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Life in Emergistan

EPs Are More than Just Doctors (or What to Do When You Get Fired)

Leap, Edwin MD

doi: 10.1097/01.EEM.0000616480.07487.97
Life in Emergistan

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I increasingly hear about emergency physicians (and other docs) losing their jobs for reasons unrelated to patient care. It's a strange time.

This was less likely in the days when many of our colleagues were partners in fee-for-service groups. But since employment is increasingly common, firings are increasingly common as well.

Among the reasons I have heard? Loss of contract is way up there. We all know the drill because we've seen it again and again. Hospital administration negotiates more lucrative contracts with separate groups or corporations. Subsequently, physicians who have invested their lives into their local hospitals and communities are cast into the darkness.

Often it has to do with metrics. The fired physician wasn't fast enough, which means, in all too many cases, a good physician was saddled with a reprehensible EMR and told to be thorough and make no serious mistakes, make patients happy by sitting and talking to them, see patients fast enough so that no patient leaves without being seen and that all the proper metrics are met for throughput goals, and chart all of it in an easily billed and contemporaneous manner. This is a conundrum everyone faces from time to time these days.

Some have been fired or threatened with lost pay over insufficiently stellar satisfaction scores. Sadly, statistical analysis does not account for situations where abusive, aggressive patients threaten staff or constantly seek narcotics and the physician in question struggles to consider them “valued customers.”

What else? Daring to speak opinions that are not in agreement with department policy or collectivized values, such as speaking out against advertised door-to-doc times. We'll see more of this, rest assured, as medical science is subsumed by political and cultural pressures.

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A Blow to Identity

I know there are substandard physicians. (I'm not talking about those punished for bad outcomes when everything was done as well as possible.) And I'm not saying that there aren't times when colleagues haven't done something that leads to reasonable dismissal.

Still, whatever the cause in these crazy times, a fact remains—firing is a body blow to physician identity. Whatever the (nonmedical) cause may ultimately be (economic, political, legal, or interpersonal), physicians tend to take firing as an implied criticism of their medical knowledge and skills. In short, “I was fired. I must be a bad doctor.”

Sadly enough, I suspect other physicians or facilities and companies may, however subtly, believe the same. We live and practice under a microscope all the time. We spend decades keeping ourselves up-to-date and our credentials squeaky clean, and it only takes one or two things to draw the reviewers' eyes from the enormous good to a minute problem, from the untold tens of thousands of successful patient encounters to the belief that this doctor is apparently a problem.

I'd love for the current medical climate to change, but I'm not confident it will anytime soon. What can change is the degree to which we believe that our total identity is inextricable from our physician identity.

The danger of relying too much on our title and profession is that it is all too vulnerable. Whether it's a firing, an injury, an illness or simply exhaustion, or the need for change, one can easily go from respected physician to, well, mere mortal (even if still in practice).

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Beyond a Physician

We must learn (and teach our young charges) to see our wonderful profession as a great gift and opportunity, worthy of respect and fair compensation but not as the total sum of a person.

Christmas time is here, and I am reminded during this season that my personal identity is anchored in my faith. An end to my practice would be financially painful and emotionally difficult, but I know that I have transcendent worth and purpose beyond the letters at the end of my name.

For those who are not religious, the point is the same. Identity can be focused on other things outside medicine, on our relationships in particular. The love of family and friends can carry us through enormous change. My identity as a husband and father is far more essential to my being than my medical degree.

Identity can also be located in philosophy or in a sense of mission. Certainly, politics can be a source of identity, but I fear that causes more pain than joy. Nevertheless, I'm sure readers have many sources of identity beyond physician.

Medicine can be toxic. And the loss of a job can be a bitter poison that seeps into the heart and soul. But this Christmas, I wish you the gift of a higher identity, impervious to the vagaries of work and degree.

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Dr. Leappractices emergency medicine in rural South Carolina, is a member of the board of directors for the South Carolina College of Emergency Physicians and an op-ed columnist for the Greenville News. He is also the author of four books, Life in Emergistan, available atwww.nursingcenter.com, and Working Knights, Cats Don't Hike, and The Practice Test, all available atwww.booklocker.com, and of a blog, http://edwinleap.com/. Follow him on Twitter @edwinleap, and read his past columns athttp://bit.ly/EMN-Emergistan.

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