All right, welcome back, everyone, to emergency minute. Hard to believe this is episode number 17, a day in the life of an ER physician. Want to thank everyone that joined me last time for episode 16, which is obesity and what they told you is a big fat lie. Got some great reviews, saw a big bump in my reviews on Apple and also Spotify. So I do appreciate that. I certainly encourage you to go out and leave a review on any podcast platform that you use. It helps me. I put a ton of time and, I do put a ton of money into this. Hard to believe with all the editing that must be done and everything else. So I do appreciate your support. I am trying to grow that presence on social media to get this show out there. So please join me on YouTube, Instagram. I'm at DrJParente. Of course, I'm on TikTok and Facebook as well.

All right, so throughout the show today, I'm going to discuss what it's like to be an ER physician during basically one day. And you're going to hear me kind of go through the show and it's going to sound a little bit like I'm whining or that I'm saying my job is harder than yours because it is joking. Maybe not, I don't know. But at the same time, I want to discuss what my life looks like during an ER shift, and that would be almost impossible to do without describing some of the difficulties and the challenges that we face. So it may sound like I'm whining, but I'm not trying to. So join me today for a day in the life of an ER physician like these influencers on TikTok and Instagram. Solid.
All right, so before we get started, we kind of have to understand what an ER physician is. So there's this notion of triage, and that's kind of what we do now. Of course, that's the butt end of a joke at times where people say, well, the ER doctor is just a glorified triage nurse. Ha. Yeah, we've never heard that one before. So our job is not to diagnose our job, I think, by the way, let me say that again. Our job is not to diagnose. You should not go to the emergency department and expect to have a diagnosis. Our job is to rule out life and limb threatening pathology, things that are going to kill you or take off your arm. So these things, some of these diagnoses can take days. They can take weeks, months, years. Ms. Some of these neurological conditions, ALS, et cetera, these things take forever to diagnose. It would be nearly impossible to diagnose that in the ER. That's not the purpose of the ER. The ER is to identify those acute problems right now.
And the other thing we hear a lot of times is, oh, they missed my appendix three times. No one missed it. We did the labs, we did the CTS, we did those things, and it just wasn't there yet. Sometimes disease processes. Must evolve. Now, are there cases where people have missed these things? Of course, that does exist. But for the most part, these things do take time to develop. And for us to be able to diagnose them, we must see them. So I can't say you have appendicitis if the damn CT says you don't. But maybe three days later it will be different. So I digress. But the point of the ER is not to diagnose. So what do we do? Well, we have to be masters of efficiency. You see, in the ER, your visit has basically three components. You have the front end, which is like your triage, and getting in the door. Then you have the things that happen while you're there. You're getting blood work, you're getting X rays, CAT scans, whatever, and then the back end, you're going to be either transferred, admitted, or discharged. Or if you're unlucky, you're going to go to the morgue. So this is what an ER physician does. We have to be a master of that efficiency to get patients through that process.
And at the end of the day, I think residencies do a really lousy job of teaching this. I think the residencies do a great job of teaching the medicine part, which is important, don't get me wrong, but I think they do a lousy job explaining management of resources. You are the captain of the ship. Look at me. Look at me. I am the captain now. So why are the labs not back? We’ve got to find out. You have got to call. You got to be on that. Why did the nurse not give the medications, the antibiotics that were ordered an hour ago? Why is that EKG still not done? Why haven't they come to do the X ray on the person who's literally actively dying in front of me? Where the hell is the radiologist? And why has it been 2 hours since my CT was done and I still don't have a reading? So being an ER physician just isn't about medicine. It's about managing resources in an entire department.
All right, so what are some of the challenges that we face? Challenge number one is shift work. So obviously, this is not unique to emergency medicine. THis happens to multiple disciplines across multiple different jobs, et cetera, places in the hospital. But I'll start with what I normally do. I work a 07:00 a.m. To 07:00 p.m.. Shift. And obviously there's other people that are working afternoon shifts and night shifts and that kind of stuff. And to have the challenge of going. Bouncing back and forth, working random days followed by random nights or afternoons obviously can be challenging. Now, there are some pros to this. With scheduling flexibility, I could pretty much take a vacation every single month if I wanted to. That's the good news. The bad news is I would pretty much just have to sandwich all of my hours. And I typically work at least 200 hours every month, and I would have to sandwich that into like, a three week period. So anytime I take off, I'm just basically punishing myself the rest of the month and trying to work harder in a shorter period of time. And, yeah, obviously we have to work weekends, we have to work holidays, we have to work nights. It sucks, but it is part of the job that we signed up for. But, yeah, I mean, when you see your friends that are some in the corporate world and they're pretty much off every night, they're off every weekend and they're off every holiday, it does make you reconsider your life choices.
