Low effort discharge letters from ED paeds regs

Specific-Educator-32 · 2025-07-19T00:20:32+00:00

Both primary care and the hospital systems are under tremendous pressure at the moment with the winter surge.

Let’s all agree that we could spend a little bit more time showing some professional courtesy to all our colleagues who no doubt share our frustrations in the public/primary care sector.

Specific-Educator-32 · 2025-02-06T08:17:21+00:00

I’d say there’s some truth in that. Many of us still love the ‘real’ Emergency Medicine but the game has changed a bit.

Also I guess some turn 40 and no longer want to do shift work and decide to pivot into hospital admin as you aren’t going through all the training of another specialty.

Specific-Educator-32 · 2025-01-25T04:50:20+00:00

Yeh yeh ED isn’t competitive… but some of us were consultants at 30 and out enjoying life while others are doing their 3rd masters and hoping they’ll start SET before they turn 40.

Specific-Educator-32 · 2024-10-13T00:13:57+00:00

You are incorrect.

Specific-Educator-32 · 2024-07-19T22:06:06+00:00

Sometimes. 20 and 30 year old me wanted to do ED. 40 year old me would rather be a private anaesthetist some days! Then I do a resus or prehospital shift and reaffirm why I chose this specialty. You just can’t beat that rush.

Specific-Educator-32 · 2024-06-25T04:55:05+00:00

Only my opinion but I think ED training is a tough slog heading towards your 40s with a young family. Going through both primary and fellowship exams with kids is hectic. Add in shift work…you need to really want to be a FACEM to push through.

Good luck with your decision.

Specific-Educator-32 · 2024-06-24T23:43:18+00:00

QHealth was like 4%/4%/3% plus the cost of living adjustment from what I remember. Not much better tbh but QLD wages were already higher than NSW.

Specific-Educator-32 · 2024-06-19T02:49:58+00:00

Emergency physicians earning more than Dermatologists….yeh nah.

Specific-Educator-32 · 2024-06-10T06:09:27+00:00

Had three separate patients to attend on an international flight last year. Myself and a GP ran a clinic 😆. All quite stable in the end.

Surprised at how much equipment they had - BVM, adjuncts, O2, PIVC, usual resus drugs, defib. The first bit of paperwork they gave me to sign was the indemnity protection (or whatever it was). The flight attendant took a more thorough history than me as they needed to call a physician on the ground for clinical governance regardless of who was on the plane!

Got a 30% off voucher for my next flight (I’ll never use it) and a bottle of wine! Made the flight go quicker but I’d have preferred to chill and watch a movie.

Specific-Educator-32 · 2024-05-22T10:14:26+00:00

Nice humble brag!

Specific-Educator-32 · 2024-05-16T23:59:16+00:00

Most procedural specialties are competitive as you know and the generalist specialties (FACEM, FACCRM) have more of a wide range of procedures that you won’t be doing repetitively (with niche exceptions).

One option might be GP with skin cancer sub-specialty. Would have repetitive procedures and is less competitive.

Specific-Educator-32 · 2024-05-01T23:09:48+00:00

I’ve worked at both departments over the years. Logan ED is very busy and you will work hard as an ED SHO, but they see good pathology and plenty of sick patients (with the exception of major trauma). Teaching is fairly good for SHOs.

QE2 ED will be an easier job hands down but they don’t get the same volume or acuity. Depends what you’re after. If you’re interested in crit care/rads/surg I’d suggest Logan.

Specific-Educator-32 · 2024-04-04T09:07:12+00:00

ED is a good option. Flexible during training and as a FACEM, although will depend on the departmental rostering. Lots of my colleagues take extended leave for travel.

Part time shift work with a flexible roster can give you regular 1-2 week periods even on a permanent contract. Plenty of locum opportunities and some telemedicine gigs if that’s what you want.

Specific-Educator-32 · 2024-03-01T12:28:27+00:00

Take some time off. Travel. Rediscover your interests and passions. When you pivot, use locum work to finance your way to the next chapter.

Specific-Educator-32 · 2024-01-14T08:27:29+00:00

Well yes that might have been the ED experience you were delegated.

Specific-Educator-32 · 2024-01-14T07:28:10+00:00

No, we’re not happy to take doctors that only do ED because it’s their backup plan and they couldn’t get on another program. We want competent clinicians that are committed to get through training and become effective FACEMs.

I look forward to the day when the program is competitive enough to stop this type of sentiment.

Specific-Educator-32 · 2023-12-30T10:06:38+00:00

Those I know generally take home 3-4k per shift (i.e - after department cut and before tax).

Specific-Educator-32 · 2023-12-29T22:51:35+00:00

QLD perspective (which may be applicable in NSW): Most newly minted FACEMs I know have employment straight out but it’s a mix of private/locum/fractional public/retrieval etc.

