Don't invest your self-worth in playing a game you're designed to lose.

 

[EctopicFetus]

To those going above and beyond, I understand and sympathize. For your own well being, realize that the game is rigged. It always has been. But now it's been weaponized against us. People that never experience the consequences of their actions deliberately withhold resources so that every day is designed to be a just barely avoided disaster.

And not because that's the way it has to be, but because these people dream that turning our EDs into burnout factories will get them money wealth and a promotion that will give them the chance to do the same thing to even more people. Don't invest your self-worth in playing a game you're designed to lose.

Focus on what you enjoy. I do more than the bare minimum but I very much minimize anything I don’t enjoy or think is stupid. Hospital emails deleted. Requests to change my charting. Deleted.

 

[GonnaBeADoc2222]

Daily reminder to do the bare minimum (and buy Titanfall 2 on Steam for 3 dollars)

 

[RustedFox]

To those going above and beyond, I understand and sympathize. For your own well being, realize that the game is rigged. It always has been. But now it's been weaponized against us. People that never experience the consequences of their actions deliberately withhold resources so that every day is designed to be a just barely avoided disaster.

And not because that's the way it has to be, but because these people dream that turning our EDs into burnout factories will get them money wealth and a promotion that will give them the chance to do the same thing to even more people. Don't invest your self-worth in playing a game you're designed to lose.

Wow.
How very powerfully stated.

 

[ScepticSkeksis]

To those going above and beyond, I understand and sympathize. For your own well being, realize that the game is rigged. It always has been. But now it's been weaponized against us. People that never experience the consequences of their actions deliberately withhold resources so that every day is designed to be a just barely avoided disaster.

And not because that's the way it has to be, but because these people dream that turning our EDs into burnout factories will get them money wealth and a promotion that will give them the chance to do the same thing to even more people. Don't invest your self-worth in playing a game you're designed to lose.

Love the term "Burnout Factories". It perfectly describes how admin organizes most EDs.

 

[RustedFox]

Daily reminder to do the bare minimum.

 

[greatnt249]

Daily reminder to do the bare minimum.

 

[RustedFox]

Daily reminder to do the bare minimum.

 

[ScepticSkeksis]

Daily reminder to do the bare minimum.

I got chewed out last night by a surgeon for "not writing holding orders" on a patient. This was at 7PM and surgeon was physically in the hospital. Why are we expected to do the work of other physicians during reasonable hours when they should be awake? Also EMR makes it easy to put in orders from anywhere.

 

[RustedFox]

I got chewed out last night by a surgeon for "not writing holding orders" on a patient. This was at 7PM and surgeon was physically in the hospital. Why are we expected to do the work of other physicians during reasonable hours when they should be awake? Also EMR makes it easy to put in orders from anywhere.

Lol. What year is this? 2008?

 

[ScepticSkeksis]

Lol. What year is this? 2008?

Actually the hospital is like a time capsule in many ways. Midlevels/residents are banned from the "Doctor's Dining Room" and my midlevels are not allowed to talk to Admitting docs/consultants. Bizarro world.

 

[RustedFox]

Actually the hospital is like a time capsule in many ways. Midlevels/residents are banned from the "Doctor's Dining Room" and my midlevels are not allowed to talk to Admitting docs/consultants. Bizarro world.

A physician to physician discussion?
Radical idea.

 

[ScepticSkeksis]

A physician to physician discussion?
Radical idea.

Good in theory, but a huge disruption in work flow. No reason a midlevel can't call an ortho and ask for an ankle fracture to be seen in clinic the next day. Again, remember we are trying to do the minimum here.

 

[EctopicFetus]

Good in theory, but a huge disruption in work flow. No reason a midlevel can't call an ortho and ask for an ankle fracture to be seen in clinic the next day. Again, remember we are trying to do the minimum here.

Midlevels gonna mid level. Fwiw mlps shouldn’t be in the physicians lounge. Neither should nurses.

 

[RustedFox]

Good in theory, but a huge disruption in work flow. No reason a midlevel can't call an ortho and ask for an ankle fracture to be seen in clinic the next day. Again, remember we are trying to do the minimum here.

I agree.
I run into too many situations where the PLP calls the specialist, or even the admitting physician, only for them to ask to talk to me because they can't even articulate what's going on.