All right, so what does a morning look like? Well, I get up super early and I try to be wide awake. When I do get to work at 07:00 I usually like to try to get there early. And one of the reasons why, obviously, being a director, I kind of have to set a good example of being there on time. Doctors are notoriously late. However, I will tell you, in emergency medicine, they're not. They're pretty much there. And I always say, if you're not ready to run a code at 07:00 a.m. Or 07:00 p.m. When shift change occurs, then you're kind of doing a disservice to your colleagues that are trying to get out of there. So you have to get there on time. I do have a story one time for that sign out process from the night shift where I walked in, in, and my colleague was just like, oh, okay. Well, in room three over there, there's a belly pain that's just waiting on a CAT scan, and someone just checked in for a cough and cold. And in the trauma bay, there's a gunshot to the chest. I kid you not. This actually happened. I'm like, what? You didn't lead with that? Okay, what's the status? What happened? GSW to the chest, and they've been here for about 20 or 30 minutes. And the trauma surgeon's in there, and, yeah, so have a good day. And just, like, walked out the door, and I'm like, you've got to be kidding me. Oh, my God. So obviously, I had to go into the room, and luckily there was a surgeon there, but not an ER physician. What a disaster. And like I talk about all the time, healthcare is broken. And that story, I will never forget that story.
And one time I did actually just recently work a shift where I walked in at 06:00 a.m. I was working 06:00 a.m. To 06:00 p.m. At this one facility, and there were nine patients waiting to be seen, multiple patients that had been waiting for longer than, like, 910, 11 hours because the physician that was on had become overwhelmed with the amount of work that was needed. And quite frankly, this physician has really no business practicing emergency medicine. But I digress. And so it just absolute disaster that I have to walk into, and that reflects poorly upon me and the hospital and everything else. Right? Because I have to walk in and be like, oh, hey, sorry. You were here for the last 11 hours with your hand injury, and the X ray is done and already read. I'm going to go ahead and send you home because you have a sprain. So it really does reflect poorly on us. And of course, that'll show up on my patient satisfaction scores. Not the guy that didn't see the patient for the last 11 hours. So I digress. But the sign out process is always a bit of a nightmare. Luckily, I work in a very stable, very good group now, and so that type of stuff hardly ever happens. But I can tell you some horror stories over the years.
All right, so what does a typical patient encounter look like? So I go see the patient in the room, get the history, do a quick physical exam, come back, and then I put the orders in. And at that point, that's when we start to, we open the note on the computer, and we spend a lot of time in front of the computer doing the history, doing the exam, and sort of documenting everything. And then I go see the next patient. Now, in the meantime, I typically work with a physician assistant, and we kind of function similarly, other than they will go see the patient and do the exact same things that I'm doing on obviously different patients. But I do still have to kind of oversee what they're doing. So I look at whatever labs they're ordering, their imaging. I do look at the vital signs, and when things come back, like labs or. X rays. I do supervise them because there's a wide variety of talented and intellectually variable people that work in emergency medicine, whether it be a nurse practitioner or a physician assistant. So obviously, there's different levels there, and you get those levels of comfort working with people over the years. But at the end of the day, I'm still responsible for those patients as well.
Now, a lot of our time is spent in front of that computer documenting everything. And. And that's important. Medical. Legally, yes, because obviously we're going to get sued. It happens. It's an unfortunate part of what we do, but also for patient care. When a patient comes in and they were just seen a week ago, the first thing I do is I go look for that prior note. I go to that paragraph where the ER physician or the PA kind of summarizes exactly what happened during that visit. And that's the first thing I read. And I can learn more about that than spending, like, 30 minutes with the patient, because I know exactly what I'm looking for. And the person, theoretically, if they were good and documented well prior to seeing that patient, I will be able to get the information that I need right from that chart very quickly. So it's important for us to have this access to patient records. I cannot overstate this, but this does lead to one of my biggest pet peeves. Not just a pet peeve, but also challenge number two, which is getting information.
