Lessons Learned

Reflecting on my personal career redesign and exposure to the business of emergency care, here are a few lessons:

1. Midcareer change can create tremendous learning. Aging can bring complacency without change. Career change disrupts habits and can generate dramatic learning (at least, it did for me), particularly when shouldering new responsibilities. For example, I had to learn the language of business (comparing business and academic physician lingo is not unlike comparing Mandarin and English).
2. Emergency medicine as we know it is under siege. This may come as no surprise, but broader forces in medicine and health policy are focused on reducing ED visits and keeping patients away from hospitals (and us). Furthermore, there are great efforts underway to reduce payments to physicians through surprise billing legislation and other policies. In the future, we will probably make either somewhat less or a lot less money for seeing patients. It also means we will increasingly see sicker patients and those with self-pay or public insurance. Sorry if you didn’t know that.
3. Despite this, emergency physicians bring unique value. When it comes to delivering on value-based care, emergency physicians’ abilities to care for the acutely ill and injured patient are unrivaled. In the changing world of new care and payment models, these skills will become increasingly marketable. Don’t worry, you will always have a job. But you may have to be nimble regarding how and where you practice.
4. Real innovation in emergency care is really, really hard. Trying to implement new approaches is entering a shark pit surrounded by landmines. Even innovations that conceptually make all the sense in the world sometimes get crushed because of competing interests or complacency. Do not discount the powerful effect of personalities, those who create barriers versus those who facilitate.
5. The success formula to innovation is good idea + alignment + the right team + persistence. Having a good idea is the easy part. Everyone has good ideas. But you have to have an idea that aligns stakeholder interests and is facilitated by the right people. Show return-on-investment and avoid stomping on someone else’s budget. Even getting this recipe right requires persistence because failure is the default and success is the exception.
6. Business in emergency medicine is not evil. Feel free to disagree. Great vitriol divides our specialty over how we should organize. Realize that medicine is a business and care cannot be delivered unless there is a business model. In my view, all organizations—large for-profit groups, democratic groups, and nonprofit academic centers—act in their own financial interests within the existing legal framework. I see no angels and no demons. Particularly given lesson 2 above, I find it more fruitful to fight-out than fight-in in emergency medicine.
7. Re-examine your life, and then redesign and pivot if necessary. When it comes to your life redesign, take all four aspects into consideration: work, play, love, and health. Take stock of where you are and what alternative realities might look like. Along with Designing Your Life, there are a lot of great books out there on the topic. To quote the 1980’s hit Ferris Bueller’s Day Off, “Life moves pretty fast. If you don’t stop and look around once in a while, you could miss it.”