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The Chair’s Letter

By Christopher Beach, MD, FACEP

Beach2014A Changing Landscape

The culture of physicians and healthcare is in constant evolution.  However, in the last decade or so, our culture has changed direction and pace.  In the previous century, physicians were largely autonomous, solo practitioners who were perceived by many as infallible.  The procurement of knowledge and application of that knowledge was used to establish oneself as a ‘better’ doctor than others, often only within a specialty or silo.  Although these characteristics from 20th century medical culture are still evident, the shift in the 21st century to ‘systems’ of care, high performance teams, and multidisciplinary problem solving is rapidly emerging. 

Movement from fee-based reimbursement to value-based reimbursement has been a slow but unstoppable force that has placed quality ahead of quantity.  The implementation of teams of healthcare providers working within a well-engineered (often wholly electronic) system is a sharp departure from the autonomy of individual practitioners documenting on paper.  Collaborative care processes have improved quality and safety and have been structured to bring the healthcare team (not just the physician) to the patient.  Some examples include telemedicine, stroke, and STEMI teams.  Managing costs while maintaining or improving quality of care will distinguish the highest value healthcare systems from others.

This culture change is perhaps less evident for emergency physicians than physicians in other specialties because we are accustomed to team-based care working within a larger system.  In order to deliver high value care, emergency physicians communicate with practitioners from all other specialties, assuring multidisciplinary problem solving.  The culture of Emergency Medicine has been an important contributor to the positive changes in the culture of medicine as a whole.

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