And the pet peeve I have about this are these multi hospital patients. If you have surgery at hospital A, and then you go to Hospital B with a complication of said surgery, what the hell are you doing? If you buy something from Home Depot, you do not return it to Lowe's or to target. I don't understand why this happens. And it happens like, ten times a shift, that people. I had surgery at the Cleveland Clinic and got this tube hanging out of me. And so, yeah, it's starting to hurt. So I decided to come here to your hospital. You understand we don't have those records. You understand the surgeon that did that procedure doesn't come here. This creates a giant barrier, and it's hard for us to get this information. We have these hospital bouncers that bounce all over the place. I was at this hospital on Wednesday, and then I went to that hospital on Thursday, and now I'm at your hospital. And two weeks ago, I was at this other hospital and I had blood work done there, but then I had extra. That's not good care. I can't give you good care because I can't see what the hell is being done at all these other places. It's very difficult for us to get this. And if you're like, oh, just fax over the records. Yeah. It takes like 4 hours by the time you get records from one of these places. Now they are starting to create some things, like something called clinisync, where you can get some of this information online, which is good. They've created these federal privacy laws, which just sound great on paper, but are extremely restrictive in patient care. So that's a huge barrier for us. And another heart of this is know when you go into a room, these patients, a lot of times they don't know their meds, they don't know their doctors, they don't know their allergies. Sometimes they don't even know where the hell they are. Literally, they don't know which hospital they're at. I'm like, where'd you have that surgery? I don't know. You had your surgery a week ago? Yeah. I don't know. Awesome. It was somewhere in Cleveland. Fantastic. That narrows it down. At the end of the day, people are horrible at giving us information. And it's so critical to actually giving patient care.
All right, so what's challenge number three? Challenge number three is the sprint. Once that shift starts, there's no turning back. I mean, this is a total sprint. This is like sprinting on the treadmill at its highest speed for, like a twelve to 13 hours shift while people are throwing apples at you from all directions and shouting at you and peeing on you. Not really, but sometimes. The last two months, my average shift count has been 62 patients in 12 hours, which is a little over five patients per hour. Now, that's with myself for 12 hours, plus a PA from anywhere from eight to 12 hours and a second PA for four to 6 hours. So this is just a sprint every day. Now, if I see 63 in a day or 62 in a day, that means that's my average. So obviously, there's days that I see 40, 50, but there's also days that I see 70 and 80. And it's crazy. It's crazy to see that kind of volume. But unfortunately, that's what post COVID emergency medicine looks like. We have way less doctors, we have way less shifts available, so we're all working harder and more with less resources. And these corporate giants have used this as a way to make money off our backs. Like, hey, oh, well, we lost a lot of money with COVID so we're going to short staff. You. You're going to see the same volume or higher that you've always seen, but we're going to pay you less with less staffing. That's cool, right? So that's a big challenge. And the other thing that makes this even more difficult is that obviously there's going to be patient complaints. When you're seeing that many patients, things are going to slip through the cracks. I don't necessarily have time to sit at the bedside, hold their hand, smile, and do these things that try to help with patient satisfaction.
And what's even more ridiculous is these hospital administrations, they don't care about someone being ridiculous that calls and complains. I just read a story of the physician that was working after the recent tragic shooting that occurred in the great state of Maine and obviously had a lot on his plate during this time where the victims were coming into the emergency department. And there was a discussion on a group forum online amongst other ER physicians that someone called administration and complained because they waited too long with their cough during this absolute horrific tragedy of multiple GSWs overwhelming an emergency department. Absolutely insane. And what's crazy about this is that I guarantee you hospital administrators took that call, gave it to the director for the emergency department and said, you, need to call that patient and explain and make sure you try to do service recovery. We need that patient to want to come back to our hospital. Make no mistake, healthcare is a business. And the fact that we even entertain these complaints when something like that is so ridiculous and so egregious is really disheartening, unfortunately. All right, so what's challenge number four? What's one of the hardest things that we have to do? Well, we have to know a lot about a lot. And I remember, it doesn't make any sense, but when I was going through my training, I remember hearing different descriptions of what a primary care specialist looked like versus what a specialist, like, surgeon looked like. And specialists know a lot of information. About a little area. For example, if you're an ophthalmologist, you know a lot about the eyeball, which is a tiny little area on your head. But a primary care physician knows a little bit about a lot of different things. Like, as a primary care physician, you need to know lots of things. What's funny about emergency medicine is you kind of need to know a lot about a lot. And we have to be a patient advocate. I mean, we have patients coming, coming in with chest pain and cardiac issues, but they're pulmonary and now they're trauma, and I need critical care, and they come in with vaginal bleeding, and they come in with weird infectious diseases. And also, I'm a dermatologist because they come in with a rash. So you have to kind of know a lot of these things. And by the way, you have to be a patient advocate.
