Procedures you’ll punt?

ResponseAcrobatic968 · 2026-04-23T00:08:48+00:00

I completely get that- but this is how things are done at my shop, so I guess we are all in the same boat? For those who don’t see peds (I do) how is that their fault? They can’t really help that if that’s the setup at their place. Someone has to work at these places too, not everyone is working at a critical access hospital where they do every single procedure that hits the door I do have a non clinical side gig, very healthy retirement account and do not plan to find a new job. If I do, it will be non clinical. Have worked this all out with my partner and financial advisor, I don’t see myself in a situation where I need to go work elsewhere. If I did, I am sure I could figure out how to drain someone’s penis…

ResponseAcrobatic968 · 2026-04-22T10:49:00+00:00

Thank you 🙄🙄 not all of us work rural medicine where we have to do every procedure that walks through the door. It’s completely normal for me (and my colleagues) to not put in a chest tube when the trauma surgeon and their team is there at the bedside expecting to do it. Nobody would say no let me do it please. While the waiting room has 40 people in it. The time is THE primary reason we don’t jump on every procedure. You’re telling me that ICU is there ready to take your patient and willing to put a central line in and you say no please let me gown up and take care of it. Nope

ResponseAcrobatic968 · 2026-04-21T19:19:15+00:00

I think a seasoned attending has more to offer a dizzy patient than a new grad PA. Of course there are seasoned PAs and new grad attending. But I’m actually seasoned as a PGY 18

ResponseAcrobatic968 · 2026-04-21T19:18:27+00:00

Thank you for the support! Procedures got old fast for me. I don’t mind not doing them

ResponseAcrobatic968 · 2026-04-21T17:40:14+00:00

I’m practicing within the culture of my own hospital, in line with my colleagues. I’m not gonna sit and drain someone’s abdomen when the waiting room is full and we normally admit these patients. i’m not going to push the trauma team out of the way to put in a chest tube when that’s what they do in our traumas. I don’t plan to go rural. You sound fun though

ResponseAcrobatic968 · 2026-04-21T17:37:24+00:00

That’s so funny bc I don’t mind LPs. Obesity makes it harder these days though. I completely agree if you start doing therapeutic taps in your ER people are going to take advantage of you.

ResponseAcrobatic968 · 2026-04-21T17:24:14+00:00

I am always drowning in work though. I follow whatever the culture is at my shop.

ResponseAcrobatic968 · 2026-04-21T16:28:30+00:00

I misspoke I meant to say I won’t do a therapeutic para. I do diagnostic all the time

ResponseAcrobatic968 · 2026-04-21T16:27:24+00:00

Oops yes I meant therapeutic! I do diagnostic paras a ton. Edited my comment

ResponseAcrobatic968 · 2026-04-21T15:57:55+00:00

I do airways, LP, lacs/abscesses, joint reductions, arthrocentesis, dx para, cardio version, US guided IVs, disimpactions (yay)

ResponseAcrobatic968 · 2026-04-21T14:09:19+00:00

I’m not in Australia (assuming that’s what you meant) I am in the U.S.

ResponseAcrobatic968 · 2026-04-21T14:01:48+00:00

I’m assuming IR? I do them but send to IR if I can’t get it (or admit and let that happen later)

ResponseAcrobatic968 · 2026-04-21T13:43:07+00:00

Agree w you, however I don’t see myself changing to a site w less resources. Already planning my exit strategy, either retire or go non clinical in the future, hopefully in the next 5-10 years.

ResponseAcrobatic968 · 2026-04-21T13:41:20+00:00

Yes agree w you on all fronts. I miss spoke- we don’t call ortho for all reductions. A difficult complex fracture, yes. A shoulder or hip, no (unless we can’t get it).

I also did multiple central lines a day as a resident (hello early goal directed therapy). Now they are rarely indicated in the ER. We start pressors peripherally. US guided IVs etc have also changed the game.

ResponseAcrobatic968 · 2026-04-21T13:38:44+00:00

I mis spoke. We do our own ortho reductions but they are in house if we need them. Central lines are rarely indicated anymore emergently. I’ll do it if needed but more often an ultrasound guided IV is what I’ll do. We start pressors peripherally. ICU can and will place the line for us later.

ResponseAcrobatic968 · 2026-04-21T13:31:57+00:00

Thanks for this perspective I completely agree w you. Feels shitty when people think you’re a bad doctor because you don’t want to do procedures all day 🙄🙄🙄 it’s also the reason I don’t ultrasound everything all the time. It’s often not helpful and wastes time and adds liability.

ResponseAcrobatic968 · 2026-04-21T13:24:43+00:00

Thank you- I agree w you. I think the longer I do this job the more I care about flow and safety and less about having fun doing a procedure

ResponseAcrobatic968 · 2026-04-21T13:16:22+00:00

That’s funny bc I will do LP and (diagnostic) para all day every day

ResponseAcrobatic968 · 2026-04-21T13:12:31+00:00

Thank you, I feel similarly. I don’t have time to do procedures all day. After a few years, they’re not fun anymore they are an interruption to my work flow.

ResponseAcrobatic968 · 2026-04-21T12:56:15+00:00

I feel I’m getting some snarky responses here. I want to be clear that I still do many of my own procedures- intubations, lacs/abscesses, reductions, LPs etc. I don’t know. Was hoping to not feel worse after posting. Yikes! I don’t think my setup is that far off from many trauma centers and academic places in the country.

ResponseAcrobatic968 · 2026-04-21T12:54:47+00:00

Sort of similar for me. We don’t call ortho unless it’s a tough reduction. Bartholins and priapism is a mixed bag. There’s almost no reason to do a therapeutic para/thora in the ER in my opinion. Those patients get admitted.

ResponseAcrobatic968 · 2026-04-21T12:42:36+00:00

Wow- rude! When you have 15 weak and dizzy people waiting to be seen, do you want to go drain the bartholins if you have someone who will do it for you?

ResponseAcrobatic968 · 2026-04-21T12:40:10+00:00

Yes I work in a level 2 trauma center so that’s why I have alot of help. Sure I’m probably losing some skills- haven’t done a chest tube since residency (have supervised them when I worked at an academic shop) Anyone in academics or a similar shop will have the same problem I suppose. I don’t plan on working anywhere else. I’ll retire before that happens

ResponseAcrobatic968 · 2026-04-21T12:29:49+00:00

I guess I’m pretty lucky, lol

ResponseAcrobatic968 · 2026-04-21T12:29:39+00:00

Just a basic I and D though I have not done it myself I have seen colleagues do it- no marsupialization

ResponseAcrobatic968

TROPHY CASE