An ER Doc’s Top Ten List

Posted: March 19, 2007 by Doc in ER Docs, Medical, Uncategorized

The post below was circulated to me anonymously. Yes, it’s a rant but I think it is extremely pertinent to the discussion and would like to share it with you all. I agree with many of the points made, (except for the FMGs):

Tom Scaletta, MD FAAEM: …”For instance, it could be required that physicians are board certified (or prepared) in emergency medicine.”

MY TOP TEN LIST:
1) What about the fact that only about half the ER docs are EM-RT (in spite of HUGE increases in our EM residency slots and programs) ?

2) What about the fact that ‘MORE THAN HALF’ the ERs in the country are covered with non-EM-RT docs ? (because we don’t train for, and we cannot interest the new grads in working in the trenches, and we don’t have ANY solutions to discuss) ?

3) What about the fact that 1/3 of the resident in the country are FMGs already ?

4) Where do we get these residents to fill all those forth coming (not really) NEW GME slots ?
(does medicare fund this…someone should just tell them we need more money…I think they will just write us a check, because health care has been so thrifty and cost effective

5) Where do we get the spots in medical school to teach them ? (AAMC says we need a 30-40% increase across the board, maybe more in states likeTexas and Florida)

6) What about the fact that already the Number 1 and Number 2 schools filling residency slots are Caribbean schools ? (St George’s Univ and Ross Univ…Number 3 Illinois…) (AAMC data)

7) Why don’t we just STEAL the medical students going into Internal medicine
and Family Practice ? ( it doesn’t matter that they have a crisis too and want more GME slots and are filling about half their classes with US grads ALREADY—hey we should look into getting more docs to leave their county and practice here–who cares about their country

8 ) Where do we get the college grads interested in Medical School ? (med school deans say there are less than 20% quality applicants out there to increase it to, not the 30-40% AAMC wants)

9) What about the fact that the med school deans say it will take 15 years before we see the first grad out of residency ?

and the MOST IMPORTANT OF ALL

10) The Lawyers, Insurance companies, Chiropractors, Nurse Practioners, Optometrist, Psychologist, Physical Therapist, Acupuncturist are just jumping for joy that we cannot “COME TOGETHER” (great slogan I heard somewhere). That we spend time and money fighting WITH EACH OTHER in Florida and other places, to make our product look better, to make more money, to increase the cost of healthcare.
Because the Nurse Practioners in Texas only have one issue this year….increased scope of
practice…..and the Optometrist have only one issue this year….increased scope of practice. and we should have 67 from the IOM report. But no, apparently THIS is a priority issue. I am sure our patients would just love to hear about how we smart doctors are looking out for ourselves, oops I mean “their safety”.
If this is such an important SAFETY issue, perhaps we should just close half of the already overwhelmed ERs in the country seeing 11% more patients in the last 2 years (while gearing up for the next Bioterrorism Event), because we don’t have a better “solution”. ”

“We must all hang together, or assuredly we shall all hang separately.” -Ben Franklin

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  2. I have spent many years looking at what physicians know in our specialty and I have come to the conclusion that they are the worst, most angry group of infighting people. Such a disgrace. It is all about money…I noticed that for years physicians complained about their tuition for example. Well when you look at the number of hours, I was right in line…Oh I get great reviews but I did not like their focus…And the Daniels case…he ended it himself by becoming board certified through the AAPS as enough hospitals in the US accept it…The truth is there is plenty of need and those physicians who are residency trained well I worked with plenty…thousands who had very unfortunate experiences of an education that was OTJ…not a real education…ABEM has made ludicrous statements about the need to recertify in ACLS, PALS, and ATLS years ago…they published that in the AEM and then now they require specific reading lists…they go so far as to say they own the information…it is all a big racquet and the quality is way down..I recently did some clinical hours…clinical care is a joke now…I spent 72 hours watching it…Our specialty needs to come together as one unit and we need to get rid of the aristocrats…most of you who dont know me at all think I sit at home and play…Well I have spent 144,000 hours in class teaching multiple specialties and I know what you do and dont know…Many of you dont care and should get out and dont belong. I have kept quiet for many years…I stopped full time education as I was tired of physicians cursing and complaining in a classroom…Do something about your problems…If you cant handle being asked a question in a group well that is no different than rounds and it makes no sense to ramble, curse and cause dissent…I saw so much of it that I have taken a little sabatical and now I am working and teaching and I find that the people that I taught whom I work with mostly have good intentions but are often disillusioned…EM is difficult under the best circumstances…If you are going to do it do it knowing you are there because you love helping the sick and dont judge anyone…not one person…dont read a chart and wonder why someone is there at 3 am…just go see them or get out…YOU HURT OUR SPECIALTY with that kind of behavior…and the rest of you should do some reading everyday…I write virtually everyday…and I have for decades…I know that I know very little but you all think different…well you are wrong….It is easy to appear very knowledgeable when you read a little everyday…that tells me how little physicians spend on their education. Most of it is poorly designed and boring. We need to refresh our whole system., and we need to abolish any organization that is hurting the specialty and start over…Attitude is everything folks…and I saw thousands with such poor attitudes I am so ashamed. For those who do it well God bless you and your families! DDC

  3. Dr. Collman:

    Thank you for taking the time to comment on the issues brought up in this post. For our readers who are not aware of his work, Dr. Collman is the premier board reviewer for Emergency Medicine in this country, whose opinion is held in high regard by physicians in the Emergency medicine field.