Everyone seems to think that if I call the cardiologist and I'm like, look, this patient needs to be admitted. And I think they need X, Y, or Z. And the cardiologist is like, no, you're crazy. Send them home. If I send that patient home, something bad happens. I'm not off the hook. I don't just get like a get out of jail free card, like monopoly. I'm still on the hook, and I still can get sued. And you'd be surprised how many times we have to advocate for patients. It happens every single shift. Like, we call the ENT physician, we call and say, this patient needs this, and, well, no, they don't, or, oh, I can't help you with that, or, oh, you should send them some other place. And this goes on all day long. So I guarantee you one of the reasons why your ER visits delayed is there's somewhere in ER physician that's making these conversations with these hospitalist specialists, et cetera, and trying to be a patient advocate, trying to do what is best for the patient. Yeah, just a few weeks ago, I had a hospitalist telling me to send this patient home that couldn't walk and was falling at home and had some positive back findings on, like, a CT of the lumbar spine. I'm like, hey, pal, this is medical malpractice. This is like failure to provide a safe discharge. This patient's not going home. So you need to figure out a way to do it, or we're going to go up higher, we're going to go to the CMO, I'm going to call the CEO, I'm going to call the governor, the president. I don't care. We're going to call somebody and we're going to get this patient admitted, so let's figure it out.
All right, so what's the other hardest thing that we do? Well, this is challenge number five. We juggle with constant interruption. Imagine juggling 100 balls in the air while someone's throwing knives at you. That's kind of what we do. It's just constant interruptions. They actually have studied this and they said the average ER doctor is interrupted twelve plus times per hour. Think about that for a minute. Now, they didn't come to my hospital when they were doing this because I think it's twelve times per minute. But I digress. So they've done some studies on this. They've done studies on multitasking and how it makes us all inefficient and slows us down and somehow we have to sort of power through. And I love having this argument with people. They're like, oh, I'm a good multitasker. No, you're not. You're not. I promise you, you're not. You're just better at it than someone else. And the reality is, if you had ten tasks to complete, you would complete them. If you sat down and did task number one, start to finish. Task number two, start to finish without interruption, would be faster than if you did 10% of task one and then you did 3% of task. Four and then you did 1% of task ten, et cetera. Being a multitasker, unfortunately, is inherently a very inefficient way to function.
But there's really no other way to function in emergency medicine, so you kind of have to do it at the same time. Understand that it is a very inefficient process. All right, so what type of interruptions do we encounter? Well, there's all kinds of things, honestly. So at any point during my shift. Hear this all the time. Dr. Parente, the pharmacist is on line two, wants to know about a prescription that was written yesterday. Oh. On line one is a family doctor that's sending in someone to be seen. Hey, Dr. Parente, room seven's in pain and also can room ten drink some water? Hey, Doc, EMS wants you on line two. They have a patient that's coming in that's combative and they need some orders. Oh, by the way, the psych patient just ran out the ambulance bay naked. The chronic back pain patient threw herself onto the floor. She's now laying face down, she's bleeding. We're just not sure from where. Meanwhile, there's a screaming child in the room that's closest to the ER physician because inevitably that's where the nurses love to put that screaming child. And there's an elderly woman next door screaming at the top of her lungs. Help me. While the police are walking through the ambulance bay with a patient that's high on meth and PCP who's being tased. I digress. Moving on.
