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At Your Defense

Seven Predictions for EM Residency Graduates

Reyes, Carlo MD, JD

doi: 10.1097/01.EEM.0000578620.39217.d1
At Your Defense

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Congratulations on your tremendous achievement! You've completed your residency in emergency medicine! All those years of hard work, dedication, focus, and restraint paid off. It got you over all the hurdles: achieving stellar grades and MCAT scores in college, ranking high among your medical school class, and matching into emergency medicine, one of the most competitive specialties in medicine.

I remember when I was you. The feeling was almost magical: All of a sudden, I was an attending physician! Making clinical decisions without oversight was surreal. Presenting cases to an attending was a thing of the past. Even as a chief resident I still had the training wheels on as I ran rounds, quizzing the other residents. My attendings still supervised what I did, and provided valuable input.

Seventeen years later, I'm a seasoned, mid-career emergency physician. How have I changed? My wisdom is up, my stamina down. These are to be expected. But what surprised me was a growing sense of humility with medicine and what academics doesn't teach. The academics are obviously critical but not complete. Emergency medicine is taught not by an attending but by the hard knocks of clinical experience. It's not just clinical acumen but the nonclinical street smarts I'm talking about. By mid-career, I predict that most of you will experience the following.

You will work more shifts than you anticipate. Working full-time in emergency medicine is 12-16 shifts a month, so adding one or two more shifts will seem doable. With the drive to pay off school loans, buy your first home, and support a family, emergency physicians always hit the ground running.

You will struggle to balance your work life and home life. Only shift workers can understand the schedule of shift workers. Most of us won't be with partners who also work shifts, which commonly leads to your partner's dissatisfaction with you. EPs who pick up more shifts unwittingly sacrifice their time with their spouse and children. At some point, this issue will need to be addressed.

You will be able to do things that physicians in other specialties would never be able to do. Some of you, especially those not married, will devote a substantial amount of time to non-work activities. Emergency medicine allows extreme flexibility in pursuing other interests. I have peers who are TV show directors, best-selling novelists, world-class athletes, and attorneys. I know actors, spiritual leaders, and lifeguards who also save lives in the emergency department. I know so many inspiring, talented, and devoted people who just happen to practice emergency medicine. In fact, one survey indicated that 58 percent of EPs report feeling very or extremely happy outside of work. (Medscape Emergency Medicine Physician Lifestyle Report 2018. Jan. 24, 2018.) Having fulfilling lives outside of emergency medicine is likely the reason.

You will eventually face a malpractice suit. Some of us were already involved in a malpractice case during residency. For those who weren't, that day may come at some point in your career. We practice in a relatively high-risk field, and that's why we have malpractice insurance. The good news is that the incidence of malpractice in emergency medicine is dropping. The reason for this may be that emergency physicians tend to be good risk mitigators.

You'll learn over your career to be thorough in documenting medical decision-making and consultant conversations and reassessments. You'll work hard at demonstrating to patients that you are working hard to give them the care they need. And you'll make sure you are up-to-date and as evidence-based as possible. You'll realize that accurate and thorough documentation is the strongest risk mitigator.

You will have to scream, claw, and fight for a patient to receive the care he needs. At some point, your emotion will come out, and you will show frustration. You will go out of your way to care for a patient because only you will recognize the gravity of the situation. Once I uncharacteristically yelled at an on-call surgeon to come into the ED to help stabilize my dying patient. I wasn't having his nonsense. Not this time. Because I knew this patient would die if I didn't do something.

You will take pride in caring for patients who can't afford health care. We are the only medical specialty that is routinely expected to treat patients regardless of their ability to pay. EMTALA has created this expectation, and we painstakingly labor to comply. I have come to embrace it because I take pride in caring for any patient who comes through my door.

You will eventually find balance, and experience a tremendous sense of self-worth. My career has had twists and turns like a good novel. My balance is better now than it was when I started. I have honed my skills, identified my limitations, and continued to improve myself. I realized that I must continually seek professional and personal balance to achieve it. It requires knowing the things that are most important in life, making sure you devote enough time and energy to each.

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Dr. Reyesis the vice chief of staff and the assistant medical director of emergency medicine at Los Robles Hospital in Thousand Oaks, CA. He is also a clinical professor in emergency medicine and pediatrics at Olive View/UCLA Medical Center, a health law attorney with Boyce Schaeffer Mainieri, LLP, in Oxnard, CA, and the founder and CEO of Health-e-MedRecord, a patient-centered and emergency physician-designed EHR solution. (www.health-e-medrecord.com.) Follow him on Twitter @carloreyesmdjd, and read his past articles athttp://bit.ly/EMN-Defense.

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