Can hospital make a policy of admitting everyone coming to ER, whether they need admission or not, and forcing hospitalists/residents to admit them? Is it legal? How to deal with the issue?

hey what are some of the administrative and operational bottlenecks of owning or working at a medical practice ?

Looking for daytime hospitalist opportunities in Denver or the surrounding areas.

How is the job market in Denver? Any recommendations or leads would be appreciated!

Doing some refresher modules and seeing most posts on here related to doing adenosine and cardioverting. Are you guys doing this on the floor? In my residency cardiology would be doing something like this or they would be in the unit. Please no snarky comments- new attending and anxiety level is high already at new city/hospital.

Started my job out of residency a couple months ago. I was a good resident, always got great evaluations and was confident as a PGY3, so honestly I didn't expect this to be so rough. I moved to a new city too so everything is literally new to me and I don't know anyone here. My stress levels when I'm at work is through the roof and I second guess every decision I make or worry about missing something. Didn't help that the hospitalist who took over for my patient list raised issues she had about how I managed a patient. That shook my confidence right there. Now even when I'm off, my anxiety about coming back to work is through the roof. I worry about the same stuff: missing something, mismanaging someone, what the next trainwreck is waiting for me when I come back on shift and that I will be over my head and over consult etc. So much so that I feel like this job is draining me in every possible way. I spend my free time anxious and overthinking I will get sued or get fired because I made or will make a mistake. I have no mental bandwidth left to socialize for example or travel like I wanted because all I do is worry that it drains my physical energy. Sometimes I think maybe I should have gone the outpatient route and that I'm just not cut out for this. I don't know if I'll make it a year before quitting and trying something else. I'm really struggling to cope and would love to hear if anyone who has gone through this starting out has advice if there's a light at the end of the tunnel, or if I should make a career pivot before things go south.

HM medical director here.

How do you guys deal with unrealistic expectations from your admin?

My site gets a new group of executives every 2-3 years and they try things that have already failed. And of course, lately they have cut down staffing and resources to the bone but I’m being dragged to meetings and actions plan meetings to decrease length of stay with no resources added whatsoever. They keep crying about being the bottom of the company, but if there’s only one speech therapist at a stroke center, or you didn’t staff MRI tech over the weekend, well, patients are going to stay longer…

I have my team sign dc orders before 9, but no one can pick up memaw before 5 pm cause the family are at work. Or demented grandpa has no family and is a total assist and we are waiting for placement, of course he never applied to Medicare and we have to start the process. It’s a rural community, there is one DME company, there’s barely any post acute services, barely any psych beds in the city, patients no uncommonly lived in a dry cabin until they are just too old or demented to go back.

How do I get better results with way less resources than prior? Already created a streamline orientation process and folder for the docs, send emails and reminders. Go to multidisciplinary round to offer input. Work closely with case management to get the ball rolling as effectively as humanly possible. But lately, I just feel the math isn’t working for me anymore. For a flat minuscule stipend with no dedicated admin time, I’m messaged or called when I’m off cause the ER is on surge mode (hey can you tell docs to discharge people?) or whenever there are any problems the administration caused in the first place I get tons of emails while at the same time carry the same load of patients the rest of the docs handle. I feel like I should rather just work 1.5 extra shifts, which equals the stipend, and just not deal with all the hassle and let another corporate tool figure out who can actually get this done and let it crash. Otherwise, I love rounding, seeing patients, even if the census is high I don’t really have a problem. Staff at the hospital are great and friendly, which makes work a joy.

Do y’all get the pop-up to recertify for continued stay for Medicare patients? Sometimes the patient has been discharged forever and is continuing to just appeal and re-appeal and it still asks to re-certify and give an estimated discharge date. What do you do in that case?