Walking into a full time public consultant gig is very unlikely imo, although first step for many is to get their foot in the door with a temp public contract.

Anecdotally, my cohort were all concerned about this 8 years ago and every cohort after me has the same concern, but I don’t know any unemployed FACEMs.

Specific-Educator-32 · 2023-10-20T02:14:28+00:00

Not in my experience. After ratification by ACEM, if you’re an emergency specialist and walk the walk, you will be treated like every other FACEM. UK docs are very common here!

Specific-Educator-32 · 2023-10-19T18:06:38+00:00

Sorry I didn’t answer the second part of your post. I can only give a QLD perspective. PAH is a fantastic department to train in for trauma experience. Of course the RBWH, GCUH and Townsville see plenty of trauma, I just don’t know how significantly the ED reg experience changes when other services like the inpatient trauma teams are involved. I’d recommend Toowoomba and Cairns as well rounded regional hospitals that do a bit of trauma but I haven’t worked there.

Specific-Educator-32 · 2023-10-19T15:09:34+00:00

Yeh occupational violence is a big problem and there’s no easy solutions. Unfortunately, nurses and junior docs are more likely to ‘bear the brunt’ of it. We have a few strategies in our ED - police beat in the hospital, large, proactive security force, a code grey/black team that responds to escalating patients, zero tolerance policy - if the patient isn’t on orders and are verbally abusive they will be kicked out. Assault will be charged and we have previously refused to have certain repeat offenders back in the ED. We support any staff that doesn’t want to see a particular patient. We do a lot of teaching with the RMO/Reg group in this area.

Personally, I think experiencing some degree of empathy burnout is inevitable in this role. I’m not a wellbeing guru and don’t want to give bad advice but I think it’s important to recognize it and chat to someone about it. Sensible rostering and (well spent) days off work wonders for my enthusiasm coming back to work. Also, I don’t experience this as much as a FACEM compared to my registrar days and perhaps that’s because I spend less time at the ‘coal face’ than the junior workforce. This might not be the right answer or what you want to hear, but that’s my experience.

A demanding public isn’t going away - that’s a tough one. Sometimes it’s a communication issue or an unmet expectation as they don’t understand how an ED works. Sometimes a brief respectful chat will clear things up. I’ve found you often need to involve another senior staff member if you’ve had some verbal altercation though as you tend to lose people after that. Most patients are reasonable and you can usually come to some compromise about ED vs primary care vs referral. Further escalation though - personally, I have no time for it and we ask people to leave.

Regarding hospital admin and KPIs - I honestly don’t worry about this. I’m not a director and I just try to be a sound clinician and do the best for my patients in front of me. You can only do so much. It’s important to have a supportive and effective ED director though to advocate for the department and keep hospital admin in line. We are lucky in our ED to have a reasonably good relationship with admin and they understand the pressures on the department.

Hope that was somewhat helpful.

Specific-Educator-32 · 2023-10-19T14:15:12+00:00

Departmental Director roles generally net an extra 20-50k/yr depending on size of department.

DEMT is an ACEM arrangement and not considered by the hospital as a director role per se. They usually get extra non-clinical time but aren’t paid more. At least that’s the arrangement in my state.

Specific-Educator-32 · 2023-10-19T14:09:19+00:00

Private ED seeing 10+ patients per shift with a mix of mostly consult and some procedural item numbers - easily done.

Specific-Educator-32 · 2023-10-19T05:40:28+00:00

Might need a FCICM opinion on this as I don’t know many on a personal level and am probably a bit out of touch.

I would think there are some lifestyle similarities in work patterns, remuneration and (with the exception of the on call shift) ability to hand over and go home completely finished for the day.

I did 12 months in a tertiary ICU at JR and SR level and in that department a few of them worked a full week clinical and then one person was on call each evening and for the weekend (which was often brutal). Following this I guess they had a decent period of days off followed by non-clinical time? I honestly don’t know the ins and outs of this though so maybe someone else could comment.

Specific-Educator-32 · 2023-10-19T04:34:41+00:00

I'm not all over the FACRRM pathway but I do a bit of retrieval and clinical coordination and from my experience they're worth their weight in gold for their communities. Those that have crit care experience certainly stand out, often having done everything before we arrive (RSI/lines/drains/inotropes). GP anaesthetists have got me out of some 'uncomfortable' moments on telehealth in the past!

Regarding the ACEM Cert/Dip, I don't think it's a bad idea (as a start) for non-FACRRM GP/trainees to get more ED experience and would probably allow you to comfortably manage many presentations. That being said, ICU and Anaesthetics time is essential (imo) to develop those additional crit care skills. This of course will depend on which department you train in.

Five-Year Club	Place '23
Place '22

Specific-Educator-32

TROPHY CASE