    DW most definitely agrees with you that EM physicians need to work together to solve the emergency care crisis in this country. I would like to correct the misconception that BCEM, which is EM board certification through AAPS, is widely accepted by US hospitals. Due to opposition from ACEP and AAEM, BCEM certification is only recognized in a handful of states (see: https://docwhisperer.wordpress.com/2007/02/05/disposable-doctors-2-er-docs-fight-back-in-ny/

    and https://docwhisperer.wordpress.com/2007/11/07/response-to-florida-acep-no-correlation-between-doctors-who-failed-to-meet-standard-of-care-and-board-certification/)

    BCEM certified physicians in New York are attempting to rectify this situation

    (see: https://docwhisperer.wordpress.com/2008/04/04/news-from-aaps-vs-ny-doh/)

    and we would be very interested in any thoughts you may have on this topic.

    Best Regards,

    DW

  4. I have spent now 5000 hours revamping my entire programs to gear them also towards midlevel providers. I will be teaching EPs besides the midlevels because the “cross-pollination” of information for all who practice acute and emergency care need to know the same pathophysiology. I have read now Tintinalli 7. I am constructing 27 modules, all quicktime movies and in other formats you will be able to download and watch and learn at your own pace. I have embedded untold numbers of images in full color of all of the core content of EM.

    I will begin advertising in the fall on a new website and I hope all the EPs who need to take either part I or part II will come to this new and even more comprehensive program. I will teach it live every summer. I also have 240 clinical hours I work each month.

    I plan to charge 100.00 per day for a 12-14 hour day of teaching and yes, again, I will be the only lecturer. It will take two summers for the midlevels to complete the program and the second part for them is to enhance their clinical skills: from Data acquisition (the Hx/P Exam/Lab/Special studies for acute/EM care/fast track care and even outpt urgent care) ; My goal is to prepare them for the real world while I teach the EPs what they keep forgetting over and over…I have worked in over 15 hospitals in the last three years and now I am taking a teaching position so I can start this program. I believe that how EM is still stagnating, more and more the midlevels are going to be the backbone of healthcare almost universally at every front door. I love them because of their attitudes. I have completed now over ten of the modules…look on the internet in the fall for a new website; I will for the next year or two still charge the physicians my standard rate for this program (which could take many a year to watch)…I decided to treat you to the visual….so I have spent thousands and thousands of hours making movies…they will primarily follow the content order of T7 for referencing by I still use T2-T6 for some key issues. The website will likely be CollmanInstitute.org…For those of you who want a sample please text me at 561-305-8163 and I will begin to send them out in the fall…it will be on a first come first serve basis…I have a new administrator and we will be growing our staff because I expect the client base who will want this continuing education will not just be the EPs/NPs/PAs but also CCRNs who work in any med/surg ICU/or ED/any RN/LPN who wants to truly understand acute care medicine possibly because they want to enter the field. At 500.00 tuition I am making this the rate for all non-physicians. Due to my heavy work schedule for the next 12 months, I will teach two to three programs in the summer of 2013….they are going to be the most comprehensive, unique, fun, educational experiences you could ever wish for. You will all go home with a 6GB drive that will contain all the modules if you attend the live . Otherwise you can complete it all at home as a Home Study a (HSP). I hope many of the younger residents will consider investing in this education because I promise you will leave having the confidence to practice and you will know the why for what you are always doing. I have many other medical educational projects in the fire…one is to update what will be my personal version of the most important questions to know for Pearls in acute care and EM. This will include ICU and Hospitalist-relevant questions as well education on how you can truly grow your mind/memory…and how by reading with my trademark language Density, you will read in full sentences w/twice the speed at times with full comprehension and recall because I have built in the reinforcement and repetition as we study each organ system or homeostatic mechanisms that maintain physiology and then, of course all of the pathophysiology. This program if you complete it is five days but a total mind blower, because I am going to entertain you as well as educate you but the entertainment contains the building blocks of how you will retain. How you will gain the confidence, clinical acumen and judgement. Emergency medicine is a that is disposition more than Dx driven…I will show you how to speed up your minds, and how to move your patients while actually improving your outcomes…we dont want them surviving our care…we need them to feel and know that they received true benefit by our approach. Each pt is unique but there are common themes that if you use them you will always be able to keep the pt flow steady. So T-7 is 2000 pp and already out of date, ie no text represents a standard of care….I have bolused my videos and presentations w/journal readings and editorials to keep you current.
    Please wait till Oct to see a website; thanks for your patience.
    Warm regards,

    Dwight D Collman MD DABEM, DABFM.

  5. CollmanInstitute.org is now Collmaninstitute.us……….come and visit. He just finished orals prep for one super ER doc after a string of 12 hour shifts…..gratis cause this guy is an awesome EP!…W Selde MD! It was a great to work with Will clinically and I had no doubts about him passing. He is brilliant…Now that he is ABEM-certified he is off to work in WY. I asked Will to come back and participate in future programs. Im hoping to be working near LV soon. Then we’ll have lots of meeting space. DDC.

  6. Hope you are doing well Ed. You are modest, but Im sure you do great work cause you do so much and we all benefit greatly from you..the hospital is your church–I am sure…mine too. all my best…DDC

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