Co-editor's Corner
Julia M. Huber, MD, FACEP
Welcome to the spring edition of the Section of American Association of Women Emergency Physicians’ (AAWEP) newsletter. As editor of our collective compilation, "Pearls from the Pit", I have been impressed by the number of responses to this edition’s topic, "Why AAWEP?" and, in lieu of my usual column, I have opted to dedicate much of the newsletter to this discussion. Lily Conrad, MD, PhD, FACEP, our chairperson, opens the conversation with some challenging questions, and our well-known and stunningly articulate Louise Andrew, MD, JD, FACEP, has also contributed a commentary that stands on its own. Please, however, do not miss Jane O’Shaughnessy, MD, FACEP’s, piece on ED directorship. It reminds us that female EPs are in positions of leadership, and it is refreshing to hear some tips on how to be good at what you do once you get there! She reminds us that "administration is not the Enemy", and I would add a quick corollary to that comment: Our male partners and colleagues as well, are not "the Enemy", and it is possible for us all to work together on many of our goals, such as running a smooth ED and providing our patients the best care possible. Please, also, do not miss the stomach-churning account of being sued, contributed by Connie Nichols, MD.
I love early spring. It is the time just past Ground Hog Day, which, unlike the movie, is a time of great change, but change that perhaps cannot be seen quite yet. Deep underground, the seeds and roots are sensing the turning of the sun, and beginning to send green shoots toward it. Classically, this is considered a time of a chthonic awakening, or the time in which the gods and goddesses of the underworld begin to stir around and consider spring. I ask each of you to look inside and think about how you want to grow personally and professionally, as a woman, perhaps as wife/partner, mom, ED director, community leader or mentor, or just plain you. As your co-editor, I seek to provide a forum for discussion of any and all issues pertaining to women emergency physicians, whether it’s guidance on being a manager, director or other type of leader in our field, or support for balancing out those professional commitments with a healthy, satisfying personal life.
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Letter from the Chair
Winter 2007
To AAWEP... and Beyond
By Lily Conrad MD, PhD, FACEP
As most of us slog through cold and snow and slush to work, it is a warming thought to contemplate AAWEP and its camaraderie, thinking of all of us out there practicing emergency medicine, running our departments, keeping the home fires burning, doing it all. (Those of you in Florida, never mind. Even San Diego has had snow this year!)
In this contemplative season, there is time for reflection on "Why AAWEP?"
The need for sharing with someone who understands and who does what you do, that’s one reason as to "Why AAWEP?" and quite possibly the most enduring. When other reasons have passed, this will remain. For all our lifetimes, there will be differences between men and women, in any professional field, and a place for gender-specific support: someone who understands, because she has been there, too. Even with all else being equal (which, duh, it’s not), being in a group of other women emergency physicians is empowering, comforting, invigorating.
I believe this need to socialize and share is not only universal, but timeless. This is what will remain to sustain AAWEP as an organization even if and when other agendas are retired.
However, beside this, there are lots of reasons as to "Why AAWEP". Let’s look at some of them. Women may eventually achieve equality in representation and leadership, parity in pay and respect as partners in the practice of emergency medicine. Until then, the advancement of women into positions of leadership and power will continue to be a focus for AAWEP’s efforts. Some women, especially our younger female colleagues, may feel that this battle is won and it’s old news. I suspect that any woman who attempts to believe this will rapidly come up against the reality of the world of hospitals as well as employment and emergency medicine management. There must be some women out there having good, equal, happy experiences with their jobs and announcements of pregnancy to their groups. But the stories I hear are far more repeatedly about the stress and difficulty of managing motherhood and job, career and parenthood – from pregnancy to retirement.
My sense is that it can take some time, especially if you are successful and happy early on, to appreciate what AAWEP offers. That glass ceiling – whether shattered or still solid – may not be too visible from a bit further away. (It sure wasn’t to me: I can be good at denial.) It would be very interesting to hear from our colleagues entering practice whether the advancement of women within emergency medicine in numbers, influence and leadership, in ACEP or at the hospital, is an AAWEP goal that still needs work – or is there a feeling that we’re there, things are good now? How many of you have a female ED director? Department chair? Over 50% of entering medical students are female these days. Who are the people making the decisions about your career, your pay, your employment? I’m just asking, and hoping it’s you, or another AAWEP member.
