altDear Director,
We recently changed our coverage pattern from three 12-hour shifts per day to five eight-hour shifts. While this increases our daily coverage, we’re all working more shifts, despite hiring more docs. And now it seems like some of us get stuck doing more of the nights and weekends than others. What’s the appropriate length of shift? How do we divide them up evenly?

Dear Director,
I’m 62 years old, and have been with my group for 20 years. Although we evenly split the overnight shifts, I’m having a hard time doing them, both physically and mentally. Don’t you think there’s an age cut off where we shouldn’t have to do overnight shifts anymore?

Dear Director,
I received a complaint from a patient who was sent by their physician for an ED evaluation and possible admission. I saw the patient, did an appropriate workup, and discharged them with a treatment plan. But the patient complained that I was supposed to have arranged for their PMD to see them in the ED. How am I supposed to respond?

Dear Director,
I’ve worked for a group for several years as an hourly employee but they now want me to get paid on a productivity based incentive plan and I have a lot of concerns. Can they do this and should I be concerned?

Dear Director,
I’ve been thinking that I want to cut back clinically and maybe get started doing administrative work for our department. I’m pretty good at picking out some things that need improving in our department. How do I know if I’m ready to take that next step up?

Dear Director,
During a blizzard last year I couldn’t get in for a shift and I caught a lot of grief from my medical director about it. What’s my responsibility and what should I do if it happens again?

I requested a vacation from December 20th-30th this year thinking it would allow me to work my holiday (New Year’s Day) yet spend time with my family. My chairman said I couldn’t do it. Can I ever take off around the holidays?

Dear Director,
I’ve been recruited to be the medical director/chairman for a 40,000 visit ED. My concern is that the hospital wants me to work 12-14 eight-hour shifts a month in addition to the administrative responsibilities, and there is no plan for an associate director. Is this too much?

altDear Director,
I’m a medical director and have one doc who I’m under pressure by administration to fire.  Although he’s a good clinician who saves lives, at least once a week he gets complaints from patients, nurses, non ED attendings, etc…What can I do?

I just finished my first year as an attending and while I feel like I’ve made progress since residency ended, I am not the “master” physician I thought I would be. Will I always feel this way or will I eventually be a true expert in my field?
Signed,
No Master Yet

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