EM Docs has gone global. Our 10,800-plus members are teaching and learning from other physicians practicing emergency medicine in some areas with extremely limited resources. We have quite an international reach! Our members are living and practicing on every continent (except Antarctica). We are represented in North America in the United States, Puerto Rico, and Canada; in South America in Chile and Honduras; in Africa in Egypt; in Asia in India, Japan, Saudi Arabia, Taiwan, and Singapore; in Australia in Australia and New Zealand; and in Europe in Sweden, United Kingdom, and Norway, among others.

We Are EMPOWR’d

We are empowered by other EM Docs. Practicing emergency medicine is hard. It has always been and will always be hard—that is the reason most of us chose it! We have disruptions to our sleep with odd shift times. We sometimes see people at their worst as they yell and blame and call names. We finish a code, deliver terrible news to a family, and walk into the next room with a plastic smile and the lingering knowledge of what just happened. We cover the “code brown” after the disimpactions with deodorizers and cover our heartaches after we lose the ones who came in too late. We compartmentalize our lives so we can function inside and outside the emergency department. Occasionally, we realize our family member is saying, “Are you listening?” as our mind drifts to the 15-year-old with a gunshot wound. We work with empty stomachs and full bladders. We drive home with the images of broken anatomy and aching souls. How do we answer our families when they ask, “How was your shift?” We titrate our own emotions to a professional level and manage our own frustrations despite the fact that we are human. To deal with the unrealistic expectations on us, some use sarcasm and dark humor or alcohol. Many of us exercise and get outdoors! EM Docs tend to have an amazing sense of adventure and love for extreme sports.

We empower each other. We understand each other like no one can. We speak the same language and share the same culture of caring like a tribe. We have always been the safety net for our communities. Now EM Docs are the safety net for their colleagues. Working a holiday or a nightshift seems a little more bearable when we know so many of our colleagues are also out there doing the same. On EM Docs, we have a night shift/holiday shift “roll call” to identify colleagues working that shift, and we share favorite songs that we play on the way in to a shift or that we sing in our minds when we walk into a shift or when the “brown stuff” hits the fan. “Welcome to the Jungle” seems to be a favorite, along with “I Gotta Feeling,” “Highway to Hell,” and “Crazy Train.”

Photos (top left to bottom right): Eric Klotz, Tom Quimby/Russ Johanson, Elizabeth Nicholson, Ryan Brass, Siri Daulaire, Mark Wright, Laurie DuBois Doty, Leela Sirotkin

We share and discuss cases. We inspire one another to stay current on evidence-based medicine. We laugh at ourselves and each other. “JAFERD” is a nick name that some EM Docs have taken on as an inside joke after one member told a story of a patient who was angry with her for refusing to fill his opioid prescription. She said that this unnamed patient walked out and said to her, “You are just another f***ing ER doctor.” She abbreviated it to JAFERD and it stuck. “Own it,” many said. Another member made T-shirts, and some even put it on their car license plates. We fight among ourselves on some issues, but we stand up for our profession and for each other. We are out of isolation and have a united voice now.

Heated Discussion

EM Docs survived the election with mostly respectful discourse. There continue to be occasional heated discussions that allow us to learn from one another on (usually) divisive topics such as abortion, gun control, gender issues, and the Affordable Care Act. Some members participate in the discussions, and many more follow it. Even when the discussions get a little dramatic, all sides are heard.

The connection and communication between the bedside physicians and our professional organizations are faster now. It helps the fiercely passionate bedside physicians be heard, and it helps our trailblazers in leadership know our most pressing struggles so that emergency medicine can better address our challenges right away.

Metrics

One EM Doc, who will remain anonymous, posted about door-to-doctor time, door-to-disposition time, patient satisfaction scores, and similar measures, stating that these metrics have unintended consequences such as “encouraging physicians to sign up before they are really ready for a new patient just to stop the clock,” which “does nothing to actually improve patient flow.” The member discussed how patient satisfaction scores “can lead to inappropriate medications and tests. Performing to timed metrics may lead to poor charting and increased risk for errors. The end result is physician dissatisfaction and fewer EM Docs willing to serve in leadership positions.” “Time to take back control of our profession,” another EM Doc said, but from whom—the Centers for Medicare & Medicaid Services, government intrusion, third-party payers, corporate medicine?