For another committee, I’ve just been reviewing our ACEP policies and noted that we have virtually nothing that deals with parenting, family management, or pregnancy during residency or career. Maybe these topics are too contentious, too tough, and too individually variable for us to tackle. Or, if we do want our professional organization to support us on these issues, maybe we should think what policies we want ACEP to have, what direction we would like to see the College go with respect to supporting EPs who are also parents.
What would you, our membership want? Should AAWEP look to setting out guidelines for pregnancy in residency or career? Be really clear about expectations and needs? Provide a resource to other young women EPs trying to figure out how to negotiate this path?
What else can AAWEP do for us? We – the female emergency physicians within ACEP, members of AAWEP – we can make AAWEP go in whatever direction we decide. Meeting the fundamental need for social support and collegiality is a given – where else shall we go?
Why AAWEP?
By Louise Andrew, MD, JD, FACEP
This is a great idea stimulator, and if people participate, it should be an eye opener. Frankly, many of us "older" women would like to know what the "younger" generation thinks of and thinks they need from AAWEP. We know what it meant to us, but we wonder if there is similar enthusiasm coming down the pipeline, especially when we observe a lack of interest in leadership coming from the trenches. Does this mean that there is no potential there? Or that we failed to inspire such potential in the next generation? Or does it mean that the next generation has been brainwashed into thinking that women have already arrived, or worse, that this is "as good as it gets?"
I am going to refer to a SUPERB and thought provoking book called Sex and Power by Susan Estruch, which was published in the wake of the MIT gender discrimination study some five years ago. It is tempting to say that gender discrimination is now passé, but to do so would only serve to confirm the central thesis of Estruch’s book, summed up in the following sentence: "Being unconscious of discrimination that is practiced, unconsciously confirms it." Such is true of course with discrimination of all kinds, and can be found lying unconscious in both genders and all age ranges and for that matter, races, nationalities, social classes, sexual preferences, etc., but we are talking about AAWEP here.
In her introduction, Estruch confirms something I have observed repeatedly, that even the most successful women want to believe that things have changed more than they actually have, and that many buy into the fiction that not thinking about gender is the route to equality. Those who have achieved some semblance of power want to believe that if they did it, others could too, if they only work hard enough; and those who desire to achieve power (but have not) want fervently to believe that if they want it, they can have it (if they work hard enough) because things are all equal now.
If this were true, of course, the ostrich would be a national symbol. What AAWEP meant for me, was exposure to strong, optimistic and confident women who revealed to me not only my own capacity for leadership, but who through unbiased reflection also enabled me to recognize how often I had allowed my own perceptions of what was needed and what was right to be subsumed by what was deemed acceptable by powers that be (were), at the time almost exclusively men. Estruch makes this point again and again, that what spells success for women in most organizations is the "comfort factor", that is developing a style with which male managers are comfortable (second only to exceeding performance expectations). She elaborates, "When
women use the same direct management styles as men, they tend to be rated roughly equally. But...many women don’t use that style: They talk less, and let others talk more; listen more, exercising influence and wielding power indirectly."
A young woman who wields the "direct" style too early in a typical organization gets branded an upstart, an "unfeminine" woman who will not be good leadership material because she will probably upset the status quo. (Imagine that, a leader might have new ideas!) So after a few rebuffs, most fall back on the indirect "receptive" style as described above. This style, when you are young and feminine, results in others believing that THEY are the leaders and that you as a follower clearly recognize that they are good leaders. It does not make you remarkable or even noticed by them if they are egocentric, as so many leaders are. It takes a confident, receptive, and selfless leader to recognize that followers are potential leaders, too, and that is exactly what I found in abundance in early leaders of AAWEP.
AAWEP was a great preparation for future leadership precisely because all leadership efforts were heralded and appreciated and missteps were not fatal errors, but were useful learning experiences. After leadership in AAWEP, leadership in ACEP was relatively easy to negotiate (though not so easy to break into, see below). Once I achieved some moderate leadership within ACEP, I always tried to utilize this receptive style (some call it Transformational leadership), because it made me feel as if I was nurturing future leaders and changing by example, not by imposing my style on others. And it seems to have met with some success considering the current crop of leaders!
