Sustaining a Life-Long Career in the ED

As your new president-elect, the “On Deck Circle” will be my quarterly column to provide updates on ACOEP and emergency medicine. Erin Sernoffsky, who has been with ACOEP for 11 years, tasked me with the topic of career advice, on the experiences I’ve had both inside and outside of the ED. I thought about this for a long time.

Over the last 19 years, I have seen a countless number of patients and learned many lessons. I recall seeing an article titled, Now that You’re a Real Doctor by James Roberts, MD, who writes a monthly column in Emergency Medicine News. The article dealt with the transition from resident to attending and how to find your way in the world of emergency medicine. One of the points he made in that article that still resonates most with me today is, “Be the advocate for your patient. They need you!”

Over my career, this thought has always been with me as I cared for each patient. It seems such simple advice, yet we often lose sight of this in the ED. We want to make the diagnosis, provide a disposition, and try to continue managing our flow of patients. In the extraordinarily busy world of our departments, this thought may seem a herculean task at times.

I was struck by this recently when a patient I saw in my department, who I have taken care of many times, told me, “You know why I keep coming here? Because you always treat me like you would your mother. It just shows in your nature. I feel like I’m part of the family.” After hearing this, it validated not only my reasons for choosing medicine as a career but why I chose osteopathic medicine. Even though the emergency department is acute care, some of the patients we see are “frequent flyers.” They do indeed become a part of who we are and what we accomplish daily. After that shift was over and I was driving home, I thought to myself, “If someone asked me why I chose emergency medicine, what would I say?” Here’s my answer:

DON’T LOSE SIGHT OF LEARNING POSSIBILITIES

When you are a new attending physician, the possibilities seem endless. You have a “real” paycheck, and you now get to make your own decisions. The real world is a scary place when you are a new attending.

You will order more tests than you need, you will admit more people than you should. Every physician has been in this position. Your learning curve will improve each day of your career. In five years, you will be more confident. In 10 years, you will feel like a pro, and in 20 years, you will feel that there is no case you cannot handle.

The physician who tells you they have nothing left to learn is a fool. When I was a new attending, I valued the experienced physicians in my group as mentors. I bounced cases off them when I needed to, I talked to them about how to improve my work, and how to best succeed. As an experienced physician (now PGY 20-something, as my friend Dr. Siberski loves to say) the new physicians in my group seek my help and advice, and I seek theirs. They are my colleagues, my teammates, and my family.

FAMILY COMES FIRST

My wife and I have one daughter, who is now a college senior. She was three when I graduated from residency. Watching her grow up and sharing those experiences with her has been one of the most satisfying experiences of my life, and one that I would never want to miss. Your family is your support system and will always be there for you. Be there for them!

Don’t be afraid to come home and talk about what happened at work. Share the good and bad times with them. They will likely never realize the enormous burden you carry dealing with the acute and chronically ill patients on a day-to-day basis, but they will always listen and comfort you, as you do for your patients. Don’t miss those milestones in your family’s lives. They only come once, and you will never get those moments back.

Your “second” family is the ED staff. They are an important part of your life as well. We typically spend 40 or more hours each week working 10 and 12-hour shifts with them. They will share their happiness, their grief, their successes, and failures with you, as you will with them.

Take care of your second family as well! Treat your ED staff with respect and kindness. Your nurses, paramedics, technicians, and unit secretaries are what truly make an ED successful. They will make you a better physician.

BE MONEY SMART

Financial savvy is something all of us lack at some point. One of the most important conversations I had as a new attending was with a senior partner in our group who told me, “Don’t live beyond your means.”

Once you see that first paycheck, it’s tempting to start dreaming of things you want. I was fortunate to find a good financial advisor early in my career. He files my taxes each year, reviews my investments with me frequently, and has dispensed invaluable advice. Begin your 401K early. Make sure you are vested in your group’s pension fund. Start planning for your children’s education early. The amount of debt they will incur will likely be two or-three times, or more, what we paid for medical school.

Missouri, my home state, has a 527 MOST plan that allows you to invest money for your children’s education. One of the gifts my wife and I wanted to give our daughter was to graduate from college (and graduate school, if she chose to pursue higher degrees) debt-free. It is one of the most rewarding gifts you will ever give to your children.

CULTIVATE OTHER INTERESTS

One of the unique things about emergency medicine is that it provides us with time away from the job to pursue outside interests. As you progress in your career, you will come to realize that we cannot eat, sleep, and breathe medicine 24/7/365. All of us need time away from a demanding job.

On your days off, explore what life has to offer. My family and I love to camp and enjoy the outdoors. I play ice hockey and have been studying Tae Kwon Do for 13 years. On November 23, 2019, I tested and received my 5th-degree black belt. Tae Kwon Do has provided balance to my life and kept me physically, emotionally, and spiritually healthy.

I encourage you to follow those interests that make you happy and keep you healthy.

SPEAK UP FOR YOURSELF

We advocate for our patients for healthy lifestyles. Advocate for yourself! Your health is just as important as your patients’ health. We often put ourselves on the back burner, so to speak, but it’s important to take care of yourself as well. Get a primary care physician and keep up with your routine health screenings.
We cannot care for others if we don’t care for ourselves!

REMEMBER YOUR WHY

The last, and the most important, piece of advice from a guy who has been on the front line for almost 20 years: be true to your passion for medicine. Think back to what motivated you to pursue this career, and remember that every day before you see your next patient. Many patients, families, friends, and ED staff have asked me, “How can you come back, day after day, and do this job?

Doesn’t it get to you? How do you handle this?” My answer each time is this: making a difference for one patient each day, no matter what it is, is the “juice” that keeps me coming back each day. Whether it is getting a patient a warm blanket, having someone thank me for sitting down and listening, or even just a smile from a patient — that’s what this job is all about.

My passion for medicine many years ago was to make a difference. My passion for medicine today is just as strong, if not stronger. Be the leader in your department and set that example every day. You will go home with a sense of satisfaction and will light the path for others to follow.