Redesigning My Life

As I read this book, nagging questions started haunting me about my career in academics: Can I do this for the next 20 years? If I do, will I have the greatest impact? Am I still growing and learning?

I wasn’t so sure. Borrowing from a Designing Your Life concept, my work view (ie, why I was working so hard) did not exactly match my life view (ie, what was most worthwhile to me). I had summited my mid-40s, and my pace of learning had slowed. The marginal excitement from the next paper or grant had waned. The reality of complex stakeholders in academics becomes tiresome. I thought to myself: Instead of sitting in an ivory tower writing papers about how to change acute care, maybe I could go and actually try to be a change agent myself. Maybe I could have greater impact in a different role?

My change was not so radical. I did not leave health care or even emergency medicine. I went from one EM community to another, from one platform to another, and from academics to private enterprise (which, in practicality, have similar goals: to provide excellent care at a margin). Instead of just innovating in a single hospital, I am now able to innovate across more than 200 USACS sites and over 6 million ED visits. Much changed, but much stayed the same, like my ability to produce scholarship through the USACS Research Group and my clinical practice.

So what is my new position? As the USACS national director of clinical innovation, I try to design and implement programs that allow emergency physicians to deliver innovative care, adapt to market changes, remain competitive financially, and operate in novel environments that best leverage our skillset. The goal is to find and implement win-win projects that address age-old struggles in our practice. For example, I am working to implement a system that assesses care experience after discharge and admission with good response rates. This will provide actionable feedback (unlike Press Ganey–like instruments) and allow us to learn more about patients’ recovery and follow-up experiences.

Another area of focus is in novel payment models: programs with private and public insurers that align emergency care and population health, allowing us to take financial risk from (and benefit from) good care decisions and value-based care. This includes efforts aimed at lowering rates of CT scan use when clinically unnecessary and lowering hospital admissions. I am also helping to develop new programs in telemedicine, opioids, and direct-to-business models for USACS.