To reprise anything, one first has to conclude that it made some impact the first time. Following the entr’acte, you expect only the mellifluous strains that carry the strong feelings of the first act. To this end, I want to acknowledge all of you who have written about the last column which dealt with the natural maturation continuum of a career in emergency medicine.
Emergency Physicians Monthly readers offer sage suggestions for the maturation of the Emergency Medicine career, from hospice to admin to the DOC.
To reprise anything, one first has to conclude that it made some impact the first time. Following the entr’acte, you expect only the mellifluous strains that carry the strong feelings of the first act. To this end, I want to acknowledge all of you who have written about the last column which dealt with the natural maturation continuum of a career in emergency medicine. It is always great to hear from readers, but this time the feedback regarding the expansion of the emergency medicine career was so helpful and diverse that it deserves revisiting in this month’s column. There were some general themes I wish to summarize and reiterate.
First, we are scientific engineers. We apply scientific principles to solve practical human problems. We are the ultimate in blue collar realists. The proper beginning of this combination of practicality and ethereal experience needs to begin in our training programs. Residents should be taught to recognize two principles by the time they graduate. Number one, change is the only constant. Heraclitus was right, we never step into the same river twice. Second, the world of emergency medicine is expansive and they should not expect to be doing the same things at age 60 as they do at age 30. The balance between clinical shifts and the vast array of other potential activities will continue. For example, who is better prepared to run hospice programs at the end of life than those doctors who have had to manage the end-of-life cases and the all-too-frequent middle-of-the-night nursing home transfers? These are colossal wastes of resources in a country that is going broke from medical excess.
One of my old friends, Andrew Sumner wrote in response to the January article, “Our specialty is uniquely qualified to serve as Vice-President for Medical Affairs or Chief Medical Officer. What other doctor understands the system better than we?” That is simple, direct, and correct. But being able to do so is not a right and certainly not by accident. Chance favors the prepared mind, so preparation for leadership roles must take in conjunction with clinical practice so we are ready to assume such positions.
Community outreach, EMS, public health and a fundamental understanding of business and legal principles should not be merely tacked onto emergency medicine training; they are intrinsic to the nature of what emergency physicians do. I hope our training programs reach out and make active attempts to involve emergency physicians who have assumed these roles so they may be allowed to mentor and inspire our young. The goal is simple: the supply of a basic platform which will launch careers in which new horizons are continually being sought and continuously being conquered. I have loved every aspect of my career and the best I can wish upon my young colleagues is that their mid-sixties will be as exciting as the day they first entered residency.
Some sage readers have written suggesting that there are obvious changes which we need to enact in order to extend the quality of life and effectiveness of emergency doctors. Shortening the shift lengths as we age was repeated by several. Face it, all eight-hour shifts become 10-hour shifts, so why not plan on six-hour shifts after a certain age? Many people are now experimenting with starting out a clinical shift in the “main” department and only taking rapid treatment, urgent care type cases for the last two hours of that shift. This gives the physician the chance to properly disposition the earlier cases and still get out on time without the medical and legal problems of transferring cases and care.
The use of mid-levels and, more importantly, scribes to increase the productivity of the physician is so obvious as to seem unnecessary to mention. But it’s not. Doctors should think, not work. A doctor doing order entry is a disaster. If we were another business, we would fold. This is a soapbox I refuse to turn into firewood. Rethinking jobs and what people do will be essential if we are to present a coherent picture of our profession to bureaucrats and administrators who have nothing but a desire to cut our funds.
A Canadian physician also wrote in, pointing out that in the second half of our careers we should be shifting our work to clinical work in correctional institutions, occupational medicine, and public health endeavors. These endeavors, which usually require normal working hours, can serve to increase both the interest and longevity of our career. Good point! Emergency physicians are the only professionals who work 75% of their time while other professionals are at leisure.
Another reader had the audacity to suggest we should use our vast experience to benefit our fellow citizens. While these are obviously the rantings of a hippie communist, let’s here them out. This physician suggested that we add years to our working lives by serving in rural communities in two- to four-week stints. Or, through telemedicine, we could give our vast array of experience and clinical expertise to physicians and mid-levels who could use such guidance. Will this pay as much as a lucrative suburban ED? Probably not. But it could be a lot of fun, and at a certain age, maximum dollar activity is not always the necessary or principle goal of working. It was suggested that these programs could have some governmental sponsorship and all malpractice could be covered by the federal tort claims act so doctors could get back to loving the practice and not fearing the attorneys. Who knows, this getting back to being a doctor might catch on. Be honest, when you saw the Haiti photographs appear on television, you wished you were there. I know you did. Because you are emergency doctors, the best people I know, and the only group of doctors who still deserve to carry the staff of Asclepius.
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Greg Henry, MD
Founder and CEO of Medical Practice Risk Assessment, Inc.; past president of ACEP.