National Security Council staff director for medical preparedness policy, Richard Hunt, MD, FACEP, discusses the value of emergency medicine training in the ED and on the national stage

Emergency medicine’s rigorous training and focus on patients’ needs has produced many leaders, both within and outside of the specialty—including the current director for medical preparedness policy for the White House’s National Security Council Staff, Richard Hunt, MD, FACEP. Former federal administrator of the National Highway Traffic Safety Administration and mentor Ricardo Martinez, MD, FACEP, now chief medical officer and vice president of North Highland Worldwide Consulting in Atlanta, recently sat down with Dr. Hunt to discuss the value of emergency medicine training—both in the emergency department and on the national stage. Here are some highlights from their discussion.

RM: Dr. Hunt and I go back decades based on our common interest in emergency medicine and in EMS and injury prevention. It’s been a real joy to watch him not only grow as a professional but really contribute to how we practice today and—based on his latest appointment—how we’ll practice in the future. With that, Rick, tell us about your new job.

RH: The title that I currently have is director for medical preparedness policy for the National Security Council Staff at the White House. The National Security Council Staff supports the National Security Council. In this domain, I work with a team of people that spans the whole spectrum of preparedness and response, addressing all hazards, both manmade and natural. We have an opportunity to interact with all federal departments and agencies as well as organizations and individuals outside of government. It’s really humbling when you walk down the steps of the Eisenhower Executive Office Building where I work and you’re 30 steps away from the West Wing.

RM: It’s important that there’s been recognition that emergency physicians should be involved in this process—and, in fact, leading parts of it. Are you finding that there’s a cadre of emergency physicians that you can work with to develop policy, identify problems, and find workable solutions?

One thing our specialty should be proud of is that the chair I sit in is the same seat that two other emergency physicians have sat in: Drs. Kathy Brinsfield and David Marcozzi. –Richard Hunt, MD, FACEP

RH: One thing our specialty should be proud of is that the chair I sit in is the same seat that two other emergency physicians have sat in: Drs. Kathy Brinsfield and David Marcozzi. Dr. Marcozzi was here for four years. Beyond that, we have extraordinary leadership, both past and present, in the federal government, such as Drs. Martinez, Jeff Runge, and John Krohmer, and Past Presidents of ACEP who have held federal roles, as well. There are also leaders in emergency medicine who hold positions on the state and community level. It’s a magical thing for any of us to call any emergency department in the nation at 3 in the morning and say, “I’m an emergency physician from X, and I need your help with this.” People in our discipline really take care of each other. The ability to reach back and have thoughtful problem solvers thinking through hard things with you—every day I’m grateful to be an emergency physician to be able to do that.

RM: How does emergency medicine, both training and experience, help prepare you for this role? Being in emergency medicine residency training is different than some of the past experiences you’ve had, so how does that come to bear for you?

RH: The irony is that it’s some of the stuff you actually taught me, like the ability to triage, that is really important. Figuring out what’s important and what’s not important—we do that really well. Our interface with multiple disciplines is a huge training ground for people who want to expand their horizons beyond emergency medicine. Trying to bring three different specialties together at the bedside and being able to come up with a solution to a difficult patient problem is a very useful skill set. Those skills have served anyone in our discipline well when they’ve gone outside the walls of a hospital. The other one is multitasking. It feels like we’re the founding fathers of multitasking, in some respects. We were doing it a long time before people were talking about it in the news every day. If you don’t gain it quickly, you’re not going to make it taking care of people in emergency departments. There’s also the ability to know when to act. It’s not something you learn in medical school; it’s a skill gained over time. My emergency medicine experience has also taught me a foundational principle that I bring to this job: our emergency care system has to work well every day to be able to respond well when disaster strikes.

RM: You make great points because that is one of the outcomes of experience in high-stress and critical settings. You learn how to prioritize, you learn how to look at the system, and you know how to tell sick from not sick without having to order a bunch of tests because something’s “gotta be done.”

