3

Click here to load reader

Work Hard. Have Fun. Overachieve

Embed Size (px)

Citation preview

Page 1: Work Hard. Have Fun. Overachieve

CELEBRATING ACEP’S 40TH ANNIVERSARY

Work Hard. Have Fun. Overachieve.

Nicholas Jouriles, MD From the President-Elect, American College of Emergency Physicians, Dallas, TX, and Departmentof Emergency Medicine, NEOUCOM/Akron General Medical Center, Akron, OH.

0196-0644/$-see front matterCopyright © 2008 by the American College of Emergency Physicians.doi:10.1016/j.annemergmed.2008.07.005

[Ann Emerg Med. 2008;52:314-316.]

Funny saying. I’m not sure when I started using it. To me,it’s the perfect metaphor for emergency medicine. Work hard.Have fun. Overachieve. As we celebrate ACEP’s 40th birthday,it’s time to reflect on our amazing history and accomplishments.

TIME FOR CHANGEWhat were they thinking? How could any self-respecting

physician give up an office practice and venture into theunknown of seeing all comers 24/7? The emergency departmentwas a place so disrespected that the specialty didn’t matterenough for others to scorn. But that’s what Jim Mills andcolleagues did in 1961. They worked hard. They persevered.They won over their hospital’s medical staff. They succeeded.And the rest is history. Work hard. Have fun. Overachieve.

Now fast forward 7 years. By all accounts, 1968 was severalstandard deviations different from most years. There wereassassinations (Martin Luther King and Robert Kennedy), riots,bodacious clothes (think tie dye, bell bottoms), music (thinkSergeant Pepper) and the birth of the Big Mac. Jackie Kennedymarried Aristotle O. In Prague, the people rebelled against theSoviet Union and were crushed. There were Olympic gamesprotests and a contentious election (a sitting US presidentchallenged by his own party and then dropping out because ofan unpopular war). We witnessed the first televised beatings/demonstrations at the Democratic National Convention. Theyear ended with Apollo 8 circling the moon, televising the veryfirst ever observed earth rise while the astronauts read from thebook of Genesis. Wow!

And on August 16, 1968, 8 physicians met in a LansingHoliday Inn. They were invited by John Wiegenstein. Eightmen. None of them were really emergency physicians. Thoughthey hailed from around the country, they didn’t representanyone. They descended on Lansing (motto: we’re a safedistance from Chicago and Detroit) and boldly declaredthemselves the American College of Emergency Physicians.Their hope was that they and ACEP would both develop intotheir dreams. It probably helped that both John Wiegensteinand John Rupke had spent time in the seminary beforebecoming physicians. Their dreams were to do nothing lessmiraculous than creating a brand new medical specialty. Thehouse of medicine did not recognize the need for emergency

medicine. Many simply wanted emergency medicine to go

314 Annals of Emergency Medicine

away. All the king’s horses and all the king’s men could notdeny these men. ACEP—and emergency medicine—worked!Among all the events of 1968, the success of ACEP/emergencymedicine was probably the most improbable.

The original 8 had no idea what would come next.Woodstock, landing on the moon, Kent State, gas crisis #1,Watergate, inflation/recession, Reaganomics, EMTALA,Monica, the Rock-n-Roll Hall of Fame, hanging chads, 9/11,Iraq. But they believed in emergency medicine. They believed inthemselves. They believed in their patients. And they believedthat by placing their patients first, by doing the right thing(attention Spike Lee), and by working hard that they wouldsucceed. And they did. More than in even their wildest dreams.Work hard. Have fun. Overachieve. ACEP and emergencymedicine were born.

At first, ACEP provided educational opportunities about thepractice of emergency medicine. This included clinicalknowledge and administrative and business expertise. Ourfounders realized that there was a unique body of knowledgethat was the specialty of emergency medicine. Through the longprocess of collecting information, sharing best practices,meeting face to face—often with adult beverages—inprogressively nicer locales (“no more Holiday Inns” was one ofJim Mills’s many contributions), these pioneers did theimprobable: They created emergency medicine.

We had our share of detractors and challenges early on. Bydefinition, you can’t be a specialty society until the specialtyexists. Our founders’ dream was to make ACEP and emergencymedicine bigger, better, and more fun than everyone else. Andthey did.

Shortly after ACEP was formed, Bruce Janiak (past ACEPand ABEM president) created his own residency program inemergency medicine, the world’s first (lesson: it never hurts toask; you just might get what you want). Gail Anderson createdthe first academic department (lesson: don’t go on sabbaticalwhen the dean has a meeting to discuss a problem), and ourACEP founders were soon knocking on the doors of the AMA,asking for recognition of our new specialty. In 1975, emergencymedicine officially became a specialty.

And the birth of residency programs and academicdepartments begat other programs/departments, whichreaffirmed the need for a professional forum (ACEP), which

begat the need for a journal (ACEP again) and a certifying

Volume , . : October

Page 2: Work Hard. Have Fun. Overachieve

Jouriles Work Hard. Have Fun. Overachieve.

board (ACEP again as ACEP members—and only ACEPmembers—made voluntary contributions to fund ABEM, thenwent to battle with the AMA and the ABMS to get ABEMapproved). Work hard. Have fun. Overachieve.

And emergency medicine grew. And soon enough, we werebig enough for others to notice. Then the real work began.