One commented that door-to-doctor time was originally designed to assess adequate ED coverage, not measure individual physicians. Times for individual physicians can be affected by the shifts they work. Wait times go up, and satisfaction scores go down. Physicians are frustrated by nonclinical leadership that sees only multicolored charts and graphs that do not represent what truly happens at the bedside. One EM Doc cited a New York Times article from January 2016, “How Measurement Fails Doctors and Teachers .”

ZDoggMD will be speaking at this year’s Leadership & Advocacy Conference.

One argued that “to improve, we must measure.” Many said that most of the metrics are not under our control. One said that some of the most important things we do in emergency medicine—practice compassion and empathy—cannot be measured nor should they be. There are only demerits given for “lost efficiency” when spending time with grieving families. Some of the most important parts of what we do include reassurance for the souls who come to us scared and hurting. It is up to us to advocate for our patients with the administrators and policymakers.

ZDoggMD at LAC

ZDoggMD, an internal medicine physician who is known for music videos, parodies, and comedy sketches about medical issues and working as a physician, is coming to the ACEP Leadership & Advocacy Conference, March 12–15, 2017, in Washington, D.C. He is the only non-emergency physician on EM Docs, voted in by the membership because of his advocacy efforts for the practice of medicine. Now he has a better understanding of emergency medicine challenges and he will be meeting us in D.C. to help us advocate for real solutions to the opioid crisis and to discuss social media, resiliency, and how to be a leader in Health 3.0 that we are building together.

Subgroups

Since we have a no-advertising and a no-recruiting policy, with only emergency physicians on EM Docs, we have a few free subgroups:

• Doc to Doc Rental and Homes for Sale: (multispecialty) for vacation rentals or when one of our colleagues is relocating.
• Doc to Doc Job Connect: (multispecialty) no recruiters are allowed on this page, but we allow physicians to connect with one another when there is a need to fill a position or when someone is considering a career change.
• EMDOCS Mentoring Medical Students Interested in EM: when they match, they can stay on as mentors and also join the main EM Docs group.
• Physician Entrepreneur: a place where we can support our colleagues who have created a useful tool or service.
• EM Docs Education: where conferences, board review courses, books, and educational opportunities can be announced and discussed.

EMPOWR Events

EM Docs are getting together outdoors through EM Physician Outdoor Wellness for Resiliency (EMPOWR). Have your local event! Just make it happen and take photos to encourage others to do the same.

EM Docs Meet-ups/EMPOWR events

At ACEP16, we met at 6 a.m. for group runs, and we had the outdoor terrace area designated for EM Docs at the Opening Party in Las Vegas.

Plans for face-to-face meet-ups (EMPOWR events) so far in 2017 include:

• March 12–15, 2017: ACEP Leadership & Advocacy Conference meet-ups include a wellness room for 6 a.m. yoga and ballet and group outdoor runs/walks before lectures.
• May 16–18, 2017: At Essentials of EM, we will have daily outdoor events specifically for members of EM Docs as well as EM Docs designated VIP rooms.
• Summer 2017 (date TBD): Meet-up in New Mexico for hiking in the Pecos Wilderness.
• Nov. 3–5, 2017: Meet-up in Arkansas for a free cattle drive and barbecue at my family ranch.

If you want to be included in the conversation, ask a colleague to add you to the Facebook group—chances are, someone in your department is on EM Docs. Send a private Facebook message to the admin page for EM Docs with proof that you are an emergency physician, for example, a photo of your ID badge or diploma, etc.

Dr. Moody, founder of the EM Docs Facebook group, is president of the Tennessee College of Emergency Physicians and former emergency department chair for Mountain States Health Alliance.