But Estruch warns that women whose leadership style varies from the male norm run the risk in traditional organizations of being seen as tentative, indecisive, and worst of all, weak (or vulnerable). This type of leader can be cherished, but may not be elected (or reelected!). Especially if ambitious others seize upon the opportunity and successfully define this style to influential others as "ineffective leadership" because it does not reflect the pre-established norm. Numerous post election reports in this newsletter have demonstrated how this works. Sometimes, however, I had to use the more aggressive style, and was able to do so ONLY because of a strong sense of injustice which observation of the unfair experiences of other women in ACEP had alerted me to. When I adopted this style in a particularly egregious situation, I stepped way outside of my own comfort zone, and in the process engendered several apparently lifelong enemies. This was incredibly difficult for me, having not yet realized the literal translation of my own name, but I was able to take this risk because I was confident of the support of a circle of likeminded colleagues in AAWEP despite the strong likelihood of the immediate and vicious backlash of those in power in ACEP who would have preferred I stayed "in my place". Ironically, it was crossing this threshold which launched me into ACEP leadership. I suppose it is possible I was acknowledged as someone to be reckoned with when I had the courage to do what I knew to be right.
So what AAWEP taught me was that sometimes it is acceptable, even necessary, to be what is often described (in polite company) as a "difficult woman". And although I still would prefer to be liked by everyone, I ultimately learned that part of leadership is being able to tolerate being disliked or even despised by people who are threatened by your power. What it often means is that in fact they feel disempowered by you. And if so, then really that is a manifestation of a shortcoming on their behalf, not an unkindness on yours. That I can live with. That is something AAWEP helped me to understand.
Why AAWEP: Members’ Brief Comments
Marni J. Bonnin, MD, FACEP writes:
Why AAWEP? AAWEP give me a place to reconnect to other women doing what I do. I work in a variety of settings and almost none have other women EM physicians. The articles discuss the "unspoken" topics such as career and family balance and the anti-female prejudice faced by many of us at work on a day to day basis. I’ve been a practicing full-time EM physician for 18 years and it’s refreshing to have this forum to speak out and hear others do so.
An anonymous contributor has this to share:
Why AAWEP? Someday I’ll get up enough nerve and time to send in some of my past experiences. I’ve been through episodes of sexual harassment and outright hostility over the years, just not quite sure I’m ready to "go public". But the younger doctors could benefit from knowing what we were up against and why some of the policies are there.
Jane O’Shaughnessy, MD, FACEP, writes:
Why AAWEP? For the fun of it. There are many useful tips and especially a lot of information available for younger women physicians dealing with balancing career and family issues. But I never had children and am now retired. I remain a section member because of the pleasure of the camaraderie.
Another anonymous member weighs in:
Why AAWEP? My first job out of residency was truly egalitarian, with a democratic group that had almost 50% female, emergency medicine residency trained and board certified physicians. Then I got married and this restricted my practice to a specific region. While the kids were small, I worked for a small contract group. The men held meetings that excluded me. Paychecks were late, and when they arrived, often bounced. The head of the contract group was caught doing indiscreet acts in the parking lot, mostly having to do with misuse of his narcotics license. After a slap on the wrist, he is back in practice. The rest of us left. As long as physicians like him are allowed to stay in practice, I will need AAWEP.
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The Ten Most Important Things I Learned as ED Director Dealing with Hospital Administration
By Jane O’Shaughnessy, MD, FACEP
- Administration is not the Enemy. Your goal is to deliver excellent patient care. Their goal is to do the same, while keeping the hospital solvent. Understand what administration needs you to do to help the bottom line and make it your business to do it, whether generating admissions, avoiding diversion, documenting and billing better, or whatever.
- If other department chairs complain and moan endlessly about administration, keep yourself a little apart from all that. Be collegial but don’t join the us-against-them crowd. Position yourself and the ED as part of the solution, not part of the problem.
- Try to get a regular, preferably monthly, meeting with the highest member of administration you can get access to, preferably the CEO. (The best time to do this is when they first hire you.) If this is not a regular feature at your hospital, request such regular meetings. Avoid meeting only with middle managers who do not have ultimate decision-making power. At these meetings, always lead with the positive and inquire what you can do to help the hospital. Only then bring up your problems and requests.
- When you present problems to administrators, present your well-thought-out proposed solutions, with back-up information. Don’t just vent and dump.
- Every single time you encounter an administrator, whether in the hall, at an individual meeting, or in a group, have a nugget of positive information to convey. It can be that admissions went up last month, pediatric visits increased 4%, the ED nurses took blood pressures at the mall or any other bit of positive news, however minor. NEVER start with CT was down all weekend, etc. Bring these things up after you first set a positive tone.
