I read with interest the article in the August issue of ACEP News about the 50th anniversary of the founding of the first group of emergency physicians at Alexandria Hospital (“Commemoration of the Alexandria Plan at 50 Years,” p. 32). What an exciting and uncertain time that must have been.

These doctors chose to leave well-established private practices to become emergency physicians with no guarantee of success.

Certainly the gravity of the decision is much more evident now than it was then. They knew they were doing something unique but probably did not imagine they would light the flame for emergency medicine as we practice it today. I’m sure they would be pleased and amazed at the progress that has been made.

And what progress has been made!

Being general practitioners, these men had a broad knowledge base, so emergency practice was not completely foreign territory for them. I’m sure there were many times, however, when they called upon consultants to help with problems we would routinely resolve on our own now.

Those midnight conversations were probably more collegial than what many of us experience today. Those consultants were thrilled to have dedicated emergency doctors because they no longer had to take their turn at ER duty themselves.

Compared to spending the night taking care of problems foreign to them, answering the phone from their comfortable bed was probably a welcome change.

Those days are long forgotten by today’s consultants.

Establishing rapport with their medical staff may have been easy for these docs; however, taking on this job full time meant that they were expected to develop some level of expertise. Otherwise, they were no better than the random collection of docs and trainees who took their turn in the ER.

From the first patients they treated, these men began the process of collecting the body of knowledge we all share as emergency physicians.

Each generation of emergency physicians stands on the shoulders of the men and women who trained (formally or in the school of hard knocks) before them. These are the docs who learned to take a foreign body off the cornea using a slit lamp, learned to use ultrasound, and figured out how to manage the financial and political obstacles that come with running an ED.

These doctors earned a seat on the executive committee of the hospital, battled to place the responsibility for admitting orders in the proper hands, developed training programs, organized the specialty, created original research, and learned to manage risk and improve patient safety.