The Pitfalls of the County Hospital

This past Monday, I started my first job after residency at the Maricopa County hospital in Phoenix, Arizona. Although I am excited about the new position and its potentials, and yes, even the patient population, I find that the infrastructure for providing the best care to the patients is not there. As you can imagine, the county system is probably slowest to change. For instance, I found that there is no acute pain service at the hospital to manage patients postoperatively. This was one of the strengths of University of Virginia's program. If I choose to do an intervention to help postoperative pain such as a thoracic epidural, I will have to work harder to follow up with the patient on the daily basis. Regional anesthesia is also another rarely practiced adjunct to anesthesia. The other issue is that it is hard to do procedures in patients who do not speak your language. Interpreters are also not always available, so cases are held up to ensure that the informed consent happens appropriately. Lastly, there seems to be no production pressure, Turn-over times that are up to 45 minutes certainly slow the day and make it longer on the other end! Nevertheless, there is potential for growth here and I am looking forward to being part of the "growing pains"!