Those are all very realistic things that happen every day. All right, so what's challenge number six? Well, that's just the grind. It's the middle of the shift getting through this shift. At any given point, I could have zero patients on the board. I could have 35. At the end of the day, I'm responsible for all 35. Now, nurses obviously have staffing ratios and we could talk. We could do an entire show on staffing ratios for nurses. Most of them will have four at bad times, five, six, seven. But any given moment I have 35. Now obviously the nurse is going to be spending a lot more time at the bedside and I do rely upon them to be my eyes and ears on that patient because it's not possible for me to be at the bedside of 35 people at once. Now this doesn't make me any better than the nurse. I'm not saying that. I'm not saying I work any harder. But if that patient dies and a patient dies in the room or dies worse yet, in the waiting room. That's on me. It's not on the nurse. Are they going to name a nurse in a lawsuit? Sure, it could happen. I mean, I know one just happened down in South Carolina recently, but that was a whole different situation where that nurse pushed medication that was not ordered and it was the wrong one and it did cause a death. And that's a whole nother podcast we could do. But my point is, I'm responsible for this patient despite the fact that I may never have seen them. I always say the waiting room is the most dangerous room in the entire hospital, and it drives my nurses crazy. I know it does. But a lot of these nurses are so overworked by this point that a lot of times they just don't care. Let them sit out there. We have no place to put them. They probably don't even have a real emergency. And it's kind of sad because that is a very dangerous place out there. And the thought process is, well, if we bring them back to the ER, who's going to be able to take care of them? Well, I get that. I get that there's nursing ratios and you're going to have to go to an uncomfortable. Level, you're going to go from four or five to six or seven and maybe even eight. Yeah, I get that. And that's the part that sucks.
But even if I could just run into that room for 10 seconds and just kind of get a feel for what's going on, is this patient safe? Do they have an actual medical emergency? Because a very few percentage of patients that come to the ER actually have an actual medical emergency that can go a long way. A lot of emergencies don't necessarily really look like emergencies. I'll never forget the case I had once of a patient that came in by squad and they were like, the call came in, this patient's got back pain. He's got chronic back pain. He was like in his thirty S or forty s, and it's just a typical back pain. So we're bringing him in by squad and everybody's kind of like grumbling and another chronic back pain. Awesome. And calling him by an ambulance, so being a wool and then this guy rolls by on the cart, I just happened to be at a point where I could see him, and it was just kind of incredible to see this guy roll by because I'm like, that guy doesn't look well. There's something going on there. And so I remember, well, I better go see this guy. So I go and we hook him up to the monitor, and this guy's throwing PVCs. So these irregular contractions to your heart, like all over the monitor. Now, you can have those and be completely normal, but if you have a whole bunch of them, usually it's not normal. And he was actually having what's called non sustained VTAC, which is basically the thing that happens before you die. You go into VTAC, which is a dysrhythmia of the heart. And so he's going into VTAC. So we ended up doing this big workup. Long story short, this guy had back pain because he had emboli, which are blood clots basically thrown all over his entire body. He had them into his brain, into his eyeballs, into his arms and legs, into his back. He just had this like, shower of emboli. And I remember we put him out of blood thinner. We did all these scans and everything else, and we flew him to a level one center. He ended up doing okay. But the point was this guy came in with back pain and probably didn't look or sound like an emergency to a lot of different people and probably could have gone out to the waiting room or something else, and God knows what would have happened. But there is some value in just being able to see that patient, even just for a few seconds, and saying, yeah, there's something not right with this guy. We need to look deeper right now. We can't wait.
And this gets into the concept of Gestalt. And do you guys know what Gestalt is? So it's kind of like a fancy word for your gut feeling, and they've actually studied this. And a physician's Gestalt, especially someone that's well trained and has a lot of experience, is basically more sensitive than just about any other test we order. Meaning if your gut feeling tells you that there's something wrong with that dude, then there probably is something wrong with that dude. And I remember my Gestalt on that guy was, oh, boy. This is not our average back pain. We need to get this guy looked at right away. All right, so what's challenge number seven? Well, let's talk about the types of people and the types of patients that we deal with every day. Now, if you think about your neighbor as the guy that comes to the ER, probably not, although my neighbor did and was happy to take care. Of them. But people that have an actual emergency. Yeah, that's your neighbor. But there's, like, this entire subculture of patients that comes to the ER. I think if the general public saw what we saw on a daily basis, there would be a collective dropping of the jaw. I want to plug an interesting case where I had a chest cracked open doing cardiac massage as we were rolling by patients and family members. And I discussed this on my most recent podcast of interesting cases. But moving on. Obviously, something like that is truly shocking to see.
