Reflections on 37 years practicing in the same ED
My partner Neil Joebchen and I have practiced at the same hospital for 37 years. That’s a long time in the ER.
We met in 1969 as Navy doctors at Camp Pendleton during Vietnam where we shared interest in the excitement of emergency medicine. We went different ways completing our military service but kept in touch. When discharged in 1973, Neil saw an opportunity at nearby Tri-City Hospital in Oceanside where the emergency room was staffed by random moonlighters. He contacted the hospital, scheduled an interview and asked me to join him. He told the hospital administrator and senior physicians we had ER experience and wanted to provide full time coverage. They liked the idea and awarded a contract. Neil recruited two more doctors our age and we began September. 15th 1973.
In 1973, emergency medicine was not a specialty, and the American Board of Emergency Medicine did not exist. Five emergency medicine residency programs existed but they were unregulated, untested, and had yet to graduate a single physician.
There were no standards of training or experience for ER physicians; the only requirement to practice in an “emergency room” was a state medical license. As a result, a full-time emergency group was controversial and threatening to the medical staff that referred to us as, “those boys in the ER”. We responded by being polite, reliable and very respectful of our elders.
For reasons that seemed good at the time, we began working shifts in large blocks: seven, ten-hour, day shifts, seven days off, then seven, fourteen-hour, night shifts. After six months one partner resigned.
We three that remained, pressed on, each working one eight-hour shift daily for six months until we found another partner. We survived because we were young, and had no idea how an emergency medicine practice was supposed to be.
During the day, the staff willingly taught us the emergency aspects of their specialties. At night they were much less available and we were on our own. In 1973, there were no seat belt laws or airbags. There were no paramedics, trauma centers, CT scanners, ultrasounds, thrombolytics, cardiac PCI, rapid sequence intubations or call panels. Patients arrived unannounced with all varieties of traumatic and medical emergencies. With our limited experience and support we did the best we could. There were many terrifying nights when we watched in awe the incredible resilience of the human body, and were pleased and thankful our patients did as well.
Over the past 37 years, our facility has grown from a small, “emergency room,” with ten beds, seeing 700 patients per month, to a large, emergency department, with 47 beds, seeing 6,000 patients per month. Our group has grown from three doctors to 25. The completely democratic structure Neil began has remained intact, producing a group of highly motivated, board certified, ER docs with unique purpose and camaraderie.
Now approaching the end of my ‘shift’, my fascination with this specialty hasn’t changed. I’m as stimulated by the difficult and urgent clinical decisions, and as humbled by the enormous variation and complexity of the human condition, as I was 37 years ago. I just would not want to do that first year again. J. A. Bushong M.D.