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

Dear Director,
I’ve been a dedicated part-timer for years, but now I’m not getting my shifts. Why is that, and what can I do about it?
Signed,
Left Out

Dear Director,
I think my nurse manager is ineffective and has lost the support of the ED staff. She doesn’t report to me. How involved should I get in the nursing business?
Signed,
F.B., MD

Dear Dr. Silverman,
I recently admitted a patient with pneumonia which was causing some altered mental status. When the house staff came down to evaluate the patient, they lowered the guard rail down, then walked away. The patient fell and broke a hip. I told the house staff they would need to deal with the family, but they wanted me to do it because the patient was in the ED. It’s not my fault the patient fell, and I didn’t want to talk to the family as it could increase my risk of getting sued. What do I do?
Signed,
Trying to avoid the suit

Dear Director,
Our hospital has started enforcing a policy saying that every doctor has to participate in a hospital committee. I get paid by the patient, not to go sit at meetings. Why should I do that?
Signed,
A Clinician
Length-of-stay (LOS) is quickly becoming a key metric of focus for our EDs. This is even truer with the inclusion of LOS into CMS’s core measures list. The importance of understanding LOS cannot be overstated, given that it is instrumental in determining the number of ED beds you need. This treatise is simply an overview of a little known law called “Little’s Law” and how to use it to gain new insights into managing your ED.

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