Like millions, I am a fan of Malcolm Gladwell. He has written five books that hit number one on the New York Times bestseller list over the past decade. I often recommend two of his books to residents. Blink, which discusses the pros and cons of making “snap” judgments (which emergency physicians often must do), and Outliers, which considers why successful leaders not only are talented, but usually the benefactors of luck.
Mr. Gladwell's detractors say he cherry-picks examples for his books that agree with the point he is trying to make. Regardless, I enjoy his work because it forces me to think outside of the proverbial box.
His latest book, David and Goliath, makes the point that the underdog in many situations is actually not weaker than his competition, but rather has an advantage because of his perceived disadvantage. Reading the book led me to think how the specialty of emergency medicine moved up the ranks from red-headed stepchild to one of the most competitive medical specialties.
Each year, like most residency programs, we recognize one resident as Resident of the Year. Take a close look at the undergraduate and medical schools of our award winners for the past 10 years. (See table.) See any trends? All of the colleges are public state schools with the exception of the award winner in 2005 and two osteopathic school graduates. None of them, except Johns Hopkins, is considered an elite school at the top of school rankings. The most successful residency graduates in our program do not come from privileged families as graduates of elite schools but from modest backgrounds and a relatively inexpensive undergraduate and medical education.
That's not to say we have not had residents and many applicants who attended prestigious schools after growing up in privileged environments, but they have not on average achieved the same level of success as their less-privileged peers. I suspect this is the case at many other emergency medicine residencies as well.
Our program's faculty members have similar characteristics. Only one of our 21 attending physicians has a parent who is a doctor. Most of the other parents are blue-collar workers, farmers, and military servicemen.
Emergency medicine is a dirty, tough job that somehow entices highly intelligent and dedicated people with an outstanding work ethic. These men and women would work with colleagues and clientele similar to themselves in education and lifestyle if they were in any other career. Emergency physicians, however, choose to work with the most difficult members of society during incredibly stressful moments. Loud criticism, insults, and even violence are commonly directed at emergency physicians and the ED staff. Most lay people in society are grateful for their dedication, and most are willing to admit that it is not for them.
Could it be that the humble background of many emergency physicians provides them with an advantage to excel in the specialty? Coming from a disadvantaged background may contribute to success in emergency medicine, allowing these doctors to be the proverbial David to society's Goliath — the aging and increasingly sicker patients who present to emergency departments in greater numbers every year.
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