- Whenever administrators, attendings, or others outside the department ask how things are going in the ED, the answer is always "good!" If you can’t resist mentioning your over-crowding, lack of staff, equipment failures and so on, at least use humor and provide some balance. Otherwise you are positioning your department as a problem.
- Utilize your entire department’s physical space maximally at all times. If you leave a closet half-empty for a week, another department will try to claim the space. Never give up physical space without a fight to the death.
- Be a booster for the hospital as a whole. Be available for last-minute press interviews, JCAHO prep, talks to seniors, and other jobs for which administrators do not find ready takers. Talk up your hospital at every opportunity.
- Work to get on important committees and eventually to chair them. Look for exposure to high-level administration and the Board.
- Keep that all-important balance; protect your patients, back up your staff to the hilt, and still be an ally to your hospital and its administrators.
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Letter to the Editor Regarding Part-time Status
I agree congratulations are in order for all the women physicians who have obtained leadership positions. It is truly wonderful to know we as women are represented and our voice will be heard. Keep up the good work! On the line of potential future topics for women in EM, I am wondering how other women have dealt with pregnancy and working in the ED. I am 36 years old and have been full-time in the ED since I graduated. I agree congratulations are in order for all the female physicians who have obtained leadership positions. It is truly wonderful to know we as women are represented and our voice will be heard. Keep up the good work!
On the line of potential future topics for women in EM, I am wondering how other women have dealt with pregnancy and working in the ED. I am 36 years intra-kinetic dysfunction (ikd) and have been full-time in the ED since I graduated residency. I have found almost all of the emergency departments I have worked in that I am the only woman physician. My husband and I have been trying to start a family for almost 2 years and have had difficulty. My OB/Gyn and I discussed my schedule as a contributing factor in our problems with pregnancy. All 3 emergency departments I have worked in as an attending have been understaffed with rarely enough part-timers to make up the needed shifts. For the past year I have been working 18 to 22 8-hour shifts per month as a requirement of my full-time position. Although my contract states 14 shifts is considered full-time, it also states I may be required to work more than that to provide coverage if needed. As our ER is understaffed, extra coverage is needed every month. All the full-timers share equal burden of days, mids, and night shifts. I finally had to give notice to terminate my full-time contract in order to control my life and schedule. Of course I am still working 12 8-hour shifts per month, but lost out on all the benefits of being a full-time employee because I am not willing to work an average of 20 shifts per month and switch constantly between different shifts. I have talked to the "boys" but no one really wants to change the system. Has anyone else had these problems? Are there any suggestions on how to avoid this in future jobs if I should someday accept another full-time contract? Right now I am working at two hospitals, 8 shifts at one and 4 to 5 at the other. This is a nice way to balance my work and my life. I am happy to say I finally feel like I have a life!
Sincerely,
Christina L Campbell, DO, FACEP
Co-editor’s comment: I would love to hear members’ responses to this letter, to be included in the next issue. JH
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Trial by Trial: A Firsthand Account of Being Sued
By Connie Nichols, MD, FACEP
We all talk about malpractice legislation, litigation reform and even "what to do once you’ve been sued". But, what happens personally once you’ve been sued? Let me share my story.
First, there was the shock of being served, which occurred during a work shift. Let’s talk about patient safety. In my experience, it became hard to concentrate when my entire ego had just been smashed with a thousand-pound subpoena. Then, I looked at the name. Did I even remember this person?
Experts tell us it isn’t personal. From my experience, it certainly feels personal when your name is on the page of "legalese" next to words like "willingly neglected" and "malfeasance".
We’ve all attended the seminars on "what to do when you are sued". In the abstract it is all well and good. You get served, your insurance company gets you a lawyer or maybe they decide to settle (game over). Now starts the endless rounds of meetings and paperwork. I saw my chart and thought to myself, "Oh, we were using those charts back then. Why was I so terse in my history of present illness? Boy, we treat this differently than we did then!"
