By embracing appropriate mid-career shifts, we can re-infuse maturing EPs with the excitement that once drew them to the specialty     

I have just returned from my annual sojourn to the peripatetic holy shrine of emergency medicine, the ACEP Scientific Assembly. It is, for people in emergency medicine, the greatest show on the planet: vendors hawking dubious wares, unspeakable displays of marketing opulence mixed with the wide-eyed stares of first-time resident attendees. This is the place where you would think the marketplace of ideas would prevail – economic openness from Marxist deconstructionism vying with the rules of Milton Friedman. And by the way, Uncle Miltie wins.

In this sea of intellectual biodiversity, you would think that no subject would be taboo. But in my self-proclaimed role as Arbiter Bibendi – encouraging both thought and a little irreverence in confronting the problems of our specialty – I’ve found an area which begs addressing: the mid-life crisis of emergency medicine. Gone are the days of young medical radicals trying to build a board and a profession. The “long hair” – mine was down to my shoulders – and tacky sport coats have faded into legend. Political correctness along with Armani suits and Bulgari ties have now become the order of the day. But there are humanistic values which we once held close that are becoming museum pieces.

What value is being lost with almost no fight? What is slipping away in silence with little being said? It is emergency medicine’s youthful sense of adventure, the spirit that wonders what lies over the next horizon. It is my opinion that we as a specialty do not know how to re-infuse our “maturing” members with the excitement and joy that once brought them into emergency medicine. We need new vistas to explore. In short, we do not know how to mature the emergency medicine career.

Orthopods start out doing trauma and end up replacing hips. OBGYNs start out delivering babies and end up delivering uteruses. But what is the expected maturation of the emergency medicine career? It’s a lot harder to wrestle drunks when you are 65. Night shifts get tougher and tougher. If you think I jest about this situation, you are either very young or very numb.

A note to my almost infantile resident colleagues: I render to you that you shall age and have exactly the same questions with regard to your life and job situation. And lest you think I have joined the Grub Street hacks, turning out copy to fill throw-away journal pages, do me a favor: At your next group meeting start the discussion of maturing the emergency medicine career and watch what happens. They all want to talk about it. The veil of silence will be lifted. The xenial relationship between doctor and profession is not ephemeral but real. And career maturation, like death, awaits us all.

I’m a First Amendment guy all the way. We should be able to express ourselves and talk about real issues. As I spoke at the ACEP convention to my more mature compatriots, it was clear that there is a lugubrious malaise abroad in the land. And they are looking for leadership to cure this ubiquitous nosocomial depression. They are looking for a way to mitigate the effects of time. I can see opportunity in this now that I missed when I served as President of ACEP. Seventeen years ago I proposed we study fast-track and off-site urgent care centers as a mid-career pathway for our members. The tenaciously negative response I got was unbelievable: how could I even suggest that there was a life to be had outside the hallowed halls of our hospitals, wallowing in depravity and cold pizza? 

Listen up troops. Here’s the plan – and I will need your help on this one. I’ve already spoken with the Executive Director of ACEP to add to the 2013 ACEP Scientific Assembly a mid-career job fair. We hold such events for medical students. We have the entire tract devoted for residents looking for their first jobs – and well we should. So why not have a place where seasoned physicians can go to learn what it takes to advance their careers? Did you even know the Navy takes physicians up to age 53?

Did you know that the most sought after physicians by headhunters for the role of Vice President of Medical Affairs are experienced emergency physicians? Why? Because we’re the doctors who must interact with all other doctors every day, and, more importantly, every night. Not to mention that our sense of when we’re being lied to has been honed to a fine degree.
I think our professional societies should care about us throughout our entire career. They should be the vehicle for lifelong learning and change. We need to have a place where we can talk together about what we want and how to get there. A life of experience in emergency medicine and board certification should be a springboard – not an anchor. Emergency physicians should be the ideal group to organize and lead. Doing ten things at once and having to be pretty much right all the time is just our norm. No big deal. Yes, it is a big deal; most people don’t have those skills.

So what can you do? Three things. First, write to your specialty society and tell them this is an idea whose time has come. It is an appropriate venue for our specialty society and we need to get with it. This is why we pay dues dollars. And for what it’s worth, we need to try something new. Second: Send me your thoughts and ideas about what you would like to see, learn and get from such an experience. If you have had a great second career and want to share, by all means do so. Make a comment online, or email This e-mail address is being protected from spambots. You need JavaScript enabled to view it . We want to hear what you’ve done, and your colleagues want to hear from you. You will see endless possibilities only when you believe in yourself. Remember there were 169 people at the first ACEP Scientific Assembly forty years ago. How did that turn out? Lastly: Come out of the intellectual closet. Talk openly about what you want your work life and personal life to contain. You will not be fulfilled until you have been honest with what you want. “Most men lead lives of quiet desperation” does not need to be your sentence.

Why am I on this kick? Simple. As I looked around during the Scientific Assembly, I saw a total spectrum of ages. We didn’t have this in the past. We must learn to extend the working life of a physician well into their 60s and 70s. But you need to add more than just years to your working life. We need to add life to those working years. I have had a great life in emergency medicine. I do not intend to be marginalized by a few gray hairs. I am in no need of cerebral Viagra. Let’s do this together for our generation and for all those that will come after us. We will be thanked by our progeny.

Finis Coronat Opus
‘The end crowns the work’

Greg Henry, MD
Founder and CEO of Medical Practice Risk Assessment, Inc.; past president of ACEP.