Strange question from the NREMT-P test today

[Kiwiology]

That is like one of the most awesome stories I think I've ever heard ...

Good bloody luck finding an after hours dentist here; it's not part of our health system unlike NHS in UK so as private practitioners who work during the week the overwhelming majority choose not to work on the weekend. It's almost as bad finding an after-hours GP but you can always go to the Emergency Department; at the very least they will have an International Medical Graduate first year House Surgeon on duty who has the tiniest amount of acute care experience required to graduate ... but hey he is still a doctor, technically.

[ERDoc]

You won't find a dentist in the US who will come in on a Sunday anymore. Go to the ER and you will find attending physician. Take that Kiwi.

[MedicAsh]

Got any ketamine in your hip pouch? That would be being of service, I need to get four teeth extracted and at $200 a tooth that ain't cheap, some ketamine and a bro with the pilers would be you know, free ... and I'd have some good ketamine dreams! so its win-win

Nope no ketamine. Sorry

[Kiwiology]

You won't find a dentist in the US who will come in on a Sunday anymore. Go to the ER and you will find attending physician. Take that Kiwi.

Come on bro, every emergency department in the country cannot possibly have an Attending (Consultant) Physician 24/7 wait maybe they do if it's only like 4 years of post-graduate training instead of like 7; hmm .... but still, this,

[ERDoc]

OK, maybe it is not 100% correct but you will not find any interns alone in an ER. You will in most cases have an attending (though they maybe be surgeons, IM, FM) but you can find some fellows trying to make some extra money (but technically they are at the attending level as most have completed an IM residency) or some 3rd year residents who are only a few months away from being attendings.

[Kiwiology]

In situations where the House Officer is "alone" in the emergency department it just means they are the only doctor physically present in the emergency department; it happens less than it used to but it still happens; for the nearly three decades I have been alive we've had a shortage in the specialist medical workforce because as a small country we can't compete with the lucrative international salaries/working packages and experience available elsewhere in the world. Take emergency medicine, go to Australia, South Africa or US and you will see more shootings and stabbings in a week than you will in your entire career here. In fact in Australia the pay even for a junior doctor (House Surgeon or Junior Registrar) is up to double what it is here and it's only a four hour flight away!

Anyway, yes in some situations the House Surgeon is "running" ED (i.e. the Doctor physically present) but this is usually only overnight in the smaller hospitals and they have a Surgical Registrar on-call as well as a Consultant Emergency Physician. The Surgical Registrar is often (if not always) physically onsite and the Consultant generally has it in his contract he must live within a certain travel time from hospital e.g. 20 minutes. There is also a Medical Registrar (internal medicine) awake in the hospital as well. Our hospital also has ICU but I'm not sure if they have a medical officer on 24 hours; I think after 11pm they have a Reg on site i.e. asleep in the on-call room.

Locally ED has a Consultant during the day and a Registrar until 11pm/midnight during the week then at least one House Surgeon sometimes two; in the weekends we have a Reg on overnight.

Remember the sixth year of our Medical Degree is our "Intern" year and we are the only country in the world to do this; you have the full responsibilities of a House Surgeon but you cannot prescribe (this may change in the future to some simple things like it was 20 years ago e.g. IV fluids, antibiotics, laxities, analgesia) so really a first year House Surgeon is what would be considered elsewhere in the world in their second post graduate year as far as their experience is concerned.

Edited April 2, 2012 by Kiwiology

[ERDoc]

I've seen some locum tenens positions in NZ that pay pretty well. I guess they would rather pay to bring in foreign docs than pay their own. It could be because we look better in speedos.

[chbare]

I've worked in a few tiny and very rural hospitals. All were staffed by physicians that were either board certified in EM, IM or FP with the occasional general/vascular surgeon. I've seen a few hospitals in special situations have a midlevel staff an ER type clinic, but the situation was very unique and not the norm. An IHS clinic for example.

[Kiwiology]

I've seen some locum tenens positions in NZ that pay pretty well. I guess they would rather pay to bring in foreign docs than pay their own. It could be because we look better in speedos.

Locum pays crazy insane here but reliance upon locums has been recognised as unsustainable by Health Workforce NZ

They have to pay well to match up to what is on offer elsewhere in the world and in some cases to attract anybody; I know one hospital had a single Consultant OB/Gynae and they'd been relying on locums for over two years because nobody wanted to come work there.

I've worked in a few tiny and very rural hospitals. All were staffed by physicians that were either board certified in EM, IM or FP with the occasional general/vascular surgeon. I've seen a few hospitals in special situations have a midlevel staff an ER type clinic, but the situation was very unique and not the norm. An IHS clinic for example.

Wow I am jealous seriously; all of our hospitals are teaching hospitals so they must have a Consultant (board certified/Attending) in whatever speciality they are accredited to offer a training post for however that doesn't mean the Consultant does not work 8 hours a day on-site with the other 16 hours on call.

[Fox800]

Pt.'s saliva > milk > saline > water.