I cringed every time a fancy high bond envelope showed up with my attorney’s firm name on the return address. Large thick bundles of paper showed up containing interrogatories and counter interrogatories. It was still all "boiler plate" stuff, but my name was featured prominently amongst all the pejorative adjectives such as "willingly", "mindlessly", and "negligently". I began to wonder: what do my colleagues think? (I actually thought twice about telling my spouse – What makes you think anyone tells their colleagues?) Being sued is the elephant in the room: nobody wants to acknowledge it or even think about it. I had to tell my spouse who was, by the way, the only one to whom I could talk. I just asked for odd days off and hoped that the lawyers didn’t reschedule everything, which happens constantly.
The physician being sued generally meets with his or her lawyer to practice for the deposition. In my case, it was scheduled and rescheduled multiples of times. I thought to myself, "Why did it have to happen at that hospital? The lawyers are 50 miles from home. I hate driving in that city." After oaths are sworn, questions are asked by the plaintiff’s lawyer. With proper coaching from the physician’s lawyer, this part is generally tolerable. It is actually kind of like a trial without a courtroom, jury, or judge. The reporter is there to take down every word, and then it’s over.
Next, there will be months, if not years, of waiting. There is nothing for you, the physician, to do as the attorneys are doing all the behind the scenes work. I just filed it away in a little locked box in my brain and only think about it when one of those fancy envelopes shows up in the mail. My kids wondered about my mood. I seemed snappish on some days when I brought in the mail; other times I was sad and even tearful. I told my spouse. He is also an ER doc so he had a clue.
Does anybody have any idea what kind of mental torture the physician goes through? My case happened in 1998. What emotions did I feel when I thought about the case? Doubt: Maybe they are right; maybe I did mess up and cause a bad outcome. It’s hard to leave that feeling at home before the next shift. Anger: How dare they sue me after everything I tried to do-that is if you even remember the patient? It can be years before you are sued. Frustration: I can’t believe this is taking so long! I also noticed a change in practice habits. Wow, this one kind of reminds me of my malpractice case. Maybe I will do the extra tests and CT scan even though they will probably be negative. So are doubt, frustration, and anger only applied to the case? It’s hard to remember it’s not personal when these emotions seep out into life at home as well as work. Patients that remind the physician of the malpractice case may end up getting more tests done than necessary.
In my situation, life went on. I didn’t get any fancy envelopes for a while and was able to let the case slide to the back of my brain until, out of the blue, the lawyer called about court dates. There it was, real and alive; we were having a trial. It was now 8 years after the case occurred. Although most cases don’t take 8 years to come to trial, three postponements will do just that. A trial is the most exquisite form of torture designed for a physician. On the first day, they picked a jury of people that I hoped could follow the arguments. Court only lasts from 9 am to 1 pm. Lots of paperwork and counter motions get done. I was only there for 4 hours a day. Do I go home, go to work or run away? How do I spend the time I’m not in court? I studied my copy of the chart and depositions until I can see through them. The commute was a bear. Fortunately I had friends with whom I did stay.
The next day, after lots of motions, counter motions and passing of papers, the trial got going with opening statements. So, I sat there in my nice clothes and listened to an attorney describe me as the worst doctor to practice medicine in this century. I was presented as stupid, inattentive, careless, and reckless and a disgrace to the practice of medicine, and they had an "expert" to back up that claim! All the time I sat there with my best attentive but pleasant face on, while inside I was thinking about how I would love to strangle that weasel with my bare hands. My attorney described me as hard working and caring and said that I followed the standard of care rendered by an average emergency physician. Even that comment hurts a little. I always considered myself a little above average. However, "average" is the standard that the plaintiff has to prove the physician has violated. I had to stop thinking so hard and keep my face in order.
Joining the physician in the gallery, since we didn’t sit with the attorney like on Law and Order, was the patient and/or family that was suing me. Remember, this is civil, not criminal, law. This scenario, however, is anything but civil, and this is something they don’t talk about in the classes on malpractice. I skillfully learned to avoid eye contact, find a different bathroom to use on breaks and do everything possible not to look at them. This also applied to the jury. I didn’t want to be anywhere near them on breaks. Nothing experienced thus far seemed "civil".
Next, the plaintiff stated the case. In my situation, we listened to an expert – another emergency physician – describe how I egregiously violated the standard of care in this scenario. After the plaintiff attorney put me on the stand to answer questions, the people suing you get to have their say on the stand. My lawyer was polite but firm with them, bringing out all my good points and finding any inconsistencies. Again, I sat there with an attentive but noncommittal face on while other people talk about the thing I have dedicated my life to doing well. It was hard to remember that this was not personal.
