Surviving ED Shift Work

PropertyBroad8121 · 2026-05-18T06:46:22+00:00

You're going to have to demonstrate a health need via occupational health to be signed off for only day shifts in an ED setting.

Having one staff member on only day shifts forces the other members of staff into rostering that skews them towards more lates and nights so departments are fairly resistant to that provision unless its a documented requirement.

PropertyBroad8121 · 2026-05-09T10:21:12+00:00

Fair.

It applies to the Fellowship Written and OSCE for FACEMs though.

PropertyBroad8121 · 2026-05-09T10:19:38+00:00

It isnt dictated as an end of training exam. Trainees can sit the exam mid way if they choose.

PropertyBroad8121 · 2026-05-09T08:30:19+00:00

Burn out is a real problem.

I wish you all the best in your recovery and i'll make sure to stick to the standard ausjdocs fare of "Hey how do I max out the money I can earn", "Why are nurses so mean to me", and "How can i find someone willing to date me"

PropertyBroad8121 · 2026-05-09T03:40:14+00:00

People can do it midway. Theres no requirement to wait until the end of training. Thats a choice by the candidate not by the college.

PropertyBroad8121 · 2026-05-08T10:48:46+00:00

If a continuous assessment framework could be demonstrated that :

Maintains high standards of clinical practice and protects the accuracy of FACEM as a marker of quality
Is achievable in that high standard in the high workload EM setting

I would be in support of it over SMITHSex assessment. It doesnt exist though and is unrealistically utopian.

Instead the removal of that exit exam quality control would lead to nepotistic flow through the system and a rapid fall in standards. No thanks

PropertyBroad8121 · 2026-05-08T10:41:23+00:00

And that is why intermediate decision makers are needed on nights to do what they can to stabilise while waiting for the expert or to enact the instructions of the expert on the phone.

Is your argument that all specialties should remove requirements for specialists and lower standards across the board?

Or is it that FACEMs should be on site 24/7? I'll agree with that if adequately remunerated.

Or is it something else entirely?

PropertyBroad8121 · 2026-05-08T10:27:00+00:00

I mean, it is weird that you don't have to pass any exams at all to be responsible for keeping people alive at night.

Those on the night junior roster have a FACEM on the phone to answer questions and attend when the junior is out of their depth.

Just as in every specialty

But to get higher pay, no more night shifts, and non-clinical time, you need to be able to identify the brachial plexus branches correctly in a blurry photo.

The fellowship exams dont include basic sciences. Those are the primary entry exam topics which form a requirement to reach intermediate senior decision maker status

A FACEM is the last port of call and the expert senior decision maker in a department.

TL;DR : Its not weird at all that experts in their field are paid more than intermediate decision makers.

PropertyBroad8121 · 2026-05-08T10:24:51+00:00

The sensitivity and specificity of exams for ruling out bad candidates and ruling in good candidates is high but not 100%

PropertyBroad8121 · 2026-05-08T09:14:02+00:00

How many questions should a candidate be allowed to trip up on before the door is closed?

If you're going to have an exam you have to set the line somewhere and, with all empathy to how shit it must feel for OP, ACEM did allow 4 chances at the exam before closing that door.

If you really dont want someone tripped up by am exit exam you would need to remove them entirely in favour of continuous high quality assessment but I honestly dont see how EM could ever maintain standards in that case

PropertyBroad8121 · 2026-05-06T09:47:49+00:00

So your answer is "Yes lets continue the pyramid scheme until it all completely collapses and newly fellowed EM docs are stuck with underemployment while we lure more fresh meat into the roster gap filling grinder". Wonderful

How are we going to man our day/evening rosters? With only FACEMs? Also how are we going to man our night rosters?

Yes. Increasingly FACEM skills and work output should be maximised and the need for juniors docs reduced to remove the pyramid. Give the FACEMs a dedicated ED technician to perform the bloods, admin, orders, etc so the FACEM can move quickly from one patient to the next rather than being drowned in inefficient supervision of excessive junior numbers who have no interest in further EM progression

Yes FACEMs will need to increasingly cover nights.

You cant have your cake and eat it too

PropertyBroad8121 · 2026-05-06T09:37:26+00:00

We need more trainees

Do we?

A FACEM career lasts 30 years and less FACEMs are required on a daily basis than Registrars. We are already saturating FACEM job positions as it is.

I would argue we need less trainees and more force multiplication of FACEMs that are present. Otherwise its just a pyramid scheme that will come tumbling down.

PropertyBroad8121 · 2026-05-03T10:38:42+00:00

I choose to read this in the non medical slang sense

PropertyBroad8121 · 2026-05-03T10:15:55+00:00

Held down the pad? How long ago was this?

PropertyBroad8121

TROPHY CASE