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Viewpoint: Emergency Medicine's Four-Letter Word: Retirement

Kumar, Rani MD

doi: 10.1097/01.EEM.0000423202.05060.94

Dr. Kumaris an assistant professor of emergency medicine and the chair of the emergency department at University of Pittsburgh Medical Center in McKeesport, PA.





Emergency medicine began as a specialty because of public need. Those of us who grew with it know the battles we faced for ourselves and our patients. That new road was not paved, and it cut through some rough mountains and steep valleys.

Now it is a beautiful highway traversed by millions of patients and thousands of clinicians who proudly call themselves emergency physicians.

The path was mapped by the wisdom and dedication of leaders who worked at the federal and state levels. It was paved by each practicing emergency doctor who dared to travel the road not taken. The hard work for patient rights, quality care, and respect has given our specialty its own dignity and brand name.

We are now one of the most competitive specialties, sought out by the brightest medical students, because of this hard work. Our highly qualified residency programs train the smartest physicians to provide high-quality medical care in emergency departments in every corner of our country. That has given us a permanent seat on the medical executive committees for most hospitals, and our experts are appointed to highly respected and powerful positions in government. We are a specialty that is familiar with and knows how to multitask, triage, build teams, think critically, negotiate, listen patiently, create policy, manage systems, serve as resource managers, review utilization data, adapt to unpredictable situations, provide care in disaster settings, and solve problems.

Each day we accommodate double and triple our patient load when needed. We are there for our patients, rain or shine, 24/7. We leave our families and children early on Christmas morning and during Thanksgiving dinner to keep our doors open. We work endless chaotic long shifts without a bathroom or food break because we love what we do; it is rewarding to revive a cardiac arrest, reverse florid pulmonary edema, intubate a cyanotic asthmatic adult, and console a scared mother holding her seizing child. We know the pride of a saved patient who is safely hauled to the intensive care unit, even though he may never remember our names or faces.

Younger physicians bring infectious enthusiasm, energy, and inquisitiveness to the table. Experienced, seasoned physicians bring wisdom and clarity to this scene. Both add endless value to the arena.

But this well lighted highway comes to an abrupt end as it turns the corner. No exit is designed to allow drivers slow their speed or find directions. We must run at high speed or leave.

I was at the American College of Emergency Physicians' Scientific Assembly in Denver last month. I talked to several recruiters, and did not find a single one that had a job opening that would utilize the wisdom of emergency physicians who choose to slow down and go another direction. There was a job fair for residents ready to graduate, but not one booth offered opportunities for the folks who wish to sit back and offer the lessons they learned and help repair systems in many industries (health care or otherwise).

The recruiters only offered the roller coaster ride of emergency medicine!

So does that mean that each emergency medicine career must end abruptly? No cool-down period on this treadmill?

Emergency physicians have a unique perspective and the ability to work in a changing environment, adapting to the needs of time and resources. They are experts and familiar with all facets of medicine, and are immensely talented and valuable.

It is up to each of us to find our own niche and exit when the time is right. Many are lucky enough to find the right opportunity, but for now that the exit is to be carved out by individual efforts.

It is a tremendous waste of talent for those who have exited or retired quietly. Hopefully in a few years there will be as many recruiters seeking the expertise of seasoned emergency physicians as there are looking for new graduates. This is important even for those just starting their careers. Each of us will need to consider our future as we approach that point.

For now, the individual search for a few doors to open is a tough job. Imagine the possibilities and pride when our organizations put some strength behind it! It will bridge this high-speed Autobahn into a valuable exit for all.

Those of us who chose emergency medicine are a different breed. We thrive on challenges, and I hope I can find ways to challenge my mind and be able to make a difference in someone's life when I am ready to exit.

Contact your ACEP representatives, and ask them to build on this highway of emergency medicine. This effort, no doubt, begins with individual physicians. Examples are set by many who have shown the immense value of emergency physicians in various arenas of health and other industries. The task will be accomplished faster with the collaborative efforts of individual and organizations. Let's get to it!

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