Next, it was the defendant’s turn. In my situation a "good" emergency medicine doctor came in and told how I clearly met the standard for an "average emergency physician" (why doesn’t that feel good?) and the jury seemed to get it. I was next on the stand. My attorney led me through the case and everything seemed good. The plaintiff’s attorney then got to take a shot at me. This was so hard. "Listen to the question, don’t be in a hurry to answer," raced around the inside my skull as I tried to listen, answer the question and not try to explain. Even if I did, the plaintiff’s lawyer, whom I thought of as "the weasel", wouldn’t let me. He asked impossibly complex questions to which he required a yes/no answer. Fortunately, my record was reasonably documented, and I don’t remember most of the details. I mostly stated, "I have no independent recollection of this case". It was amazing to me what 8 years, a new ER, building a new home and raising kids did to my memory.
Finally, the time in court was nearly done. I didn’t manage to damn myself on the stand or come across as arrogant. I remembered that statistic about 90% of physicians winning cases. I was completely emotionally exhausted, but maybe I knew I would get through this. I was driving home that night.
After the closing arguments there was nothing to do but listen. My attorney went first. He was wearing his best suit since the trial started. This was day eight. Thank goodness I worked those shifts over the weekend, I thought. My lawyer described the case, summarized the expert testimony and mine. It was looking pretty good and I started to relax. The plaintiff attorney was the last to speak. It seemed to me somehow unfair that he had the last word. He took everything that had been presented over the last few days and twisted it into some horrible tale with me as the monster. He essentially said I lied in my record, I had lied on the stand, that my experts were just protecting a fellow doctor and my attorney skillfully twisted the truth. While the bile rose in my throat I resisted the urge to fling my water bottle at him. The jury was dismissed and I got out of the courtroom as fast as I could. My lawyer caught up to me, hustled me into an unused room and said "Calm down". Right. All the anger I had been squelching now bubbled up and burst out in a rush of questions laced with profanity. ("How can that *#@& say those things about me?? He says I lied!!! He says my chart lied!!! In fact he said our expert lied and even that you lied!!! How can he get away with that?") I felt violated. I felt as if I had been physically attacked. This is the justice system? This is "civil" law??" Once I calmed down, I understood that his closing was just that, a closing just like any lawyer’s.
The next day the jury received its charge from the judge. These instructions are complex but the judge is very clear and they seemed to comprehend. They were sent to deliberate and court was adjourned. Now what? I stood there waiting to be told what to do. I felt numb and nauseated. My lawyer made sure he had my cell number, told me to go home and that he would call when the verdict was in, or when deliberations were over for the day. It was assumed I would now I just go home and resume my life.
The call came two hours later. The jury found the case in favor for me. It’s over. I "won". Somehow, it doesn’t feel like a victory.
Editor’s Note: We strongly suggest our readers refer to the Litigation Stress materials onwww.acep.org, especially the "So You Have Been Sued" article written by the Medical Legal Committee,http://www.acep.org/practres.aspx?id=32132. We also recommendhttp://www.mdmentor.com which has many more useful materials and links for folks who find themselves in Connie's situation. It could be lifesaving.
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Transplanting the Soul
ShayBintliff, MD
Tentative...
yes, that is what life is
from one beat to the next
until that final encounter.
Knowledgeable professionals
mend and medicate
a heart gone bad.
Poets let it die in metaphors of perpetuity.
Once thought a sacrilege to touch,
this oh so vital organ
is subject to the surgeon’s meddling,
Defacing, replacing this organ so sacred.
The scalpel falls!
Is the soul’s energy now in shutdown?
Has the seat of the soul been
Invaded, removed, and replaced
By those with cardiac paranoia?
"As he thicket in his heart, so he is"
so seethe Proverbs.
Where now do we house our emotions?
What is this strange inner hollow,
never here before?
Unknown to the present self.
Can I still touch another’s heart?
Or is this the end?
Oh, to feel the resonant beating of my resolve.
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Who Are the Female Owners of Emergency Physician Groups?
By Diana Fite, MD, FACEP
I am continually impressed at how little progress we have actually made as female emergency physicians. I get very enthused that we will soon have our second female president of ACEP, with more to come over the next few years. That part is fantastic, but also overdue!