BACK IN THE DAYThe 1980s saw the establishment of emergency medicine all

over the country. It was a slow, painful process. Many of ourfledgling outposts did not survive. Some in the house ofmedicine wished us harm. Some still do, but those folks willsoon enough retire to their tar pits. As we grew, we improved.We became a specialty demanded by a growing population. Apopulation that was increasingly mobile and increasinglyinterested in speed. The fast food culture benefited emergencymedicine as our patients wanted care fast, when and where theyneeded it. In emergency medicine, our patients define their ownemergencies and have access to care on their own terms. It’s theAmerican way. As America changed, emergency medicine wasnot only ready but was a perfect fit.

PERSONAL ASIDE: MY FIRST DAY INEMERGENCY MEDICINE

When I entered medical school, I had no idea thatemergency medicine existed. One night during my MS3 year, asurgical attending mentioned that there was a specialty calledemergency medicine. Given the wonderful support foremergency medicine by my medical school, I matched ininternal medicine, only to have to apply to emergency medicinelater. That’s how I found myself in Colorado one NovemberMonday interviewing. At Denver General. With the legendaryPeter Rosen.

My interview was the last of the day. And what an interview.It occurred in the solarium on one of the top floors of St.Anthony’s hospital. Peter had just finished a clinical shift andsat at a table with his back to the window. As I interviewed, thesun was setting over the front range immediately behind Peter.There was a glow that formed a halo around his head, whichnot only reinforced the words of wisdom that he spoke but mydesire to become an emergency physician. That interview beganmy professional career. I am a little Peter, pun intended. Andemergency medicine, to me, will always be the glow of a settingsun over the Rockies, shared with a good friend and valuedmentor.

USWhat makes emergency medicine special? For us, it’s fun.

We help patients in their moment of need. We share cures,births, and deaths. We literally and figuratively touch their lives.For society, we’re special because we are there 24/7/365.

We save lives. We provide quality, efficient, affordable care.Americans support emergency medicine as a core value. They

want something beyond market forces to ensure that they have

Volume , . : October

affordable access to care in their time of need. That would be us.We are valued by the American public. It is the support of ourpatients that gives us credibility and our raison d’être. AsRalston R Hannas, Jr, MD (they called him “R squared”) saidduring our 25th anniversary meeting, “Sometimes a good idea isa good idea.”

TODAY AND TOMORROWAs the 21st century unfolds, we have become a mature

specialty. We are disproportionally represented in medicalschool and medical society leadership. Our residency programsand board certification process are the envy of organizedmedicine. Emergency physicians are good, play well with others,adapt well, are bold enough to try new ventures, and persevereenough to accomplish our goals. We work hard. We have fun.We overachieve.

In 2008, ACEP membership is at an all-time high. We areable to do things that we never dreamed possible. We caninfluence elections and the debate on health care reform. Wehave shown leadership in other medical societies. We are asinfluential as any other medical specialty. We are secure andhave a solid foundation. There are more emergency medicineresidencies, more publications, more academic departments. Wehave turned up the volume with a record number of media hits.We’ve rallied at the Capitol, released a national report card onemergency medicine, and coaxed the IOM to release a report onthe state of emergency medicine. The new ACEP Foundation istaking the message of emergency medicine directly to thepublic. We have arrived. We have succeeded and are now readyfor the next revolution.

Our next big adventure will take hard work. And just asBenjamin Franklin pointed out many years ago, we will fail ifwe do not work together. Forces external to emergencymedicine are large, are well organized, and wish us harm. Welive in a zero-sum game environment. Squabbling withinemergency medicine, although healthy, should remain in thebackground. We must work together to accomplish our biggergoals.

We must eliminate boarding. We must attract the best andbrightest into emergency medicine. We must become theleading specialty in the house of medicine. We must lead thehealth care reform movement. We must acquire more resourcesfor our patients, our EDs, and ourselves.

We need to do what our original 8 members did. We need todream big. We need to make emergency medicine a better placefor our next generation. We’ll have to perform as well as orbetter than our founders. John Wiegenstein et al set the barhigh. Very high. We are the legacy of our original 8. In myopinion, we are up to the challenge. Together, we can takeemergency medicine to a level that John, from his currentcelestial perch, will undoubtedly approve. We’ll have to workhard. We’ll have to have fun. We’ll have to overachieve. Wehave to succeed.

Thanks John, John, Eugene, Robert, Richard, John, Robert,

George. Well done!

Annals of Emergency Medicine 315

Page 3: Work Hard. Have Fun. Overachieve

Work Hard. Have Fun. Overachieve. Jouriles

Happy Birthday ACEP! Happy Birthday emergencymedicine!

Funding and support: By Annals policy, all authors are requiredto disclose any and all commercial, financial, and otherrelationships in any way related to the subject of this articlethat might create any potential conflict of interest. The author

has stated that no such relationships exist. See the

316 Annals of Emergency Medicine

Manuscript Submission Agreement in this issue for examplesof specific conflicts covered by this statement.

Reprints not available from the author.

Address for correspondence: Nicholas Jouriles, MD,Emergency Medicine, NEOUCOM/Akron General MedicalCenter, 400 Wabash Avenue, Akron, OH 44307;

330-344-6326; E-mail [email protected].

Volume , . : October