However, the day to day horror that we experience in the ER is really something that you can't describe and really can only be exceeded by people that have awful experiences. Like, I'm sure a lot of our military members have to endure. God bless them. So, I mean, we are yelled at, we're spit on, assaulted, puked on, pissed on. We have screaming, drunk patients who are just punched in the mouth and beat up, spitting blood with their tooth hanging and fighting us as we're trying to help them. We're doing CPR on patients covered in vomit and stool that pissed themselves and then laid in it for three days. We do wound care on patients that have maggots crawling on their diabetic foot ulcers. We have to find a way to take care of a 900 pound person that needs intubated or needs a procedure, who, by the way, doesn't fit in our CT scanner. Then we have the homeless person who comes to the ER for God knows what, random complaints because they have no other place to go. But then at the end of the day, they're so ungrateful, they refuse to leave. And then we have old people everywhere who are usually falling. They're getting horrible care at home from their families or even their nursing homes. We can't send them home because they're too weak and falling, but we can't admit them because they actually don't have a medical diagnosis for admission. So at any given time, I can look at my board, and I can just be overwhelmed with what's going on. I have three abdominal pains that are pending CT scan. I have the trauma that just came in. A stroke is rolling in through the door. I have three squads out on a three car MVC with God knows how many victims are coming in. I've got the sore throat that's been waiting for an hour, the cold that's over there as well, that has a sore throat for the last ten minutes. And they came in by squad because that actually has happened. We have the chest pain patients that we're kind of concerned about. Then we have the septic patient that's crashing, and the nurse keeps coming over saying, hey, their pressure is dropping now they need oxygen. We need to order antibiotics. They need more fluid. Now they need BIPAP, they need intubated. And you're managing this critical care patient. And, oh, by the way, you got to meet all your stroke metrics. Don't forget, the patient is here. If we're going to give TPA, got to do it in under 30 minutes. Run over to the CAT scanner, hurry up. And it's just an absolute grind. And in order to be able to do this, it's actually pretty remarkable that we're able to do this.
So challenge number eight is short memory. And I put this one in here because this scenario of the dead baby being brought through the door is like every ER physician's complete nightmare. And it's happened to all of us. It happens more often than you care to admit it and care to talk about, but we have to take care of that baby to the best of our ability. These. And look, when people die, it's sad, don't get me wrong, but we have a pretty hardened exterior. Shell healthcare workers in general, specifically, that work in the emergency room. When Grandma dies, it's a sad day for everyone. But when you lose a six month old, a nine year old, a seven year old, those are all patients I've lost over my career. It sticks with you. And I'll tell you, is on the entire department. And the bad news is you're sweating, you have tears, you're trying to manage the resources that we've discussed about this patient that just died that's six months old, and you just have to turn it off, and you got to go see the next patient. And by the way, now everybody's pissed, and so you got to go talk to the back pain that's standing in the doorway staring at you as if standing there and staring at me is going to make me get to their situation any faster. You just have to be able to turn it off and then just keep going. And I talk about this often, this sort of air traffic controller analogy.
When an air traffic controller is involved in a really bad, horrific experience or a near horrific experience, they're taken out of circulation. They're taken out, and someone else is brought in that's fresh and has a clean slate, so to speak. And I think that's great. I think that's fantastic because there's this emotional component that does kind of cloud your ability to think clearly at that time. And in the emergency room, unfortunately, we don't have that. Hospitals are operating at these super thin margins. The people that are staffing the emergency departments obviously have to make profit off of our backs. That's just the reality. So we don't have an on call physician. I can't just leave my shift, so I have to just turn it off. If I'm lucky, I go in the back and take five minutes to sort of just try to clear my head about what just happened and then go see the pissed off patients that are mad. They've been waiting for an hour or two because we're doing CPR on a six month old. So if you're wondering why your ER visit takes so long, this is a pretty good refresher. I'd highly recommend you take a listen to my podcast from February. Why does my ER visit take so long? But look, at the end of the day, all shifts do end. And that's the best part of the shift. That's the best part of shift work, is the light at the end of the tunnel. And so when that does happen, we have a sign out process. Some hospitals, you have to kind of stay and finish what you're doing, but obviously you're going to be not picking up for new patients for the entirety of the shift because that doesn't make any sense. Otherwise you'd be staying late every single day. Luckily, where I work, pretty much 07:00 we walk out the door unless there's something that we can kind of get rectified in the next 15 or 30 minutes.
