Letter to the Editor
I recently read Dr. Edwin Leap's column, “An Emergency Physician's Guide to Locums.” (EMN 2016;38:1; http://emn.online/May16Emergistan.) Wow! How I can relate! His column was so comforting. I had felt that I was the only one going through this, but now it really sounds like we are an Emergistan Foreign Legion.
I, too, was at one facility for 17 years. In fact, it was my first and only full-time EM job fresh out of EM residency. I met my wife, an ED nurse at the time, there. We moved into the community, had our firstborn in that hospital, and I thought I had the “dream job” for an emergency physician. It was home.
Our group carried various positions throughout the hospital, served on many committees, and had great relations with the CEO and medical staff. Then as health care changed with the Affordable Care Act — mandates of going in-network with insurers, EMR, core measures, Press Ganey, and strict if not vindictive scrutiny of throughput times and patients seen an hour — and all of sudden my dream truly looked like a nightmare in Emergistan.
It became worse. Our former familiar administrative faces, who were like family away from home, were all promoted or relocated, or they resigned of their own accord. My group partnership was asked to leave because corporate had other plans, and all of a sudden, my home-away-from-home became enemy territory. Very quickly, well respected and tenured emergency physicians who lived and worked in their community and served that community's health needs were treated as a dispensable commodity, and one quickly feels ambushed and alone. The passion and pride is lost. The work becomes just a job, more like a customer service job where your manager implores you to ask your ordering party if they would like wine or delicious desserts to boost sales. And they always required us to thank them for choosing us for their care. It was like saying, “Thank you for choosing Emergistan Airways. We know you have other choices.” Should they not be thanking us? I felt after a while that trying to keep up was like being an overpaid desk clerk. I had to ask if their pain was controlled and dare I say it, but yes, “Would you like to supersize your analgesia with an extra dose of Dilaudid?”
Now, I must leave my community, for which I am the EMS medical director, and pack my bags weekly to work in rural emergency departments who are so thrilled to have an Emergistan veteran from the big city that they pay us well, feed us, and comfort us with encouraging words all while respectfully working under the same harsh ACA conditions that the bigger city hospitals do. And let me tell you, it is worth the drive! Pack up fellow emergency physicians and find that passion! It's out there.
Levon Vartanian, MD