RH: Absolutely. It’s as if it’s a constant iterative process when you’re practicing emergency medicine. Outside the discipline, that skill set is a pretty rare thing to find. Another thing that I bring to this job is that we have, in emergency medicine, an amazing snapshot of society. In bed eight, there might be the mayor of the city, and in bed 12, there might be somebody who’s been out of work for 20 months, and everything in between. That really helps us have a snapshot of the world in profound ways. The skill that is probably the most paramount is the commitment to a singular mission: to save lives and decrease suffering. Almost anybody in our career has said, on multiple occasions, “Well, let’s do what’s in the best interest of the patient here.” That has carried me personally and professionally.

RM: Over time, we find that emergency medicine really prepares you for a lot of different journeys. What advice do you give to emergency physicians out there who are looking to expand their horizons? What sorts of experiences do you think they should have, or in which areas do you see great need for their talents?

RH: One area that I certainly think about is mentorship. The word “mentor” is tossed around in academic medicine and in other disciplines, too. I’ve never found that to be extraordinarily useful unless there is an absolutely strong bond created by a give-and-take with someone who has vast experience beyond what you have. I’ve been blessed in that regard: Past Presidents of ACEP Dr. Jack Allison, Dr. John McCabe, and Dr. Dick Aghababian; executive directors of ACEP Colin Rorrie and Dean Wilkerson; Dr. Bob Bass; Dr. John Krohmer; [Dr. Martinez]; Dr. Jeff Runge certainly with his roles with DOT and the Department of Homeland Security; and my predecessors in my current role. If you can have more than one mentor, all the better. We pride ourselves on having short attention spans in order to multitask, but it’s important to stretch into some long-term problem solving. To give you the greatest breadth, start to go to hospital committee meetings, where it’s not like you have to make a decision in five minutes. People have talked to me about doing the federal government thing, and quite honestly, building a strong foundation in your primary discipline of emergency medicine is really important. You don’t build all those skill sets in a few years; it takes a while to get to some of them.

Over time, we find that emergency medicine really prepares you for a lot of different journeys. What advice do you give to emergency physicians out there who are looking to expand their horizons? –Ricardo Martinez, MD, FACEP

RM: To reflect on what you’re saying, a lot of this is experienced based, and as you mentioned earlier, that actually can be used to train very important and strong judgment that can be applied to other things besides just emergency medicine.

RH: Absolutely! It’s translating that skill set to many different kinds of not just disciplines but private, non-government, government positions—the whole spectrum. Engagement outside of the emergency department is not just leadership; it’s learning how to be a good member of hospital committees, your local community organizations like the Red Cross, EMS, fire, police, schools, and nonprofits in your local community. It doesn’t even have to be medicine related. Get to know your congressional staff. Providing a local-level perspective to congressional staffers is important for giving them a bigger picture of what’s going on in the universe, and that will help the discipline take care of patients better. Certainly at the state level, there are multiple opportunities within the discipline with ACEP state chapters and health care coalitions, and then on the national level, our conferences within the College are just extraordinary. I have watched a lot of people in our specialty shift after shift after shift. What I’ve observed is that there comes a branch point where you continue to do what you do for the rest of your career or there’s something that says to you, “You know? I’m tired of seeing some of the horror here, and there might be a way of approaching this beyond taking care of an individual patient at a time.” I think that’s a healthy thing for an emergency physician to realize—that there may be some other ways of doing what’s in the best interest of the patient.

RM: So in summary, after you’ve really understood the clinical skills of taking care of the people in front of you in emergency medicine, you begin to look at greater societal issues at large to find out why these people are coming in and what they can do about it. Your encouragement is to follow that desire by getting involved at local, state, and national levels because that skill is needed, and we’re one of the physician specialties that teaches it.

RH: Dr. Martinez, you just wrote a great speech.

Dr. Martinez is chief medical officer and vice president of North Highland Worldwide Consulting in Atlanta and assistant professor of emergency medicine at Emory School of Medicine. He attends at Grady Memorial.