All right, challenge number nine is decompressing. So this is a big challenge. That drive home, this need for unwinding and decompressing from a shift is critical, and I do drive almost 40 minutes. To my main hospital, but there's some other hospitals I work at that I drive like an hour or so. And honestly, that drive is kind of good. I kind of need that drive because I have to be able to flip the switch on some level. When I get home, I have to talk to my wife. I have to be a dad. I have to smile and be present as a father and not just be there physically, I have to be there mentally, which is really hard to do, especially after seeing some of the stuff that we see and enduring that and talking to these families and having people yelling at you and just these emotional roller coasters that we go through. It's hard to just flip a switch and then be the smiling husband and father that you need to be. And so that's one of our biggest challenges as well.
All right, so what about the future of emergency medicine? I don't know. My goodness. I think everyone's starting to see what's going on in emergency medicine. The most recent two matches that we've had nationally have been open positions, which has historically never happened in emergency medicine. We had over 500 positions go unfilled this year. Typically, emergency medicine is extremely competitive because usually the pay is decent and you get to do this shift work so you don't have to be on call. You can go home and be with your family and not worry about things after your shift, as opposed to family doctors that are either on call or they're getting calls from their patients, or they're concerned about their one patient that they've known forever know is going through something. So there obviously are some positives to emergency medicine, but I think with what's happened post COVID has been a real eye opener. And I don't know if you guys follow Stevie Joe on social media. He is absolutely hilarious. He is a former ER tech. Everyone thinks he's an ER doctor or an ER nurse. He's not. He's an ER tech who made it big, making videos, basically making fun of patients and emergency department patients on TikTok and Instagram. And now he does stand up comedy and he goes around the country. But anyways, I just listened to a podcast where he talked about COVID and the nursing shortage and how this has created a big problem. And I obviously discussed this in a lot of my podcasts as well. He's talking about how now charge nurses are like two years out of training and things like that because people are either going some other place, they're not going into nursing, they're going to become nurse practitioners. They're doing something else. Because to be an ER nurse and to work in the emergency department in general, it's a very difficult grind, and you have to have a certain type of person that can do that, and not everyone can do that.
And then, furthermore, why are people not going in an emergency medicine? Well, I haven't had a raise in ten years. I've taken multiple pay cuts. I'm seeing more patients now than I ever had before with less resources. That's not a good thing when you see your friends getting promoted and, oh, this one's just got a nice promotion and this one's moving up the corporate ladder, what am I going to do? I can't go up the corporate ladder. I'm not getting promoted. I haven't had a raise in ten years. I'm actually losing money and I'm working harder than I ever have. So you could see why people are not going into emergency medicine. It's not for everyone. And we'll see. I don't know what the future holds, to be quite honest. Honest. But as always, I try to end on a positive note. I think one of the things that I am very proud of in the emergency room is that we do function as America's safety net. If you don't have a place to go, if you have a medical emergency, you can't get in to see your primary care physician, maybe you just got fired from your pain management doctor. Urologist won't see you. Do you need a work note? Grandma's falling down and isn't safe to live at home anymore. Come to the ER. Are you have a sore throat for 30 minutes and you came in by squad. We're here for you. We truly are America's safety net. When there's no other place for you to go, you come to the emergency room. And you'd be surprised the things that we deal with, not just medically, a lot of social issues as well. So that's what we're here for. And I am proud of that. I'm proud of the work that we do. I wish we could do more, but it's just not possible in the short time that we get.
So I want to thank everyone for joining me today for a show where we discussed a day in the life of an ER physician. I hope I shed some light on why your ER visits take so long and be kind to us when we're grumpy. I apologize for not doing the podcast on how broken healthcare is. That'll be my next one. But I wanted to dedicate some more time and resources to that podcast because I think this is at the core of my presence on social media and why I wanted to do this podcasting thing to begin with. So join me next time for how broken healthcare is. I think you're definitely going to want to hear that and not wanting to miss that one as well. And again, thank you to everyone leaving me all the love on social media and the reviews on Apple and Spotify or wherever you get your podcast. I truly do appreciate you and I appreciate you getting this show out there and up and off the ground. As always, peace, love and happiness to everyone. Cheers, guys.
Bình luáºn