However, I am not aware of any female emergency physicians who are the owners or presidents of any small or large emergency contract groups in Texas, or any large contract groups in the nation. I know a couple of female vice-presidents of groups, and I am aware of a couple of female emergency physician owners of smaller groups nationally. But this is a very tiny percentage of female ownership/leadership.
Would it be helpful to have more females in these ownership positions? Personally, I think so. Although I have worked for, and am currently working for, some good or excellent male-run groups, I have also been involved with one group where the president of the democratic group autocratically fired physicians with no due process for various reasons and lost contracts due to administrators’ perceptions of unethical conduct of business. Would that happen with a female at the helm? I bet it would be a lot less likely.
At this point in time, a physician cannot come out of residency and realistically find a group to work for that is owned by a female emergency physician if she or he wanted to for whatever personal reason or preference.
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Well Being Committee Communiqué
Editor’s Note: The following communiqué to Well Being Committee members is included here because it is relevant to those AAWEP members who may also seek to promote awareness of women emergency physicians’ needs with regard to issues such as pregnancy, early child care, and other related issues.
By Alex Rosenau, MD, FACEP, Board of Directors Liaison to the Well Being Committee
The Wellness Committee has identified important future shock for ACEP: Aging physicians, change of guard to generation xylem and z and the increasing number of physicians whose family obligations stand to impact workplace commitments. This includes the so-called sandwich generation caring for elderly parents and young children, the increasing percentage of female EPs who will certainly require accommodations for pregnancy and early child care (especially if we are to benefit from their simultaneous practice while meeting obligations of pregnancy and new family) and the number of physicians whose government entitlements may vaporize, leading to a later retirement age.
As a professional society dedicated to the overall health of its members and the profession that they practice, ACEP is the organization in a position to carefully address these issues. As with any policy we will want to consider impact on the individual, seek to avoid painting ourselves into any legal quandaries while crafting policies that bring value to the member.
One route may be for the Section of Wellness to suggest a category or set of policies via Council resolution. These would be assigned to the wellness committee and then reviewed by the Board. The committee members may have other suggestions for navigating the waters on this.
It’s great to have this enthusiastic group recognizing issues that are pertinent to our members’ challenges in this area. Even on a business level the emotional intelligence of ACEP as a group is demonstrated by paying attention to these issues, many of which have the potential to affect the bottom line of EP practices and the College itself.
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Quality Course at Spring Congress
If you are an ED administrator, the Quality person, or just a practicing clinical physician or nurse, you are involved in quality to an extent. If you are not practicing quality emergency medicine, you will probably be out of business soon so ignore this brief article. Quality is something we all want to do and it is something our patients demand. So why doesn’t quality happen all the time?
The Section of Quality Improvement and Patient Safety is offering the first of its kind "Quality Course" at this year’s Spring Congress in San Diego on April 25, 2007, from 2:30-6:30 pm. If you are registered for the Spring Congress, there is no additional charge. Who should take this course? Anyone working in ED Quality, new graduates, nurses, and anyone who wants to learn how not to end up on the wrong end of a quality review. There will be four 1-hour sessions in the afternoon of Day Two of the Spring Congress. The format will be:
- The Case Review
- Data Collection and Analysis
- Fixing Systems to Improve Outcome
- Panel Discussion on Proven Success Stories
The lectures will be case based and practical. We all get plenty of lectures on theory and error reduction. This course is designed to be practical and hands on. When you leave you should be able to design an ED Quality Program or re-tool an already existing one. We have commitments from some of the best and brightest in the College as faculty. Please send along your Quality people, nurses, physicians, and mid-level providers. All are welcome.
For more information or to register for the ED Quality Course, contact ACEP Customer Service Representative at (800) 477-2237. You may also leave a message at that number or send an e-mail to meetingregistrar@acep.org. For additional information contact Angela Franklin, MD, FACEP, at qips.section@acep.org.
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This publication is designed to promote communication among emergency physicians of a basic informational nature only. While ACEP provides the support necessary for these newsletters to be produced, the content is provided by volunteers and is in no way an official ACEP communication. ACEP makes no representations as to the content of this newsletter and does not necessarily endorse the specific content or positions contained therein. ACEP does not purport to provide medical, legal, business, or any other professional guidance in this publication. If expert assistance is needed, the services of a competent professional should be sought. ACEP expressly disclaims all liability in respect to the content, positions, or actions taken or not taken based on any or all the contents of this newsletter.