FWIW, I also had neurosurg call me last shift after I admitted a Parkinson's with "off-period" motor dysfunction because (and I quote): "The hospitalist just called me and ordered MRI from nose to toes and said we may have cord compression, but I wanted to talk with someone who knows what he's talking about. Should I go to sleep, Fox?"

"Yes, you should go back to sleep. You know how dumb this guy is."

"Yeah, I figured - just wanted reassurance. When you didn't call me first, I had my doubts."

 

[emergentmd]

I got chewed out last night by a surgeon for "not writing holding orders" on a patient. This was at 7PM and surgeon was physically in the hospital. Why are we expected to do the work of other physicians during reasonable hours when they should be awake? Also EMR makes it easy to put in orders from anywhere.

Really? Really? I would have hung up on his A$$ and told him to do his job. I can say I have never been chewed out by anyone since residency.

 

[TooMuchResearch]

Really? Really? I would have hung up on his A$$ and told him to do his job. I can say I have never been chewed out by anyone since residency.

Just remember when the guy on other end is angry, he's having the problem, not you.

I had a spine surgeon yell at me for doing a contrast enhanced MRI. Dude, it's a radiology protocol order. If you have a problem with it, talk to radiology. Guy is a dick to everyone all the time. Luckily his group is no longer taking spine call.

 

[ScepticSkeksis]

Really? Really? I would have hung up on his A$$ and told him to do his job. I can say I have never been chewed out by anyone since residency.

His complaint was "All the other doctors do it for us! The nurses had the audacity to call me and ask for holding order!"
If he had asked politely for a few holding orders when I initially called I would have had no issue with that.

 

[emergentmd]

His complaint was "All the other doctors do it for us! The nurses had the audacity to call me and ask for holding order!"
If he had asked politely for a few holding orders when I initially called I would have had no issue with that.

There in lies the problem. I did holding orders all the time. Document he accepting, put basic stuff, add in at the end "Call attending" when on floor. Easy, takes 1 minute.

But be an A$$ and I am not doing it for you.

Be nice/pleasant and I will go to the floor and put in a central line for you. Don't like it but docs who are easy to work with I will bend over backwards for them. Be an A$$ and they are dead to me.

 

[ScepticSkeksis]

There in lies the problem. I did holding orders all the time. Document he accepting, put basic stuff, add in at the end "Call attending" when on floor. Easy, takes 1 minute.

But be an A$$ and I am not doing it for you.

Be nice/pleasant and I will go to the floor and put in a central line for you. Don't like it but docs who are easy to work with I will bend over backwards for them. Be an A$$ and they are dead to me.

I've nevery understood their laziness. If I'm an admitting doc, taking LEGAL RESPONSIBILITY for a patient, would I want to put my own holding orders in, or would I rely on another doc, who I don't know to do it for me? It's just a bizarre situation, and makes no sense in the age of EMR. I'm sure he has holding order sets and could place whatever he wants in about 2 minutes.

 

[bravotwozero]

I've nevery understood their laziness. If I'm an admitting doc, taking LEGAL RESPONSIBILITY for a patient, would I want to put my own holding orders in, or would I rely on another doc, who I don't know to do it for me? It's just a bizarre situation, and makes no sense in the age of EMR. I'm sure he has holding order sets and could place whatever he wants in about 2 minutes.

grandpa has technology issues and can't work the EMR very well

 

[RustedFox]

grandpa has technology issues and can't work the EMR very well

Ugh. THIS.

 

[ScepticSkeksis]

grandpa has technology issues and can't work the EMR very well

Not sure, he seemed to be in his 50's when he briefly walked by. Though I know plenty of 40-50 year olds who are technologically deficient.

 

[RustedFox]

Not sure, he seemed to be in his 50's when he briefly walked by. Though I know plenty of 40-50 year olds who are technologically deficient.

This drives me nuts.
Like, if you're gonna be in healthcare in the 21st century, you've had enough exposure to computers in all their forms that there's no excuse.

 

[Mount Asclepius]

There is liability exposure to an EP for putting in holding orders for admitting patients. Our malpractice carrier has advised us against placing any holding orders. It’s the responsibility of the admitting service to place admission orders.

 

[ScepticSkeksis]

There is liability exposure to an EP for putting in holding orders for admitting patients. Our malpractice carrier has advised us against placing any holding orders. It’s the responsibility of the admitting service to place admission orders.

I agree completely. At most I'll put an NPO and maintenance fluid order. They can have one dose of pain meds before they leave the ED.