How do family doctors competently work in ERs?

[F508]

It also doesn't make sense to have a specialized medical professional work in a hospital serving 10 000 people.. unfortunately there doesn't seem like there's any good solutions to solve the rural-urban divide (for urgent medical issues anyways)

[Comprehensible]

2 hours ago, blah1234 said:

I think while rural Canada served a purpose in the past I think the maturing of the economy means that these rural communities are slowly becoming liabilities in terms of healthcare expenditures. 

While I agree that it may be more expensive to serve people living in rural communities, I think it's a bit short-sighted to say that such communities no longer serve a purpose. Depending on location, these are the people who feed the rest of the country (and the world in some cases) and provide us with many essential resources that feed our economy. Also, while not everyone living in rural environments prefers them, some definitely do, and would be very unhappy in urban landscapes.

[medigeek]

4 hours ago, katakari said:

 

I will be doing single coverage ER this summer out of residency. From advice of those around me, and my own thoughts, the situation you describe is incredibly rare, especially in a low volume center like where I will be. With 5-15 patients a day just based on probability you won't see as many emergent cases. Despite this, I made sure back-up was good as well and there will always be a physician back-up in the community who is more experienced with procedures if I find that I need extra help. 

Then of course, knowing your principles, doing as much reading as you can, and having a good plan for these scenarios is optimal. Start with VL, know your airway algorithm, prepare for surgical airway, use techniques that maintain airway reflexes if you are particularly concerned. Simulation can't be understated for High Acuity Low Opportunity scenarios; take extra courses to fill in knowledge gaps.

And lastly, something that often goes unsaid is that, unfortunately there is an understanding that due to nature of the location that these patients live that health care outcomes may not be as good compared to living across the street from a Toronto hospital. You just simply can't get Icatibant and a specialist with an airway fellowship to your patient in five minutes. But you do the best that you can to bridge health care disparities.

The more you think about it, it's pretty backwards that the areas with the lowest amount of resources also have practitioners with the least formal training.

Interesting that it's that few patients, I know some rural ERs easily see 40 a day during summers.

Curious what sort of numbers you got in residency? Central lines, chest tubes, intubations etc. 

[blah1234]

25 minutes ago, Comprehensible said:

While I agree that it may be more expensive to serve people living in rural communities, I think it's a bit short-sighted to say that such communities no longer serve a purpose. Depending on location, these are the people who feed the rest of the country (and the world in some cases) and provide us with many essential resources that feed our economy. Also, while not everyone living in rural environments prefers them, some definitely do, and would be very unhappy in urban landscapes.

I 100% agree. I was too broad in my statement as a lot of rural areas are still play a valuable role in important industries. However, I have worked in many small communities as part of my rural rotations that were essentially legacy settlements from a bygone era. 

People definitely have a right to live wherever they wish but in the context of providing healthcare from a single pot I think citizens have to accept that there will be an inevitable disparity between rural and urban services. 

[katakari]

11 hours ago, medigeek said:

Interesting that it's that few patients, I know some rural ERs easily see 40 a day during summers.

Curious what sort of numbers you got in residency? Central lines, chest tubes, intubations etc. 

Yeah, I specifically looked for a low volume site to start out. You have to be a bit careful and know your limitations as people will let you work in almost any of these places. I was offered to cover a site with 70 visits/day.

My numbers aren't anything special. I have had enough experience that I feel comfortable with my plans and procedural skills to successfully run a low volume rural ER, especially with good supportive back-up starting out.

If you had a more specific question it would be easier to provide more information. Are you looking into doing ER yourself after 2 years of residency?

[NLengr]

On 4/6/2019 at 11:19 PM, blah1234 said:

 

I think while rural Canada served a purpose in the past I think the maturing of the economy means that these rural communities are slowly becoming liabilities in terms of healthcare expenditures. 

Agree 100% with rural care being a liability for the system. Rural Canada is dying slowly. The rural population is aging. And it costs much more per capita to supply care to rural populations. 

As for rural vs. urban outcomes in emergencies or acute situations: they are worse. Everyone knows it. You just don't have the resources rurally. At my center (rural center 4.5 hours from tertiary hospital) you aren't getting PCI or neurosurgery if you have a big MI or a head bleed. That's just part of the tradeoffs you make when you decide/have to live in a rural area. (I say have to because many of the docs here, including myself, would never choose to live here if we could help it).