The Slow Pivot

One of the greatest benefits of being the executive editor of Emergency Physicians Monthly is that I get to read Greg Henry’s column before any of you do. I get to laugh at his unending wit, look up all the Latin phrases I’ve never heard before, and occasionally censor some of his more bawdy phrases. But I never cease to be challenged. This month, Greg’s column on “maturing the physician career” is so important that I want to use this editorial space to give a resounding “Amen!”

One of the greatest benefits of being the executive editor of Emergency Physicians Monthly is that I get to read Greg Henry’s column before any of you do. I get to laugh at his unending wit, look up all the Latin phrases I’ve never heard before, and occasionally censor some of his more bawdy phrases. But I never cease to be challenged. This month, Greg’s column on “maturing the physician career” is so important that I want to use this editorial space to give a resounding “Amen!” He writes about the need to develop pathways for seasoned physicians to advance their careers, and in future issues, EPM we will be highlighting some emergency physicians who have taken their EM skills in some different directions. So I thought I’d kick this off by telling a little of my story, particularly about how EPM actually came about.

First, I must confess that I am, and always have been, a rather average emergency physician. In what I do now, I find that to be a strength (I can easily relate to our readers), but in the early part of my career it was a source of a great deal of fear about my future. After residency training I succeeded in getting into several administrative roles for which I was not particularly well suited. Consequently I bumped from job to job over the first ten years of my career. Let me just say it: I was fired several times. I tried getting more education – a law degree to be exact – but found the idea of being a lawyer somewhat distasteful. So I wasn’t quite sure what the future held for me. I literally wasn’t sure I could hold a job for the next twenty years. Then two things happened.

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First, I was contacted by a publisher to become the editor of a medical/legal newsletter. The way the publisher found me is an entirely different story, but suffice it to say that I didn’t seek them out. I wasn’t even aware that the newsletter existed. But by luck or Providence, I fell backwards into becoming a writer.

When I wasn’t writing the newsletter, I perused the classified ads of all the ‘throwaways’ that I got, looking for a job, just in case my current one didn’t work out. That was when I took a hard look at those ‘throwaways’ and realized what they were missing – editorial content written by emergency physicians themselves. It would be nice to say, “And the rest is history!” but that’s not how it happened.

My first attempt at medical journalism was a newsletter called Atlantic Search Report sent to around 1200 EPs in the mid-Atlantic region. Some of you may have even gotten one in the late 80s, early 90s. We printed it at Sir Speedy in black and white, put it in envelopes, and snail mailed it. We sold ads, but it was largely paid for by working extra shifts in the ED. Needless to say, I was not a business major. But that led to my second career epiphany. I literally couldn’t work enough to support this project, so I decided to leave my group and become a full-time locum tenens EP. I made a little more per hour, set my own hours (for the most part), but most importantly, I didn’t get fired anymore because the hospital really needed me and I would “fire” myself when I got tired of the them. It was an exhausting lifestyle for sure – I’d routinely fly from Delaware to Texas for a string of 10 consecutive nights – but it gave me the freedom to practice the medicine I loved while working on my little side project that I thought just might augment my retirement.

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In August of 1992, Atlantic Search Report morphed into Emergency Physicians Monthly and one night during a slow part of my shift in an ED somewhere in rural Pennsylvania, I poured out my life into a column titled “A Night shift in the ER”. It wasn’t particularly well written, but it was honest. Someone read it and wrote me that they felt they had someone who understood who they were and what they were doing. Suddenly I found a human connection with all my brother and sister EPs who were up all night waiting for the next heart attack, the next kid with croup or the next drunk. For me, it didn’t matter that I was shuttling all over the country, working terrible hours, pouring all my extra cash into this pet project. I had found my niche doing the two things that I loved most, practicing emergency medicine and sharing that professional life in some small way with my colleagues.

Now, it would be misleading to suggest that everything will be smooth sailing if you just find your niche and follow your dreams. Bill Green, the EP who invented and developed the T-ring – the little device that you use to tourniquet a finger for laceration repair – will be the first to tell you that developing an invention is a long and arduous task. But he will also tell you that inventing a product that improves the way we practice emergency medicine is as personally satisfying as it is profitable. Kip Benko, the EP who invented ‘The Dental Box’ will echo the same sentiment. Rick Bukata, EPM’s own chief clinical editor, took a very necessary activity that everyone hates to do – review all the current EM research – and created Emergency Medicine Abstracts, the most successful and impactful courses and publications in our specialty. The list goes on and on.

But why should EPs consider branching out in their careers, other than the need to calm their ADHD, phobia of getting fired, or any other adjustment disorder? For one, emergency physicians are some of the best people to contribute to society outside of the practice of medicine because of our training. We deal with other specialties in their worst hours and in the most tense situations. We’ve learned to deal with their rantings and develop their trust and cooperation. That makes EPs ideal candidates for medical leadership roles, in the hospital or out, whether it’s a VP of Medical Affairs or Chief Medical Officer for an insurance company. Our skill at doing the best with the least makes us ideal candidates to lead the future of medicine as resources get pinched more and more. Whether it’s politics or policy, EPs are the physicians best equipped to lead health care reform. The years of team leading make EPs ideal consultants on a variety of health related topics. The list goes on and on. When I asked Greg Henry for a few ideas, off the top of his head, for different directions that EPs could pursue, he listed so many things that he had to stop and take a breath before going on.

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The opportunities exist for emergency physicians to contribute their talents in a wide array of areas to the benefit of themselves as well as the communities we live in. Step back and take an assessment of your strengths, or as in my case your weaknesses, and see if there is a niche for you.

Mark Plaster, MD Founder and Executive Editor of Emergency Physicians Monthly

1992–2012
Mark Plaster celebrates 20 years of chronicling night shifts in this column. Tell us about your most memorable night shift at epmonthly.com